Wednesday, 27 February 2013

Liverpool Care Pathway - The LKP Can Deliver.

In the beginning was the Find Your One Percent Campaign...

And GPs have a surfeit of guides available now to assist them in their search to hunt down their 1%...
Macmillan Quick Guide

There's the EoLC 1% GP Pack Folder full of useful weblinks; an EoLC One Percent 'Top Tips' guide which shares the Dying Matters logo.

There's the Six Steps To Success, of course.

Even Macmillan have got in on the act with a 'Quick Guide'.

Who needs euthanasia booths when you can keep them grinning on a fast-track to the grave?

The British public have been groomed to accept death and dying as a positive life choice for many years now. This shows up in many of the comments posted on newspaper columns.

The 'Six Steps' is the North West end of life Care Model. GPs are advised -

Ask yourself

• Can you identify those in your care who are approaching the end of life?
• Have you noted triggers that might indicate it is an appropriate time for discussion?

Your role

• Recognise when a patient’s signs and symptoms have increased or his or her condition has deteriorated
• Ask yourself: “Would I be surprised if this patient were to die in the near future?”
• Identify those who need to be receiving end of life supportive care
• Remember to take into account triggers such as recent changes in circumstances.

Triggers could be the death of a spouse, increase in hospital admissions or a change in care setting, e.g. a move from a residential to a nursing home.


Care Home staff, GP practices, those in the community, will be supported by an End of Life Care Facilitator from the local area who will deliver the Six Steps to Success workshops and provide support and education to all staff.

Psychometric Testing 

There's even psychometric testing on hand via the Dignity Care Pathway (DCP).

The DCP "was acceptable to the community nurses, helped them identify when patients were at the end of life..." [Evaluation of the Dignity Care Pathway for community nurses caring for people at the end of life]

"Nurses identified that using the DCP allowed them to reconsider which patients required palliative care. In line with Scottish Government (Scottish Government 2008) policy, this study encouraged nurses to consider approaching any patient who the nurse considered was in the last months of their illness, regardless of diagnosis, and including the frail elderly."
[PAGE 12 - QNIS Project Report]

"The community nurse makes a prognostic, clinical judgment to decide when to start a patient on the DCP..." [Dignity in End-of-Life Care]

Martin Amis has said previ
ously (The Telegraph) that euthanasia is 'an evolutionary inevitability' and that the 'primitive' Christian notion of the 'sanctity of life' is holding back debate on assisted suicide.

And now, lo and behold, having found their 1% who have less than a year to live, it is proposed that GPs have an additional option to offer (on top of the LKP)...

This is the Telegraph -

Allow assisted suicide for those with less than a year to live

Doctors should be allowed to help terminally ill patients kill themselves – but only if they have less than a year to live, under proposals published in a major report today.

7:30AM GMT 05 Jan 2012

The independent Commission on Assisted Dying, whose members include several prominent peers and medics, wants GPs to be able to prescribe lethal doses of medication for dying people to take themselves.
The report, published today, calls for the “inadequate and incoherent” law against assisted suicide to be scrapped following a series of high profile cases where patients have used the Dignitas suicide clinic to take their own lives.
Although helping someone to die is punishable by up to 14 years’ imprisonment and police still investigate all cases, there have been no prosecutions since landmark guidelines were set out almost two years ago.
The Commission says the situation is “very distressing” for families, “uncertain” for health workers and place a “deeply challenging burden” on police and prosecutors.
Under its plans, doctors would be allowed to prescribe drugs to end the lives of terminally ill patients who have fewer than 12 months to live provided they are judged to have the mental capacity and clear desire to die.
If implemented, it could mean more than 1,000 people a year being helped to die in England and Wales.
The year-long inquiry admits legalisation would create a “real risk” of pressure on vulnerable people to end their lives, either from family members or a sense that they were a burden on society.
It says that to safeguard the vulnerable, disabled people and those suffering from dementia or depression would not qualify for help in killing themselves.
It also recommends that two independent doctors’ opinions are required before deciding that a patient should be entitled to assisted suicide, and that they should have a “cooling off” period of up to two weeks before being given the drugs that they must take themselves.
In addition, the report calls for better end-of-life care in hospitals and hospices across the country, as well as more open discussion about death.
The final report of the Commission, chaired by the former Labour minister Lord Falconer, concludes: “There is a strong case for providing the choice of assisted dying for terminally ill people.
“Even with skilled end of life care, the Commission finds that a comparatively small number of people who are terminally ill experience a degree of suffering towards the end of their life that they consider can only be relieved either by ending their own life, or by the knowledge that they can end their life at a time of their own choosing.”
Its recommendations are likely to be discussed in Parliament, with one of the commissioners, the Tory MP Penny Mordaunt, calling for a Westminster Hall debate rather than a Commons vote.
She added: “I think if it was a motion asking the Government to consider the Commission’s report and was limited to terminally ill people who met the criteria, I think you would get a much more positive response.”
No political leaders have publicly backed scrapping the law, not least because it would prompt claims that the Government wanted to kill off the elderly and ill at a time of cutbacks in health and social care.
Yet polls suggest that public opinion is moving towards a change, particularly among those who have watched loved ones suffer in their final days. A new survey highlighted by Dignity in Dying found that 61 per cent of people questioned would want Parliament to debate “the issue of Britons travelling abroad for help to die”.
There is also widespread agreement that the current regime in England and Wales, under which assisted suicide is illegal but perpetrators are not prosecuted if they act out of compassion, is unfair.
It favours those people with the money or practical support to travel to places where the practice is allowed, such as the “suicide clinic” Dignitas in Switzerland, while the poor or physically disabled are often reduced to botched suicide attempts at home.
Grieving relatives, and health workers who may have discussed suicide with patients, must deal with the threat of arrest and prosecution.
The new 415-page report, published on Thursday, represents the first detailed model of how a relaxed system could work.
It would allow assisted suicide to over-18s with less than 12 months to live, who have the mental capacity to decide to die and who have not been coerced into it.
This would mean that Debbie Purdy, the right-to-die campaigner who has Multiple Sclerosis but is not terminally ill, would not qualify for help, nor would Daniel James, the paralysed teenage rugby player who chose to end his life at Dignitas rather than live a “second-class existence”.
Sir Edward Downes, the former BBC Philharmonic conductor who died at Dignitas, would not have been given help to end his life but his wife, who had terminal cancer, would have been.
It would mean a regime more like that of Oregon, where “physician-assisted suicide” is allowed for those who have less than six months to live, than the Netherlands, where children as young as 12 are eligible for euthanasia, as are those experiencing “unbearable suffering” rather than a terminal disease.
Police would still be able to investigate cases where the criteria were not met.
The new proposals place much of the responsibility on doctors. They would have to check that a patient was eligible, tell them about possible treatment for their condition, ensure the lethal prescription was delivered safely, be “on hand” during the death, provide bereavement services to relatives, co-operate with police and give data to a national monitoring service.
But many medics fear it would compromise their relationships with patients and their duty to preserve life, with one expert telling the Commission: “The health service is not the environment for a death service.”
A spokesman for the British Medical Association, the leading doctors’ union, said: “"While there is a spectrum of views on assisted dying within the medical profession, the BMA believes that the majority of doctors do not want to legalise assisted dying.”
The Commission itself has faced accusations of bias as it was funded by Sir Terry Pratchett and chaired by Lord Falconer, both long-standing supporters of assisted suicide.
Several organisations, including the BMA, declined to attend its evidence hearings.
Dr Peter Saunders, Campaign Director of Care Not Killing said: “These recommendations if implemented will place vulnerable people under increased pressure to end their lives so as not to be a burden on others. This pressure can be especially intense at a time of economic recession when families and the health service are already feeling the pinch. The so-called right to die can so easily become the duty to die.”

No, nothing so crass, surely; after all, with all the EoLC Pathway options available, it is just not necessary:
"Euthanasia is rightly illegal, and not necessary with good end of life care that we hope to deliver across Swindon in 2012 and into the future." - Dr Eric Holliday GP at Eldene Surgery. [swindon link]
It's "not necessary..." The LKP can deliver.

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