Tuesday, 6 November 2012

Liverpool Care Pathway – Doctor Knows Best


Doctors do know best... Don't they?

In recent days, this was posted on these pages -
Liverpool Care Pathway – Death By Prescription

Here, we repeat Mr. Triggle's preamble from his  BBC NEWS Health article quoted on that post and follow with comments which are entirely consequent upon the mindset which produced it -


"The Liverpool Care Pathway is a fairly innocuous name for what is perhaps one of the most difficult decisions a doctor has to take: deciding when someone is ready to die."
- Nick Triggle, correspondent for BBC NEWS Health

Yes, this is, indeed, a difficult decision, but these are decisions that doctors have to take - and take them they do, every day. 

Thank goodness that we have a National Health Service staffed with such doctors possessed of the courage to make such decisions on our behalves and fearlessly act in what is quite plainly our own best interests even though we may fail to see that this is the case.

Once, these brave doctors - and nurses, too, it must be said, lest we forget them - took such risks that required them to act under the cloak of secrecy that their profession permits them. Now, thank goodness, there are protocols set in place that afford them a measure of protection at least. Some would say - with impunity!

Thank goodness for the Liverpool Care Pathway. Thank goodness that our brave doctors and nurses may continue to act, and to take those decisions which must be taken but which we, confused by emotion and redundant morality, are unable to take ourselves.


Thank goodness for the Liverpool Care Pathway.Thank goodness for the impenetrable wall of Hospital Managers and their cohorts upon whom our intrepid doctors and nurses may call, and rely upon, to protect them.

Thank goodness for the sound, rational reasoning of the DOH in their ruthless determination to roll out these measures and, even in the face of an equally determined opposition to these plans, to stand firm in their support of them. When a useful life has been lived up to the end of its usefulness such that all the usefulness has run out, then what is the point of it any longer?

Thank goodness for the Liverpool Care Pathway and thank goodness that doctors know best.

Doctors do know best... Don't they?

Unthinkingly, Mr. Triggle has said the unthinkable and, here, the MailOnline reports on the consequence of that arrogant conceit -

 
Grandmother told doctors to remove 'do not resuscitate' order from her medical file... then died days later unaware a SECOND one had been issued

  • Janet Tracey, 63, fractured her neck in a car crash two weeks after she was diagnosed with terminal lung cancer
  • Doctors at Addenbrooke's Hospital in Cambridge issued a DNR notice
  • They cancelled order when Mrs Tracey objected
  • She expressed fears to her family that staff 'wanted to get rid of her'
  • Three days later, a second DNR order was placed on her medical notes
  • Mrs Tracey then died - her family deny doctors' claims they gave consent


A mother died two days after a ‘do not resuscitate’ order was put on her medical notes against her will, a court heard yesterday.

Janet Tracey had already made doctors remove the instruction once but they are accused of reinstating it ‘in her best interests’.

The doctors say consent was given by the 63-year-old’s family – an assertion her four daughters dispute vehemently.

Patient: Janet Tracey, pictured with her husband David, was being treated in Addenbrooke's Hospital in Cambridge when doctors issued not one but two DNR notices, apparently without her consent
Patient: Janet Tracey, pictured with her husband David, was being treated in 
Addenbrooke's Hospital in Cambridge when doctors issued not one but two DNR 
notices, apparently without her consent

The family says Mrs Tracey, who was being treated for terminal lung cancer and a broken neck, told them that hospital staff wanted to ‘get rid of her’.

Her husband David has launched a landmark case at the High Court against Cambridgeshire University Hospitals NHS Foundation Trust for defying his wife’s wishes and ‘acting unlawfully’.

Mrs Tracey, a care home manager, was involved in a head-on collision last February – just two weeks after she was diagnosed with lung cancer and given 18 months to live.

She was taken to Addenbrooke’s Hospital in Cambridge where she picked up pneumonia.

Described as a strong woman with a ‘thirst for life’, Mrs Tracey responded to treatment and was horrified to be told of the DNR notice, which stated that her family had consented.

Legal battle: Mr Tracey stands outside the Royal Courts Of Justice with his daughters Kate Masters (second from right) and Alison Noeland (right) and solicitors Sophie Turner (left) and Merry Varney (second left)
Legal battle: Mr Tracey stands outside the Royal Courts Of Justice with his daughters 
Kate Masters (second from right) and Alison Noeland (right) and solicitors Sophie Turner 
(left) and Merry Varney (second left)

Mrs Tracey received treatment, and died, at Addenbrooke¿s Hospital in Cambridge
Mrs Tracey received treatment, and died, at Addenbrooke¿s Hospital in Cambridge

Fears: Mrs Tracey told her family that staff 'wanted to get rid of her'
Fears: Mrs Tracey told her family that staff 'wanted to get rid of her'
In a statement read to the court, Mr Tracey, 65, said: ‘I found her in tears, so distressed. It was horrible. She told me the doctor had told her about the DNR and the decision had been made. I told her neither I nor the girls would do that to her.

‘We managed to reassure her we hadn’t agreed to this.
‘At one particular point, she did say they were trying to get rid of her.

‘I told her not to be so silly, which proved to be a mistake.’
The order, issued on February 27, was cancelled on March 2. Her family claims she was then ‘badgered’ by staff when she was alone to make a decision about resuscitation options.

On March 5, a second DNR was issued with the notes: ‘The patient does not want to discuss resuscitation.’ It was claimed three of her four daughters had agreed to it.
When Mrs Tracey died two days later, her daughter Alison Noeland found the note and raised it with staff.

She says she had specifically told the doctor who issued the second DNR that they had refused consent for it on March 5. Mr Tracey, a retired engineer from Ware, Hertfordshire, said: ‘My girls told me they found a second DNR on mum’s notes and the notes said I had agreed.I was disgusted and shocked. I would never have agreed to something against my wife’s wishes.’

The family also claim that Mrs Tracey, who had seven grandchildren, was placed on the controversial Liverpool Care Pathway without her consent or knowledge, although this will not be dealt with during the court hearing.

The LCP involves the withdrawal of lifesaving treatments and means patients are sedated and denied nutrition and fluids by tube.

Mrs Justice Nicola Davies is hearing evidence to determine the facts before a judicial review in February, which will seek to clarify whether there is a legal duty to inform patients about a DNR notice.

Edward Faulks QC, representing the hospital trust, said doctors had issued the DNRs after consultation with senior staff, Mrs Tracey and her family.

A DNR notice tells staff not to try to restart a patient’s heart, saving them traumatic and often pointless pain.
The hearing continues.


Such arrogant conceit...

Of course our doctors know best!

Don't they...?

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