Tuesday, 5 March 2013

Liverpool Care Pathway - Obliged By Obligation!

An Address to The Honourable Gentlemen of the Bench (with apologies to Ben Franklin)

May it please the Honourable Bench to indulge me a few Words: I am not at all acquainted with a thorough knowledge of the law such as your good selves. Indeed, I am of but humble origins and, may I say, proud of it. I shall not trouble your Honours with long Speeches; for I have not the presumption to expect, that you may, by any Means, be prevailed on to deviate in your Decision from the Law, in the Trust's Favour. All I humbly hope is, that your Honours would charitably move to place a Bearing upon the Trust to supply sincere apology for the damage they have committed and permit Appeal to proceed to the Goodness on their Behalf, to that Highest Court in the Land where sit the Noble Lords that this decision may be rescinded and rightful purpose served.

Laws are sometimes unreasonable in themselves, and therefore repealed; and others bear too hard on the Subject in particular Circumstances; and therefore there is left a Power somewhere to dispense with the Execution of them; I take the Liberty to say, that I think this decision, by which the good family of Mr. James must suffer further ordeal and discomfiture, is both unreasonable in itself, and particularly severe with regard to the Barracking upon the Net that has pained them and grieved them above and beyond that grief that Death must bring. Debauch’d and ignoble swain of these Vile Doctors have caused this family insult such that Mr. James had lived too long, so said they, and that may he rest in peace. Depraved and Base are they!

This family have always lived an inoffensive Life in the Neighbourhood where they were born, and defy their Enemies (if any they have) to say they ever wrong’d Man, Woman, or Child. Abstracted from the Law, I cannot conceive (may it please your Honours) what the Nature of your deliberations were that this Judgement entered into.

It has been the Much Respected determination of 
the Honourable Bench that the Good Doctors are not obliged to prolong life. I cannot conceive (may it please your Honours) what an injustice it is that has been wrought at your hands in this respect. The Good Doctors, you say, are not obliged but, say I, although lacking in the legal propensities, perhaps, to say so; the Good Doctors by virtue of the great wrong incurr'd Mr. James in causing great mal-afflictions to befall him in their care, had obligation placed upon them thereby; a Higher Moral Law commanded them, by redress,  to press and to persist with those attempts to assist Mr. James in the struggle for his life.

I appeal to your Honours. You are pleased to allow, I trust, I don’t want Sense; but I must be stupid to the last Degree, for is not every intervention by these most able Doctors, sworn by goodly Oath to protect life, intention'd thereby, to prolong life at all costs? Were it not so, I say, every febrile miasma and bad air of whatever sort they would permit to reign among the Populace; to take the firm and the feeble, the mother and the child; yet they do not, perforce, so do. Then, why say you thus? May it please the Honourable Bench to be so advised: the Good Doctors, duty-bound by Oath so they are, did permit Mr. James to fall into harm's way whilst in their care and to contract such mal-afflictions that brought him to his sickbed; thence sought they to cover up a wrong with a wrong, that Mr. James' life was not a life worth living.

Mr. James was caus'd to become sore afflicted in their care; the Doctors, doubly sworn, by Oath and by that Higher Moral Law to set right a vile neglect on their part, yet did further disservice; though it were within their power to do so, they did not revive him; vile criminals they have revived, purged with guilt for taking life most cruelly, but the life of an inoffensive gentle man who never wrong’d Man, Woman, or Child is dealt with thus; and therefore ought, in my humble Opinion, instead of a verbal Whipping at the Bench, to have a Statue erected to his Memory.

This is BBC News [4 January 2013] - 
When his heart stopped beating on New Year's Eve, doctors at the hospital he had been taken to - which cannot be named for legal reasons - did not resuscitate him.

The hospital trust was exercising a right it had won in court. But the family believes that was not a doctor's choice to make.

"I told the doctor, 'you think you're gods but you are not'," said Mrs James.

"And there is no doctor on this earth who can predict when a person is going to die."

Her daughter Julie added: "Where there is life I think doctors should do everything they can to preserve life."

Mr James, 69, was a talented and fit musician who had been performing two nights before he fell ill in May last year when he was admitted.

He contracted an infection and his condition worsened. He eventually suffered kidney failure and brain damage

The trust then decided it would not be in his best interest to resuscitate or treat him for his kidney condition.

May James
May James fears her husband's case could set a precedent
Mr James's family, who are from the north west of England challenged this in court but the trust maintained: "The burdens of administering this treatment outweigh the benefits as there is little prospect of any meaningful recovery and therefore such treatment is futile."

May James fears her husband's case could set a precedent
The Appeal Court agreed with the hospital early last month, ruling that it was acting in Mr James's best interests and praised the care he was receiving.

"Who has the right to judge anybody's quality of life?" said Mrs James.

But his family argue that even at the end of his life he was waving and smiling and would have wanted to live.

This is The Telegraph -

Judges rule that doctors are not obliged to prolong life 'at all costs'
A desperately ill man to die after Appeal Court judges ruled that doctors were not obliged to prolong life at all costs or to “needlessly prolong dying”.

6:41PM GMT 01 Mar 2013

The “deeply unhappy case” resulted in the death of David James, 68, a retired musician, on New Year’s Eve, seven months after he was admitted to hospital.
His wife May, 67, and daughter Julie, 48, took on an NHS trust in a legal bid to keep him alive but ultimately failed to convince the court that he should continue to be given life saving treatment.

Sir Alan Ward said that in reaching his decision, he had to take into account the “virtual certainty” that Mr James would never have left intensive care, that he would always have been reliant on a ventilator and that he would continue to fall victim to recurring infections.

“The harsh reality, so harsh that it was understandably impossible for the family to accept it, was that his position was hopeless,” he said.

The judge accepted medical evidence that Mr James’s life would have become “quite intolerable” were he to survive a further setback.

Aintree University Hospitals NHS Foundation Trust launched a rare legal action against the family last summer, seeking permission to withdraw potentially life saving treatment from the grandfather on the grounds that the suffering it would cause would outweigh the slim chance of recovery.

Mr James was first admitted to hospital last May, suffering from what he believed was constipation.

However, three weeks later, he was on a ventilator having contracted pneumonia and blood poisoning. He subsequently suffered multiple organ failure and became entirely dependent on life support.

Despite being treated with a range of antibiotics, he contracted a chronic infection about twice a month and suffered brain damage.

As he continued to deteriorate, the trust saw no option but to take the family to court.

Mrs James, a civil servant, insisted that, although her husband could not speak due to a tracheostomy, he had shown an interest in family events, news, music and the radio.

The court heard that he held his son's hand, kissed his wife when she leaned towards him and watched her as she moved around his bed. He smiled and laughed when sung to and mouthed 'yes' when asked if he was a good singer.

Mrs James said he had been "very alert" when they celebrated their golden wedding anniversary together at his bedside in September and described an incident when he appeared to try to get out bed when a friend joked that they should go out for a pint together.

The family won its case but the trust appealed. In an emergency hearing just before Christmas, three appeal court judges overturned the ruling and allowed doctors to issue a "do not resuscitate" notice. Mr James had a heart attack and died 10 days later.

Publishing the reasons for his decision, Sir Alan accepted the trust's plea that further treatment would have been "futile" and that there was "no duty needlessly to prolong dying".

He said: "There is no duty to maintain the life of a patient at all costs. There is no duty needlessly to prolong dying.

“(Mr James’s) wishes, if they were to be the product of full informed thought, would have to recognise the futility of treatment, that treatment would be extremely burdensome to endure, and that he would never recover enough to go home.

“All this would be extremely distressing for his family. One is driven to conclude that his wish to survive was unattainable. Miracles may happen but on the facts of this case the probabilities were overwhelming against a miracle happening in this case.”

The judge paid "respectful tribute” to the family, whom he said had won the court’s "admiration" for the devotion they showed to Mr James.

Raanan Gillon, Emeritus professor of medical ethics at Imperial College London, described the judgment as a “welcome breath of common sense” that recognised the limits and underlying objectives of medicine as well as the various ways in which medical interventions could be regarded as “futile”.

He noted that the main aim was to produce benefits for the patient with as little harm as possible.

“The appeal judge showed welcome appreciation of the medical evidence by straightforwardly accepting it, in flat opposition to the first judge's view,” he said.

A transcription document of THE COURT OF APPEAL (CIVIL DIVISION) hearing on appeal from the Court of Protection may be read here.

1 comment:

  1. I thought the patient and/or the family were supposed to be involved in these kind of decisions. It seems not, and this is another example of the slide down the slippery slope to euthenasia without consent.