Liverpool Care pathway: Dying With Dignity?

Who Said That…?

1.       “We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”

2.      “Dignity in Dying is hugely important.  We should all be given the right to choose how we deal with the close of our lives.”

3.      “Such an ending can help those left behind to pick up the threads of memory and begin to move forward.”

4.      "A good death should be the norm not the exception in our society…
"A bad death is no longer acceptable.“

Answers below…

What is being proposed here? Are these quoted statements referring to the same thing? Each is discussing the manner in which we die. The statements are, surely, complementary if nothing else.

“Dignity in dying…"

"A bad death is no longer acceptable…"

There is no substantial difference in meaning between these two statements. The one statement does not detract from the other.

Who is speaking?

The innocuous, laudable, "Death With Dignity" is a cornerstone declaration of pro-euthanasia campaigners.

It could, equally, be a cornerstone declaration of LCP campaigners.

Or anyone else for that matter…

Who is speaking?

1.        “We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”

Sir Patrick Stewart

Patron, pro-euthanasia campaign, 

Dignity in Dyimg

2.        “Dignity in Dying is hugely important.  We should all be given the right to choose how we deal with the close of our lives.”

Susan Hampshire

Patron, pro-euthanasia campaign, 

Dignity in Dyimg

3.        “Such an ending can help those left behind to pick up the threads of memory and begin to move forward.”

Dame Cicely Saunders 

Founder of the Hospice Movement

4.      "A good death should be the norm not the exception in our society…
"A bad death is no longer acceptable.“

Professor John Ellershaw, 

Professor of Palliative Medicine, MCPCIL 

Director and OPCARE9 

Scientific Project Co-ordinator, 

Liverpool Care Pathway

SUMMARY AND CONCLUSION:

The NHS Cancer Plan (DoH, 2000) states that ‘the care of all dying patients must improve to the level of the best’.

That is commendable. It is most worthy and perfectly laudable without question that those diagnosed with a terminal illness should expect and receive such care. This is why the Hospice movement was founded. No doubt, this is why such an umbrella protocol such as LCP was first devised for the Hospice setting. That this may be safely translated into a non-hospice setting is another matter.

In the non-hospice setting, in hospital and care home, in whatever facility, NHS and non-NHS, throughout the land, there should be no need for any such specific designation as ‘the dying’. It should be the plan and the objective that ‘the care of ALL patients must improve to the level of the best’. That all-encompassing umbrella designation of ALL will automatically ensure the ‘best death’ for the dying. It is a dangerous and unsafe matter to attempt to translate a Hospice protocol directly into a Hospital setting in which the patient has not been previously diagnosed with a terminal condition!

The OPCARE9 Liverpool Declaration:

Every person has the right to die receiving optimal care with respect to their wishes.

That, also, is commendable, but is not translating into reality.

At birth, control may be exerted through induction to provide a timely birth.

At death, it may be argued, like control may be exerted through both LCP and euthanasia to provide a timely death.

It becomes self-evident, therefore, and it may be argued thus, that proponents of the Liverpool Care Pathway and proponents of Euthanasia belong in the same camp or are fellow camp-followers. Certainly, that would explain away accusations in the press of LCP being used as a substitute for euthanasia.

Dignity in Dying only supports assisted dying if it is the patient's informed choice.

According to the Bible, there are ten Commandments; according to Dying With Dignity, there are twelve Principles of Law Reform.

The first of these is:

All people have the fundamental right to die with dignity.

Again, it is worthy of comment to say that death is not apart from life but a part of life. It is not separate from it!

It does bear repeating, therefore: The first principle of a free and just and caring society should be thus: that,

All people have the fundamental right to LIVE with dignity.

The sixth Commandment states: Thou shalt not kill

The sixth Principle states: A request for euthanasia must be made freely, voluntarily and without duress and must be clearly expressed.

At the present time, euthanasia remains unlawful in the UK.

The LCP is lawful and its protocols are adhered to relentlessly.

Elsewhere, the Netherlands for example, even though euthanasia is legal, clinicians are preferring to use CDS (terminal sedation):

“doctors may be issuing the treatment either too early or without the patient's consent” and “are using it to sidestep legal requirements to perform euthanasia.”

In The Telegraph: 

"He [Prof David Jones] claimed this situation already exists in the Netherlands, where voluntary euthanasia is legal but where about 500 patients are also killed a year by their doctors without requesting to die. 

"Prof David Jones  mentioned the comments of Lord McColl made in the House of Lords that in the Netherlands, where euthanasia has been officially legalised and regulated since 2002, doctors found the cases increasingly easy to carry out while “many elderly people in the Netherlands are so fearful of euthanasia that they carry cards around with them saying that they do not want it”."

Is this Dying With Dignity?