There were a lot of emotional reactions to my Wednesday column on Alfie Evans, the brain-damaged child whose parents were legally prevented from removing him from the British hospital after it had decided to remove him from life support. Many readers were confused by what I meant by “liberal individualism” — which is not “left-wing politics,” but “the political philosophy which takes the maximization of the freedom of the individual as the best aim of politics, and society.”
I am a liberal, in this sense: Most of you are almost certainly a liberal, too, no matter what party you belong to. Since its origins during the Enlightenment, liberalism’s long march to political ascendance has been completed so successfully that most people in the West are liberals without even realizing it. All of us, more or less, assume each individual is entitled to choose their own path through life without unchosen obligations, or unduly fussy laws and customs that stifle our desires.
Because of this confusion, many read the column as an attack on the left, rather than a query over whether the political philosophy I myself subscribe to might have reached its natural limits. Given that assumption, they quite naturally assumed this was really all about Britain’s National Health Service, or NHS. In fairness, they may have gotten this idea from conservatives such as Sen. Ted Cruz (R-Tex.), who were running around saying Evans’s sad case was a searing indictment of nationalized health-care systems.
In fact, as I noted in the column, the Evans case had little to do with the NHS, other than the fact an NHS hospital happened to be where the drama occurred. As Walter Olson of the Cato Institute laid out, the roots of the dispute lay elsewhere, in the excessively generous leave that British law gives its courts to overrule parents in what the court perceives to be the best interests of the child.
As a liberal, I’m not totally opposed to such interventions; children are individual human beings, not the property of their parents. But if a court is going to overrule parents who are trying to keep their child alive, then for the reasons laid out in the column, I demand a high burden of proof. A bunch of doctors guessing what Alfie Evans might or might not be able to feel does not satisfy that burden. It would be comforting to believe that experts have definitive answers about questions such as this, but that comfort would be false.
This, I think, was part of the vitriol I triggered. After years of writing about health care, I have a great respect for doctors. But I also respect the limitations of what they can know. And I think a grave mistake of late modern liberalism is to overestimate the powers of science and expertise.
Those powers are great, mind you; through science and expertise, we have conquered all sorts of disease and hunger and general human misery. I admire these achievements as much as anyone. But it’s no good tearing down ignorance and superstition if we just erect an idol to science in its place — which some of my interlocutors seemed perilously close to doing. Imperiously informing me that the courts were very careful and serious about their decision does not go very far towards proving that those judges were right. Stating that all the experts agreed about the decision simply begs us to ask the question: “Experts in what?”
There are many questions science still doesn’t know the answer to; there are others science can’t know the answer to, like “What is a good death?” Asking scientists to answer those questions is like trying to bake a cake with a hammer; you’ve got the wrong tool for the job, and you’re about to make a fearful mess.
This is not, in our society, a very welcome message, in part because it is often associated with bitter political disputes. (For the record: I’m not sure that experts are right about the ultimate extent of anthropogenic global warming, but I’m quite sure I don’t want to run a dangerous experiment with the only climate we have, so you can count me in the “AGW believers” camp.) But it is also unwelcome because, in the modern world, we are so dependent on experts. Not one of us understands more than a small fraction of the technological, social and economic systems that support our lives; we must rely on experts to do their jobs well. If we start thinking we can’t trust them, then that’s pretty terrifying, isn’t it?
As it happens, I finished writing that column in the emergency room of a Kaiser Permanente facility. I had gone to my new doctor for a routine checkup, which ended abruptly when a check of my vitals showed my blood pressure had crashed to 80/40, and was still dropping. Given that I take quite a lot of medication to control my normally high blood pressure, this was a bit alarming, and they wheeled me down to urgent care post haste.
An unfortunate side effect of writing regularly about health care is that I had a pretty good mental list of things that cause a sudden, rapid, and completely unexpected decline in blood pressure. Some of them were quite dire. I knew that, as reassuring as everyone was trying to be, they were watching me closely for signs that I was losing consciousness. Also that they didn’t really have a very good idea of what was going on. And yet even knowing all this, I still had to trust they were going to get it right.
Ultimately, they never did figure out exactly what was wrong; their best guess was sudden onset stomach flu combining in unhappy ways with that aforementioned aggressive regimen of blood-pressure medication. They pumped a bunch of fluids into me, and sent me home to vomit in private. But it was a good reminder of why we want so badly to feel that experts have all the answers; when I was lying on my side, with saline running into my veins, I wanted nothing more than to believe these omniscient wizards knew exactly what they were doing.
And if I had lost consciousness? I would have wanted them to push fluid into me as fast as I was losing it, and start looking for internal bleeding. But I also would have wanted them to call my husband. Bureaucracies, no matter how kind, are still bureaucracies, and they have their own internal logic, which is not mine. When my life is on the line, I want someone in my corner who is not thinking first of standards of care, or of procedures, but of me.
Call this irrational, if you like, but having seen my mother through a life-threatening illness, I know that several times, my interventions may have saved her life. The details don’t matter, and would bore you; the important point is that to the hospital, my mother was, necessarily, one of many patients. But she was the only mother I had. I certainly didn’t know more than the medical staff, but I cared more, and that mattered.
Both medical bureaucracies and courts work the least well where we are asking experts to make highly uncertain judgments, like “What is the subjective experience and prognosis of a young patient with an undiagnosed neurological condition?” Or to answer value-laden questions such as “What constitutes a worthwhile life?”
That last is not a question that can be answered by a doctor or a judge. It’s a question we want to answer ourselves — or if we cannot speak, to have answered for us by someone who knows us as something more than a case in a docket, a patient in a hospital bed. Not because we cannot trust experts to generally do their best, but because there are, and will remain, many areas of life where their best simply isn’t adequate to the job.