Liverpool Care Pathway - Dutch Style

Dutch euthanasia stats - the introduction of LCP puts the vulnerable and the elderly at risk.

A detailed report in the New England Journal of Medicine by a group of Dutch doctors reveals that a small decrease in voluntary euthanasia has been more than offset by an inordinate increase in what is called "terminal sedation". Patients are given drugs which sedate them, "continuously and deeply" until death, in 8.2% of all deaths! Voluntary euthanasia (1.7%), non-voluntary euthanasia (0.4%) and terminal sedation accompanied by withdrawal of nutrition and hydration now account for nearly one in ten Dutch deaths.

Note: -

Patients given drugs which sedate them, "continuously and deeply";  the withdrawal of nutrition and hydration...

                                       - this is the Liverpool Care Pathway.

Care Not Killing has expressed concern that fresh attempts will shortly be made to legalise euthanasia in Britain, most likely beginning with Scotland, which is seen as a soft target by pro-euthanasia advocates. However, Dr Peter Saunders, Campaign Director of Care Not Killing, might pay more attention that the insidious creeping threats posed by terminal sedation - which, as Dutch statistics show, is being used more and more in place of legalised euthanasia in the Netherlands - will make actual legalisation superfluous and redundant.

Recent years have witnessed a deliberate campaign to soften up the British public for the legalisation of ending life. The Liverpool Care Pathway has been a means to bring this to fruition. In the Netherlands healthcare is covered by insurance, but in the UK most people rely on the State. In a cash-strapped NHS, where hospitals are being closed and elder abuse is on the rise, there is growing prejudice against the chronically ill and disabled who are seen as disproportionate consumers of limited resources. Vulnerable lives are at risk. And the Dutch statistics, when properly examined, actually raise great cause for concern.

We should not be placing before health providers in Britain the temptation to consider ending life as a therapeutic option as some perverse act of kindness and compassion to be used in the patients' "best interests".

With the introduction of LCP, killing has become a ‘legal’ therapy!

LCP means withdrawal of treatment! Liverpool care has become a viable, cost-effective alternative option to cost-intensive real palliative care!

The Liverpool Care Pathway is established  as a legal "therapy". Through the Department of Health CQUIN incentives, it has been made the subject of cost/benefit assessment by health managers and economists. In a cost conscious health service, a short sharp end will be a tempting therapeutic option to £500 per week and more for ‘continuing  care’.

CQUIN is the DOH funding policy. CQUIN has set targets for 2011/2012 with regard to the End of Life LCP program. The forward plan is to increase the number of patients identified to be on the end of life care pathway from a baseline of 0% to 20%; it is further planned to have 30% of all patients who die in hospital dying on the Liverpool Care Pathway.

To ensure they receive their provider income in full, Trusts have to comply with or exceed these goals.

The protocol of the LCP is to look for signs of ‘dying’ in order that life might be placed on that downward cycle toward a controlled and predictable and predicted final termination. While the protocol of the Hippocratic Oath is to look for signs of life in order that life might be saved and secured and preserved.

Is, then, the LCP counter to the Hippocratic Oath?

Care Not Killing argues that legalising euthanasia would place pressure, whether real or imagined, on vulnerable people - the lonely, elderly, sick, disabled or depressed - to request early death. These people might already feel themselves to be a financial or emotional burden on relatives, carers or society and this is why they need strong legal protection. The "right" to die, can so easily become a coercive ‘duty’ to die. The law should not be changed just because a small number of insistent people wish to have their lives ended by doctors. It would result in a much larger number of vulnerable people being placed at risk.

Lady Warnock

It is frightening, then, that in 2008 Baroness Warnock said that 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. These are the words of a respected commentator on medical ethics. Lady Warnock’s comments were published in an interview with the magazine of the Church of Scotland, Life and Work, and have been condemned by dementia charities.

This fear was borne out by opinion polls published at the time of the defeat of Lord Joffe's Assisted Dying Bill in May 2006, which showed that 65 percent of people agreed that if the law changed "vulnerable people could feel under pressure to opt for suicide", 75% of people agreed that "people with treatable illness such as depression might opt prematurely for suicide", 73% said that a change in the law would "make it more difficult to detect rogue doctors such as Dr Harold Shipman" and 82% said that if Dutch laws were adopted here they would be concerned that people would be killed without an explicit request.

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.  - Baroness Warnock

It is worrying that the LCP and its pathway of terminal sedation bypasses the actual need for such legislation to be passed and placed on the Statute Book. Just look to the statistics of the Dutch example. This worry is compounded with the Brave New World attitude to organ harvesting as reported below.

This is not at all a far-fetched speculation when 'Living Wills' may specify organ donation. Lady Warnock would find this a most sensible use of mortal remains!

A detailed report in the New England Journal of Medicine by a group of Dutch doctors reveals that a small decrease in voluntary euthanasia has been more than offset by an inordinate increase in what is called "terminal sedation". Patients are given drugs which sedate them, "continuously and deeply" until death, in 8.2% of all deaths! Voluntary euthanasia (1.7%), non-voluntary euthanasia (0.4%) and terminal sedation accompanied by withdrawal of nutrition and hydration now account for nearly one in ten Dutch deaths.

Note: Patients given drugs which sedate them, "continuously and deeply"; the withdrawal of nutrition and hydration - this is the LCP.

People are having their lives ended without giving consent.

Arbitrary decisions are being made to place those who appear to fit the protocol’s guidelines to determine the onset of ‘dying’ in a ‘one size fits all’ diagnosis of death!

This must stop!