Monday, 8 August 2011

Liverpool Care Pathway – When Routine Is Policy

If something is happening 'routinely', there is the distinct suspicion - it becomes the distinct possibility - it is happening as policy.

One of the country’s leading health campaigners has urged the Scottish Government to urgently tackle the problem of malnutrition of the elderly and vulnerable in the nation’s hospitals, likening the problem to a form of “euthanasia”.

Dr Jean Turner – executive director of Scotland Patients Association (SPA), a GP and former independent MSP – warned that hundreds of patients, particularly the elderly, are languishing in hospital beds undernourished because they are not given help with feeding.

A recent report estimated that 50,000 patients are dying each year in NHS hospitals in a state of malnutrition, which may have hastened their end. (Glasgow Sunday Herald, July 4, 2010).

My mother’s meal was brought in and placed on the bedside table. I took it upon myself to attempt to feed her as they had reduced her to an almost zombie-like state. If I had not been present or had not taken it upon myself to do so, I now ask myself, would anyone have done likewise and attempted to feed her? 

 Removal of feeding and hydration is a protocol of the LCP. A patient unable to feed themselves should not be required to do so against their will…such life-sustaining efforts are futile and even burdensome.

What is going on?

The SPA would call this a form of euthanasia to allow dehydration and malnutrition to develop due to lack of awareness, lack of staffing or carelessness 

When something is happening 'routinely', however, there is the distinct suspicion - it becomes the distinct possibility - that it is happening as policy.

It is difficult and probably wrong to attribute motives to those who deliberately use the combination of sedation and the withdrawal of fluids and nutrition to hasten a patient’s death.

There is little doubt that sedated patients are probably a great deal easier to manage, and death by starvation or dehydration in such circumstances has a predicable time-line, whereas death from the underlying disease may not.

With an ageing population and increasing health care budgets, this sort of “nudge-nudge, wink-wink” approach to reducing costs must be a great temptation.

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