Deadly one-way street
Tens of thousands of patients with terminal illnesses are placed on a “death pathway” to help end their lives every year. However, in a letter to The Daily Telegraph, six doctors warn that hospitals may be using the controversial scheme to reduce strain on hospital resources.
SIR – Remarks on the Liverpool Care Pathway by Professor Patrick Pullicino at a conference of the Medical Ethics Alliance (report, June 20) gave rise to controversy.
But he is not wrong to say that there is no scientific way of diagnosing imminent death. It is essentially a prediction. Other considerations may come into reaching such a decision, not excluding the availability of hospital resources.
Since his talk, members of the public have given examples of inappropriate use of the Liverpool Care Pathway (used with 29 per cent of patients at the end of life). The onus of proof that the pathway is safe and effective, or even required, is upon its authors, who should furnish their evidence.
The combination of morphine and dehydration is known to be lethal, and four-hourly reassessment is pointless if the patient is in a drug-induced coma. No one should be deprived of consciousness except for the gravest reason, and drug regimes should follow the accepted norms as laid down in national formularies.
In the elderly, natural death is more often free of pain and distress. The only certain way of assuaging thirst in the conscious is to provide fluids orally or occasionally by another route such as subcutaneous infusion.
The matter of informed consent is another major consideration, and it is therefore not surprising that patients are refusing the pathway in advance directives, or carrying cards refusing this form of treatment, as a measure of self-protection.
Professor Peter Millard
Dr Anthony Cole
Chairman, Medical Ethics Alliance
Chairman, Medical Ethics Alliance
Dr Rosalind Bearcroft
Dr Gillian Craig
Dr David Hill
Dr Mary Knowles
Chairman, First Do No Harm
Chairman, First Do No Harm
Hospitals 'letting patients die to save money’
Hospitals may be depriving elderly patients of food and drink to hasten their deaths as part of cost-cutting measures to free up bed space, leading doctors warn.
 |
| Supporters of the Liverpool Care Pathway, which allows medical staff to withhold fluid and drugs in a patient's final days, claim it is the kindest way of letting them slip away Photo: ALAMY |
Tens of thousands of patients with terminal illnesses are placed on a “death pathway” to help end their lives every year. However, in a letter to The Daily Telegraph, six doctors warn that hospitals may be using the controversial scheme to reduce strain on hospital resources.
Supporters of the Liverpool Care Pathway, which allows medical staff to withhold fluid and drugs in a patient’s final days, claim it is the kindest way of letting them slip away. But the experts say in their letter that natural deaths are often freer of pain and distress.
Informed consent is not always being sought by doctors, who fail to ask patients about their wishes while they are still in control of their faculties, warn the six. This has led to an increase in patients carrying cards informing doctors that they do not wish to be put on the pathway in the last few days of their lives.
The six doctors are experts in elderly care and wrote the letter in conjunction with the Medical Ethics Alliance, a Christian medical organisation. They say that many members of the public have contacted them with examples of inappropriate use of the pathway, which is implemented in up to 29 per cent of hospital deaths.
They warn that there is no “scientific way of diagnosing imminent death.” They write: “It is essentially a prediction, and it is possible that other considerations may come into reaching such a decision, not excluding the availability of resources.”
The Liverpool Care Pathway, so called because it was developed at the Royal Liverpool Hospital in the 1990s, aims to ensure that patients who are close to death can die without being subjected to unnecessary interference by staff. In addition to the withdrawal of fluid and medication, patients can be placed on sedation until they die.
Dr Gillian Craig, a retired geriatrician and former vice-chairman of the Medical Ethics Alliance, is one of the six signatories to The Daily Telegraph letter.
“If you are cynical about it, as I am, you can see it as a cost-cutting measure, if you don’t want your beds to be filled with old people,” she said. She advised that those who did not want to be put on the pathway should carry cards made by Dr Rosalind Bearcroft, a consultant psychiatrist from Kent, and another signatory.
Last year The Daily Telegraph reported that the numbers being put on the pathway had doubled in just two years, with tens of thousands of patients now involved. But up to half of families are not being informed of clinicians’ decision to put a relative on the pathway, the report by the Royal College of Physicians found. Advocates point out that the Liverpool Care Pathway has been approved by the National Institute for Health and Clinical Excellence (Nice) and is backed by the Department of Health.
A Department of Health spokesperson said: "People coming to the end of their lives should have a right to high quality, compassionate and dignified care.
"The Liverpool Care Pathway (LCP) is not about saving money. It is an established and respected tool that is recommended by NICE and has overwhelming support from clinicians at home and abroad.
"The decision to use the pathway should involve patients and family members, and a patient's condition should be closely monitored. If, as sometimes happens, a patient improves, they are taken off the LCP and given whatever treatments best suit their new needs. To ensure the LCP is used properly, it is important that staff receive the appropriate training and support."
No comments:
Post a Comment