Tuesday, 12 June 2012

Liverpool Care Pathway – The Role Of Financial Considerations In Determining Prognosis

This article from National Review Online argues the case of financial considerations intruding into diagnostic assessment of a patient’s prognosis.

JUNE 4, 2012 4:00 A.M.
‘Death with Dignity’ in Massachusetts 
Elevating doctor-prescribed suicide to “treatment” puts patients at risk.
By Greg Pfundstein

Abdelbaset al-Megrahi in Tripoli in 2009

Abdelbaset al-Megrahi, the Libyan convicted of the 1988 bombing of a Pan Am flight over Lockerbie, Scotland, died of prostate cancer on May 20. Nearly three years earlier, on August 20, 2009, Scottish authorities had released him on compassionate grounds so that he could return home to die. At the time, he was thought to have three months to live. Some think that al-Megrahi’s survival of his prognosis undermined whatever grounds there were for his early release. But if we set aside his crimes and consider him as a patient with medical needs, his case sheds light on the current proposal for doctor-prescribed suicide in Massachusetts.

Three days before al-Megrahi died last month, the disability-rights group Second Thoughts submitted a challenge to contest a measure on the November ballot in Massachusetts, arguing that the initiative’s language for legalizing doctor-prescribed suicide is “clearly misleading.” Second Thoughts objects in particular to the use of the term “terminally ill.” According to director John Kelly, “People will be encouraged to assume that being ‘terminally ill’ is a biological fact, rather than a human guess.” In the case of al-Megrahi, a human guess resulted in the transfer of a convicted terrorist to his home country of Libya, where, remarkably, he found care superior to what he was receiving in Scotland. The “human guess” that allowed for his release was off by over 1,000 percent.

The Massachusetts initiative proposes that “the public welfare requires a defined and safeguarded process by which an adult Massachusetts resident . . . who has been determined by his or her attending and consulting physicians to be suffering from a terminal disease that will cause death within six months may obtain medication that the patient may self administer to end his or her life in a humane and dignified manner.” The provision that the disease will cause death within six months is central to the proposal. But John Norton, a member of Second Thoughts, points out that “everyone knows someone who has outlived their terminal diagnosis.” As the cases of al-Megrahi and many others make clear, a diagnosis of death within six months is highly speculative — and a weak basis for securing the “public welfare.”
It is important to note that, according to the Wall Street Journal, the U.K.’s National Health Service had denied al-Megrahi “standard docetaxel chemotherapy.” When he was transferred to Libya, he received advanced chemotherapy, radiation, and testosterone inhibitors. To put it plainly, Britain’s rationing bureaucracy denied al-Megrahi the treatment that extended his life nearly three years beyond his 2009 prognosis. In an age of increasing bureaucratic control of health-care decisions, shouldn’t such rationing concern us, especially when we consider the question of legalizing doctor-prescribed suicide?

It has already been documented in Oregon, where doctor-prescribed suicide is legal, that the Oregon Health Plan has refused patients life-saving cancer treatments but offered “comfort care, including ‘physician aid in dying.’” Nor is the state making good on its purported goal of protecting patients from receiving lethal drugs when their decision is influenced by depression: Oregon’s latest annual report indicates that only one of the 71 persons who killed themselves with drugs in 2011 was referred for psychiatric evaluation, even though, according to a 2008 BMJ study, 25 percent of patients seeking doctor-prescribed suicide were depressed. Moreover, 9 of the 71 patients who killed themselves in 2011 received prescriptions for lethal drugs in “previous years,” making clear that the six-month-terminal-illness provision is a farce: “Death with dignity” laws are no more than efforts to elevate doctor-prescribed suicide to an accepted and inexpensive “treatment” under the pretense of compassion.

At first glance, legalization of doctor-prescribed suicide appeals to the libertarian in us all: If someone wants to end his life, who are we to stand in his way? But the members of Second Thoughts know what it is like for a medical professional to assume that their lives are not worth living, and they help us focus on the relevant question: What happens when death becomes a recognized and reimbursed medical treatment for “terminal” conditions? As a teenager, Norton was diagnosed with “terminal” Lou Gehrig’s Disease, but 50 years later he is alive and well.
What about the “terminal” mother who desperately wants to live but feels obligated to choose “death with dignity” so that her children can wrap up the division of her assets and property? What about the father who, on learning that advanced cancer threatens his life, loses for a time the will to live and is offered by his “compassionate” doctor a poisonous dose of barbiturates to end his life with? What about the patient who, in hope of a cure, is awaiting medical breakthroughs? Do these people deserve to be belittled with the offer of a fistful of lethal pills as a treatment option?

Al-Megrahi probably would have died earlier if he had stayed in Scotland, where his survival was balanced against the cost of his survival. In Libya, he was given state-of-the-art treatment for his disease. The prognosis is best when patients are free from pressure to accept the denial of medical care that they need and want. When care is rationed and the crime of assisting a suicide is redefined as medical treatment, the picture changes. Those who may see themselves as a burden on loved ones feel pressure to consider suicide a “treatment” option. How does that promote the public welfare?
— Greg Pfundstein is a member of the board of the Patients Rights Council.

The NHS (National-socialist Health Service) rations healthcare options. A Mail Online article outlines how we in the UK have the worst cancer survival rate in the western world. Doctors tend to late-diagnose older patients or provide them with less beneficial treatments. The elderly are routinely denied surgery or drugs -

Failure to treat elderly cancer sufferers 'is costing 14,000 lives each year'

  • Britain has one of the worst cancer survival rates in Western world
  • Thousands of elderly denied treatment after being deemed too frail

PUBLISHED  20:51, 20 Marchl 2012  |  UPDATED :  20:51, 20 Marchl 2012

Up to 40 elderly cancer sufferers are dying needlessly every day because they are being denied the best treatments, a damning report warns...

A further Mail Online article cites this example -

Sentenced to death for being old: The NHS denies life-saving treatment to the elderly, as one man's chilling story reveals

When Kenneth Warden was diagnosed with terminal bladder cancer, his hospital consultant sent him home to die, ruling that at 78 he was too old to treat.
Even the palliative surgery or chemotherapy that could have eased his distressing symptoms were declared off-limits because of his age.
His distraught daughter Michele Halligan accepted the sad prognosis but was determined her father would spend his last months in comfort. So she paid for him to be seen privately by a second doctor to discover what could be done to ease his symptoms.

Still fit and active: Kenneth Warden is now cancer free after his daughter Michelle
fought to get him treatment

'They told me I had to accept my father was dying'

The Department of Health committed to investing 286 million pounds over the two years to 2011 to support implementation of this End of Life Care Strategy. That is 286 million pounds spent to assist people on their path to the next world while denying the necessary funding to keep them alive and well in this!

It is a duty incumbent upon every medical person to protect life and to do no harm. So, what is this policy set in place at Caterham Dene - and across the NHS and beyond - to make no great effort to intervene to preserve life, to let them go and even to help them on their way?

So much of the public purse to spend on death, so little to spend on life. There is something very wrong here.

The elderly, suffering from the most terminal of all illnesses - OLD-AGE, are on the sharp end of this cutting-edge of end-of-life policies. A culture of death is pervading the NHS in the UK. A dark shadow is stalking our hospitals and care homes. The right to death is become paramount over the right to life!

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