Liverpool Care Pathway – The Nuremberg Pathway

Dr. Patrick Pullicino:

It is not scientifically possible to diagnose impending death as the LCP purports to do. The LCP is instead an assessment of the perceived quality of life of the patient by the medical team and as such is euthanasia.

The NHS has always had to juggle available resources. Financial constraints have determined the decision to favour best outcomes and so it was hardly a matter of surprise to read in The Scotsman:

Dr. Brian Keighley, chairman of the British Medical Association Scotland, said in some cases tens of thousands of pounds were spent on drugs to extend cancer patients’ lives for relatively short periods…Speaking about cutting costs, Keighley said, “This is a decision not for doctors, but a decision for society.”

 Mail Online:

What awaits us in old age? Well, the triumph of actually reaching old age for a start — not a privilege offered to all…The twilight years might be preferable to the cold alternative, but the prospect of facing them is even grimmer. Particularly, if those years are to be accompanied by new social pressures to do the decent thing and kill ourselves the second we become a burden to our nearest and dearest.

 “Don’t fall for this toxic idea that the old are disposable” argues the Mail. Still, the disposable society of discardable consumables is become the disposable society of discardable people.

The gathering momentum has won sway. Those no longer fit to live, whose duty it is to die, must be sacrificed for the common good. The Nazi flame is kindled once more.

Nuremberg Code

Doctors' Trial at Nuremberg.

Credits:United States Holocaust Memorial Museum, courtesy of Gerald (Gerd) Schwab

The Nuremberg Code was introduced in August 1947, after the Nuremberg trials. In these trials, Nazi doctors were convicted of the crimes committed during human experimentson concentration camp prisoners. It attempted to give clear rules about what was legal and what was not when conducting human experiments.

The Nuremberg Code was compiled to broach the wicked acts perpetrated in the name of medical research. 

The Nuremberg tribunal did not respond to each argument set forth by the defendants but rather responded with the Nuremberg Code which emphasized the primacy of the informed, voluntary consent of the patient in governing physician behavior. The Code rejected the utilitarian argument that the few may be involuntarily sacrificed for the benefit of the many.

(Caplan A. The Doctor's Trial and Analogies to the Holocaust in Contemporary Bioethical Debates. in Annas G. and Grodin M. (editors). The Nazi Doctors and the Nuremberg Code. New York, Oxford University Press, 1992, pp. 265-270.)

The doctor-defendants never expressed any regret, nor did they deny their actions. They argued that they were following lawful orders and that in the euthanasia program they were motivated by the desire "to solve an old medical problem." In addition, the physicians argued that in a time of struggle for national survival, exceptions to ordinary moral standards were justified. The doctors argued that it was justifiable to call upon individuals to forfeit their lives for the sake of national preservation. 

However, are we not still in breach of the Nuremberg code if we expect 'that the few may be involuntarily sacrificed for the benefit of the many' and without 'voluntary' consent?

The physicians argued that in a time of struggle for national survival (finite resources), exceptions to ordinary moral standards were justified.

The Nuremberg Code emphasized the primacy of the informed, voluntary consent of the patient in governing physician behaviour. Victims are placed on the Pathway with no such consent.

The Nuremberg Code rejected the utilitarian argument that the few may be involuntarily sacrificed for the benefit of the many. Then, where does that leave our illustrious band - Gates et al?