Friday, 21 December 2012

Liverpool Care Pathway – The Implications Of Policy

Clearly, the world economy is in crisis. When the Fed actually prints money to pay its bills and Nero fiddles while Washington burns, calling it 'quantative easing' instead of what it is - then we're all going to be spending Monopoly money and the Dollar might as well be One Big Dud.

Is it all a question of control and maintaining control? Expectations have been raised by the spectacular gloss of commercialism that all is available and affordable. Adam Smith correctly points out that poverty is relative. In a more prosperous, technically advanced society, it may be considered a condition of poverty not to possess a television set. In a less technically advanced society, to possess one may be considered a condition of affluence.

Clearly, we are in crisis. Society cannot afford to give everyone a good life, but can Society afford not to give everyone a good life. Is this the focus of giving everyone a good death? Is this what is going on?

This was published in 2007, one year prior to the publication by the UK government of the End of Life Care Strategy for England. This is Civil Service College -


Current trends suggest that end-of-life care will increasingly need to become integrated with elderly care as the world's population ages rapidly, instead of targeting only terminal illnesses like cancer.

In Singapore, end-of-life care is mainly associated with terminal illnesses and remains largely the responsibility of the individual and his/her family network. End-of-life care is currently administered by private hospices, which are mostly funded by public donations.

As Singapore's elderly population increases, our healthcare system will have to contend with long-term healthcare needs on two fronts: curative care for chronic illnesses associated with ageing and end-of-life care in patients' last years of life. The growing demand for end-of-life care may lead to calls for it to be better integrated into our healthcare system to facilitate better continuum of care, from diagnosis to the end of life
Aside from navigating a host of ethical, legal and medical issues, our policy-makers will also have to deliberate on the costs and benefits of government support for end-of-life care. The complexity of end-of-life care policies will also be magnified in Singapore's multicultural and multi-religious society. Consideration of issues surrounding end-of-life care and public education efforts will need to take into account the diversity of views, values and beliefs towards death and dying.

Prepared by:

Soh Tze Min
Research Unit, Institute of Policy Development, CSC

Sheila Ng
Assistant Editor, 
Centre for Governance and Leadership, CSC

What is being discussed here is social cohesion. Can Society afford not to give everyone a good life.

This is from the NCPC website -

Dying Matters – raising public awareness

In 2008 the government published the End of Life Care Strategy for England, in which NCPC was invited to lead a national coalition to increase public awareness, discussion and debate around dying, death and bereavement. NCPC accepted the challenge and in 2009 the Dying Matters Coalition was born. In a short time the coalition has become established and respected and now boasts over 16,000 members. Whilst the Dying Matters Coalition’s main focus is England, we support and encourage better public awareness across the UK.

NCPC today

NCPC celebrated its 20th birthday in 2011 and is going from strength to strength. We produce a range of publications, leaflets, DVDs, conferences and training programmes to help our subscribers around the country deliver the best levels of care. We work with government, the NHS, the voluntary and private sectors to shape future strategies and plans. We involve patients, carers and families in everything we do to ensure our work is informed by people with real experience.

Is this a 'junior partner'? Who is in charge; who is controlling whom?

This is Civil Service College -

The Policy Implications of Dying: End of Life Care

Ethos Perspectives — May 2007
Soh Tze Min and Sheila Ng
Social Policy

End-of-life care—which refers to the care needed during the deterioration of an illness in the months or years preceding death—has traditionally been a peripheral issue in healthcare. Around the world, healthcare institutions have always focused on delivering cost-effective curative treatment. Ironically, it is medical advance that has generated the debate over the value of end-of-life care, the quality of "death" and the relationship between the two. Modern medicine has not only extended overall life expectancy but also made it possible to sustain the sick for longer, inadvertently prolonging their period of disability and pain. At the same time, the growing nuclearisation of families and the declining proportion of younger adults in an ageing population mean that families will find it an increasing burden to care for their disabled or ill family members.

With this, the need for palliative care—providing symptomatic relief and emotional, spiritual and social support for the dying—has become more important than before. While legal, clinical and ethical guidelines such as the Advanced Medical Directive (AMD) and laws on euthanasia help to address some of the issues around dying, society and healthcare systems remain unprepared and unable to provide adequate holistic, effective and compassionate end-of-life care.

Without a doubt, end-of-life care is fraught with complexity and controversy. For example, there is continuing debate whether it devalues life by abandoning curative efforts too early, or is more respectful of life as it seeks to give the dying greater dignity and quality of life. While most respect individual choice and one's right to die with dignity, interpretations—whether individual, societal, cultural, religious or clinical—of what constitutes "quality of life" in one's dying years vary greatly. There is also a lingering perception that palliative care can result in substandard medical treatment, or is a way to end the burden of caregivers.

To what extent governments should advocate and regulate end-of-life care? While it may ease the financial, physical and emotional burden of the dying and their families tremendously, how can these benefits be measured tangibly? Should the government subsidise end-of-life care if the end-point is certain death? This issue of Ethos Perspectives aims to highlight the complexities and dilemmas that surround end-of-life care and the assumptions behind it.

The Good Death is a policy decision in response to the perceived threats to social cohesion.

1 comment:

  1. "Should the government subsidise end-of-life care if the end-point is certain death?"

    Should the government refuse to do so, in my opinion, they will be ripping both the NHS and the social compact to shreds.

    Not a good idea, Mr Cameron.