Listen up folk !

Listen up folk !

Listen up folk ! Zog our tribal leader has kept us safe from harm these last months. he has protected us from wild animals who wanted to devour us. He has protected us from other tribes who wanted to kill us. He even protected us from ourselves when he lead us away from mistakes and disasters we would have made. Let us give our young women and food to the great Zog so he continues to protect us.

Listen up folk ! Our King Albert has kept us, his loyal subjects, safe for another year. He has protected us from King Zog who surely wished to invade and kill us. He has wisely guided us and avoided many a disaster that would otherwise certainly occurred without his wise council.  Without King Albert the barbarians at the gate would surely have entered our lands; killing our men, raping our women, and butchering our babies. So let us give thanks as we give our labour and produce to our monarch and prepare for another year.

Listen up folk ! The church has again saved us;  not just our bodies but also our souls. Our priests have guided us well in ensuring we do not fall prey to heathens at the gate. We know the pagans sit and wait for the chance to kill us and take our women and children. The warn us and protect us from the work of witches and demons. Thanks also to the clergy who, through their wise advice, have kept our souls safe. They warned us of our sins and saved us from eternal damnation and the pains of hell’s fire. So let us arrange a tithe to give a portion of our wealth to the Church so it may protect us for another year.

Listen up folk ! The government has lead us safely through another year. Without them no roads would have been built, no one would have cared for the poor, our children would have been uneducated and ignorant and doctors would not have attended to our sick. Without our ruling class we would have descended into savagery killing and raping our fellow citizens. So let us feel pride when we pay our taxes as we are protecting ourselves for another year.


Check who is taking your possessions, check who holds the power. This will let you know who is your enemy.


 

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In Loco Parentis – the terrifying tale of Charlie Gard

In Loco Parentis – the terrifying tale of Charlie Gard

As a doctor I have found the unfolding tragedy befalling Charlie Gard and his family extremely upsetting to follow.  This poor boy and his family are butterflies being crushed on a wheel to press home a legal point, they are unfortunates being punished having committed no crime.

Let us firstly be clear what this case is not about. Despite protestations to the contrary this case is not about the best interests of Charlie Gard. The best interests of the child (1)  are clearly important and made paramount both in the UN Convention of the Rights of the Child (2) and in British Law with the Children Act of 1989 (3) . It is clear that all the parties involved in this debate are acting because they have the best interests of Charlie at heart. The doctors and hospital feel that they, by virtue of their knowledge, know what is best to do. His parents, through love and affection, also believe that they can see the best plan and hope for their son. Both are acting in the best interests of Charlie, this is not the problem. The problem is who decides what exactly are Charlie’s  best interests.

It has always been the case that the parents of the child decide what is in the best interest of the child. This is as it should be as it reflects the natural law and ensures that the people most attached to the child’s interest are those who act as the child’s guardian. There are very few circumstances when this can be changed and they depend upon proving that the parent is being either negligent or malevolent. Neither of these factors are in play here and, if anything, the parents have taken extraordinary steps to secure chances for their child, well over and above what many parents would have been able to do.

It is interesting that, at the 24th hour, Great Ormond Street Hospital has made an application to court to revise its plans (4) possibly starting to realise that the parents’ opinion may have been closer to Charlie’s best interests, than had their own opinion been. So in this difficult calculus of what is the best plan of action it appears that Charlie’s parents may have been the better judge all along.

While these arguments over the ‘best interests’ may mean that the parent disagrees with the medical team it does not mean that the parent can compel a doctor to do something they feel is inappropriate or wrong. But again this is not the case in this situation. Charlie’s parents have never asked GOSH or the NHS to undertake treatments they do no agree with. They have gathered together sufficient resources to enable Charlie to receive this treatment by doctors who believe it is, worth a trial, in the child’s interests. This should have been the end of the dispute. Charlie and his parents should have used their money to go and try this last ditch attempt, to catch this glimmer of hope.

GOSH and its staff, however, stopped this. Their court battle stopped the treatment and refused the parents the ability to move their child. In their paternalism they not only refused to help but also stopped anyone else helping. The thousands of people who collected money to help Charlie were thwarted by this as well as Charlie’s parents and the other hospitals and doctors who wanted to help.

I am a very old-fashioned doctor and I don’t fear paternalism per se. A desire to act like a father, is a a desire to be benevolent, guiding, helpful and wise. In itself not a bad thing. It becomes bad when it belittles another party and reduces their agency. When doctors worked in a professional relationship with their patients, the doctor’s paternalism would drive them to seek the best for their patient and was usually leavened by respect for the patient’s autonomy. This combination could be valuable when there were difficult scenarios – when the future was unpredictable and  the efficacy of plans of action difficult to assess. Much of the placebo effect of medical intervention depends on this aspect of the relationship and large parts of the benefit of of healthcare comes from this caring, guiding, advisory aspect of medical care.

There was always one very good safeguard against this paternalism becoming intrusive or  belittling, when the relationship was between doctor and patient, the patient could always terminate the relationship. If they felt that the doctor’s approach was wrong they had no need to continue to use them. This was a way to safeguard the patient and also a way in which the doctor would know that they had overstepped the boundaries and they could learn where paternalism started to erode patient autonomy. But in the NHS this is difficult. The patient can’t change their doctor without a great deal of difficulty. If they change they will probably be labelled a “difficult patient” which might mar relations with their next medical practitioner.

In addition, under the NHS the patient is no longer the employer of the doctor in the UK. The most important relationship for the doctor is the one with his employer – the state, the NHS – not the the patient directly. It is the state who pays his wages, sets his targets and assesses his performance and we know “he who pays the piper calls the tune“. In this scenario paternalism is largely unchecked and can be very dangerous. Paternalism, appearing kindly and wise, can mask actions that are not in an individual patient’s best interest. Rationing and refusal of therapy is hidden as medical advice and choices are withdrawn from the patient. Doctors often find, when working in the NHS, that their attempts to maintain professional standards and a focus on their relationship with the patient can cause them difficulties. They are made to feel as if they are being disruptive when they call for what is appropriate for the patient. They can be told they are jeopardising the budgets, failing to be a team player by not following the organisation’s line, and generally made to feel awkward if they behave in a manner that was formed by their vocation and training.

In this case paternalism seems to be being employed to sweeten a bitter pill. The state wants to end Charlie Gard’s life before all options that are available have been tried. Despite having seen parents act heroically and selflessly for their child, without an ounce of malice, they would prefer Charlie died rather than allowing the parents to try all they can do. But rather than admit this we are told that they are the wise and kindly people who know what they are doing, we are awkward and unruly children causing a fuss.

Well thank God for the fuss that Charlie’s parents have made;  it may not save Charlie but they will have opened the eyes of many people and might save future families from the horror that they have had to endure. They truly are a heroic family who deserve our support (5)

 

 

 

 


[1] https://en.wikipedia.org/wiki/Best_interests

[2] https://en.wikipedia.org/wiki/Convention_on_the_Rights_of_the_Child

[3] https://www.publications.parliament.uk/pa/cm201012/cmselect/cmjust/518/51807.htm

[4] http://www.telegraph.co.uk/news/2017/07/07/hope-charlie-gard-great-ormond-street-seeks-explore-new-evidence/

[5] http://www.charliesfight.org/

Pope Francis and the “invasion of libertarians”

Pope Francis and the “invasion of  libertarians”

The Pope’s recent foray onto the political stage has been rather disappointing.  I had been heartened over the first few years of his Papacy that he seemed to be the man required to rejuvenate the Catholic Church and to reconnect it with the  people. He seemed to be able to recognise areas of public life that were problematic and also to be able to see ways to counter these. His comments on issues such as war, hatred, and greed were both welcome and wise. However, his recent attack on the philosophy of libertarianism was thus both a surprise and a disappointment.

This is firstly a surprise because he has previously been well informed and accurate in analysis but on this occasion he has revealed himself mistaken.  Secondly it is a disappointment as it is likely to neither help the Church nor the people.

It is apt that Pope Francis  was not speaking ex cathedra as on this occasion he is clearly not infallible. He fears that libertarians will fail to work for the “common good”. As he is reported to have said :-

“A common characteristic of this fallacious paradigm is that it minimizes the common good, that is the idea of ‘living well’ or the ‘good life’ in the communitarian framework,” Francis said, while at the same time exalting a “selfish ideal.”.. ..

…. ..”because on the one hand he supposes that the very idea of ‘common’ means the constriction of at least some individuals, and on the other hand that the notion of ‘good’ deprives freedom of its essence.”

He labours under the common misconception that libertarians reject society and, as individualists, wish an atomised existence. This is wrong as all libertarians see the value of associations and communities and encourage their development as long as they are voluntary arrangements.  Most libertarians see the development of the capitalist society as one of the great successes of humanity  as it lifts so many out of poverty and want. This is a system clearly based on trade and agreements between individuals so that all parties can benefit. People trade as equals and both parties benefit, subjects obey because they must and only the ruler consistently benefits. Though self-interest guides the arrangements that people make this is not the only motivation people have. Our desire to assist our fellows is also a serious motive for our actions and as Adam Smith mentioned in the first sentence of his book :-

“No matter how selfish we suppose man to be, there is obviously something in his nature that makes him interested in the fortunes of others and makes their happiness necessary to him, even if he derives nothing from it other than the pleasure of seeing it.”

The main focus of libertarianism is to set the individual free so that he, or she, can make the arrangements that they wish.  Adam Smith reminds us that  “man is an animal that makes bargains, no other animal does this, no dog exchanges bones with another” . We exist in order to, and by reason of, making  alliances and exchanges with other people. We do this in order to improve our own lot and the lot of those we  cooperate with.  As Thomas Paine stated in “Common Sense”  :-

Society in every state is a blessing, but government even in its best state is but a necessary evil; in its worst state an intolerable one; for when we suffer, or are exposed to the same miseries by a government, which we might expect in a country without government, our calamity is heightened by reflecting that we furnish the means by which we suffer…”

Libertarians wish to allow people to make their own societies not simple to follow the diktat of those who have cornered power. From a Christian viewpoint this is important: we have free will to allow us to live our lives as we wish. In doing so we may become good people or we may not. If we simply do as the state commands us, we are not good, we are simply disciplined. We are only good when we, ourselves, make the choice. I have no choice but to pay my taxes to ensure the welfare state runs (as well as paying forthe military machine unfortunately), my payment was not a good act, simply a necessary one. I paid my taxes primarily to avoid suffering on my part (jail or other penalties)  rather then to benefit others (though that is a happy side-effect). Leaving people free to make these arrangements themselves allows us to be good rather than obedient. If I want to be good then I need to be charitable or, possibly, pay extra taxes. Though the latter system may not, on balance, work as while you may give more to support the welfare state you may also be contributing to fund wars abroad,political initiatives at home you disagree with, or to fund corporations as they use government legislation to stifle free trade through competition.

We should recall that this is not a minor point. Of the many virtues that we may aspire to exhibit the greatest of all is charity, as we demonstrate our care for our fellows. All the writings are clear that, of all the gifts, charity is to be preferred over all others. Taking this options away from us, doing it on our behalf whether we wish to or not, and distancing us from our fellows would cause serious problems to many Christians who see, in libertarianism, a manner in which to practice faith and recall the first letter from Paul to the Corinthians :-

If I speak with the tongues of men, and of angels, and have not charity, I am become as sounding brass, or a tinkling cymbal.  And if I should have prophecy and should know all mysteries, and all knowledge, and if I should have all faith, so that I could remove mountains, and have not charity, I am nothing.  And if I should distribute all my goods to feed the poor, and if I should deliver my body to be burned, and have not charity, it profiteth me nothing. Charity is patient, is kind: charity envieth not, dealeth not perversely; is not puffed up;  Is not ambitious, seeketh not her own, is not provoked to anger, thinketh no evil;

Rejoiceth not in iniquity, but rejoiceth with the truth;  Beareth all things, believeth all things, hopeth all things, endureth all things.  Charity never falleth away: whether prophecies shall be made void, or tongues shall cease, or knowledge shall be destroyed.  For we know in part, and we prophesy in part.  But when that which is perfect is come, that which is in part shall be done away.

When I was a child, I spoke as a child, I understood as a child, I thought as a child. But, when I became a man, I put away the things of a child. We see now through a glass in a dark manner; but then face to face. Now I know in part; but then I shall know even as I am known. And now there remain faith, hope, and charity, these three: but the greatest of these is charity.

As individuals we have to make choices and stand by these. The sum of the choices we make and the associations we form are what defines us as an individual. In libertarianism we don’t have the luxury of a relative morality we are obliged to be responsible for ourselves and our morals. Mathew 7 is quite clear; people will know us by our actions.

Watch out for false prophets. They come to you in sheep’s clothing, but inwardly they are ferocious wolves. By their fruit you will recognize them. Do people pick grapes from thornbushes, or figs from thistles? Likewise, every good tree bears good fruit, but a bad tree bears bad fruit. A good tree cannot bear bad fruit, and a bad tree cannot bear good fruit. Every tree that does not bear good fruit is cut down and thrown into the fire. Thus, by their fruit you will recognize them.

Rather then being a risk to the ‘common good’, libertarianism is a way to increase it. A mercantile society with free trade has increased the number of people free from poverty. Libertarianism promotes the ideas of personal responsibility, moral behaviour and freedoms in association and thought. Perhaps, the Pope has mistaken libertarians for libertines but he should be aware that personal responsibility is a very effective antidote to unrestricted hedonism.

The Pope is in a difficult position. His church is associated with a history that is often far from glorious, his church is mired in present scandals and his church operates in increasingly secular societies.He should see that perhaps the growth of libertariansim might actually be associated with a growth of interest in issues of morality and responsibility. While this may not benefit the church it may be very valuable in helping people find their own faiths and morality and this is probably the greater good.