Sunday, 29 December 2013

Liverpool Care Pathway - Cold, Cruel, Callous, Heartless, Without Pang Of Remorse

They bodged a simple tonsillectomy. You would think they would be falling over themselves to fall in line with the parent's wishes.

Komo News reports that,
In its court memorandum, the hospital said it has no duty to maintain life support because Jahi's condition is irreversible.
"Ms. McMath is dead," the hospital said in the memo. "Children's is under no legal obligation to provide medical or other intervention for a deceased person."
The family says the girl bled profusely after a routine tonsillectomy. She then went into cardiac arrest before being declared brain dead Dec. 12.
The teen's mother, Nailah Winkfield, over the weekend pleaded for prayers for her daughter.
"Despite what they say, she is alive. I can touch her, she is warm. She responds to my touch," Winkfield said in an open letter Saturday. "Given time I know (God) will spark her brain awake."
  1. This is CBS News -

    "It's wrong for someone who made mistakes on your child to just call the coroner ... and not respect the family's feeling or rights," Sandra Chatman, Jahi's grandmother who is a registered nurse, said in the hallway outside the courtroom. 
    "I know Jahi suffered, and it tears me up."

US News

The family gave Jahi her Christmas in her hospital room.
The family of Jahi McMath will wait until Thursday to discuss a possible appeal of a judge's decision allowing a hospital to remove her from life support, said Omari Sealey, the girl's uncle.

"We're going to discuss our opportunities tomorrow. Today we are going to keep as regular as possible," Sealey said.

Alameda County Superior Court Judge Evelio Grillo ruled on Tuesday that the hospital could remove Jahi from the ventilator keeping her body functioning, but gave the family until 5 p.m. on Dec. 30 to file an appeal. Until then, she will stay on life support.

The Calgary Herald
Alameda County Superior Court Judge Evelio Grillo has ruled that Jahi McMath, who was declared brain dead after suffering complications following a tonsillectomy, can be removed from the ventilator keeping her body functioning.

But the judge gave Jahi's family until 5 p.m. Dec. 30 to file an appeal. Until then, she will stay on life support at Children's Hospital Oakland.

The hospital says they are under no obligation to provide medical or other intervention for a deceased person. Well that’s convenient. Jahi’s costing them big dollars so they declare her brain dead.
Carina Melchior was declared brain dead.

Read further here -

Liverpool Care Pathway - Presumptuous And Arrogant
Four specialists declared Steven Thorpe to be brain dead.

Read further here -
Here is the San Jose Mercury News

OAKLAND -- The family of Jahi McMath said Thursday that they are preparing to move the 13-year-old to another facility -- a move officials at Children's Hospital Oakland indicated almost immediately that they would resist. 
"It looks like we may have found a miracle to keep Jahi alive and to give her another fighting chance to wake up," the girl's uncle, Omari Sealey, told reporters Thursday evening. Sealey said the family had found a "greater Bay Area facility" that would care for the girl, who doctors say was left brain-dead from complications after a Dec. 9 tonsil surgery. 
In order to move the girl, Sealey said, doctors would have to give her a tracheotomy so she could have a permanent breathing tube, and give her a gastric tube to provide nutrition.
They bodged a simple tonsillectomy. You would think they would be falling over themselves to fall in line with the parent's wishes. But the Medics and the Judiciary have declared Jahi to be dead and they don't perform surgery on dead people...!
The family's attorney, Christopher Dolan, said that the hospital's stance defied explanation. 
"It appears the hospital is hell-bent on this girl going out in a box,"

Saturday, 28 December 2013

Liverpool Care Pathway - A Negation Of Trust

When those placed in a position of trust to stand as impartial champions hold partial consort with those we challenge then they negate that trust.

Are these those we should trust?

In their own self-audit, they could find nothing wrong, only much to praise...

The Generic Report 2008/2009 was cited as gospel and clung to as the spoken and incontestable word of the Prophet, John Ellershaw.

The PHSO (Parliamentary and Health Service Ombudsman) is our last port of call in the complaints process. This is the PHSO Submission to the Independent Review –

And are these those we should trust?

The supposedly independent PHSO actually met with John Ellershaw of the Marie Curie Palliative Care Institute in Liverpool in 2012 to discuss how they should deal with complaints about EoLC and the application of the LCP!

In their submission, the PHSO reports that an increasing number of complaints they receive are in relation to EoLC.

Scenarios are discussed. One such is that the patient deteriorates and a decision is reached that their prognosis requires EoLC or a DNAR.

"As a result, some of the complaints we see in this area are about the deterioration in the patient’s condition which is seen by the families concerned as having been caused by poor care and treatment."
Such cases, apparently given such scant consideration, are actually well-founded as we know from the David James case and others mentioned in these pages!

The submission does mention cases where complaints were actually upheld. These were all where EoLC
“was not implemented soon enough and opportunities were lost to make patients more comfortable during their final hours.”
And the submission gives them particular mention...
 “We upheld one particular complaint in a community setting where a GP’s delay in considering palliative care meant that the patient and his wife did not have access to the full range of services which should have been available to support them at the end of his life. In another case palliative end of life care was not put in place as a result of delays in diagnosing terminal cancer.”
While the submission acknowledges complaints in regard to “patients being put inappropriately on the LCP by medical staff or against the wishes of the patient and their family” and that “the patient should not have been put on the LCP at all or that the patient was put on it at the wrong time, leading to an unnecessary or premature death”, it would seem that these cases were not taken seriously enough to pursue. There is good cause for this.

In such cases, where the LCP has been enacted and execution of death completed, there is only one charge to bring, and that is a charge of murder.

In such cases, where the LCP has been enacted and execution of death not completed, there is only one charge to bring, and that is a charge of attempted murder.

Hence, with all the clamour abroad in the press, notably the much maligned Daily Fail, it became necessary to meet with the Chairman himself in 2012.

Hence, with all the clamour abroad in the press, notably the much maligned Daily Fail, the trawl of data the PHSO undertook was from 2010 and covers only the period of the legal Version 12!

The submission concludes that all the complaints can really be put down to miscommunication and misapplication.


Who is going to be taken to task for that; anyone, anytime soon?

Any excommunications by the Prophet Ellershaw of those who perpetrated the misdeeds or of those whose provision of guidance and training was inadequate and wanting?

In 2012, The Mail reported that 5000 patient records were going missing every day. That is really quite extraordinary. This is the Mail Online

The Mail reports on records being dumped and even being posted on the internet. That is really quite scandalous. However, it is also all rather odd.

It could not be the case, but could it be, that there is something more sinister here and that these records are being LCPed for good reason?

Recent times have seen a fundamental revamping of the NHS with the creation of Commissioning bodies and so-called University Hospitals.

This has also facillitated misplacement of hospital records as we have found in chasing these down.

But what is the drive behind creating University Hospitals apart from the status this brings with it?

This is from the Surrey and East Sussex GP Newsletter
Associated University Hospital Status
This year we have developed a strategic and clinical partnership with Brighton and Sussex University Hospitals NHS Trust, which is one of the most oversubscribed medical schools in the country. It has a strong reputation for educating and training health professionals, teaching science and advancing research. It is also consistently highly regarded by its own students in annual university surveys.

The benefits to us of becoming an Associated University Hospital of Brighton and Sussex Medical School include gaining additional students and student resource, investment in our teaching facilities and a positive impact on our Research and Development opportunities. This is a significant building block for the future that makes us more attractive for medical staff and improves our clinical reputation.
And this is NHS England 
NHS England Business Plan
We will act as a facilitator of research – for example, we are planning to investigate a system of ‘presumed consent’ to take part in research studies for all patients treated in teaching hospitals.
NHS England Business Plan
Presumed consent...?

The Review says -
1.23 Formal, independent, prospective testing of the LCP has not yet been carried out after nearly 10 years of its dissemination, which is a major cause for concern. The National Care of the Dying Audit – Hospitals (NCADH)24 does provide some limited evaluation of the LCP.
That is to say, in effect, that the LCP has, for the past 10 years, been little more than a clinical trial and that The National Care of the Dying Audit was based on a clinical trial.

Only recently has a randomised clinical trial of the LCP proceeded. Another is under way in Flanders. Whatever succeeds the LCP in a hospital setting may now proceed, openly, as a clinical trial. 
Clinical Trial Agreements
The Trust supports the use of the DH Model Clinical Trials Agreement. This was developed by the DH and the Association of the British Pharmaceutical Industry and is a standard contractual framework for commercial trials involving NHS patients.

The model covers the legal and financial issues raised by NHS participation in contract research sponsored by pharmaceutical companies. Leeds Teaching Hospitals
The Department of Health Model Agreements (2011) provide for clarification of indemnity and bring US and UK bribery legislation into line.

However, there is no indemnity for what has proceeded for the past ten years. May we now see some prosecutions, please?

Further reading - 
Liverpool Care Pathway - A Cost Efficiency
In regard to hospital records we have chased down, these serve to demonstrate that both the Healthcare Commission and the PHSO lied to us by omission in not revealing certain facts.

My dear mum was admitted to what was described to her as an old-fashioned Cottage Hospital for rehabilitative care. She was joking with the ambulance crew on the way there, saying, "You won't drop me, will you?" She was alert enough that evening after I left her in their care to ask the nurse if I had safely gone upon my way.

In the Healthcare Commission report, the nursing adviser refers to poor nursing practice and there is an admission that the medical notes kept are inexact and slapdash, not to be trusted and not to be relied upon for their accuracy. It must be significant therefore that, following the Healthcare Commission report and the PCT’s review, recommendations were made in respect to the administration of analgesia that Caterham Dene were required to put in place!
The Commission’s GP advisor expressed concerns about “undated entries being entered on to the wrong notes” and cast doubt upon the accuracy of blood pressure readings. These are damning words which cast into actual doubt the validity of the medical evidence! Lack of care and attention to properly and accurately maintain the written record constitutes a negligence which directly threatens the well-being and safety of the patient.

They also permitted mum to present cyanose and did nothing but stand by and watch her condition deteriorate - because this is what they are trained to do; they are trained to let them go and help them on their way.

The notes we have obtained reveal that, upon arrival, she was 'whimpering constantly' (not true) and that, over the following 24 hours, her repeat medication removed, mum was dosed with a cocktail of Temazepam, Tramadol and Oramorph (of which we knew nothing and the HC and the PHSO kept from us) and reduced her (small wonder) to a state of total incoherence and confusion.

The nursing notes appear 'doctored' with two leaves added and written in a careful hand in the Multiprofessional Progress & Communication Sheet and with the wrong dob at the foot of the page. It is noted carefully that I have said I want it "documented that we are killing his mother with morphine."

A report in 2009 (prior to the PHSO and Marie Curie trawl) by BBC News notes that -
Research suggests use of CDS in Britain is particularly high - accounting for about one in six of all deaths.

There are fears that CDS is being used inappropriately.

Father's death
Dr Philip Harrison, a GP now based in New Zealand, set out his concerns recently in the British Medical Journal, following the death of his father in Doncaster Royal Infirmary. 
He was put under continuous deep sedation without being consulted, and so had no chance to say goodbye to his family. 
Dr Harrison reached the hospital two hours before his father died. 
"I'm 100% certain he would have been horrified to know that he would never see us even though we were coming," he said. 
"There was no reason on earth why he would have wished to have been put to sleep, unless he was obviously distressed or agitated or in pain. 
"But there was no evidence he was in pain at any stage during his admission." 
Dr Harrison, who has long experience in palliative care, decided not to sue the trust - but he did try to get reassurance that it couldn't happen again. 
Despite an apology he is still not satisfied. 
"I don't know what the legal term is but to me it was as near to a form of murder that I had come across," he said. 
"I have never seen that in my medical practice before. I've seen euthanasia once, but I've never seen anybody being put to death without consent." 
Dr Harrison said he is concerned about what could be going on across the NHS in the name of caring and terminal sedation. The truth is, no one knows.
Further pertinent reading -
Liverpool Care Pathway - The Report

Liverpool Care Pathway - Cast Iron Protection

Liverpool Care Pathway - It Is MURDER!

Liverpool Care Pathway - After The Review, After Everything, They're STILL Killing People

Liverpool Care Pathway - A Medical Mischief at Work.

Liverpool Care Pathway - A Right Carry On Up The Pathway

Liverpool Care Pathway - The Early Years

Wednesday, 25 December 2013

Liverpool Care Pathway - A Message For Christmas

If you ain't dead yet, you ain't dead yet and life is precious because living matters.

This is Paul Russell

Times Square to light up with disability message against assisted suicide
A brilliant new initiative from Not Dead Yet USA and ADAPT

You can see this on the big screen in Times Square NY
This week ADAPT and Not Dead Yet launched a new messaging campaign which will be displayed on the New York City Times Square CBS Super Screen. The video message will be displayed once an hour, eighteen hours a day for three months.
The Super Screen is 26 ft wide and 20 feet high. You can find it under the CBS logo on 42nd St., between 7th and 8th Avenue. This is - no pun intended – kind of a big deal.


 Paul RussellPaul Russell

Not Dead Yet is a national, grassroots disability rights group that opposes legalization of assisted suicide and euthanasia as deadly forms of discrimination.
ADAPT is a national grass-roots community that organizes disability rights activists to engage in nonviolent direct action, including civil disobedience, to assure the civil and human rights of people with disabilities to live in freedom.
For more information on our organizations, visit and

Liverpool Care Pathway - The Execution Of Death

IVADS, including Midazolam, "significantly increased risk of death".

This is Family Practice News
Although prospective, randomized controlled trials are needed to confirm the findings of this retrospective cohort study, the data should heighten awareness of the potential adverse effects of anesthetic drugs, Dr. Peter W. Kaplan said at the annual meeting of the American Epilepsy Society.

Of 171 adults who presented to University Hospital Basel, Switzerland, with status epilepticus between January 2005 and January 2011, 63 (37%) were treated with intravenous anesthetic drugs (IVADs), including thiopental, midazolam, propofol, and/or high-dose phenobarbital, and 18% of the patients died. After adjustment for status epilepticus duration and severity (based on status epilepticus severity score) and for critical medical conditions, those treated with IVADs had a significantly increased risk of death, compared with those who did not receive IVADs (relative risk = 3.16), said Dr. Kaplan of Johns Hopkins University, Baltimore.
Those who received IVADs also had a significantly higher rate of infectious complications (43% vs. 11%). The infections were diagnosed during the course of treatment, and 25 of 27 infections were respiratory infections. The remaining two cases were urinary tract infections.
Severe hypotension also occurred more often in the patients who received IVADs.
A Pubmed submission confirms this last finding -

A 72-year-old patient received 0.1 mg morphine by the intrathecal route and 2 x 1.5 mg midazolam as adjuvant therapy. Severe respiratory depression and somnolence supervened 3.5 h later, which lasted over the next 24 h and necessitated intubation and mechanical ventilation. Continuous administration of >6 mg naloxone to antagonize the supposed effect of the morphine had no effect. The patient's condition was not normalized until a single dose of 0.3 mg flumazenil was administered. For the time being, especially in the case of elderly patients, we recommend that strict indications are adhered to when intrathecal administration of morphine is considered and that less than 0.1 mg morphine is given. Diazepines should be avoided. Respiration should be monitored for quite some time.

This interaction between Morphine and Midazolam to compound their effects is also of note. This was not picked up on by Baker (Gosport Inquiry), was not considered by Ellershaw (LCP) and was not acknowledged by Neuberger (LCP Review). That is gross oversight and negligence.

Morphine depresses respiratory drive in any case.

Hence, use for symptom management for breathlessness? All nice and tidy and reassuring for the relatives at the bedside...

But fatal if you've been diagnosed as 'dying' and you're not actually dying.

Perception is everything. Those PROMs are all-important to tick the boxes.

There has been outcry in the US in regard to Midazolam being a 'cruel and unusual punishment' and this has been reported in these pages. This is a more recent report in the Guardian

The European Commission imposed tough restrictions on the export of anaesthetics to US corrections departments in 2011, and amid the squeeze a succession of states has been running out of their primary lethal drugs supplies. As a result, Florida has turned to midazolam hydrochloride, a drug never before used in executions, provoking an outcry that it might be inflicting cruel and unusual punishment on condemned prisoners.
The EU Commission moratorium has so affected application of the ultimate sanction that Correction Boards are now resorting to other protocols including Midazolam to execute death.

Please! Mr. Ellershaw, a letter to the Florida Department of Corrections in regard to the safety and efficacy of Midazolam would, surely, not go amiss.

Further reading -
Liverpool Care Pathway - A "Cruel And Unusual Punishment"?

Saturday, 21 December 2013

Liverpool Care Pathway - Ethics For A Brave New World

We are seeing this enacted before our eyes and blind are we to all...?

And are these those we should trust? In their own self-audit, they could find nothing wrong, only much to praise...

The Generic Report 2008/2009 was cited as gospel and clung to as the spoken and incontestable word of the Prophet, John Ellershaw.

How flawed were its self-congratulatory expoundings...

Now, a Leadership Alliance is formed under the tutelage of Dr. Bee Wee. And whither does this go?

The iceberg is hit. The ship is going down. The call is to abandon ship...

Is not the cry, "Women and children first!" and, in that number included, are not the weak, the frail, the fragile, the elderly...?

Don't they also evacuate the wounded and the injured first from the field of battle?

No more... Chivalry belongs to another age and ethical considerations are given a new dimension.

Here is discussed the problem of instituting and enacting such plans without the prior grooming of those expected to deliver them...

A 'reverse triage' will be used to identify “too sick patients”. Traditional triage is described as an 'ethical trap'.

This is Altered Standards Of Care: An Analysis Of Existing Federal, State, And Local Guidelines

There is an unspoken assumption that all healthcare personnel in an emergency or crisis situation will essentially share the utilitarian perspective of each plan. Philadelphia and TPC plans casually declare that any newborn or infant with a genetic disorder that is likely to be fatal before the age of two should be treated in the same way as an adult who requests a “do not resuscitate” (DNR) order. There is no discussion regarding how different individuals will be able to comply with this directive. There are no plans or templates for holding discussions with all healthcare personnel as part of the preparedness stage of crisis management or medical surge management. There is only an assumption that during a moment of crisis all personnel will know what to do and will do it in the most ethical and moral way possible.

The ethical issue is utilitarian in its approach to resolving problems. The ethical concern is presented as the welfare of the community over the welfare of individuals, and the unspoken guideposts are a need to foster the greatest good for the greatest number of people.

The 'utilitarian' ideal of the greatest good for the greatest number of people will take primacy. Patients will be identified as 'too sick' for treatment.

This is the stark logic of Communitarianism and Zeke's Complete Lives System.

It is exactly this course which is being followed in the 1% campaign, downsizing healthcare options and the DoH EoLC programme. There are 'too many' old ones; there is what the Harvard Gazette has referred to as a global "demographic nightmare"; they have to be dealt with by process of elimination.

It is the financial impact on the fiscal budget that is the focus of concern and is expressed in Parliament – 

Public spending and older people
Much of today’s public spending on benefits is focussed on elderly people.  65% of Department for Work and Pensions benefit expenditure goes to those over working age, equivalent to £100 billion in 2010/11 or one-seventh of public expenditure.  Continuing to provide state benefits and pensions at today’s average would mean additional spending of £10 billion a year for every additional one million people over working age.
The financial constraints were among those that set the world on the road to another holocaust.

Dr. Anna Pou has been involved in the writing of laws to provide legal protection to health care professionals acting under the provision of such plans. Pou has further acted in an advisory capacity on disaster preparedness. She has lectured at conferences and addressed military medical trainees. She promotes changing the standards of medical care at times of extraordinary necessity. She has said that doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have DNR orders.

Who is Dr. Anna Pou...?

- Alaska Report
The Naval Post-Grad School Thesis above discusses Dr. Pou -
"Criminal and civil liability remains a major concern among healthcare providers. Although Anna Pou and her legal and civil problems in Louisiana are never mentioned in any plan, the underlying causes of Pou’s difficulties are expressed in all documents. It may be that liability is a particular worry for American physicians and that this fuels concerns with altered standards of care. The absence of altered-standard-of-care protocols may also be due to an American political divide on what constitutes the sacredness of life. During the debate on President Obama’s healthcare reform plan, many opponents of the plan pointed to provisions they claimed created “death squads,” concerned with saving costs over saving lives. Given the intense and often highly contentious debates over healthcare, the question of liability is a genuine one for physicians and other healthcare personnel."
"For those who would work under such circumstances, the fear of potential legal action is not unfounded, given the charges filed against nurses and Dr. Anna Maria Pou for failure to care and inappropriate use of medication in New Orleans following the flooding associated with hurricanes Katrina and Rita (Okie, 2008, p. 4)."
"The ethical imperatives of deciding what to do with “too sick” patients and whether proactive lethal medication, such as that practiced by Dr. Pou in New Orleans during Katrina and its aftermath, is an option in certain crisis situations."
"The concept of altered standards of care was not introduced until recently, and there is still much to be learned. The benefits are not yet completely known, but those benefits that have been documented cannot be ignored. Additionally, the paucity of literature supports the importance of continued research in this area, especially in the development of triggers, guaranteed minimums of care, and liability protection for healthcare providers."

In an interview with Sheri Fink, Irene Ogrizek discusses what happened at the Memorial and Dr. Anna Pou.

This is Sheri Fink in her own write in the New York Times Magazine
Investigators pored over the evidence, and in July 2006, nearly a year after Katrina, Louisiana Department of Justice agents arrested the doctor and the nurses in connection with the deaths of four patients. The physician, Anna Pou, defended herself on national television, saying her role was to “help” patients “through their pain,” a position she maintains today. After a New Orleans grand jury declined to indict her on second-degree murder charges, the case faded from view.

Pou and others cite what happened at Memorial and Pou’s subsequent arrest — which she has referred to as a “personal tragedy” — to justify changing the standards of care during crises. But the story of what happened in the frantic days when Memorial was cut off from the world has not been fully told. Over the past two and a half years, I have obtained previously unavailable records and interviewed dozens of people who were involved in the events at Memorial and the investigation that followed.

The interviews and documents cast the story of Pou and her colleagues in a new light. It is now evident that more medical professionals were involved in the decision to inject patients — and far more patients were injected — than was previously understood. When the names on toxicology reports and autopsies are matched with recollections and documentation from the days after Katrina, it appears that at least 17 patients were injected with morphine or the sedative midazolam, or both, after a long-awaited rescue effort was at last emptying the hospital. A number of these patients were extremely ill and might not have survived the evacuation. Several were almost certainly not near death when they were injected, according to medical professionals who treated them at Memorial and an internist’s review of their charts and autopsies that was commissioned by investigators but never made public.
Patients were injected with the LKP protocol drugs, Morphine and Midazolam.
"Doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have Do Not Resuscitate orders..."
Downsizing of care expectations via an elaborate grooming process of the groomer and the groomed.

A programme to limit life.

We are seeing this enacted before our eyes and blind are we to all...?

Further reading -
Liverpool Care Pathway - When The New Is Not The News

Liverpool Care Pathway - The Action Plan

Liverpool Care Pathway - A Utilitarian Pathway

Wednesday, 18 December 2013

Liverpool Care Pathway - This Is The Way It Slides, With A Slither...

This way have we trod before and have sworn not to tread again. How seductive is the box, we must open the lid to peer inside...

It is a duty incumbent upon every medical person to protect life and to do no harm. And yet, through the LCP, a policy was set in place across the NHS to make no great effort to intervene to preserve life, to let them go and even to help them on their way. Clearly, the LCP and other EoLC protocols were intended to provide legal cover to a practice that has gone on for decades, covert, unspoken and referred to, euphemistically, as TLC.

A culture of death is pervading the NHS. A dark shadow is stalking our hospitals and care homes and every facet of society. The right to death is becoming paramount over the right to life. 

Lord Davies of Stamford has said this past week - and it is on record in Lords Hansard - that, in recent years, the more usual practice has been to withdraw treatment, food and water until the patient dies...

This is the End of Life debate in the Lords 
More frequently in recent years, the patient has been referred to a hospice and there a clinical decision is taken steadily to withdraw the necessary means of life support: resuscitation, ventilation, antibiotics and dialysis will be denied or withheld. In the case of someone who was very close to me, liquids were denied. The only thing that was administered was a sufficient amount of opiate to keep the poor patient comatose, presumably on the grounds that if she was killed by an overdose of the opiate that would be against the law, but if she was killed by dehydration that would not be against the law. She actually took two weeks to die. I cannot think of a more cruel fate.
What is here being described is the LKP LCP. What has occurred in adopting EoLC Pathways is that people 'diagnosed' as dying have had their lives cut short, who would not otherwise have died.

This is the End of Life debate in the Lords. This is being freely spoken in the upper chamber of the British Houses of Parliament. This is not the Daily Fail.
At the heart of the debate there is, unfortunately, an illusion or a self-deception: the suggestion that under the present regime the medical profession does not get
12 Dec 2013 : Column 928
involved in determining the timing or circumstances of the death of its patients. In fact, as we all know, for a number of generations it has been pretty widespread practice for doctors who have a patient who is in distress right at the end of life to accelerate the process. One doctor put it to me as, “helping the patient on his way”, generally by administering a lethal dose of an opiate or perhaps a barbiturate. This is not talked about because of course it is against the law, so there is a great deal of hypocrisy here, but we should not have any illusion about the truth.
The Honourable gentleman is speaking in support of Lord Falconer's Bill being promoted by The Euthanasia Society Dignity in Dying and its charitable organ, Compassion in Dying, which has actually worked alongside Age UK in the East End.
I support the Bill of the noble and learned Lord, Lord Falconer, for three reasons. First, it would liberate the patient and give the patient a choice; it would give the patient a vote in the important matter of his or her demise. Secondly, it would liberate the medical profession from these agonising dilemmas—the conflict between the law and the duty to do the best for the patient. The third reason goes to the heart of the responsibilities of this House. The law in this country—in any country worthy of the name of a country living under the rule of law—ought to be clear, unambiguous, respected and upheld. The law in this area is none of those things in this country. The law is cruel, anomalous and nobody takes it seriously. The previous Director of Public Prosecutions said that he would not prosecute in certain cases under this law, as has already been referred to.
The Honourable gentleman speaks of 'liberating' the patient, of  'liberating' the medical profession and restoring respect for the law.

The Honourable gentleman is in grave error.

On the first count, assisted dying/euthanasia respects neither the person nor life. It devalues the person; it devalues life. Death does not liberate life; it surrenders life. On the second count, when care is responsive care, responsive to the circumstances of the individual, there is no such conflict between the law and the primacy of duty of care. The third count is cancelled out by the second count in that responsive care is always by measure and respects life, the patient and duty of care.

It is putting the cart before the horse to say that to oppose euthanasia is to deny others the right to terminate their lives. An Assisted Dying Bill places an onus on others to accept such a possibility as an option for themselves, obliged by group pressure and social disapproval and denunciation that they are acting selfishly to place the burden of care for themselves onto others and make themselves a drain on finite resources.

Once Assisted Dying/euthanasia becomes the norm - as it will should this Bill be passed - the pressure to act selflessly and to do the right thing and die will follow in its wake, sure and true. No safeguard or measure put in place will prevent this.

This has nothing to do with Right and Left; this is everything to do with right and  wrong. This is Irene Ogrizek

The elderly are the most vulnerable to the unethical use of “voluntary” euthanasia. They have financial and material wealth younger relatives may covet, and they are more likely to be nudged into this kind of “beyond hope” scenario. A little Benadryl or Dilaudid is all it would take. (Benadryl has been cited in the deaths of children under the care of unscrupulous caregivers.)

These problems will touch the rest of us. I keep hearing over and over again, from supporters of euthanasia, how “It’s my life; I have a right to take it if I want.” It’s true people have a right to commit suicide. However, what I object to is the involvement of healthcare staff. As someone who has seen abuse in the system, I do not want a doctor who believes in euthanasia. I do not want this because if I am given a bad diagnosis, he or she may push me toward it and away from a more expensive life-saving option.

And there are more complications.

Given the protectionism I’ve seen among most (although not all) doctors, I don’t think it likely Quebecers will be told which doctors are practicing euthanasia. I suspect the doctors who choose to do it will not, perhaps for reasons of safety, be putting their names out in the public sphere. Despite the fact that users of the system have a right to know, I doubt we will.

So for all the cries of “It’s my life; I can do what I want with it,” I say this: involving a doctor, a doctor in a pool of doctors we all use, contaminates and compromises their decision-making and contaminates and compromises our ability to trust them. In a sense, by insisting on your rights to such an individualistic extent, you are peeing in our pool.

Another argument I keep hearing is this: why would you insist on making someone suffer through unimaginable pain? How can you truly know what another person is feeling? Here’s my answer: I believe my mother was deliberately under-treated by a physician who tried to make a life and death decision for her. Perhaps it’s because he heard my mother had been athletic and decided she should not live out her years in a wheelchair. I suspect important procedures had been postponed — too often — because he had prioritized younger patients and de-prioritized her. Ironically, those postponements are what led to her poor condition in the end.
What is described in this last paragraph is downsizing care options. Please take the time to read the entire article; it is essential reading.

Michael Wenham speaks on Yahoo! News

Michael has some concerns about Lord Falconer’s private member’s bill in support of a change in the law. The bill would enable terminally ill adults who meet certain criteria to be able to legally take life-ending medication. The person would have to be terminally ill with six months or less to live, they would have to be mentally competent and have made a clear and settled intention to end their own life which is persistent, well informed and voluntary.

Michael feels the safeguards, are inadequate and he worries about the impact on the vulnerable and the pressure they might feel. He fears the ‘right-to-die’ may become a ‘duty to die’.
“Most domestic abuse happens within families,” he says. “Disabled people do not want assisted suicide to be legal, because they’re aware that families could see them as a burden. Now, it’s expensive to look after a disabled person if they can’t do it themselves.
“I’m concerned about the people that are vulnerable. People that might be depressed, people suffering from Alzheimer’s. There are disabled people who don’t have the resources to speak up for themselves.”

He says suicide can also leave families with a lot of mixed feelings. “Like guilt, like denial. Did I not love them enough? Did I not care enough? Did I not do enough for them?”

2013, the Chinese Year of the Snake, and this is the way our standards slide: with a slither...

This is the creeping spread of euthanasia in Belgium. In 2012, the number of recorded cases of euthanasia was up by 25% on the previous year.

In the ten plus years of euthanasia in Belgium, the number of recorded cases of euthanasia is up by more than 500% on the first full year.

This includes, this year, the euthanasia of Nathan Verheist following a botched sex-change operation. The 44 year-old grew up in a family in which she was despised for being a girl. (- Mail Online )
A culture of death is being fostered. One in five teenagers in Belgium has thought about committing suicide. One in ten has actually proceeded with the act.

There are, inherent, related dangers on this course we choose... 

This is Organ Donation Euthanasia -
Options for increasing the number and quality of organs from LSW donors
Option 1 – Changes to organ consent processes
Option 2 – Organ Donation Euthanasia: Removal of organs from patient under general anaesthesia. Death would follow removal of heart.
Option 3 – Cardiac euthanasia followed by organ donation: Euthanasia by administration of anaesthetic and cardioplegic agents. Removal of organs after cessation of circulation.
Option 4 – Neuro-euthanasia followed by organ donation: Euthanasia by occlusion of blood vessels to the brain. Removal of organs after brain death certified.
Option 5 – Organ donation prior to natural death: Removal of non-vital organs prior to withdrawal of LST.
Option 6 – Non-brain ante-mortem ECMO: Cardiopulmonary bypass to support organs other than the brain and heart prior to withdrawal of LST.
Option 7 – Reduction in asystolic period prior to certification of cardiac death.
Although there are a few jurisdictions where euthanasia is permitted, most societies hold that doctors should not kill their patients. On the other hand it is almost universally accepted that doctors may withdraw or withhold LST [Life Support]in patients who are dying or who have a very poor prognosis.

A number of countries have moved to, or are considering proposals for, opt-out consent systems for organ donation.
The Senate in Belgium has now approved measures to permit the euthanasia of children...

The Belgian Senate voted last Thursday to approve a Bill that extends euthanasia to minors. The vote went with a substitution majority of 50 votes (socialists, liberals, greens and N-VA) to 17 (Christian Democrats & V, Vlaams Belang, CDH, and MR senators Armand De Decker and Gérard Deprez).

Christian Democrats & V had another plenary submitted with three amendments, but these were rejected. The party wanted an age limit of 15 years to replace the notion of mental competence, a concept that Els Van Hoof says has neither legal nor scientific basis.
Like Pandora do we peer into the Box of Delights, intrigued, absorbed, oblivious to the dangers and evils to be let loose on the world.

Required reading -
Liverpool Care Pathway - Changing Minds

Liverpool Care Pathway - Whither Responsive Care?

Liverpool Care Pathway - It's Not the Crisis, It's What You Do With The Crisis

Liverpool Care Pathway - Of Persons and Non-Persons, Of “Worthless Lives” and “No Best Interests”