Thursday, 8 November 2012

Liverpool Care Pathway – Excuses Do Not Excuse

How can this happen?

How can they do this and not know it is wrong?

This is the MailOnline -

MailOnline - news, sport, celebrity, science and health stories
'A dog would have been treated better': Daughter's heartbreak over father's death after he was put on Liverpool Care Pathway without family's permission 

  • Arthur Oszek, 86, was admitted to Ayr General Hospital hospital after a fall 
  • Taken off drip a few days after he arrived and was begging for water
  • Family told he was on Liverpool Care Pathway - something they hadn't consented to
  • Eventually taken off it after family intervened but died less than a day later
  • 'He was left to die on his own,' claims distraught daughter

Arthur Oszek, 86, was admitted to Ayr General Hospital hospital after a fall. He was put on the Liverpool Care Pathway and had his food and fluids removed for several days
Arthur Oszek, 86, was admitted to Ayr General Hospital hospital after a fall. He was put on the Liverpool Care Pathway and had his food and fluids removed for several days

A woman has spoken of her heartbreak after her father died - she believes after being put on Liverpool Care Pathway.

Arthur Oszek, 86, was admitted to Ayr General Hospital hospital after a fall.

But for several days Mr Oszek, a diabetic, had his food, drink and some of his medication removed, his stepdaughter claims.

Ann Murdoch was told her father had been put on the Liverpool Care Pathway - a withdrawal of food and fluids - in a bid to let his body focus on medication to make his final days as comfortable as possible.

But Ms Murdoch, 65, was furious that doctors hadn't asked for permission to put him on the pathway and demanded he be taken off it. 

After 20 hours of discussions, doctors agreed to restore his food and drink.

But by then it was too late and his body gave up the fight, his feet turning back.

He died just 17 hours later on August 25 last year.

Ms Murdoch said it took her months to come to terms with her father's loss and it was only when she heard of similar cases where people were put on the Liverpool Care Pathway without consent that she felt she couldn't hold back her anger any more.

Last month a major review was announced into the Liverpool Care Pathway, by the Association for Palliative Medicine.
The group, which represents 1,000 doctors who work in hospices and specialist hospital wards, will 'identify and explore concerns' over the system of caring for patients in their final days.

The review comes as several families have said their loved ones were put on the pathway without their consent.

Speaking from her home in Kirkcaldy, Fife, Ms Murdoch claimed NHS doctors had robbed her father's right to live.

Mr Oszek's daughter Ann Murdoch (right) said her father had begged for water and his cracked lips showed he was severely dehydrated
Mr Oszek's daughter Ann Murdoch (right) said her father had begged for water and his cracked lips showed he was severely dehydrated

Mr Oszek's daughter Ann Murdoch (right) said her father had begged for water and his cracked lips showed he was severely dehydrated 

The retired shop manageress said: 'It was dreadful, he was taken into the hospital because he had a couple of falls and at first he was put on the drip.

'But then after a number of days he was suddenly taken off it and he was just begging for a drink, saying "I'm so thirsty".'

'We asked the doctors why he was taken off his drip and we were told he was on the Liverpool Care Pathway.

'We didn't even know what is was, there's no way that should have happened without asking us. 

'We kicked up a fuss and demanded he be put back on his medication, and eventually they agreed about 20 hours later.'

But Mr Oszek, a former miner, died within 24 hours as his body was unable to recover from his frail state, his family claim. 

Although the great-great-grandfather-of-one was surrounded by Ms Murdoch and his other daughter Helena when he passed away, it was an uncomfortable end to his life, they say. 

Ms Murdoch added: 'He was left dying there for 17 hours until the inevitable happened. No one should have to see their loved one needlessly die like that in front of them.

'You wouldn't even make a dog die like that, he was just left to die on his own - none of the doctors came in to check on his condition, in the end we were dabbing a damp cloth over his cracked lips.

'My granddaughter had a camera with her and she took a few photos of him when his feet turned black - it was so distressing.'

After 20 hours of discussions with the family, doctors agreed to restore Mr Oszek's drip, but his feet began to turn black and he died shortly afterwards

After 20 hours of discussions with the family, doctors agreed to restore Mr Oszek's drip, but his feet began to turn black and he died shortly afterwards

She said: 'Our dad wanted to live, the nurse even said "you want to live, don't you Arthur", but the doctors denied him that right. 

'We don't want anyone else to suffer what we have suffered. My father was a character and a very caring person, he looked after my mother in her final years when she had cancer - he didn't deserve what happened to him.

'He was on a lot of medication, but he was living at home, he was able to look after himself with the aid of a care worker from the council.

'He was fully aware of what was going on around him and he was happy. He should have lived a lot longer.'

Mandy Yule, Director of Integrated Care and Partner Services at NHS Ayrshire and Arran said although they could not comment Mr Oszek's case until an official complaint was received from his family, she insisted they always consult families before proceeding with the Liverpool Care Pathway.

She said: 'The Liverpool Care Pathway is an end-of-life care plan to ensure that patients in the last few days of life receive the quality of care needed. 

'The patient's condition is continually monitored in order to assess the patient's needs and to provide support to their relatives or carers.

'Communication with patients and their families is central to end-of-life care. The Liverpool Care Pathway does not preclude the use of clinically assisted (artificial) hydration or nutrition and all clinical decisions are made with the patient's best interest and comfort in mind.'

Do they know not what they do?


  1. You know what upsets me most about so many of the academics who are keen to get as many sick people as they can on the perverse brand of the LCP operating in the NHS now?

    They seem to have little awareness of the importance of humanity, spirit and soul. For them, life is a reductionist affair.

    Read the 'inspiring':

    Quality of life and survival prediction in terminal cancer patients: a multicenter study.
    Vigano A, Donaldson N, Higginson IJ, Bruera E, Mahmud S, Suarez-Almazor M.

    It remains unclear whether health-related quality of life (HRQoL) measurements from patients and staff can be combined with medical data to predict survival in patients with terminal cancer.

    "....The correlations between survival and potential health-related quality-of-life (HRQoL) prognostic variables were explored in 2 independent cohorts of patients with terminal cancer (248 patients in Cohort 1 and 756 patients in Cohort 2) after adjusting for clinical and demographics variables using Cox regression models."

    "....CONCLUSIONS: Health care professionals should focus on physical HRQoL indicators, such as nausea and emesis, dyspnea, and weakness, to gather prognostic clues in patients with terminal cancer. These symptoms may reflect consequences of cancer cachexia and the progress of patients toward this terminal syndrome. Psychosocial distress did not appear to be associated consistently with survival; however, future studies should clarify further the prognostic significance of "positive attitudes", such as hope and optimism, in patients with advanced cancer."

  2. Contrast the above with the words of the remarkable Dr Bernie Siegal, a top American cancer surgeon who founded the highly successful Cancer Survivors self help group.

    "No one knows what your future will be. Do not accept that you must die in three weeks or six months because someone's statistics say you will."

    "Dr. Siegel, weren’t you one of the first medical doctors to write about mind-body medicine?"

    "Many people had written about it, but it was basically limited to the psycho-therapeutic literature. Physicians like myself were not reading these things. So I created a stir because here’s a surgeon talking to a different group than if I were a psychiatrist. What started me on it was my own patient. She had breast cancer, and she said to me, “You’re a nice guy; I feel better when I’m in the office with you, but I can’t take you home with me. So I need to know how to live between office visits.”

    That sentence really led to my altering my life because I thought, “I can feel better about what I’m doing if I help people to live with whatever they’re going through.”

    So we started support groups—this was in the late ‘70s -- and certain patients far exceeded expectations. They got well when they weren’t supposed to, and this just amazed me.

    It also made me angry, because there was nothing ever discussed about this in the medical literature. I was also interested in how dreams were used to interpret a physical illness. I have never met a medical student who’s been told to ask their patient what they’re dreaming because it may tell you what’s wrong with them. These things are all totally left out of the medical training, which is not a true education about how to care of yourself and your patients.

    Do you think you made more waves because you were a surgeon?

    Yes, because it really confronted the physicians more. I had the degree and the label. Today, all this is accepted scientifically because they’ve done research on genes and the various hormones in the body and how they’re changed by all of these things. Once you can measure this, suddenly it’s not so crazy or unique.

    I was saying that even simple things like playing music in an operating room and talking to people under anesthesia could have an impact, but back then everybody thought I was out of my mind.

    Now research funded by the government has shown how beneficial music is in the operating room, and how the patients even need less anesthesia. Patients also have less pain and recover faster if you play music during the operation. Suddenly, I’m not so crazy! The government is putting up money to study this, but years ago everybody was yelling at me, “You haven’t done any research.” That’s because nobody thought what I wanted to research made sense. Then 20 years go by and suddenly it makes sense."

  3. Dr Siegal interview (continued)

    Wasn’t this around the same time that studies out of UCLA showed the healing effects of transcendental meditation?

    Right. They proved that people were able to control body functions through their own meditation imagery--changing heart rate, not bleeding from wounds, a whole host of things. Those were things I would use in the operating room. I would tell people not to bleed, what heart rate I wanted, even correct by giving them symbols through my words. Nobody is against success, so the anesthesiologists didn’t argue with me. If I could help improve the situation, fine, go right ahead. And the experience changed their attitude. I went from being this crazy doctor who behaves in a bizarre way to a respected educator. A few years later I was giving conferences to the same people who thought I was crazy. Now they were sitting there listening because they had seen the results.

    Your new book is called 101 Exercises for the Soul. Are you saying that we can exercise our souls just like we exercise our bodies?

    We’re used to exercising what’s visible, but what we can’t see is just as important. I’m talking about what is going on within us at a deeper, soulful level--you might say what the heart feels and experiences. When you begin to understand that what happens within you creates your internal environment, you also realize you’re affecting your health and your life and all the things that are involved in your existence. Your beliefs become your biology.

    You’ve written that attitude is everything. This seems to go along with the idea of having positive expectations and always seeing the glass as half full.

    Yes, but I often avoid the word “positive” because I don’t want people to try to be positive. I’m talking about finding order and a sense of peace, so that you can deal with all the difficulties in life. If your attitude about your work is, “It’s work and I don’t like it,” then Monday morning is a threat to your health. Studies show that on Monday mornings we have more heart attacks, suicides, strokes, and illnesses. But if you change your attitude or change your life, then the situation changes. I always give people two options: You can quit the job if it’s affecting your health and find something else, or you can go into work with a different attitude and you’ll be amazed at how things change.

    Volunteers live longer, healthier lives than those who don’t. So do optimists. In one study, when questioned, pessimists had a more accurate view of the world but their health and longevity was not as good as the optimists.

    So we’re better off having an optimistic view and hope for the future. My mother used to call it “God’s redirection.” Every time we had a problem in the family, my mother’s answer was: “It’s a redirection, and something good will come of it.”

    This changes your view of the future. That’s really important because when you’re perceiving a threat you go into survival behavior. Your body is under stress; your cortisone levels go up and immune function goes down. And if people live that way, constantly fearful, they add to their illness and their problems. But if you’re in a growth or love phase, then health is enhanced. So you will heal faster, resist infections, and so on.

  4. Dr Siegel interview (continued)

    "Napoleon Hill said, “Whatever your mind can conceive and believe you can achieve.” This would seem to apply to healing ourselves as well.

    Yes, because your actions depend on your attitude. If you listen to a doctor who tells you, “You have two months to live,” you can go home and be dead in a week. You just turn off everything.

    But what if you got angry at the doctor and said, “Who are you to tell me when I’m going to die?” Then you might go home and start fighting for your life to prove the doctor wrong. What a difference! So that’s why I began to learn from people who didn’t die when they were supposed to. They all have stories to tell you. They were not denying their mortality, but they were using it to truly begin to experience life, and do what felt good before they died. However, once you’re feeling good, it’s a benefit to your body and the healing process, and this is why we have spontaneous remission. It’s crazy to me that we don’t study success. Somebody has an incurable disease but survives, but we don’t rush to them and say, “How did you manage this?” We just say it’s a miracle.

    Laughter plays an important part in health and healing, doesn’t it?

    Absolutely. Humor is a big part of my life. Helen Keller put it very well when she said, “If you face the sunshine you never will see the shadows.” That’s the choice we all have. That was her way of talking about attitude. You might say Helen Keller saw God as a disciplinarian rather than as a punisher. So when things happened to her, they became things that helped her become a better person and learn from them, rather than seeing them as an affliction or punishment.

    Weren’t you one of the first to write about the power of imagery for healing?

    Yes. I learned some of these things from Elisabeth Kubler-Ross. I drew a picture for her one day, and she told me so much about my life from this drawing I couldn’t believe it. So I went back to the hospital with crayons and started getting patients to draw pictures. I saw both physical and psychological material come out in the drawing. I was so excited about what I was learning that I wrote articles and sent them to medical journals. They came back saying it was interesting but inappropriate. So I sent them to where it was appropriate and they said it was appropriate but not interesting! Then I began to talk to counselors and art therapists and discovered that a lot of the information was there, but nobody had ever told me about it. That’s when I got upset with my lack of education.

    I happen to be an artist too, so visual imagery really fascinates me. I’ve been doing drawings with patients for about 20 years now. It’s incredible the information that you can collect and how you can help people with choices. I’m talking about simple things that everybody would understand. If I said draw yourself in the operating room and you drew a black box with nobody there taking care of you, then you’re going to have a problem with the surgery. So we could use imagery: see yourself going to the hospital, having a successful procedure, and going home well. The operating room is filled with people who care about you and your family is waiting for you at the hospital. If you picture that 3 or 4 times a day for a week, then by the time you go to the operating room you will have a totally different experience."

  5. Haven’t there been people who have cured themselves of cancer using visualization and positive thinking?

    Yes! And whether their therapy is diet or chemotherapy or surgery or radiation, we can help them to enhance the effectiveness. And you want to try to resolve any conflict within the patient over the treatment so they have fewer side effects. The other thing is to enhance the immune function through imagery. You have to incorporate the person’s beliefs and images if you’re going to do it correctly. For example, we had a Quaker who walked out of the office when the doctor said he’d kill the cancer. The patient said, “I’m a Quaker and I don’t kill anything.” So you might need to describe it differently, such as the tumor is a block of ice and God’s light is melting it. You have to help the patient to discover what works for them. We can help patients become more complete human beings as well as deal with their illness.

    You’ve written that death is our greatest teacher because we all have a limited time to live. Are you saying that we should live each day as if it’s our last?

    It’s not a bad idea. I think it’s vital that we accept our mortality. In fact, when I’m on radio and TV, I always tell the person who introduces me not to forget to say we’re running out of time at the end of the program. This is because I like to say to the audience:
    “Don’t forget folks, you’re all going to run out of time. So how do you use your time? I once said to my son, ‘If you had 15 minutes to live what would you do?’ He said, ‘I’d buy a quart of chocolate ice cream and eat it.’ So what’s your chocolate ice cream? Go live with that. Don’t deny your mortality, but go live with chocolate ice cream and watch what happens.” When people accept their mortality, they may move to a place where they really want to live, or they may change their job, because so many of us give up our lives to please everybody else. When you realize you’re mortal, you start doing what makes YOU happy. That goes back to the soulful stuff. A big part of that is learning to say NO to what you don’t want to do. Most people have a hard time with that. People don’t realize they’re saying no to themselves by saying yes to all the things they don’t want to do. Don’t wait until the doctor says you have six months to live to give yourself permission to sit on the beach, or paint a picture, or work in the garden. Go do it now! I don’t judge people; I just try to make sure it’s their “chocolate ice cream” that they’re choosing."

  6. Dr Siegel interview (continued)

    "Dr. Larry Dossey has written about the power of prayer in healing. Do you think that this makes a difference?

    Yes I do. Consciousness is not local. It’s my belief that when the body dies, consciousness goes on. And I think prayer enters into this; it’s part of consciousness. Even how I feel about a patient creates a different environment, just as praying for somebody will. I think that desire, intention, determination, and prayer all affect the greater consciousness and can lead to many changes.

    You’ve written that you were trained in medical school to think of patients as machines needing repair. Do you think doctors are being taught differently now?

    It’s beginning to change. Some schools are better than others, but I think the schools are just waking up to the fact that you really need to train people to care for other people. Unfortunately, physicians are not taught to deal with all the loss they experience. They put a wall up and separate themselves so they don’t get hurt and that hurts the patients. That’s something I always teach patients: to be personal, to break through that wall, so the doctor sees they are caring for a person, not a disease and not a diagnosis.

    Do you think that aspect is changing in medical school as well?

    Not enough. It’s too slow, because the technology today just overwhelms everybody. You spend more time learning about technology than people. If you went back 100 years, doctors took care of the person because they didn’t have all the technology. Now there’s so many drugs, and various types of robotic surgery, and all this fascinating stuff--which is wonderful to have, but let’s remember there’s still a person at the end of all of this.

    You’re a big proponent of patient empowerment, aren’t you?

    Yes. It drives me nuts when I read medical journals. . . whatever the complaint, boom, here’s a prescription. In the ads the doctor never says “Sit down and tell me what’s happening.” It’s always “Take this pill.” You go into a doctor’s office and the doctor asks, “What’s your chief complaint?” So you start complaining, and saying what’s wrong with you. But what if the doctor said, “How may I help you?” Then you could discuss what’s going on in your life, or even why it is bothering you. I learned to ask people, “What are you experiencing?” Then I’d know what you’re going through. Emotional words come out of people when you listen. A headache is described as a burden or pressure. It’s something sucking away at you, a failure. So then we can look at what’s the pressure, or the burden, and I can help the person heal their lives, which then provides physical benefits also. I try to treat the experience, not just the diagnosis."

  7. Dr Siegel interview (last section)

    "Some medical practitioners say that the hardest part in helping people is compliance--getting people to follow through and take the recommended steps, whether it’s dietary changes, exercises, etc.

    Yes, I think of myself as the coach or teacher, which is where the word doctor comes from originally. If people don’t have a relationship with you, they’re not likely to pay attention to your instructions. If I’m a coach of a team and none of the team members like me or my attitude, they’re not going to show up for classes, they’re not going to stay late and really put an effort into it.

    What do you think the future of healing will bring?

    I hope it will bring us to love one another, to accept that we are all one family. I hope we can use our differences for recognition, not for substance. Because if we don’t get together and do what’s good for the entire planet, we’ll all be eliminated. Hopefully it won’t come to that, but it may, knowing what people are like. But maybe at that moment we’ll all say, “We’ve got to get together and do what’s right for life and for creation.” That would make the difference. If every child grew up loved, we would not have to worry about the future. I mean that literally."

    We do not need the Liverpool Care Pathway. What we need is to select and train all of our doctors to be Dr Bernie Siegels.