Despite the Alfie Evans disaster, Catholics can back the NHS


The story of Alfie Evans has focused the world’s attention on the UK’s National Health Service. The spectacle of NHS doctors dragging Alfie’s parents through the courts to prevent them transferring their son to another hospital should be a source of national shame.

But a group of American commentators have drawn some very broad conclusions from the case: they have denounced not just the NHS’s actions in this instance, but the whole idea of state-run healthcare.

The NHS, they claim, is a “rat-infested wait-time paradise,” a cesspool of “moral depravity”, and Alfie Evans was “a victim of socialized medicine”. Writing for the National Catholic Register, Matthew Archbold argues that “Alfie Evans’ recovery in Italy had to be avoided lest people lose faith in socialized medicine” – even though the Bambino Gesù hospital in Rome, which offered to treat Alfie, is part of Italy’s NHS.

It is disappointing to see American Catholics engage in this rhetoric. As far back as 1919, the US bishops called for the government to “make comprehensive provision for insurance against illness” funded by a “levy on industry.” The idea was based on thoroughly traditional principles. The Church Fathers taught that equitable distribution of resources within society is not so much a matter of charity as of strict justice (and therefore a proper concern of civil authorities).

The Church has traditionally taught that, if a resource is necessary for “the sustenance of man’s body” (eg food, shelter, clothing), it belongs firstly to the community as a whole. Contemporary Catholic teaching merely applies that principle to modern medical resources.

So it is no innovation that the modern Catechism of the Catholic Church teaches that “concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity” – including “health care” (2288); nor that Benedict XVI spoke of the need for “distributive justice” in healthcare provision to guarantee “adequate care to all”; nor that Pope Francis teaches that “healthcare is not a consumer good, but rather a universal right, and therefore access to healthcare services cannot be a privilege.”

This does not mean that Catholics are obliged to view NHS-style systems as the only acceptable mechanisms for safeguarding access to healthcare. Most other European countries provide care free at the point of need through mixed public-private systems, for instance. But if one takes papal teaching seriously, one can hardly reject the founding principle of the NHS (healthcare available on the basis of need rather than ability to pay).

Cases similar to Alfie Evans’s occur within America’s private healthcare system. Think of Helga Wanglie, Haleigh Poutre, or Helen Marsala, whose story was reported in the New Haven Register:

The husband of a woman who died at Yale-New Haven Hospital is suing the hospital, alleging that his wife was allowed to die despite his repeated objections to removing her from life support … [Clarence Marsala] is fighting what he sees as an impersonal health care system that seeks to end the lives of seriously ill patients despite families’ wishes that they be kept alive.

Sound familiar? What will be astounding to the British reader, however, is that the hospital was able to remove Mrs Marsala’s life support – against her wishes and those of her family – without a court order, based on the decision of an in-house “ethics committee.”

Courts sometimes get it wrong (as they did in Alfie’s case), but they can also enforce the protection of the vulnerable in a way that private bureaucracy cannot. An American court even threw out Mr Marsala’s lawsuit, claiming that since he had not witnessed the withdrawal of her ventilator with his own eyes, he could not claim to have suffered emotional distress by his wife being suffocated to death.

Whatever the woes of the NHS, healthcare arrangements in the United States are simply not congruent with Catholic teaching. Federal US abortion laws, for example, rank with North Korea as among the most liberal in the world. And as R. R. Reno points out, pro-abortion ideology in the US relies on the same free-marketeering, anarchic anti-government logic that animates denunciations of socialised medicine. The absence of state-run healthcare is not a panacea against the culture of death.

The NHS is in need of reform, but its founding principles are morally sound. In light of the Alfie Evans case, I hope would-be NHS reformers will look not to the US healthcare system, but to Catholic social thought and the prudent teaching of the popes.