Alder Hey Children's Hospital, Liverpool. Photo by Wikimedia Commons user Rept0n1x.
Advocates of a single-payer health care system, and especially one that is essentially a single-provider system such as in the U.K., should be very careful about what they wish for.
Although the National Health Service is a cherished institution in England (as are its counterparts elsewhere in Britain), amounting to a political sacred cow, even some Brits have been deeply put off by the action of a Liverpool hospital – backed by the courts – to prevent the parents of a dying child named Alfie Evans from taking him out of the country to receive medical care in Italy.
And much as our cultures overlap, I suspect a far greater percentage of Americans would find such heavy-handed official intervention in a family tragedy unacceptable, if not downright bewildering.
The 23-month-old was admitted in 2016 after suffering severe seizures. His condition declined and, based on “extensive damage” to his brain, hospital staff recommended that they halt active treatment. Disagreement between Alfie’s parents and his health care providers subsequently escalated to the point where the matter went to court.
Last week, the U.K. Court of Appeal upheld a High Court ruling preventing the toddler from traveling to Italy; his parents had hoped to take him to the Vatican-linked Bambino Gesu Hospital in Rome. Bambino Gesu offered no hope of a cure, but the hospital suggested it could keep Alfie alive for an “undefined period” with breathing assistance. Alfie's parents were considering next steps after losing the appeal, but Alfie's father announced via Facebook that his son had died early Saturday morning, a little less than a week after the hospital withdrew life support.
This was not a case where British doctors believed Alfie was receiving better medical care at home than was proposed for him abroad. After he was removed from life support, he received no curative care at all. Doctors were not even able to diagnose exactly what was wrong with him; the BBC’s accounts described his malady as a “rare undiagnosed degenerative neurological condition.” Even so, the Liverpool hospital staff argued that further treatment would have been not only “futile” but “unkind and inhumane.”
If the dispute only centered on the type of care Alfie would receive, it would not be very different from many court cases we have seen here in the States. If it were a dispute between a hospital that wanted to continue life support and parents or other family members who wanted to terminate it, the case would not be unusual either. Nor would that be the case if the underlying dispute was among different family members, as happened in the Terri Schiavo tragedy, with the state weighing in on the side of continued intervention.
This was the opposite. The parents, confronting the loss of a child, were offered transport and care for their infant elsewhere. The British system deprived them of that option. The child had no say in the matter, and the parents – who showed no evidence of lacking capacity to be his proper guardians – were told what they could and could not do on behalf of their son.
To top it off, NHS personnel whose views were harshly challenged have portrayed themselves as the victims, and police hinted darkly at a crackdown aimed at social media commentary. Members of “Alfie’s Army” protested outside the hospital and expressed their disapproval on social media, and some reports say they intimidated hospital staff and other patients. In the wake of “unprecedented personal abuse,” police said, “any offences, including malicious communications and threatening behaviour, will be investigated and, where necessary, will be acted upon.” Outright direct threats to health professionals are out of bounds, of course, but the authorities’ statements about public debate are more typical of China than of England.
To put this in an American political context, imagine a system in which there is only one widely available health care service in the country, controlled by the government. Say the parents of a pregnant 12-year-old who has been raped by a coach want to take her out of the country for an abortion that is not available here. Could an analogous court battle arise here under those circumstances, and could the government prevail? I think the answer is yes on both counts.
We have a lot in common with our British friends, but we are not the same. They may be willing to tolerate such heavy-handed state intervention in family matters in exchange for a health care system funded and run by the government. I very much doubt this is a bargain most Americans would make.