Sunday, 11 September 2011

Liverpool Care pathway: A Pathway To Perdition

Dominic Lawson: Why the disabled fear assisted suicide

It is clear that the intended beneficiaries of Pratchett's campaign must be those who are physically incapacitated – as he fears he will be: the fully able-bodied need not call upon others to kill us. For this reason, any legislators thinking of backing Pratchett's cause would do well to consult the members of the charity Scope. Scope represents the hundreds of thousands of Britons with cerebral palsy, far and away the most common form of congenital physical disability and which affects, to a greater or lesser extent, one in every 400 children born in the UK.

Last month Scope released one of the results, a poll by ComRes, which revealed that no fewer than 70 per cent of disabled people are concerned that the changes  in the law advocated by Pratchett would create pressure on vulnerable patients 
to end their lives prematurely". 

James Harris: Disabled people are concerned about legalising assisted suicide, so are Dignity in Dying...

Celebrities including the author Sir Terry Pratchett and the actor Sir Patrick Stewart have backed a campaign to allow terminally ill patients to receive help to die.

 But a new poll found 70 per cent of disabled people were concerned that such a reform would create pressure on vulnerable patients to “end their lives prematurely”.

The poll didn’t ask whether disabled people have concerns about a change in the law on assisted dying for terminally ill, mentally competent adults. Instead it asked them:

Helping another person to commit suicide is currently against the law. How concerned or otherwise would you be about a change in the law to legalise assisted suicide?
As an advocate of greater choice at the end of life, I would have answered “very” to that question. 

Adrian J Treloar
: Dutch research reflects problems with the Liverpool care pathway
The Liverpool care pathway (LCP) is the UK’s main clinical pathway of continuous deep sedation and is promoted for roll out across the NHS. Rietjens et al’s study highlights some serious weaknesses in its design.

The eligibility criteria do not ensure that only people who are about to die are allowed on to the pathway. They allow people who are thought to be dying, are bed bound, and are unable to take tablets on to the pathway. In chronic diseases such as dementia, dying can take years, but such patients may be eligible. Reitjens et al’s paper shows that GPs often put patients on to such a pathway without palliative care advice. A pathway for general use should minimise opportunities for early or inappropriate use.

Murray et al are concerned that sedation is being used as an inexpensive alternative to assessment and specialist treatment.3 The LCP recommends sedatives and opiates for all patients on an “as required” basis, even when they are not agitated, in pain, or distressed. An automatic pathway towards prescribing heavy sedatives incurs risks.

Moreover, the LCP recommends setting up a syringe driver within four hours of a doctor’s order. This is laudable, if it is needed. But the pathway encourages the use of syringe drivers even when symptoms can be managed without them.

The pathway doesn’t mention the need for food and fluids. Reitjens et al show that withholding artificial nutrition and hydration is the norm. The LCP’s omission of prompts to reconsider nutrition and hydration may allow serious errors in the care of dying patients. It is not acceptable, as Murray et al suggest, that assessing nutrition 
and hydration are not part of the pathway.  

Prof David JonesLegal assisted suicide creates 'slippery slope' to doctors killing without consent

If society agrees that it is in some people’s interests for them to end their own lives, it is difficult to resist the logical conclusion that others should be helped to die even if they have not made such a request.

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.

My view is that it will lead from people who have asked to die, to people 
who cannot ask. 

Baroness Warnock: Old people with dementia have a duty to die and should be pushed towards death

Elderly people suffering from dementia are wasting people’s lives and wasting the resources of the National Health Service and should be allowed to die. 

Lady Warnock’s comments, which were published in an interview with the magazine of the Church of Scotland, Life and Work, have been condemned by dementia charities.

She told the magazine: “If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service.”

Phyllis Bowman: Right to Live

''We always thought Lady Warnock was in favour of coercive or compulsory euthanasia. Her views are an illustration that while euthanasia is promoted as a right to choose, it pretty rapidly becomes no right to live.

HitlerNuremberg Party rally on August 5, 1929. Hitler was explicit:

As a result of our modern sentimental humanitarianism we are trying to maintain the weak at the expense of the healthy. And in this way we are gradually breeding the weak and killing off the strong.

Arguing for legalization, Len Doyal, a professor of medical ethics and former member of the ethics committee of the British Medical Association, said in 2006 that "proponents of voluntary euthanasia should support non-voluntary euthanasia under appropriate circumstances and with proper regulation".

Peter Saunders, campaign director for Care Not Killing, called Doyal's proposals "the very worst form of medical paternalism whereby doctors can end the lives of patients after making a judgment that their lives are of no value and claim that they are simply acting in their patients' best interests"

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