Last December, the medical center where Alfie was being treated, Alder Hey Children’s Hospital, petitioned the courts to discontinue ventilation and other treatment. The child’s parents, Tom Evans and Kate James, objected and wanted to take Alfie to hospitals in either Rome or Munich. The British courts have repeatedly rejected the parents preference and refuse to allow the infant to leave the country, claiming that it is in Alfie’s best interest to be taken off ventilation and to receive symptom management and palliative care. (Currently, the child is receiving food and fluids, but is not on a ventilator.)

On Thursday, Alfie’s father said he would be meeting with doctors to discuss taking his child home.

Understanding the law

Under the British law known as the Children’s Act (1989), when a court determines “any question with respect to (a) the upbringing of a child; or (b) the administration of a child’s property or the application of any income arising from it, the child’s welfare shall be the court’s paramount consideration.” The legal reasoning of the British courts is that the government is seeking the “best interest” of Alfie and thus has an obligation that supersedes the desire of the parents to seek additional care.

In a decision handed down by the Family Division of the High Court of Justice, a judge ruled that, “The continued provision of ventilation, in circumstances which I am persuaded is futile, now compromises Alfie’s future dignity and fails to respect his autonomy.” On Wednesday, the Court of Appeal—the highest court within the Senior Courts of England and Wales, and second only to the Supreme Court of the United Kingdom—upheld the earlier High Court ruling.

Understanding the ethics

The case of Alfie Evans has a host of ethical difficulties attached to it. A few questions relevant to this case include: When should someone be permitted to die? Under what circumstances is it permissible to withhold treatment and to allow natural causes to end a life? Who has the best interest of the child at heart? What is the role of the parent versus the state in deciding what medical options to pursue for a sick child?

It is within the rights of parents to decide to withhold treatment for Alfie given his grave diagnosis. This would not be considered active euthanasia since the parents would not be intending Alfie’s death, but are electing to no longer use artificial life-sustaining measures to keep him alive. This is not the same thing as killing. Allowing natural causes to end someone’s life is not morally illicit, nor is it in the same category of actively cooperating to bring about someone’s death. The parents are ethically justified to allow their son to die. This is a decision best left to parents, who have a God-given right, and natural right, to decide their son’s treatment.

What is indeed unethical is for the state to intervene against the wishes of the parents, who desire to take Alfie to Italy.

Medical decisions, especially when life and death hang in the balance, should be left to parents, not the state. The state should not interfere or block parents’ wishes to prolong a child’s life. Nor should the state actively procure the death of a child, especially when parents have other options available, as Alfie’s case certainly presents. England’s healthcare system is acting unethically in the case of Alfie Evans. By refusing to allow Alfie to seek treatment elsewhere, the state is usurping the God-given authority of parents over children, and using such co-opted authority to deny Alfie life-sustaining measures, thereby hastening his death.

Parental authority over children is explicit in Scripture (Deut. 11:19; Eph. 6:4). The parent-child relationship is one of divine origin and design, accomplished through the one-flesh union of a mother and father. Scripturally speaking, parents are tasked with raising children. For this reason, the mother and father of a child ought to retain primary authority over the child. This is grounded on the basis of an innate link between parent and child—whether biological or adoptive—and right of the parent over the child. This is both commonsensical and appeals intuitively to our sense of justice.

The love a parent has for a child is unlike any other love a human can know and speaks to the sense of care and best-interest most parents have for their children.

(Courtesy of ERLC)

The article quotes a scientist who fully acknowledges the tilted imbalance in favor of male athletes who are competing against women due to physiological factors. The article also cites a counterview by another scientist, alleging that “there’s no physiologic advantage to being assigned male at birth.”

How a reputable scientist can make such a claim against all lived experience, commonsense, and scientific data is astounding and demonstrates the ideological falsehoods made to bolster the legitimacy of transgender women (biological males) competing against women.

Here’s the dilemma: If biological males are allowed to compete as women under the philosophically problematic category of “gender identity,” how can competition be considered fair to women?

Statistically speaking, males have physiological advantages over females when it comes to sports performance. To make this observation is not to denigrate female athletics or demean female design. It is to make an objective observation, an observation that explains why athletics have traditionally remained segregated by sex. This acknowledgement protects the integrity of the sexes, the integrity of athletic competition, and allows men and women to play on level ground.

Sex segregation in athletic competition results from recognizing the differences in male and female biology. Sex differentiation is a biological reality that follows from God making humanity male and female. The differences in males and females are stark: Different chromosomes, different reproductive designs, different bodily structures, and more.

Christians ought to proudly defend the equality of the sexes in God’s eyes, because he made them in his image. At the same time, males and females are not the same, biologically speaking. Their bodily organization produces different bodily design, and this design manifests physiological differences that produce clear-cut disparities in athletic performance. Males, as a general population, are faster and stronger than females. This is especially true in distance running, where men, as a whole, produce faster times compared to women.

A host of differences contribute to increased male performance in running. According to a 2005 Sports Medicine journal article, “Running Performance Differences in Men and Women,” men have greater aerobic capacity, which makes them faster. This basic difference in men and women is the increased oxygenation rate of men over women. This is due to an increased heart size and greater ability to pump blood, the ability to create more red blood cells, and capability to produce hemoglobin from the production of testosterone. Men also have lower body fat percentages.

How should we respond?

So, what should we make of the decision to allow transgender women to compete with females?

First, it should be stated upfront that transgender women are not women. They are biological males who may or may not experience gender dysphoria that lead them to want to identity and live as women. This is not to be harsh or condemning, but truthful (Eph. 4:15). Christians should have no part in demeaning individuals who struggle with their own internal sense of gender. However, no amount of self-assertion and self-identity can override the objective biological reality of maleness. So we should be abundantly clear on what the Boston Athletic Association is allowing: They are allowing men to compete against women.

Second, by allowing men to compete in the same division as women, the Boston Athletic Association is violating a basic principle of fairness. Fairness is based on treating similar things the same way. It is unjust, for example, to use skin color as a basis for denying a black person a hotel room while at the same time allowing a white person to access one. Skin color is irrelevant to a person’s need for housing. But treating men and women differently is appropriate since, well, men and women are different when it comes to bodily distinctions and athletic performance. Treating transgender women as though they are real women is not treating women fairly, since males have a physiological advantage over women.

Third, this ought to show how far the transgender movement has reached into American culture and the level of success it has attained, despite the consequences and inconsistencies that occur from blurring sex and gender.

Fourth, this event demonstrates the fundamental hypocrisy of a culture that esteems fairness and equality, but undermines both to serve the cause of political correctness.

Fifth, the confusion that stems from blurring gender and denying the authority of biological sex is a grievous departure from God’s authority over creation. God’s lordship over creation is manifest in how he has designed men and women as distinct phenotypes. Our design as men and women is a revelation of God’s will for creation. In this, Christians declare that Christian and non-Christian alike can understand the difference between men and women. Our design reflects God’s providential governance over the world. When culture suppresses this truth, it robs God of his glory and lordship over creation, and subverts human action in society.

The Boston Athletic Association is serving its own interests by wanting to avoid controversy in allowing transgender women to compete as women. It is doing a disservice to culture by groveling to falsehood and violating the integrity of athletics. In a culture that is wanting to esteem and value women and womanhood, the BAA is undercutting both.

(Courtesy Ethics and Religious Liberty Commission)