Wednesday 9 November 2011

Liverpool Care Pathway – The Protocol Of Choice

LCP is the natural protocol of choice when it comes between offering expensive drugs which do not prevent but only delay the onset of deterioration and the alternative controversial route of actual euthanasia. Even though euthanasia is legal in the Netherlands, terminal sedation is becoming the preferred option of choice by doctors.

Research has shown that 60 percent of doctors do not report euthanasia cases to the municipal pathologist. The muddy and muddied waters of Dutch Euthanasia Law persuade these doctors to the more satisfactory course of the third option. As a last resort, such drug-induced sedation is legal in most countries including the U.S., and it is widely accepted as a mainstay of end-of-life care. Such drug-induced terminal sedation is becoming the first resort, and for obvious reasons. The possible Living Will directives of DNR and body part donation are not to ignored lightly.

The criminal code, along with the moral code, was once clear and clear-cut. Killing is a wrongful act. Doctors once took an oath to fiercely protect and to firmly defend life and the living. This is all now subverted. Perhaps this goes back to the ‘compassionate’ killings of the ‘subnormal’ and ‘demented’ in the sanatoriums of Nazi Germany in the 30’s, lauded worldwide; perhaps, still further.

A natural concern and desire to provide adequate palliative care and to alleviate suffering is seducing society into accepting termination – death by induction – as an acceptable policy option. This desire is subverting even the provision of adequate and sufficient universal palliative care itself. The economics is clear. The bureaucracy of the blanket procedure over the individualised response to the personal needs of the patient is obvious.

And death is even become spectacle.

Under the heading, ‘The modern Roman Colosseum: Euthanasia as a spectator sport’, Rachel Alexander writes:


Last month, Nikolai Ivanisovich, a 62-year old Russian man with brain cancer, supposedly sold the rights to broadcast his euthanasia to BattleCam.com, a 24/7 reality TV website. The proceeds were reportedly enough to take care of his surviving family. It turned out to be an elaborate publicity stunt, but society has become so used to it no one batted an eye. In June, BBC2 broadcast a documentary showing the suicide of terminally ill Peter Smedley, including his pitiful cries for water that were refused by the doctor.

A disturbing trend has developed over the last few years of broadcasting the suicides of the weak and elderly in society for entertainment. Much of it is due to the glamorization of assisted suicide by a Swiss suicide clinic known as Dignitas. London's Sky TV broadcast one of the first assisted suicides on TV at Dignitas in 2008 in the documentary "Right to Die?" Located in the beautiful mountains of Zurich, with Beethoven's Ninth Symphony playing in the background at the patient's request, the clinic provided a false picture of what assisted suicide is really about. In contrast, the BBC2 documentary "Choosing to Die" purposely left out the details of a secondterminally ill suicide performed at Dignitas, because the patient took 90 minutes to die, prompting the staff to instruct his mother not to hug him because it was prolonging his life. Euthanasia proponents selectively choose what to show in order to mislead the public.
  
Two assisted suicides recently broadcast on television were of people with Motor Neurone Disease. This disease includes amyotrophic lateral sclerosis (ALS), known in the U.S. as Lou Gehrig's disease. Patients diagnosed with it gradually lose use of their muscles, motor functions and become weak. Life expectancy after diagnosis is two to five years, and death can be due to suffocation.

However, doctors are not always right. Miracles can happen. Professor Stephen Hawking was diagnosed with Motor Neurone Disease in his 20s and told he would not live to see age 30. He is now 69 and is considered one of the most prominent and brilliant scientists of this era, making important contributions in the areas of cosmology, gravity and black holes.

It is true that some situations are truly heartbreaking, like that of former French schoolteacher Chantal Sebire, who suffered from a horrendous facially disfiguring disease known as esthesioneuroblastoma that also caused her to go blind. Children would run away when they saw her in public. But this does not make it right to encourage someone like that to kill themselves. Many people suffer from debilitating illnesses, disfigurement, paralysis and other difficult afflictions. Why not encourage the millions afflicted with these diseases to kill themselves then? Somehow they are able to cope. We need to set up comprehensive assisted living facilities for those who suffer like Chantal Sebire, where she could have lived with others who would love her and not treat her cruelly.

Where were the loved ones of those who have taken their own lives on camera? Did they try to talk them out of killing themselves, and offer to care for them? Motor Neuron Disease sufferer Craig Ewert, whose suicide was broadcast on Sky TV in 2008, said if he did not go through with it, he would "inflict suffering on my family." After a retired doctor with supranuclear palsy took her life at Dignitas, her son said, "She was ready to go and that makes it all the easier for us." What did he mean by that, was he tired of taking care of her? What happened to caring for the ones you love? She cared for him as a child growing up when he was dependent upon her, where is the reciprocal kindness? Average life expectancy from supranuclear palsy is seven years; was that too long of a "burden" on him to take care of his mother? The reality is, suicide usually deeply disturbs the loved ones left behind, it does not make their lives any easier. Life is full of difficulties, what makes caring for a loved one any worse than other problems, requiring it to be resolved by death?

One of the most outspoken opponents of euthanasia is Mme. Maryannick Pavageau, who was awarded France's highest decoration, the Legion d'Honneur, for her efforts. Mme. Pavageau suffered a stroke at age 29, and after being in a coma for three months, ended up paralyzed with Locked-in-Sydrome, barely able to speak. Yet she believes that all life is worth living, explaining, "I am firmly against euthanasia because it is not physical suffering that guides the desire to die but a moment of discouragement, feeling like a burden. All those who ask to die are mostly looking for love."

The real dignity lies in letting people with terminal diseases know that their lives have value, we care about them, and want to help them, not knock them off. It is telling that the organization formerly known as the Voluntary Euthanasia Society has changed its name to Dignity in Dying to disguise what is really going on. It is not brave to assist someone with taking their own life, it is brave to help them take on the challenges associated with helping them cope with their illness. What is compassionate about shortening someone's life, which brings up horrendous moral issues? If they are Christian or Jewish, assisted suicide is not helping them adhere to religious tenets. Ecclesiastes 7:17b says, "Do not be a fool – why die before your time?" Some believe that the Sixth Commandment, "Thou shalt not murder," includes suicide. We should encourage the terminally ill to find strength in their religion. It is telling that there is virtually no mention of God or heaven by the terminally ill who have broadcast their suicides, nor do the relatives accompanying them provide any spiritual comfort.

The states of Oregon, Washington and Montana (the latter through court ruling) have legalized some form of assisted suicide. It is legal in a handful of countries, and in the Netherlands, is legal for infants and often practiced without the consent of the patient. Over 10,000 citizens carry "Do Not Euthanize Me" cards in case they are ever admitted to a hospital unexpectedly. There is very little difference between euthanasia, where a doctor takes the fatal steps terminating life, and assisted suicide, where the doctor or someone else prepares everything for the patient to make the final move, which is usually by drinking a cocktail of barbiturates.

Advances in palliative care have made it possible to die in dignity and comfort. We have access to the best painkilling drugs today. People are living much longer lives due to modern medicine and able to do more activities at an advanced age than they used to. Doctors understand this and generally oppose physician-assisted suicide. A report by Palliative Medicine analyzed numerous studies of doctors in England and found that the majority of doctors in almost all of the studies opposed euthanasia and physician-assisted suicide.

Although there are some heartwrenching stories which are difficult to stomach, normalizing euthanasia will open a Pandora's Box. The box already has a crack in it, evidenced by laws that have been passed legalizing it and the increasing number of broadcasts on TV and the internet. The UK's Prolife Alliance has tracked how euthanasia in Britain began with the terminally ill, then progressed to people with progressive, but not necessarily fatal diseases like multiple sclerosis. Now, people with severe but non-fatal conditions including a man who was paralyzed and a woman merely afraid of the future are committing suicide. The healthy wife of an ailing Belgian man killed herself at the same time he took his life.

The rationing of certain surgeries and treatments for the elderly and weak has already begun, due to soaring healthcare costs. As euthanasia is normalized, there will be pressure put on elderly people to commit suicide. Elderly people may feel guilty about being a burden and become convinced it is the right thing to do, as was revealed in some of the highly publicized assisted suicides. Relatives eager for inheritances may pressure the elderly into taking their lives prematurely. Glamorizing it will make it more attractive to others – including healthy people and teenagers.

What does it say about our society that we are hurrying along and exploiting the deaths of the elderly and weak in our society in the name of TV ratings? It is trivializing death in the name of greed and false compassion. We are sliding down the slippery slope to becoming like the ancient barbaric Romans, who took pleasure in watching Christians and others murdered for sport in public arenas.


Perhaps Dignitas takes inspiration from the 1970's film Soylent Green which stars Charlton Heston and Edward G. Robinson in his final film role. Robinson's character, Sol Roth, meets a similar 'Dignitas-style' end, likewise not so dignifying.

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