Less than one year old and stricken with a rare degenerative disease, Charlie Gard is on life support. He requires artificial ventilation, nutrition, and hydration. His story became international news two weeks ago, when the European Court of Human Rights upheld the decision of a British court to allow doctors to terminate Charlie’s life-sustaining treatment, against the wishes of his parents. Donald Trump made a statement. Pope Francis made a statement. Many others made statements. We seem to be at a Je suis Charlie moment of a different sort.
Terrible things happen in this vale of tears. Sadly, infants die every day. Charlie’s story has attracted particular attention because it triggers in us a legitimate moral anxiety.
The Christian moral tradition affirms the sanctity of life and recognizes the reality of death. We are not always and in all circumstances required to make heroic efforts to sustain the life of a terminally ill or mortally wounded person. We are asked to determine when further interventions to sustain life are futile. There are times when the surgeon is permitted, even encouraged, to set aside his scalpel and accept the limitations of our interventions.
Moral theologians distinguish between “killing” and “letting die.” As an official statement of the Catholic Church of England and Wales about Charlie’s case put it: “We should never act with the deliberate intention to end a human life.” This includes never withdrawing ordinary care. Someone who abandons an infant outdoors on a freezing day is killing, not letting die. The same goes for nutrition and hydration: When we stop feeding a person, we are not letting him die; we are killing him. Thus, a feeding tube and IV for hydration represent “ordinary care.” Removing these is not permitted.
Artificial means to ensure that a patient can breathe raise a more difficult question. Once artificial ventilation is begun, stopping it means taking the positive action of withdrawing support, rather than the negative action of refraining from further efforts. Nevertheless, the mainstream of the Christian tradition has determined that taking a patient off a ventilator is permitted, because ventilation represents “extraordinary care.”
This may seem an overly nice distinction, but it is not. Consider this: If Charlie is taken off the ventilator but manages to breathe on his own, this outcome would be welcomed. By contrast, the sole purpose of removing his feeding tube would be to ensure that he dies of starvation.
When we lose the distinction between killing and letting die, euthanasia starts to seem more plausible. We’re seduced into thinking that mercy killing (the euphemism for euthanasia) is the same as a humane recognition of the fact that medical technology cannot always save us. In the case of Charlie Gard, Pope Francis made a helpful intervention, pointing out that mercy comes not in killing, but in “accompaniment.” To comfort the dying is a powerful act of mercy. It is never merciful directly to intend someone’s death.
The cessation of extraordinary care in Charlie Gard’s case may be permitted. (This is one reason why the official statements from various organs of the Catholic Church have not been trenchant.) But we must ask another question as well: Who decides? In Charlie’s case, the courts have determined that his parents must accept the authority of medical professionals. The parents have been prohibited from removing Charlie from a London hospital to take him to the United States for experimental treatments.
The British Court’s essential argument is that the state has a duty to protect the best interests of the child—and in Charlie’s case, the child is best off dead. This argument is chilling, because it’s the basis for a regime of compulsory, state-sponsored euthanasia. Charlie’s case is extreme, and the withdrawal of life support feels different from giving terminally ill children lethal injections (or aborting genetically defective children in the womb). But the logic is the same. And it is ominous—especially given the increasing frequency of involuntary euthanasia in European countries such as the Netherlands and Belgium, and the widespread use of abortion as a form of euthanasia.
Moral theologians are trained to make careful distinctions, such as those between ordinary and extraordinary care, and killing and letting die. In Charlie Gard’s case, neither his parents nor his doctors have an obligation to pursue extraordinary means to sustain his life. They are not morally culpable if they let him die. But Charlie’s case is not taking place in a vacuum. Britain’s medical establishment and legal system have politicized it by calling upon the power of the state to enforce their judgment that, for some patients, death is better than life. They have pursued a radical, post-Christian argument, one that says we have a positive duty to end Charlie’s life.
Ordinary people are often unaware of the technical notions I’ve outlined above. But they smell something rotten—which is why Charlie’s case continues to make headlines. It’s an encouraging sign that a degree of moral sanity remains alive in the body politic.
R. R. Reno is editor of First Things.