Wednesday, 25 April 2012

Liverpool Care Pathway - A Silence Of Errors

To live a long life was once an achievement. It once earned you respect - and even a telegram from the Queen if you turned the century. No more. It now makes you a target. And, as Mickey Rooney says:

"If it can happen to Mickey Rooney, it can happen to anybody."

Mickey Rooney has testified before the U.S. Senate Select Committee on Ageing in regard to how he became a victim to what has become known as elder abuse. Elder abuse has also entered into the argument against assisted suicide. This argument is not easily refuted.

Jeremy Prichard, criminologist at the University of Tasmania, writes in the Australian Journal of Law and Medicine update: March 2012 expressing his doubts that many people in the community will be able to give full and voluntary consent to ending their lives. He says that the growing prevalence of elder abuse suggests that the elderly could be easily manipulated.

“Such procedures may be safe for socially connected, financially independent individuals with high autonomy and self-efficacy,” but “circumstances may be entirely different for isolated patients with low self-efficacy who represent an unwanted burden to their carers, some of whom may benefit financially from the death of the patient (even just in a reduction of financial pressure).”

This article counters arguments made by Bartels and Otlowski in 2010 regarding euthanasia. It suggests that the authors over-emphasised the importance of individual autonomy in its bearing on the euthanasia debate. Drawing on literature concerning elder abuse as well as the “mercy-killing” cases reviewed by Bartels and Otlowski, the article contends that legalising euthanasia may increase the risk that some patients are pressured, inadvertently or deliberately, to request access. Safeguards to detect and deter pressure may be of limited effectiveness against such pressure.

BBC News Manchester, in the context of the fallout from the Shipman experience, reported on the government’s introduction of a more stringent cremation form nationally. But new tighter checks before a body is cremated do not apply to burials.

Dr Raj Patel, a colleague of Shipman, commented:

"The fact that the body is retrievable is an important factor for the process for burial to be more simple." 
"However, I certainly note that there could be potential for some wrongdoing by a healthcare professional or even a carer."
The article continued:

It is a fear echoed by Dame Janet Smith, the senior judge who chaired the Shipman Inquiry.
In an exclusive BBC interview, she said the inquiry, which concluded its reports in 2005, had still not achieved as much as she had hoped.
"We haven't moved at all on basic death certification. It's exactly the same. There hasn't been any further work done since I moved off it in 2003," said Dame Janet.
Assisted suicide is never an entirely autonomous decision; as with all decisions, it is always a decision taken in context. The context is the person's background, situation, social milieu or lack of it. These influences, these pressures, will persuade and contribute to the making and taking of such a decision.

In the context of the vulnerable, as Mickey Rooney says,

"If it can happen to Mickey Rooney, it can happen to anybody."

In the context of the Liverpool Care Pathway, it does happen to anybody.

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