Friday, 12 August 2011

Liverpool Care Pathway – The Semantic Dilemna

The -
"coupling of sedation to removal of food and fluids is often referred to as 'terminal sedation'. But what exactly does this mean?
"It is a world away from merely sedating someone experiencing unbearable pain — that is, using sedation solely as a palliative tool with a clear palliative intention to relieve someone’s pain and symptoms. This is often used to give a patient respite from pain in circumstances where their underlying illness is not yet terminal.
"Sedation in these circumstances, for a day or two, can give the pain a chance to subside. This affords the sufferer great relief. Patients, according to the stage of their disease, will often return to relatively normal conditions of life and, in the early stages, may even return home and resume receiving palliative outpatient services. But, clearly, that’s not what is meant by “terminal sedation”.
"Nor is palliative sedation at the end of the progress of a disease — in other words, when the patient is clearly dying. This type of sedation can be managed so that the patient has intervals when they are awake so that they can communicate with family and friends gathered at their bedside.
"So, if there are a wide range of circumstances when sedation is appropriate, why are not all types of sedation simply called “palliative sedation”?
"I suggest that the coupling of the word “terminal” with sedation refers to the intention and effect, as does the use of “palliative” with sedation. The intention of terminal sedation is that the person dies from the action. The withdrawal of fluids and nutrition seems to be the method which is all too often tolerated by lax laws."
– Paul Russell

Dr Philip Harrison, a GP now based in New Zealand, set out his concerns recently in the British Medical Journal, following the death of his father in Doncaster Royal Infirmary.
"There was no reason on earth why he would have wished to have been put to sleep, unless he was obviously distressed or agitated or in pain.

"But there was no evidence he was in pain at any stage during his admission."

Despite an apology he is still not satisfied.

"I have never seen that in my medical practice before. I've seen euthanasia once, but I've never seen anybody being put to death without consent."

"I don't know what the legal term is but to me it was as near to a form of murder that I had come across," he said.

Despite apologies and assurances that learnings have been taken, we are not satisfied!

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