Tuesday, 15 November 2011

Liverpool care Pathway – A Moral Minefield

Once again, we are treading that moral minefield of the ‘life unworthy of living’ and the decision with purposeful intent to terminate a life. The gaining of acceptance of this concept led, in the 20th century, from sanatorium and clinic to concentration camp and gas chamber and world war.

The Netherlands and Belgium have provided the 21st century a window for observing the practice of euthanasia for twenty years. Even though the practice is legal, there has been a demonstrated preference by MDs for the practice of terminal sedation. An associated organ donation program has produced a harvest organised on a conveyer-belt style unprecedented for its medical efficiency since the days of the Third Reich.

This is from openPR 

Transplantation of lungs: recovered from donors after euthanasia
Press release from: Pabst Science Publishers 

Donors after cardiac death have increasingly provided organs for lung transplantation in Belgium. Between 01/2007-12/2009 in Leuven 17 isolated lung transplantations were performed from cardiac death donors, including four after euthanasia, Dirk van Raemdonck and colleagues (Leuven) report. "All donors expressed their wish for organ donation once their request for euthanasia was granted according to Belgian legislation. All donors suffered from an unbearable non-malignant disorder." One recipient died from a problem unrelated to the graft. The other three patients are still alive - in a good condition.

"The donors were admitted to the hospital a few hours before the planned euthanasia procedure. A central venous line was placed in a room adjacent to the operating room. Donors were heparinized immediately before a cocktail of drugs was given by the treating physician who agreed to perform the euthanasia. 

The patient was announced dead on cardiorespiratory criteria by three independent physicians. The deceased was then rapidly transferred, installed on the operating table, and intubated. The thorax and abdomen were shaved, disinfected and draped. A rapid sterno-laparotomy was performed.
As soon as he goes beyond 60-65 years of age man lives beyond his capacity to produce, and he costs society a lot of money...euthanasia will be one of the essential instruments of our future societies.

Jacques Attali, former President of the European Bank for reconstruction and development.

The abdominal team took care of liver and kidney preservation with a rapid flush cooling technique via a cannula inserted into the abdominal aorta. The thoracic team then opened pleural cavities and quickly inspected both lungs before topical cooling with ice-cold saline was started. The pericardium was opened, the main pulmonary artery was encircled,and a 24 Fr pulmoplegia catheter was inserted through the right ventricular outflow tract. The heart was decompressed and vented by cutting left and right atrial appendages. Antegrade pulmoplegia was started with 2.8L Perfadex solution while the lungs were ventilated with 50% inspired oxygen, followed by retrograde flush with one additional liter of the same perfusion solution after the heart was extracted.

Lungs were then explanted, packed and transported to the recipient hospital in the standard way..."

This is from Mercator.Net 

Belgian doctors are using organs from euthanased patients

by Michael Cook 13 Jun 2011
Using organs from euthanased patients seem to have become a well established procedure in Belgium, only nine years after it was legalized. A press releasefrom a team at a hospital in Leuven announced last week that it had successfully transplanted lungs from four euthanased patients between 2007 and 2009.

In an article in the journal Applied Cardiopulmonary Pathophysiology, the authors observe that the quality of the lungs from euthanased patients is superior to those obtained from brain dead donors and donations after cardiac death.

 “In contrast to these donors, euthanasia donors do not experience an agonal phase before circulatory arrest as seen in donors dying from hypoxemia or from cardiogenic or hypovolemic shock.”

A number of patients who request euthanasia want to donate their organs. However, since they often have cancer, the organs are not suitable. Three of the euthanased patients who did donate suffered from “a debilitating benign disease such as a neurological or muscular disorder”. The other was not ill at all, but had an “unbearable mental disorder”.

The authors were at pains to stress that they acted strictly within the guidelines for euthanasia in Belgium. All of the patients gave their consent.

Organ donation after euthanasia in Belgium is well organized. The ethics committee of Eurotransplant, a coordination network for transplants in AustriaBelgiumCroatiaGermanyLuxembourg, the Netherlands and Slovenia, has already developed elaborate protocols for “organ donation and transplantation after euthanasia”. These include:

·                   Euthanasia must be legal in the donor country.
·                   The way euthanasia is done and how death is determined have to be legal.
·                   The euthanasia procedure and the explantation should follow a clear protocol.
·                   Euthanasia, organ retrieval and organ allocation should be kept as separate as possible.
·                   Organs should only be allocated to a patients on a Eurotransplant waiting list in countries which accept organs from  euthanased patients.

Although exploiting patients’ wish to die for the sake of organ transplants may horrify many readers, this business has not been taking place in a dark basement. The Belgian team has not been shy about publicising their work. They described it at the 2006 World Transplant Congress and last December at a conference organised by the Belgian Royal Medical Academy. The journal 
article seems to be the first time, however, that information about their work is readily accessible. 
its beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the attitude, basic in the euthanasia movement that there is such a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.

Leo Alexander, a psychiatrist who gave evidence at Nuremberg in 1949.

Criteria for accepting organs from patients were published in Eurotransplant’s 2008 annual report.
A host of probing questions need to be asked. We only know about transplants from euthanased patients at one hospital in Belgium. But euthanasia is legal in the Netherlands and Luxembourg as well. At how many hospitals is this going on? It is illegal to tell recipients where their new organs came from. Wouldn’t many recipients object to that?
A document on the Eurotransplant website, “Current ethical considerations in organ transplantation”, fails to include transplants from euthanased patients amongst the ethical problems. Does that mean that it is not an ethical problem? Eurotransplant declares that “transparency” is a key corporate value. Yet its 2010 annual report omits the word “euthanasia”.

Eurotransplant has condemned the Chinese practice of using organs from executed prisoners.

“The commercial exploitation of organs from executed prisoners is considered a breach of human rights and is an unacceptable practice… any act that risks calling the practice of transplantation into disrepute is to be regretted.”

Doesn’t using organs from a mentally ill person who thinks that life is not worth living call the practice of transplantation into disrepute as well?

There has been wide reportage of so-called Living Will DNR directives and the recommendations coming from all quarters that such Wills and directives be made in order that personal wishes might be respected and made known at that moment when a medical situation may prevent them from being made known and personally expressed.

The BMA (British Medical Association), many transplant surgeons and politicians are keen to see Britain adopt a system of ‘presumed consent’ where it is assumed that everyone in the country wishes to be a donor unless they have ‘opted out’ by registering their objection to donation after their death as part of a Living Will directive. They feel this will lead to a massive rise in donors. And it should; although, some dispute that finding.

Such measures are not only afoot; they are well advanced.

Presumed consent organ donation to be Welsh law by 2015
The Welsh government says it plans to have a new law in place for presumed consent of organ donation by 2015.
The legislation would require people to opt out of donating their organs when they die, rather than opting in by signing the donor register.

A superior quality organ harvest 

There are many ’ethical’ problems related in the article above. These pertain to the suicidal and those executed under law. One thing is clear and that is a life terminated rather than being permitted to pass naturally permits a harvest of superior quality organs.

The DOH CQUIN payment framework program of promoting universal implementation of LCP protocols throughout the NHS (National-socialist Health Service) and their rolling out across the entire health sector accompanied by and in combination with a policy of ‘presumed consent’ would also result in a harvest of superior quality organs. That is a bounty not to be easily discounted or overlooked!

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