Thursday, 22 November 2012

Liverpool Care Pathway – Is This For What We Are Destined?

"A more liberal society, but less humane..."

"If we've got it we’re dam well going to use it. And the same will happen with assisted suicide, once we've got everything in place; and according to many experts we already have with the LCP, there will be no stopping us."

"Have we asked enough about growing legions of the dead? 12 hundred in Stoke alone, over 200 at the hands of Mr. Shipman. Take the alarming death rates across the West midlands which, according to a statement by Brian Jarman, Emeritus Professor of Imperial College and world authority on mortality rates, “the only way you could get mortality rates like that would be if all three trusts suddenly became terminal care hospitals overnight........ I've never seen anything like this.” "

Is this for what we are destined - a throwaway Utopia of throwaway people?

This is the BMJ -

Re: What’s wrong with assisted dying

14 June 2012

Comment to Iona Heath following her article
“What’s wrong with assisted dying”
in the BMJ June 2012
(cite 2012:344:e3755)
By Nikki Kenward
In this month when Tony Nicklinson will resume his fight, this time in the High Court, to allow a doctor to assist him in committing suicide, the BMA will also hold its Annual Representative Meeting in Bournemouth. During this meeting members will be asked to vote in favour of allowing society and the law to take responsibility away from them for legalising assisted suicide, they want to remain neutral; although presumably not when they’ve got the syringe in hand, maybe they’ll just look away, after all isn’t that what they’ll be doing anyway. Since we won’t be invited to either event, I would like to call an imaginary meeting of the Distant Voices, or at least all those who won’t be heard, or the people no-one wants to hear, or those who for whatever reason can’t speak, or who are, esteemed members, living in all those places, in all those situations, you’d rather not go to. How do I know this?
Because if you and for that matter the general public really, really, thought about it they would have to consider their own inevitable fate and that means being very, very, careful what you wish for. I speak on two counts, one, as someone who constantly asks the general public what they think and want for their relatives and themselves and also as someone who has been ‘locked in’ and is now significantly disabled. In the first instance and I have to agree with Iona Heath’s statement of “campaigns being predicated on an excessively rosy view of society” people simply aren’t thinking this through. You see, we are a society that likes to make best and most use of everything that we pay for, especially in the NHS. Iona herself has commented publicly on breast screening and the apparently heretical view that a woman (this one anyway) could say, “No thanks.” To which their response was absolute horror that someone would decline the offer, ‘put her life at risk,’ and not be moved by all the money that had been spent on the equipment, which they in turn must make use of. Also as a woman labelled Elderly Primigravida who refused a scan, on the advice at the time of The World Health Organisation, I can tell you now saying, “No,” does not win you any popularity stakes. If we’ve got it we’re dam well going to use it. And the same will happen with assisted suicide, once we’ve got everything in place; and according to many experts we already have with the LCP, there will be no stopping us.
So, people on the street, for those of us who ask, think it’s going to be like Grand Designs whereby you say what you want and how it’s going to be, there’ll be some hassle and a bit of indecision but the doctors will see to it that it goes alright in the end – your end. People insist on saying it’s their right, to be autonomous, to choose. Professor Nigel Biggar says of legalization, that it will “jeopardise society’s commitment to the high value of individual human lives, and its support for those lives when they are ailing. It will make society more liberal at the expense of making it less humane.”
We won’t end up with the dream home but tears and rubble as lives are lost without thought and strewn carelessly around us. We can’t create the botox of death and hope that no-one ends up with a ‘trout pout’ and remember, only dead fish float the same way and that’s not an ocean any of us should rush to dive into - because we will, we will dive in. We’ll cogitate, mediate and of course procrastinate (although we can rely on Dignity in Dying to do most of that) in the end we’ll come up with some heinous logarithm only meant to be used in extremity or as a signifier of ‘inalienable’ rights, but finally, extreme situations will become orthodox. We’ll be left with, as Arch Bishop Runcie said of the church, “a lot of noise coming from the shallow end.” For these are shallow and ill thought out desires.
But what of me and the likes of me? You see sadly to most medics I’m a physicians nightmare, a reminder of failure, or as my doctor said when discussing me with my son “you wouldn’t want to end up like your mother would you.” And as for the 75 and counting, disabled people who have already died because their lives were “considered not worth living,” or so the medics thought. Are we really going to be safe in these hands? And how much are we and the elderly going to save the government if we pop off early? Lots. And who cares? Do we even know who cares anymore?
Have we asked enough about growing legions of the dead? 12 hundred in Stoke alone, over 200 at the hands of Mr. Shipman. Take the alarming death rates across the West midlands which, according to a statement by Brian Jarman, Emeritus Professor of Imperial College and world authority on mortality rates, “the only way you could get mortality rates like that would be if all three trusts suddenly became terminal care hospitals overnight........I’ve never seen anything like this.”
Hospitals offer facile apologies, relatives are left with guilt and a pain that won’t ever go away because it needs the truth to salve it.
And yet the public are placing their faith in these systems and yet, and yet, sadly they believe that in the end it’s for the best. Well it always turns out best for some there are always those out for a fast buck. Bring on the rewards for the euthanizors, the governments bent on saving money, or just bent. There always someone waiting in the shadows, what “rough beast” is this then.
And so to the Youth Worker who said she’d rather be dead than be like me, you may not have long to wait, perhaps not even until your next Botox session.
And to Mr Nicklinson I say, “Get a life,” go out more than once a year, some of us do. Whatever you do, even if you take your own life, or if you make it legal for someone to kill you, you’ve still got no right to take my life. For that is what will happen Tony unless these people let all of us speak, so I speak here at my imaginary meeting I speak for you Tony and for all those who are or who will be like you and I. “Sans everything.” Tony.
This response is sent on behalf of The DISTANT VOICES and ALERT, Defending Vulnerable People’s Right to Live.
Iona Heath is President of the Royal College of General Practitioners her comments come from the BMJ May 2012 Article: What’s wrong with assisted dying.
Nigel Biggar is Regius professor of Moral and Pastoral Theology at the University of Oxford, where he directs the McDonald centre for Theology, Ethics and Public Life. He is the author of Aiming to Kill: The Ethics of Suicide and Euthanasia (2004), he sits on the Royal College of Physicians’ Committee for Ethical issues in Medicine. From: The Case Against Intentional Medical Killing.
Brian Jarman is Emeritus Professor, Faculty of Medicine, Imperial College, London. Amongst his many positions he was President of the British Medical Association (2003-4) his recent work has involved calculating adjusted hospital death rates in England, Scotland, USA, Canada, the Netherlands and Sweden.
Nikki Kenward, human rights advocate
Distnat Voices, AlERT,Defending Vulnerable People's Right to Live, The School House, Aston on Clun, Shropshire SY7 8ET

Competing interests: None declared


  1. What a great post by Nikki Kenward and so very true. Were most of us in Nikki's position - and many of us will be, one day - few of us would be content to be treated as a disposable life and a less than human being in the way Nikki clearly is. Keep on fighting, Nikki, you have massive respect from me and others even if you aren't afforded it by some members of the medical profession.

    Tony Nicklinson: what struck me most about Mr Nicklinson's bid for assisted suicide was that he was so very afraid, not just of his condition becoming even more intolerable, but of of being placed on the Liverpool Pathway to death.

    Mr Nicklinson went to great pains to tell us that he wished to be assisted to die at a time of his choosing, when he decided that his life was intolerable rather than suffer what he viewed as a cruel death by thirst, starvation and drugs.

  2. One of the reasons I keep banging on about the EU's involvement in the LCP and so called End Of Life is because of this:

    "Quality of Life in Old Age until the End - Dialogue between Geriatrics and Palliative Medicine."

    "There is urgency to develop palliative care services for elderly patients, experts say. For this reason, the Vice-President of the European Parliament Gianni Pittella, in collaboration with the Maruzza Lefebvre Foundation, promoted a first ever dialogue between palliative medicine and geriatrics at an EU level. The event took place at the European Parliament in Brussels on September 25th, 2012.

    At this occasion, the European Association for Palliative Care (EAPC Onlus) and the European Union Geriatric Medicine Society (EUGMS) unveiled a joint manifesto promoting a European action plan on palliative care and geriatrics.

    The objective is to improve the quality of life of elderly patients with chronic diseases and cut back on health care costs by up to 60 per cent.

    Its ultimate scope is to insert geriatric palliative care in the EU agenda, hoping it becomes a human right one day.

    John Dalli, European Commissioner for Health and Consumer Policy, and Mario Mauro, Head of Delegation of the Pdl to the European Parliament, intervened. The event is embedded into the framework of the European Year for Active Ageing and Intergenerational Solidarity.


    Better Palliative Care for Older People

    European populations are ageing: 80% of citizens are dying over the age of 70 years. Increasing numbers of people are living with frailty and disability, and dying with multiple chronic diseases. Appropriate and effective management of symptoms (pain, breathlessness, fatigue, depression and other distressing problems) is often lacking; this results in poor quality of life and loss of dignity. Too frequently, older people undergo unnecessary examinations, treatments, hospitalizations and admissions to intensive care.

    This is burdensome and expensive for the patient, family and society. Access to high quality palliative care for older people, and closer interaction between geriatric and palliative multidisciplinary teams, would better meet people’s needs and save health and social care costs.


    This could be achieved by:

    1. Recognizing that older people with chronic diseases have the right to the best possible palliative care approach. EU Institutions should delineate a palliative care strategy that encompasses older people with chronic diseases and this should be included as a top priority of national health care cpolicies.

    2. Promoting public awareness EU institutions should empower older people and families, and promote public awareness of palliative care in society.

    3. Promoting a collaborative affort between geriatric and palliative medicaine EU. EU institutions should facilitate the collaboration between geriatric and palliative medicine to foster synergies, and to design a plan for developing areas of common interest.

    4. Investing in education EU Institutions should recommend that all clinicians and care workers involved in the care fo older people and their families have core competences in palliative care. These competences should be part of under-graduate, post=graduate and continuing education.

    5. Investing

    Unifying geriatric and palliative care, cutting health care costs by an unthinkable amount, palliative care for chronic illnesses of older people.

    Frightening, isn't it? The only way I can think of that the EU - which, bear in mind, now makes some 80% of UK's laws - could possibly cut health care costs by 60% chills me to the marrow.

  3. And then there's this...

    "Euroimpact -a European training network funded by Marie Curie and the European Commission."

    "EUROIMPACT - On your way to an international PhD in palliative care (EU FP7 Marie Curie)
    Start date:
    December 2010
    End date:
    November 2014

    Together with the leading centers of excellence in palliative care in Europa, EURO IMPACT is working hard to develop an educational and research training framework, aimed at monitoring and improving the quality of palliative care.

    ...please take a minute to visit our website and become as fascinated by this project as we are...

    EURO IMPACT is funded by the European Union Seventh Framework Programme
    (FP7/2007-2013, under grant agreement nr [264697])"

    Take a look at who is involved.