Friday, 12 August 2011

Liverpool Care Pathway – A Rogue, By Any Other Name…

What on earth is happening? This is, surely, unthinkable.

Evidently, it is not.
 The usual technique of euthanasia is when a doctor administers a lethal injection to a patient. However, when a doctor withdraws life-sustaining nutrition and fluid from a comatose or sedated patient, is this not a form of slow euthanasia?  

- Paul Russell

Hospital patients were 'left so thirsty doctors had to prescribe water…

Inspectors from the Care Quality Commission (CQC), the NHS watchdog, found nurses sometimes left patients so thirsty that the only way for doctors to ensure they had enough liquid was
to add "drinking water" to hospital medication charts.

The revelation comes in the first reports from the CQC into dignity and nutrition of elderly people treated by the NHS, which reveals a failure to attend to the most basic requirements of care.

The Health Secretary, Andrew Lansley, who ordered the reports, said the failings were "unacceptable". – The Independent

Of the first twelve NHS trusts inspected, three failed to meet the essential standards required by law of respecting and involving people in their care and meeting their nutritional needs. Less serious concerns were identified in three further hospitals, giving a 50 per cent overall failure rate. The reports are the first of 100 inspections carried out, which are continuing. They follow a decade of investigations that have revealed an NHS riddled with ageist attitudes, in which elderly patients are neglected, poorly treated and marginalised. Shortage of money and resources is not the problem but rather, as the NHS Ombudsman said in a scathing report last February, an "ignominious failure" to look beyond a patient's clinical condition and respond to their social and emotional needs. A spokesman for the CQC said the 50 per cent failure rate was likely to be reflected nationally.

The worst offender was Alexandra hospital, Redditch, Worcester, where the CQC expressed "major concerns" about the failure to ensure elderly patients had enough to eat and drink. The Royal Free hospital in London and Ipswich hospital also failed to meet the standards required by law.

At Alexandra hospital, inspectors saw meals being served to patients who were asleep. Trays were left out of reach, patients were not offered help to cut up their food and one patient was seen trying to tear a tomato apart with their fingers. Nobody was routinely offered hand washing before or after eating. Although the trust said it offered a choice of dishes, one patient who declined a meal had it taken away without being offered any alternative.

Medical staff explained how they prescribed drinking water on medication charts "to ensure people get regular drinks". Inspectors saw examples of this being done and were told it "worked". Ward staff said they were aware of drinking water being prescribed and that this was done to "make sure people get enough fluids".

The reports on the 12 trusts also highlight how patients were not weighed, making it impossible to check if they were losing weight. Malnutrition is a major problem among elderly patients, affecting 185,000 discharged from hospitals in England in 2008-09, and the problem is rising.

Others were not treated with dignity, involved in their own care or were spoken to in a condescending manner. One man said hospital staff talked to him "as if I'm daft".

Mr Lansley said: "The inspection teams have seen some exemplary care, but some hospitals are not even getting the basics right. That is unacceptable."

What on earth is happening?

Has the CQC uncovered a major breakdown of care across the NHS? Could it be that some tacit design or policy has been revealed? May it be a publicly lauded Pathway of Death at work…?

Life-sustaining nutrition and fluid may be withdrawn from a patient committed onto the Liverpool Care Pathway as a ‘futile’ intervention. Withdrawing life-sustaining nutrition and fluid from a patient will manifest, if these were not already present, signs that are looked for that will confirm a ‘diagnosis’ of encroaching death.

"The issue of whether or not the provision of nutrition and hydration to patients should be considered as medical treatment and, therefore, subject at some level to the discretion of doctors, has received some good press lately.

In Canada, the Euthanasia Prevention Coalition (EPC) fought a legal battle, alongside the family of a comatose patient Mr Hassan Rasouli, to prevent medical staff in a Toronto hospital from removing life-sustaining nutrition and hydration from Mr Rasouli.

An Ontario court subsequently ruled that doctors are required to obtain the consent of either the patient or a substitute decision-maker (such as the patient’s guardian) before withdrawing life-sustaining interventions." Careful!

The fact that Life-sustaining nutrition and fluid now has to be prescribed places it firmly in the realm of ‘medical treatment' and, therefore, at medical discretion to withdraw.

Is this what is going on?

It could not be such a failing, could it? Such a routine catalogue of catastrophic failure could not occur except by design. Could it…?

If that is the case, it can only be because there is nothing set in place “to ‘drive up’ sustained quality of the living through all the days of our lives!”

Care - full stop - should become a 'quality performance indicator' in support of the governance and performance management framework of all organisations at executive level!

This question really does bear repeating: Why does care of the dying take precedence over care of the living, other than that it is the cheaper option…?

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