Saturday, 12 April 2014

Lliverpool Care Pathway - Giving In And Letting Go

Life is at threat. The priorities are changed. The focus has been subtly altered. Before your very eyes...!

When they describe someone as being technically dead or brain dead, do they really mean ‘as good as dead’? It is less a scientific evaluation and more a value judgement.

We are all at risk because of this downsizing of focus. Steven Thorpe was declared to be brain dead by four medical experts. Brain scans failed to detect any electrical pulses. It was only the persistence and determination of his family that kept the death cultists from removing the life support.

This is Steven:
"My father believed I was still there.
"He expressed his views to Julia Piper and I think she listened very closely to what my dad had said.
"My impression is maybe the hospital weren't very happy that my father wanted a second opinion.
"I think the doctors wanted to give me three days on the life support machine and the following day they said they wanted to turn it off. 
"The words they used to my parents were 'you need to start thinking about organ donations'. 
"I think that's what gave my dad energy, he thought 'no way'. 
"I think if my dad would've agreed with them then it would've been off in seconds. 
"If my parents hadn't asked for the second opinion, and if Julia hadn't been there, I wouldn't be here today."
The pressure for organ donation is another real danger, another card the death cultists can play. The body is a crop to harvest. It is the strange fruit hanging from the tree.

In Wales, unless there is a declaration not agreeing to organ donation, the assumption is that you have agreed. These are all arguments in their armoury to press ahead and switch off life support.

Steven observes:
"Hopefully it can help people see that you should never give up."
Read more here -
Liverpool Care Pathway – And More Misdiagnosis

Liverpool Care Pathway - Concerning The Defining Of Death
 And further essential reading -
Liverpool Care Pathway - Presumptuous And Arrogant
When is movement just a motor response? And when does it indicate more, much more than that?

A death focus removes 'improbable' considerations from the picture. A pathway may guide the ignorant in their basic tasks and functions but, when those pathways contain No Entry signs that deny access to avenues of investigation which should be followed, they should be abandoned. This death cult which struts through our hospital wards is killing people and doing harm.

This is the Daily Record –
Doctors at Edinburgh Royal Infirmary told Lorna’s family she was “technically dead” after a heart attack in 2012. 
They turned off her life support machine and moved her to a private room so her loved ones could say their goodbyes. 
Then the family noticed signs she was still alive. 
A nurse told them they were seeing after-effects of electric shock treatment. 
But they persisted. And after 45 minutes, doctors admitted Lorna was breathing. 
She was put back on life support, but her brain had been starved of oxygen and badly damaged. 
The 51-year-old mother of four, from Prestonpans, East Lothian, can now neither walk nor talk. She needs 24-hour care.

We are, all of us, at risk.

This is from Tissue Donation and End of life Care from Kingston Hospital Foundation NHS Trust -

NICE organ donation guidance makes it explicit in its first recommendation that ‘organ donation should be considered as a usual part of “end-of-life care” planning.’
The Liverpool Care Pathway (LCP) included in its documentation, a prompt for clinicians to discuss tissue and organ donation with the patient, and if appropriate their relatives. An audit performed at Kingston Hospital found that of 20 LCP proforma’s completed, only 1 had documented that this information had been ascertained.
Should they continue to maintain your life or farm your body parts to save three, four, more other lives? Such considerations should not enter into the equation to influence the judgement of the attending doctor.

These are not the considerations of the traditional doctor whose attention is focused on the patient in front of them. These are the considerations of the politicised Communitarian Practitioner.

There is a State directed EoL programme in effect. The EoLC programme means winding down those care expectations. Limiting, removing, denying treatment options is already halfway to fulfilling the EoL prognosis.

The physician stands fast no more to fight the good fight. The lone guard at our bedside, upon whom we relied to ward off the perils which engulf us, stands back from the spectacle of the fray and is become a mere spectator.

No longer does the Healer heal. Is no-one listening? In British hospitals, there has been a programme of death initiated. The evidence is there for those who wish to see.

Monday, 7 April 2014

Liverpool Care Pathway - The Joy Of Living

Life is a gift. It is not a nuisance to cut out or a burden to put down.

Whatever your belief perspective, one life or many, or life eternal, life is always precious because living matters. You matter. Your life matters. Every ripple on the pond makes a wave upon the ocean. Every move you make; every breath you take: it really does matter in the grand scheme of things. There are always, always consequences.

Whatever your belief perspective, one God or none, or Pantheon of Gods, your place in this world is settled: you are here; you are part of the motor of existence. And you matter.

Whatever your belief perspective, there are certain universal principles that guide us: a belief in truth and justice, certainly; that those who make the law should not break the law, perhaps.

Those who place themselves above the law, we have torn down and they have paid for their hubris. And those who place themselves above and beyond the law? How shall we deal with them when the time comes?

Serious, angry thoughts for Life Café.

And some absolutely essential reading for Living Matters Awareness Week...
Liverpool Care Pathway - A Life Café Poser

Living Matters Awareness Week is less than eight weeks away – have you thought about holding an event? Whether you have a plan yet or not, here are some ideas and inspiration to help you prepare.

First of all, were you aware that April is Pet First Aid Awareness Month. Have you thought what you would do if the circumstance arose that required prompt action to be taken? American Red Cross have produced a Pet First Aid App that might help. This is American Red Cross –
Take care of your furry family member. The American Red Cross Pet First Aid app puts veterinary advice for everyday emergencies in the palm of your hand. Get the app and be prepared to act when called upon. With videos, interactive quizzes and simple step-by-step advice it’s never been easier to know Pet First Aid.
Download from the iTunes, Google Play or Amazon Marketplace app stores.

Their lives are precious, too. And living matters

Your event

A Living Matters Awareness Week event can be large, small or anywhere in-between. To give you inspiration, here's a small selection of ideas:
  • Coffee morning at the library in aid of the Red Cross, with resources on display. Red Cross will be happy to assist.
  • Living matters for pets, too. Promote that Pet First Aid App.
  • A Red Cross or St. John's display to promote CPR instruction in schools.
  • Ask Red Cross or St. John's for promotional materials on First Aid and hold a 'Live In' event.
  • A Life Cafe. 
  • An afternoon of activities, including screenings of the Vinnie Jones videos on You Tube.
  • Hold a sponsored sing-along of “Staying Alive” in aid of your local Red Cross.

With over half the population fully trained in CPR, Seattle has the world's highest survival rate, at 56%. This is Puget Sound Business Journal –
If you have a witnessed heart attack in the Seattle area, your survival rate is greater than anywhere, and it just got higher. In fact, the survival rate for a common form of heart arrest, ventricular fibrillation, where the heart stops beating and is, in essence, just quivering, is now up to 56 percent in our region.

These recently released numbers represent an increase for the third year in a row and the highest reported survival rate in the world, compared to between 2 and 25 percent nationally. The 56 percent number is almost identical in all of King County.

Today, I spoke with a man who works with Probation in ‘Pay Back’ (Community Service). They have been doing work at our project. Yes, ‘community service’ really is community service.

He talked about the private tendering of the Probation Service; how they had already tried it in London and it hadn’t worked and they had taken it back in-house. He is currently employed by a ‘holding company’ and we spoke of the moral issue involved in a business in which there is a conflict of goals.

Reducing or eliminating offending, if that is possible, must surely put the business out of business, for then there will be no business. So why should shareholders risk their money in such a venture? Can we see another Python sketch here forming in our heads?

This good man spoke of a motivational talk they had all been sent on. The speaker was a South African, he said, a blind man, whose message was that you always embrace change; you don’t give up and fold before it. “He had us in stitches!” he said.

This good man spoke to the blind man after the talk. This blind man’s name is Miles Hilton Barber. He grew up in what is now Zimbabwe. He has flown from London to Sydney in a microlight, walked to the South Pole and plans on walking to the North. He has flown a jet fighter upside down with a sighted deaf man.

He does it for charity to fund giving the gift of sight to blind African children. The joy he says to hear a mother cry to see her child can see is immeasurable reward.

This is his website –

Why would you not consider it so, that life is a gift? No matter what, you do what you can with what you have, the cards that you are dealt. It's how you decide to play them.

Sunday, 6 April 2014

Liverpool Care Pathway - The King Lives!

The King has not left the building. He has been seen on the way to and from the theatre.

This is the Chief Executive’s Report of the Guys and St. Thomas’ Board of Directors Meeting –
The Trust Management Executive recently approved new ‘Principles of Care for Dying Patients’ adapted and developed by Guy’s and St Thomas’ from the ‘Kingston Hospital tool’ in response to the recommendations made following the review of the Liverpool Care Pathway – More Care, Less Pathway (Neuberger July 2013) recommending the withdrawal of the Liverpool Care Pathway within 6 – 12 months. Following the implementation of this new approach the Liverpool Care Pathway has been withdrawn from clinical practice from January 2014.
So they’re not using the LCP anymore. Ho, ho... Just take a look at these tweets on Twitter - 
"Our survey found many trusts are not on course to scrap the Liverpool Care Pathway by the summer deadline. This change was not handled well"
"At 1 trust "heated discussions" with relatives concerned their loved one ws being killed led to big drop in use of LCP But what replaced it?" 
JustMe ‏@princessandtoad: "end of life care pathway" 
Janet Snell ‏@Janet_Snell: "Is that what's known as rebranding?!" 
JustMe ‏@princessandtoad: "pretty much. It's silly and a waste of money to be honest." 
Janet Snell ‏@Janet_Snell: "princessandtoad Guys has replaced LCP using Kingston trust idea: Principles of Care for Dying Patients A CNS reviews all cases within 48hrs"
Janet Snell @Janet_Snell is "Acting deputy editor of Nursing Standard but tweeting in my capacity as me".

And here is Nursing Standard –

Janet  put it on Twitter.

Janet put it in the Standard.

"Most acute hospitals are still using the Liverpool Care Pathway."

They're just not calling it that exactly.

So, what’s the ‘Kingston Trust idea’? The Kingston Trust ACP Clinical Audit shows -
Cycle 1:
•          Retrospective case notes analysis of the last 40 patients on the Kingston Hospital Palliative Care Register on a single Care-of-the-Elderly ward.
•          We audited five key areas: resuscitation status, prognosis, ceiling of care, re-admission plans and patient/family awareness. Our focus was whether there was a documented discussion regarding each of these rather than the outcome of the decision.
•         In addition, discharge summaries were reviewed to see whether this information had been communicated to the patient’s GP. 
Implementation of change:
     •          We introduced an ACP Summary proforma where outcome from discussions around the above five key areas could be summarised in one place.
•          On call teams had to make escalations plans for 4 patients.
•         The proforma was introduced at a local Care-of-the-Elderly department meeting and teaching sessions were held for junior doctors.

Cycle 2:
    •         The medical notes and discharge summaries of 40 further patients were audited prospectively for the subsequent forty patients on the register.
•          Patients who had died supported by the Liverpool Care Pathway (LCP) had excellent documentation. 100% of these patients were not for resuscitation, 100% had a ceiling of care documented and 94% of their relatives were kept informed. In general, documentation for these patients was clear and easily accessible.
Cycle 1:
•          Documentation regarding prognosis and ceiling of care (escalation plans) was very poor; often it was very difficult to find in the medical notes which would pose a huge problem if an on call team was called to see the patient acutely.
•          On call teams had to make escalations plans for 4 patients.
•         Despite 77% of patients and their relatives having documented discussions regarding diagnosis and prognosis, we found that this was often not communicated in a timely fashion. For instance, one family made a formal complaint that they were not aware of their relative’s prognosis until she was in her final stages of life and another was informed of diagnosis/prognosis only on starting the LCP even though this patient had been unwell in hospital for several weeks. 
Cycle 2:
•         The re-audit results following the implementation of the ACP Summary showed an improvement in all 5 key areas.  The target was not met for prognosis, likely due to the fact that prognosis is often uncertain and difficult to estimate.
•          In 3 cases, conclusive decisions about future hospital management were not possible. Importantly, all of these discussions were communicated in the discharge summaries so further discussions could be initiated in the community. No escalation plans had to be made by on call teams.
This is Newspeak:
Patients who had died supported by the Liverpool Care Pathway (LCP) had excellent documentation - They have an enthusiasm that is ruthlessly and determinedly thorough in ensuring the patients reach their final destination in one piece.
100% of these patients were not for resuscitation - They all had a DNR slapped in their notes.
100% had a ceiling of care documented - All curative care was a no-no!
94% of their relatives were kept informed - They had been convinced (groomed) that the patient had an untreatable and terminal condition... thereby causing a great deal of harm in itself and ensuring a self-fulfilling prophesy. 
In general, documentation for these patients was clear and easily accessible - The grooming was thorough so they had nothing to hide.
The Kingston ACP

With implementation of the ACP Summary there was an improvement in all 5 key areas.

The target was not met for prognosis, “likely due to the fact that prognosis is often uncertain and difficult to estimate”. Prognostic error translates into diagnostic error...

and excess deaths.

At Guy's and St. Thomas', they are proud of their record of identifying patients for palliative care. This is the home of Amber.

Excess deaths...?

There have been alarming reports of narrow escapes from the clutches of these fanatical followers of the death cult which struts through hospital ward and into surgery consulting room.

Further reading -
Liverpool Care Pathway - A Right Carry On Up The Pathway 
Liverpool Care Pathway - In The Best Interests Of The Interested
Such is the arrogance of the arrogant –

The scope of your focus will always direct the decision-making process and determine outcomes. At Guy’s even Amber has so successfully directed that focus that a report showing that the percentage of patients recorded as ‘palliative’ has increased from 1 per cent in 2008 to 32 per cent in 2012 has sent alarm bells ringing in an independent auditor’s ears to raise the alarm at Westminster.

Under the umbrella of the ruthless logic of a programme rolled out by the State and you have death on a production line.

Such is the arrogance of the arrogant –

Amongst papers submitted at the 10th Palliative Care Congress, 12th–14th March 2014, was:

This found that 25% of those surveyed (50% of those who responded) actually want the LCP as part of mandatory training.

This found that nearly a third of those surveyed (57% of those who responded) consider the LCP should only be used in the final 48 hours of life. They will use the Barton Method to determine this!

This found that those who refuse to accept the limits of their fallibility are doomed to repeat the errors of their hubris.

30 sets of LCP case notes were analysed using the NCDAH proforma template to examine compliance against the recommendations - That Marie Curie NCDA, it will remembered, sanctioned use of selected data sets to permit best outcomes being used (Shout Fix?).
Results were compared with last year's audit.
4 hourly assessments carried out by staff had increased by 1% - And what was checked?
Discussions around spirituality had increased by 9% - Talking... It's so important:
"On the day after she'd gone onto the Liverpool Care Pathway, we were visited by an end of life nurse. And he was ever so nice - I mean, the nursing staff were all lovely - and he came in and he was sort of asking us if we'd thought about the funeral and how we were going to tell our daughters, and just, sort of, getting us to talk about it, I suppose."
- Kathleen Vine's granddaughters
Medication prescribed on a prn basis had increased by 9% - All adds up to fullfillment of a self-fulfilling prophesy.

 The King has been given CPR and is in good voice.

Additional reading -
Liverpool Care Pathway - The Early Years

Wednesday, 2 April 2014

Liverpool Care Pathway - Missing The Plot

When the left hand hasn't been told what the right hand is doing, there's bound to be some lack of co-ordination...

Mail Online has reported a ten-fold rise in palliative care deaths –
Roger Taylor, of Dr Foster, explained how an elderly patient might go in to hospital with a broken hip, develop an infection and die.
Staff would then code this death as ‘palliative’ even though the patient was not initially expected to die.
This could be deliberate or a mistake, as the guidelines for recording deaths are unclear. Nonetheless it is very different from a true palliative death of a patient with terminal cancer.
Each year the Hospital Standardised Mortality Ratio (HSMR) collates the numbers of patients who have died unexpectedly.
But trusts can drastically lower this rate if they record high numbers of patients with terminal illnesses, termed ‘palliative care’.
The figures show that at one trust, London’s Guy’s and St Thomas’, the percentage of patients recorded as ‘palliative’ has increased from 1 per cent in 2008 to 32 per cent in 2012.
It has been reported in these pages how newspapers and political interest groups will report the news to suit their own particular perspective.

See, for instance -
Liverpool Care Pathway - A Political Football
In their report, Mail Online sees this as massaging the figures on the sly. It suits their editorial stance and all that LCP business has dropped out of the picture and is no longer, perhaps, newsworthy.

This is Dr Foster -

The report highlights Dr Foster’s concerns that current palliative coding encompasses a wide variety of palliative pathways. Patients admitted to hospital specifically for specialist palliative care cannot currently be distinguished from those who were admitted for treatment and whose subsequent deterioration in health led to them receiving palliative care.
Roger Taylor, of Dr Foster, explains how an elderly patient might go in to hospital with a broken hip, develop an infection and die...

Actually, Mr.Taylor, this is precisely what does happen and has been happening.

It could be a broken hip, it could be anything. Curious you should say a broken hip, though...

This is Chad -
Graham Bennett’s mum Gladys was admitted to hospital in October 2010 after falling and breaking her hip at her home at Burton Court in Bilsthorpe.
But she died later that month at King’s Mill after Graham was asked to sign forms that he now believes gave consent to put her on the Liverpool Care Pathway (LCP).
“It was never mentioned, that’s what annoys me,” said Graham (70).
“It’s taken a time to come to terms with it, even though my mum passed away at the end of October 2010.”
The Doc Foster graph fits well with the EoLC Strategy and the reported “Excess Deaths”.

Downsize care by downsizing care expectations. Initiate a programme of ‘identifying’ the One Percent who statistically die via a protocol of assessment involving statistical probability and intuitive judgement and earmark them for EoLC.

This will (of course!) trawl in many who would not have formed part of that One Percent cohort. By far the greater part of medical error consists of medical misdiagnosis. There will be excess deaths...

ITV Central have picked up the same story and have run with it -

The figures show that at one trust, London’s Guy’s and St Thomas’, the percentage of patients recorded as ‘palliative’ has increased from 1 per cent in 2008 to 32 per cent in 2012.

Actually, Guy's are very proud of their EoLC record, Mr. Taylor. How dare you slur good old Guy's, home of the Amber Care Bundle.

The impact of AMBER in King's College Hospital is being independently evaluated by the Cicely Saunders Institute. They are actually proud of their achievements!

£4.8 Million is being spent on EoLC across the local boroughs of Lambeth and Southwark.The Programme set up a groundbreaking single online patient register which identifies patients with end of life needs and shares information between GPs, hospitals and out of hours services 24/7 - a precursor to the pan-London register.

On this Guy's web page they still brazenly boast about the LCP -

Amber has been transported to Oz.

Dr. Adrian Hopper and his excellent team of roadies from Guy's & St. Thomas' have been a big hit.

Has everyone missed the plot...?

Further reading -
Liverpool Care Pathway - Still Pushing For Amber

Tuesday, 1 April 2014

Liverpool Care Pathway - The Werther Defectives

When the dots join up, do they not forge a link in a chain?

Lytic Cocktail/Demerol, Phenergan, and Thorazine (DPT)

The basis for the Wessex Guidelines and the Barton trials at Gosport which led to the development of the Liverpool Care Pathway, the EoLC Strategy and the Life Limitation Programme...?

This is Lytic Cocktail/Demerol, Phenergan, and Thorazine (DPT) -
Demerol (meperidine, an opiod) is a narcotic pain medicine used to treat moderate to severe pain.
Phenergan tablets and elixir contain the active ingredient promethazine, which is a type of medicine called a sedating antihistamine.
Chlorpromazine, a neuroleptic, (as chlorpromazine hydrochloride, abbreviated CPZ is marketed in the United States as Thorazine and elsewhereas Largactil or Megaphen.
Here, Fox News reports on possible links to Demerol in the death of Michael Jackson...
“Demerol has a tremendous amount of side effects,” Dr. Patrick Annello, an anesthesiologist and pain management specialist at St. Francis Hospital on Long Island told “It can cause rapid heart rate, arrhythmias — and given in high enough doses — it can cause respiratory depression or shallow breathing.”

If he took other medications that are sedating – which pain medications usually are – in conjunction with Demerol, it can definitely cause shallow breathing and decreased oxygen levels, ultimately leading to respiratory arrest or heart attack, Anello said.
Amongst the mix of drugs that eventually took out the 'King of Pop', was there a lytic cocktail?

It is the combination of drugs - a neuroleptic, an opiod and an antihistamine - injected intravenously, that forms an apparent connecting link, from cocktail, to concoction, to the clinical protocol of treatment that is the Liverpool Care Pathway.

A 1999 Pub Med article cautioned in regard to the administration of diazepines, in particular Midazolam, and recommended monitoring of respiration.

The lytic protocol has been likened to euthanasia...

Euthanasia: Ethical and human aspects

By Council of Europe

 In 1980 the Association for the Right to Die with Dignity (ADMD) was set up in France (branches were created in Spain in 1984 and in Italy in 1986). Article 1 of its statute states that the association’s aim is “to promote the legal and social right to have control over one’s body and one’s life in an independent, responsible manner [and] to choose freely how to terminate one’s life so as to live it to the very end in the best possible manner” (Pohier, 1998). All the Associations campaign for three things: the right not to suffer, the right to refuse unwanted life-prolonging treatment, and the right to voluntary euthanasia at the patient’s request.
In the 1980’s and 1990’s, alongside these developments, the practice of illegal euthanasia was spreading. Death was caused by lytic cocktail or DLP, a combination of Dolosal, Largactyk and Phenergan, administered by intravenous injection, or by potassium injections. Certain doctors were to become specialists in the practice of euthanasia (or assisted suicide) at their patient’s request. The best-known were Doctors Julius Hacketal in Germany, Peter Admiraal in the Netherlands, Jack Kevorkian in the United States and Léon Schwarzenberg in France.
This is -

Suffering and Dignity in the Twilight of Life
edited by B. Ars, Etienne Montero

For several years now, the results of opinion polls on euthanasia have been the same. Eighty percent of the population is in favour of euthanasia, which does not surprise me when, basically, the question asked comes down to the following dilemna: would you rather die quickly and without suffering, or in great suffering and inundated with tubes?
Misinformation, because we consciously omit to tell future patients that the physician does not have the right to persecute them, that they are legally in control of the decisions that concern them, and  that we are no longer ill-equipped to deal with pain.
Misinformation, because we are careful not to say out loud what health care professionals are perfectly aware of: that the opinion of a healthy person, and the opinion of someone who is ill, are two completely different things.
This is the die loaded, the question phrased in such a manner to produce a particular response.
Nearly all lytic cocktails are administered to patients without their knowledge, or even against their explicitly expressed desire.
This is the policy that followed through into the Barton trials at Gosport, up to the illegal Version 11 Liverpool Care Pathway - and beyond.

Physicians may choose to administer lytic cocktails if they perceive incurable disease as failure, if they do not dare tell the patient the prognosis, if they cannot accept their limitations and powerlessness. Nurses can have the same feeling, in addition to the suffering they must endure every time there is a profound difference of opinion between the curative medical care and the patient’s actual condition, every time they cannot get the necessary analgesics, every time the family turns to them because there is no dialogue with the physicians, every time the doctors desert the dying person’s room and leave the nurses to take all the responsibility.
And so, by doing away with the patient, the health care professionals get rid of the source of their disturbance. Or, sometimes, and far more cynically, it’s to manage the available beds!

This is the policy that persists to this day. It's all about the money...
Typically towards the end of life, each unplanned admission to hospital costs more than £3,000. In the last 12 months before death, patients average 3.5 admissions each, with estimates that at any one time 20% of all hospital beds are occupied by people who are dying. If each person had one less crisis admission, the NHS would save £1,350,000,000 (NHS QIPP EOL workstream 2010).
(Dying Matters)
 To be precise, £15-20 Billion...
In Liberating the NHS: managing the transition Sir David Nicholson, NHS Chief Executive, sets out plans to to lead the implementation of Equity and excellence: liberating the NHS – the White Paper published 12 July 2010.
He focuses on the need for the NHS to continue providing high-quality cost-effective services, while making the required productivity savings of £15-20 billion. The Quality, Innovation, Productivity and Prevention (QIPP) programme is central to this process.

(NHS National End of Life Care Programme - QIPP,Equity and Excellence 15 July 2010)
Was it always the final solution to the problem they saw as insoluble? Long, long time ago, just after the music died, the spark of an idea spawned by some focus group in some Wilsonian think-tank in Westminster's dark halls, perhaps...

Mr. Patrick Gordon Walker’s landmark observations echo down the years.
Patrick Gordon Walker
Political Diaries1932-71
One of the results of debates such as this—we have had a number on this subject—is that it has become generally understood, and is almost a truism, how rapidly the elderly population is increasing and will continue to increase. It is probable that by the 1980s there will be about 10 million people over retirement age, and between now and the 1980s—this is a very serious problem for those who have to plan the development of the social services—the proportion of the dependent population—those under school-leaving age, on the one hand, and those over retirement age, on the other—will be rising much more rapidly than the working population, which has to produce the wealth from which we pay for social security.
Patrick Gordon Walker 1967
"In the 1980s and 1990s, alongside these developments, the practice of illegal euthanasia was spreading. Death was caused by lytic cocktail..."
Requests from the team and from loved ones are more frequent than requests from the patients themselves. Should this not make us think twice?
The debate in Belgium has omitted ‘how’ to respect the autonomy of those patients who have not asked to die, in favor of the autonomy of those who have.
In the report to the Canadian Senate, the following statement by Y. Thompson is quoted:
“By legalising euthanasia, we worry that because of social and economic pressures, the elderly and the incapacitated will have to constantly justify their right to live. It would be a tragedy if, by legalising euthanasia for compassionate reasons, we condemned part of the community to having to justify its decision to live and to take up space in health care establishments.”
When supporters of euthanasia speak of autonomy, they only consider the patient, the family is excluded from the discourse.
If a family has helped, cared for, and supported this seriously ill person sometimes for months, it is the result of a relationship that has been going on for even longer. This family is part of the patient’s life and vice versa, they cannot be excluded for facility’s sake.
In reality, families are as present as they can be, feelings fluctuate, ambivalence reigns, and what they request one day, they can regret the next. Any member of a family who makes, or participates in making, a decision that affects the patient’s life will carry this with him for the rest of his life, with all the regrets and uncertainties that go along with it. To take a request from the family literally, is to forget that suffering can make us say things we do not really mean, or whose consequences we have not thought over properly. It means forgetting that, in situations of utter confusion, we need boundaries, limits. When a family asks to have a patient’s life terminated, it is a cry for help, and should be heard as such.
Those who leapt from the twin towers did not seek death; they saw it as their only life option. 

Those who seek death, or say they do, likewise are moved only by what is, or what is perceived to be, the desperation of their plight. We fail them, not by denying them the means to put an end to themselves, but by not providing the means to regain the will to live.

When the suicide stands on the ledge, do we give a gentle push to topple them over or do we reason with them to draw them back from the brink?

Those who request euthanasia do not ‘choose’. There is no 'right' to death. Death does not debate, but demands. There is only 'right' to life.

To comply with the wish to seek death is to recognise our failure. It is also to create precedent. It has impact and consequence for us all. We are saying it’s okay; that death is a positive life choice.

When society loses the will to care; when death is always the easiest option and is interpreted as care, then life is devalued and do we stand in disgrace and disgraced.

The Guardian, 2007
In recent years, euthanasia/assisted suicide - the hopeless resort of the hopeless - has been popularised and promoted, justified and defended.

Death, as a positive life choice, has been popularised by the popular support of cultural icons for those who celebrate them to take example by.

A cross-party group of MPs accused the BBC of showing “persistent bias” in favour of euthanasia and signed an Early Day Motion which accused the BBC of conducting a “multi-million pound campaign” to promote euthanasia.

They were unable to turn the tide.

More recently, Anna Soubry and Norman Lamb have come out in support of "assisted dying" and promoted the infamous Falconer Bill.

The vulnerable, the elderly, are under pressure to justify their existence. The psychological effects are undetermined and undeterminable. Mental health impacts directly upon the physical. Many will be made to feel acutely aware that they are a burden; some will seek to make an end of it all.

To some, death might seem the only path to follow, the one resort that is left to take.

The Werther Effect

Many will be moved by example, the celebrity of the celebrated. They are about changing perceptions and perceptions have changed. They are only half way there, they say, and there is more to accomplish. Our culture is being subtly changed before our eyes such that we do not even perceive it.

A culture that turns children into death machines is evil incarnate and so do we perceive that to be. Definitions are changing, however, and we are learning the language of Newspeak.

A culture that does not need to care because to 'care' is to provide assistance to die, is that not also evil incarnate?

Further reading -
Liverpool Care Pathway - The Pro-Death Advocacy 
Liverpool Care Pathway - A Dedication, Steadfast And Sure