Painful Paradoxes II

For the second time in this column, CHRISTOPHER HURST considers how irresolvable moral dilemmas have a way of intruding into everyday life.

September 17, 2000

FROM time to time a case comes up which arouses very strong emotions, and passionate and cogent arguments are advanced for resolving it - in different and mutually exclusive ways. A case is exercising the British newspaper-reading public at the time of writing which, in almost classic fashion, embodies persuasive moral arguments which are diametrically opposed to each other. It has apparently not reached the international media which justifies me in writing about it here. From the philosophical angle it reminded me of a recent case which was reported worldwide: the plight of Elian Gonzales, in which the issues were somewhat more straightforward and less rarefied.

Few readers will need to be reminded (but the story bears re- telling none the less) that late in 1999 a party of Cubans tried to sail from Cuba to Florida in an open boat, but the boat foundered and all on board were drowned except for a six-year-old boy called Elian Gonzales. Among the dead was his mother; the boy's father, from whom his mother was separated, had stayed behind in Cuba and of course the journey took place without his knowledge, let alone his consent. His son had survived against all the odds because, with incredible stamina, he held on to an inflated rubber tube in the water for two days before being rescued.

Elian had a great-uncle in Florida who at once claimed guardianship of the boy, and in no time he had the overwhelming support of the Cuban-Americans of Florida, whose entire sense of identity, built up over 40 years, is based on out-and-out rejection of the Communist regime of Fidel Castro, and who consequently tend to be strongly right-wing. With their numerical strength and powerful group interest, they form a lobby that the political parties have to reckon with.

Elian's working-class father was said by those who knew him to be a good fellow and a good parent, and of course he wanted his son back. If his estranged wife and her companions in the boat had survived, it seems unlikely that his wishes would have had much chance of being consulted, but her death left him as the person with the strongest legitimate claim to speak on Elian's behalf, and as his legal guardian. (Touchingly, the boy's name, which may sound typically Spanish, is in fact a conflation of "Elisabeth" and "Juan", the names of his parents, who must therefore have loved each other once).

The official view in Washington, expressed guardedly by President Clinton and forcibly by his attorney-general, Janet Reno, was that Elian ought to be sent back to his father in Cuba. This might appear to most reasonable people to be natural justice, but is was seen differently in "Little Cuba", where Elian was being held as a virtual prisoner; there were threats that any official attempt to remove him would be resisted by force. Fidel Castro, who has learned some cunning with age (consider how he made Clinton shake hands with him at the United Nations General Assembly), acted with restraint. Not so the Republican presidential hopeful, George W. Bush, who knew a handy bandwagon when he saw one, and espoused the cause of the Florida Cubans, who are a stalwart constituency of the Republican Party. Al Gore at first temporised, in an all too transparent bid for a share of the Cuban-American vote.

Even after Elian was seized from his captors by United States marshals in a dawn raid, there was a painfully long process of appeals by his Florida relations against the Government's decision to repatriate Elian. The boy's father and some of his schoolmates were brought over from Cuba and lodged with Elian at a safe house in Washington to try and ease his way back to normal life after the trauma he must have suffered as the focus of so much raw emotion (he must have seen his face or heard his name almost everytime the TV or radio was switched on). Still, he had proved himself a survivor - surely a good augury for his future.

Once the last appeal against Elian's repatriation had failed, and he and his entourage had flown out of U.S. airspace and public attention, one could try and see it all in the round. The advantage of Elian being with his surviving parent, in his native country and far away from the emotional hothouse of "Little Cuba", seemed so obvious, but when the drama was at its height it seemed far from certain that this would happen. The virulent anti-Castroism of the American right and the baleful accident of this coinciding with a presidential election, might have given the victory to the Florida Cubans. If a Republican administration led by George W. Bush had been in power, it is hard to imagine any other outcome.

But could Elian's great-uncle, who of course was portrayed by the unsympathetic part of the media as a failure and shady character, have had a point? Should the evident last wish of Elian's mother have been respected? Might Elian actually have had a better future being brought up in the U.S.? Will it be possible for an older Elian in the future to be content, after what he has seen, with life in a country which has either been dependent on, and prostituted by, its giant neighbour across the water, or impoverished and isolated under its Communist dictator?

* * *

The case to which I referred at the beginning is a drama in which the point at issue is predominately spiritual and not political (up to now the politicians have fortunately held their peace). It has in common with the Elian case the involvement of lawyers, but all of them have found it a harrowing experience, saying that it has given them sleepless nights. One can believe them.

On August 8, conjoined twins of the female sex were born to a couple hailing from what has only been stated to be a "remote European community". The birth took place in St. Mary's hospital, Manchester, England, because they could not be cared for in their parents's own country. The parents are said to be devout Catholics.

The British public was originally informed that the babies (that plural word has to be used with caution) are joined at the lower abdomen and share only one working heart and pair of lungs (and, it was hinted, one working brain). But a drawing (based on a photograph) was published a few days ago which makes it clear that even this was an understatement: they in fact have only one pair of legs and one set of genitals between them. Hence, to call them "twins", even conjoined ones, is an overstatement.

To preserve anonymity, the doctors have called the "strong baby" Jodie and the defective one Mary. (Like "Elian", "Jodie" is a name that has been manufactured, even though it is quite widely used, whereas in Christian societies there is no more quintessential female name than Mary. Even if the choice of these names was semi-accidental, the effect is not negligible). The doctors' unanimous opinion was that the correct course would be to separate Jodie and Mary; and that only if this is done would there be a fair chance that Jodie can survive, with a full set of functioning organs, but needless to say after complicated surgery. If they are not separated, it is thought, that Jodie will die through the strain of keeping Mary as well as herself alive. But one only needs to look at the picture to see that Mary, who in effect has only the upper half of a body, and that half unable to function independently, would not remain alive after separation. Because separation could mean the survival of one, and non-separation could only mean the survival of neither, the medical imperative is in favour of separation. This, one would think, is a duty in the terms of the Hippocratic oath and every known medical ethic - albeit one requiring very strong nerves to pronounce and even more, to carry out.

Permission to operate had to be sought in the High Court and the judge ruled in favour of the doctors over the objections of the parents. As Catholics, their paramount belief in this case is in the sanctity of life - in particular the lives of Jodie and Mary equally, regardless of their respective strengths and life- chances - and that nature (or, in religious terms, the will of God) should take its course without further human interference. One medical opinion was that Mary was not a person at all but a monstrous parasitic "growth" on the body of the single potentially healthy baby, Jodie (one would then have to call her "Mary"). The parents appealed against the judgment, and the court ordered a further medical examination and report. As I write, no final decision has yet been made.

It is chilling to realise that the criminal law comes into this. One of the appeal judges said: "The moment the knife goes into that united body, it touches the body of unhappy little Mary. It is in that second an assault. You fiddle about, rearrange the plumbing. An hour later you cut off the blood supply to Mary. You cannot pretend that that is not actively assaulting her integrity. For what justification? None of hers." He went on to say that those with parental responsibility could arguably be guilty of manslaughter of Jodie if they did not act but guilty of manslaughter of Mary if they allowed the separation.

A QC on behalf of the doctors said that if there is a "lawful way" of performing the operation, the case for performing it in Jodie's interests is "overwhelming". Regarding the "best interests" of Mary, "We say that there are no best interests of preserving what is unfortunately a futile life." This states the dilemma with harsh realism, giving the operation the aspect of euthanasia performed on "Mary".

It has been argued on the one hand that Jodie could live a "useful" life "on her own," and on the other that she could be severely and permanently disabled - unable to walk, doubly incontinent etc. But this is not certain, and does it need to be said that many disabled people enjoy life and live it to the full?

The Archbishop of Westminster, head of the Roman Catholic church in England, has pleaded strongly that Jodie and Mary should be allowed to die if that is God's will. Liberal newspapers generally take the same line, not on religious grounds but based on the right of the parents to decide. But what if they do not die, but manage to thrive physically? - for it is likely that if separation is ruled out, the doctors will be obliged to make every effort to keep them alive. The horror of Jodie eventually wakening to her conjoined state and having to live with it indefinitely hardly bears thinking about.By the time this article appears the legal/medical outcome will be known. The moral conundrum will be no greater or less then than now.

E-mail the writer at hurst@atlas.co.uk

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