Liverpool Care Pathway – It Is Frightening To Think…

This is all going somewhere, but where is it going? How far is it going? It is frightening to think.

These ideas are being floated more and more frequently such that they are becoming the norm. It is frightening to think.

It is frightening to think where they are leading us, where they hope to lead us.

It is frightening to think what the end game will be.

It is, truly, a terrible thing to ponder.

It is frightening to think…

Here follow reports on an article authored by Professor Raanan Gillon, an emeritus professor at Imperial College London, which appears in the British Medical Journal - ‘Sanctity of life law has gone too far’.

People with severe dementia should be starved and dehydrated to death to save money says BMJ editorial

18th July 2012

An article in the British Medical Journal argues that people with severe dementia should be starved and dehydrated to death to save money

There is an editorial in the British Medical Journal by a retired professor of philosophy titled ‘Sanctity of life law has gone too far’.

Raanan Gillon reviews the case of M, a woman in minimally conscious state, who was the subject of a court of protection ruling last year.

The Telegraph covered this story should you be interested in the history of the case.

Essentially the judge decided that M’s feeding tube should not be removed as she did not have a valid and applicable advance directive in place. Instead he gave priority to preserving her life. 

Gillon didn’t like the judgement for two reasons.

First he felt that the judge ‘did not accord “significant weight” to the patient’s previously expressed values, wishes, and views’. But in fact these were not sufficiently clear and in the absence of a clear statement of the patient’s wishes, Justice Baker was simply giving precedence to the preservation of life over uncertain autonomy.

Second, Gillon was unhappy that decisions about starting or stopping life prolonging treatment, including the withholding or withdrawal of artificial nutrition and hydration, for all incapacitated patients should be brought to the Court of Protection. But in so doing the judge was simply acting in accordance with precedent laid down in the Tony Bland case (involving a man in persistent vegetative state) and outlined in the Mental Capacity Act 2005.

Gillon’s real problem is that he doesn’t like the current law and considers that the lives of some seriously brain-damaged people are not worth living. He thinks that giving nutrition and hydration to people with severe brain damage or dementia is not beneficial and that they should have this basic care withdrawn and allowed to die. 

His real reasons come out later in the editorial:

‘The logical implications of this judgment threaten to skew the delivery of severely resource limited healthcare services towards providing non-beneficial or minimally beneficial life prolonging treatments including artificial nutrition and hydration to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment. The opportunity cost will probably be reduced provision of indisputably beneficial treatments to people who do want them.’

Now this statement is very interesting indeed as M was not actually demented, just seriously brain damaged. In addition she had some degree of residual brain function. 

It is noteworthy that Gillon is very selective in his reporting of these facts and conveniently does not mention that M had some awareness of herself and her environment, some understanding of language, occasionally spoke, appeared to be able to appreciate some things that were said to her and responded to music. Although she regularly experienced pain, this was not constant or extreme, and her condition was stable. And unlike dementia patients, who are terminally ill, she had a non-progressive condition.

Gillon's suggestion, that severely demented and brain-damaged people should be sedated, starved and dehydrated to death on the basis of their friends and relatives vague and contradictory recollections of 'what they would have wanted' would create a most dangerous precedent and place us on a very slippery slope indeed. 

His implication that we should be withholding nutrition and hydration from such people so that we can spend the money elsewhere is chilling and demonstrates precisely why we don't give doctors, politicians and most importantly philosophers (like Gillon!) the power and authority to make such decisions on utilitarian grounds. 

People who are severely brain-damaged or suffering from dementia, but not imminently dying, should be given nutrition, hydration, symptom relief and warm human interaction until the day that they die peacefully and naturally. 

We don’t kill them either by giving them lethal injections or dehydrating them to death and we ensure that there is adequate legal protection in place so that no one who has an interest in their deaths, whether financial or emotional or to get rid of an unwelcome care burden, should be able to exploit or harm them in any way.

The law is there primarily to protect vulnerable individuals from exploitation and abuse and as such it needs the strength to deter individuals and institutions who have something to gain, financially or otherwise, from another person's death. 

It does not need changing and the involvement of the Court of Protection in difficult cases is a necessary and effective safeguard. 

Life-prolonging treatment 'provides no real health benefit'

Doctors should be able to let “minimally conscious” patients slip away because advances in life-prolonging treatment mean they are often kept alive “without any real benefit to their health”, according to an editorial in the British Medical Journal.

Raanan Gillon, emeritus professor of medical ethics at Imperial College London, wrote that scarce NHS resources would be better spent elsewhere than on keeping patients alive Photo: ALAMY

By Stephen Adams, Medical Correspondent

6:22PM BST 13 Jul 2012

Raanan Gillon, emeritus professor of medical ethics at Imperial College London, said the law protecting the sanctity of life had “gone too far”.

Until quite recently doctors had “very limited capacity” to prolong life in those approaching death, he wrote.

But he argued: “Now, however, medical advances have led to a vastly increased capacity to keep people alive without, in many cases, providing any real benefit to their health.”

Scarce NHS resources would be better spent elsewhere rather than keeping such patients alive, he said.

However, his argument has been described as “chilling” by a Christian doctors’ group.

Prof Gillon believed a legal ruling made last December undermined doctors’ ability to make decisions on withdrawing life-prolonging treatment, and meant little weight would be given incapacitated patients’ formerly expressed viewsy, or those of their families.

The case was regarding a woman with extensive and irreparable brain damage, whose family had applied for an order that artificial nutrition and hydration be withdrawn.

The patient had made no ‘advance directive’ detailing how she wanted to be treated if left incapacitated.

Mr Justice Baker, sitting in the Court of Protection, said given the importance of the sanctity of life, it would be wrong to attach “significant weight” to the wishes she made prior to collapse.

He also said decisions to withhold or withdraw artificial nutrition and hydration from a patient in a vegetative state or minimally conscious state had to be referred to the court.

Prof Gillon, former editor of the Journal of Bioethics, found these two conclusions “profoundly disturbing”.

Firstly, he said the ruling flew in the face of the Mental Capacity Act, which “explicitly requires” an incapacitated person’s formerly expressed wishes to be taken into account.

And secondly, the logical implications of the judgment would “threaten to skew the delivery of severely resource limited healthcare services towards providing non-beneficial or minimally beneficial life prolonging treatments … to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment”.

This would probably result in "reduced provision of indisputable beneficial treatments to people who do want them", he argued.

But Dr Peter Saunders, campaign director of Care Not Killing, said: “His implication that we should be withholding nutrition and hydration from such people so that we can spend the money elsewhere is chilling and demonstrates precisely why we don't give doctors, politicians and most importantly philosophers like Gillon the power and authority to make such decisions on such utilitarian grounds.”

Earlier this week another group of Christian doctors claimed hospitals could be favouring use of the Liverpool Care Pathway, which involves withdrawing nutrition and water in the last days of life, to hasten death and save money.

The LCP (Liverpool Care Pathway) is all about saving cash for the NHS (National-socialist Health Service), not providing care.

The vulnerable, the old and the disabled, by mental or by physical impairment, are at risk. Do not these, who lack ‘quality of life’ in the estimation of ethicists and those so 'qualified', deserve a ‘merciful’ exit from their adjudged imperfect and unsatisfactory existence..?