Thursday, 24 January 2013

Liverpool Care Pathway - An Act Of Infamy

It is protocol that there are 'discussions' prior to embarking upon the LCP. In practice, this may be disregarded because, really, "it doesn't matter..."

Read here -
" this Brave New 21st century, in the U.K., it appears that National Health Service Apparatchiks are  permitted to instigate a medical protocol and instruct their functionaries to withdraw sustenance and medicine from patients - whom they have themselves selected - without the patient's knowledge, the patient’s family, or even that of the GP...
Although, as the GP 'Find your 1% campaign' is rolled out and Death Lists are compiled, this process will involve and may well be at the behest of the GP!"

In practice, the LCP may be started, taken as an executive decision, wholly on the part of the medical team.

An Infamous Act

Clinicians, practitioners who have taken it upon themselves to invoke the LCP without informing anyone - as has been pointed out in these pages - are actually in line with the Mental Incapacity Act and the Data Protection Act in such cases where the patient has already succumbed to any condition of semi or complete unconsciousness. The clinician, practitioner acts in the patient's best interests. The clinician, practitioner may even - as happened in the case of my dear mum - argue that they have interpreted or understood a nuance of tone or particular indication that such and such a course is indeed a patient's indicated wish. They know; they are skilled in these matters. 

"It's my mum; I know what she would have wanted and what she wouldn't have wanted..."

"We have lots of experience. We have the training. We know how to interpret the patient's wishes."

That being the case, it is arguable and, no doubt, will be argued that the 'bad drivers' we have called to be prosecuted have, indeed, acted within the constraints of law and so it will be found by the GMC and the N&MC.

The Mental Capacity Bill

Baroness Knight of Collingtree, that stalwart campaigner for patient's rights in the Upper House, did not permit the Bill smooth passage. In these pages from Hansard, our fair lady knight does battle in support of an amendment -

HL Deb 17 March 2005 vol 670 cc1441-76
11.32 a.m.

Baroness Knight of Collingtree 
My Lords, I am very happy to support this amendment put down by the noble Baroness, for whom all of us, already, have a great admiration. I confess that I am feeling a sense of déjà vu as the debates on this Bill continue. Every time we put down an amendment to remedy what we believe is a dangerous implication in the Bill—that it creates a serious risk in some of its aspects—we are told soothingly and convincingly "not to worry—that protection is in the Bill already".
Whether we are trying to ensure that suicide by advance decision does not happen, or we are trying to help those with conscientious objections by making it certain in law that their rights would be protected, or whatever protective measures we seek to make, the answer is the same. We are told, "There is no need for this amendment. The Bill will not allow any diminution of patients' rights or the rights of those who care for them". Yet we can never be certain that that is correct because it is never on the face of the Bill.
I have an unhappy feeling that the same anodyne dose will be offered to this amendment. As I have said, I have no wish to endanger the Bill by speaking at length. But if we do not speak now, when can we? Those of us who see and feel the dangers ahead have a clear duty to seek to shield patients from the pain that we have already seen many suffer.
When I introduced my Patient's Protection Bill, I did so because I had such a wealth of shocking evidence that sick people in NHS hospitals were being deliberately denied food and liquids and were dying because of it. Sometimes the food and liquids were deliberately put out of the patient's reach. I am not making those stories up: there is ample evidence for them.
The Government blocked the Bill but a Government Minister, the noble Lord, Lord Filkin, who was responsible for the Bill, assured me when I sat on the Select Committee which studied it, that the matter would be addressed in this Bill. Therefore, in earlier debates, I have not unnaturally sought to be sure that it provides the safeguards which really are so desperately needed. But, yet again, the soothing syrup which so effectively clogs the wheels of action is offered in large spoons.
We are told, "There is no need for this amendment. Such treatments as withholding food and liquids, putting them out of the patient's reach or failing to make the patient comfortable by moistening his dry mouth, are already covered by good medical practice. No hospital would act in this way".
If all that is true, why, under these present rulings, which have been referred to so specifically and so frequently, have we so much evidence from patients, their relatives, MPs and public figures who have seen it for themselves, as well evidence from television programmes, newspaper reports and even doctors and nurses? Why does it go on if it is already illegal? That seems a perfectly fair question. When Nelson said, "I see no ships", his motive was brave and noble. But when the BMA pretends that those things do not happen, it fear that I cannot ascribe to it—although I admire that profession greatly—the same noble intentions.
I am getting quite used to being told that amendments are unnecessary. The only reason that this one is in that category is either a belief that all evidence is illusory or that we can afford to turn our hacks and close our eyes on people who are suffering. Years ago I would have accepted without question that doctors would always do everything possible to help their patients, to keep them alive if possible, and to keep them comfortable. I still admire doctors, but that old belief has gone. I do not believe it any more: how can I, with all the evidence against it?
I understand that newly trained doctors do not now affirm the Hippocratic oath, which put the patient's care as a priority. They no longer sign automatically that the duties of a doctor mean also taking on the content of that oath. Whatever unwritten laws there may be in the medical profession's rule book, in the name of patients we must face the facts of evidence and try to get this amendment in the Bill.
11.45 a.m.
Julia Quenzler, a famous court artist at the BBC, witnessed her mother being sentenced to an agonising death by thirst as a result of doctors depriving her of water. She said that her mother would give a firm nod when asked whether she wanted a drink of water, but the water never came. She states: My mother was not seriously ill when she walked into hospital. In fact she was a relatively healthy woman with a relatively common problem. Six days later she was on her deathbed". She went on to state that she did not know what more she could have done, apart from abseiling off the hospital roof, to bring attention to her mother's needs. She said that she, literally begged [the doctors] with my hands pressed in supplication. I don't know why these doctors did what they did. In the absence of any plausible explanation, I can only conclude that they considered my mother an expendable nuisance".
The examples I give are all cases that have come to my notice since my Patient's Protection Bill failed to become law. A nurse, Pat Tyler, said in respect of her mother: She must have died thirsty … she must have been dreaming of cups of tea, of rivers of water. They should not have taken the water away from her". But they did.
Nurses at Kingsway Hospital in Derby have claimed also that their patients were dying of thirst and that they were not given water or drips. I have added all those cases to my large pile on the subject since the last time we debated this issue.
It is undeniable that whatever rules may govern medical procedure, they are not sufficient to stop the cruel things which are going on. Do we want to stop them? I hope that we do. Do we accept that it is wrong? I hope that we do. If so, the remedy is now in our hands to take action. Agreeing the amendment would make it clearly law that patients must not be treated in the way in which they have been treated in the past, and the amendment in the name of the noble Baroness, Lady Chapman, is the answer.
Of course, we recognise that in some cases providing food and liquid might harm the patient. Peers will observe that the amendment does not disallow the stopping of nutrition where that danger exists. The noble Baroness has been very careful about that. We cannot fail to agree the amendment if we want patients to receive the very first necessity, which is usually for comfort and well-being, but always for life.
Finally, I must express the profound hope that the other regular formula against amendments—that is, that they will wreck the Bill—will not be made in this regard. This amendment will not wreck the Bill. It will save the lives of many patients.

These ill-thought out Acts of conflict need to be addressed in a court of law and that is the place where these 'bad drivers' should be judged, not behind closed doors, but under proper scrutiny and in the spotlight of the public gaze.

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