Thursday, 22 November 2012

Liverpool Care Pathway – By Any Other Name...

From the BMJ archives -

 "The editorial comments that last year 43% non-compliance with the Dutch prescribing guidelines for terminal sedation was reported.This fact suggests that continuous deep sedation could be euthanasia masquerading under a different name."

Continuous deep sedation in patients nearing death

Re: Continuous Deep Sedation and LCP concerns               17 April 2008 
Euthanasia implied intervention to hasten death. Alice Ricciardi-von Platen (Obtituary The Times 16.4.08) noted in her book recounting the history of the killing of the mentally ill in Germany that the doctor collaborators convinced themselves that they had a forward looking approach to their patients best interests. This ideology persists. Many Dutch physicians instituting continuous deep sedation with an irreversible condition and death expected at most one to two weeks consider they are providing high quality end of life care. However in 2007 international pallative care experts decided that sedation is a valid option when other treatments do not relieve symptoms in a patient expected to die within hours or days. This decision is to be made in consultation with a pallative care specialist, Midazolam, a short acting benzodiazepine being the sedative of choice. By careful titration against symptoms the paitent can communicate intermittently and request fluids. This high quality end of life care in the patient's best interests. A patient may want to reconsider i.e. terms of his will or to end a bitter family feud. The study unfortunately discovered that only 9% of Dutch general practioners had previously sought the advice of a pallative care specialist. The editorial comments that last year 43% non-compliance with the Dutch prescribing guidelines for terminal sedation was reported.This fact suggests that continuous deep sedation could be euthanasia masquerading under a different name.
Mary Knowles Chair Doctors Who Respect Human Life
Competing interests: None declared
Competing interests: None declared
Mary Knowles, Previously an anaesthetist but now retired
Retired

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2 comments:

  1. Harlow blogger22 November 2012 at 16:58

    Well said, Mary Knowles,and thank you. Indeed, thank you to all of the doctors who belong to Doctors Who Respect Human Life.

    And to those who don't, here's the Anaesthetist's Hymn:

    http://www.youtube.com/watch?v=xuZl9tRqjoQ



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  2. Harlow blogger22 November 2012 at 17:02

    "we sometimes check the screen,
    and every now and then we write stuff.
    And if we have to intervene,
    we inject a bit of white stuff.
    And we offer to alter the light,
    or the height of the bed.
    Or fiddle with the radio, change the CD,

    we even check the patient occasionally.

    And if they move, we turn up the vapor,
    and then we go back, to reading a paper.
    Cause when the patient's asleep,
    we just sit and listen to the beep"

    Anaesthetist's Hymn by Amateur Transplants



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