Liverpool Care Pathway - Should Doctors Play God?

What is the Liverpool Care Pathway about? 

This is The Big Question -

Dr. Richard Hain –
The principle of is that there is a point in the life of a patient when we know when… when they are going to die. We may not know it with absolute certainty. We’ve already talked about how human beings find certainty desirable but we can’t always have it. If we wait until we are certain, we miss the chance to care for them over that time.
Nicky Campbell –
So, it’s about not prolonging a life unnecessarily.
Dr. Richard Hain –
Not prolonging or hastening it.

This is Julia George asking, Should doctors play god?

If you were in hospital would you be reassured or terrified to know that they can hasten your death?

Not prolonging or hastening it...? Quite clearly, this is euthanasia. To anyone who has eyes to see, this is euthanasia.

This is BBC Radio Kent -BBC Radio Kent

Julia George

05/03/2013              

First broadcast:

 

Tuesday 05 March 2013

   09:00

Tue 5 Mar 201309:00BBC Radio Kent

Transcription follows -

Julia George -
Should doctors and nurses ever play god? We need to talk about this. Dispatches last night; our local news last night; our breakfast show on BBC Radio Kent this morning; all talking about people dying in hospital - Dying in hospital because somebody has decided that it would be kinder; it would be appropriate, for whatever reason, to hasten their death, by withdrawing fluids, for instance, by withdrawing food, by withdrawing some of the drugs that are keeping them alive. Should that ever happen? Is it kind, or is it cruel?

You heard in the news bulletin there with Rosemary the case of the 71 year old man from Kent who was in the Kent and Canterbury Hospital with pneumonia, weekend staff basically started to withdraw treatment without consulting the family, which enraged the family, and a consultant on the Monday morning came in and said, What are you doing? This shouldn’t be happening. The patient went on to live for another 14 months. Was it a one-off mistake? Or is it happening more often? Should doctors ever try and play god, can anyone ever really know that we’re dying, forecast our death, and try to bring it forward for our own benefit? Is it cruel, or kind to allow someone to pass away more swiftly?
Should doctors ever try and play god? Can anyone ever really know that we're dying, forecast our death and try and bring it forward for our own benefit? Is it cruel, or kind, to allow someone to pass away more swiftly? If you were in hospital and you were seriously ill, would you be reassured or terrified to know that they can hasten your death?

That question again: Should doctors and nurses ever play god? If you were in hospital would you be reassured or terrified?

Joyce in Stroud is our first caller this morning. Joyce, welcome to the Big Phone In. Thankyou for taking part. This is going to be a difficult one to talk about when it's close to you, but I'm really grateful. It was your brother, wasn't it, Joyce?                                                                                                                                           

Joyce -
It was, yes.

Julia George -
Good morning to you...

Joyce -
It was my brother. It'll be three years this year.

Julia George -
And how... what was wrong with him? How was he poorly?

Joyce -
Parkinsons. And em, his legs were swollen. When he... He went in for swollen legs, and... because, you know, he had a job walking around.

Julia George -
Yeah.

Joyce -
And the way he was treated in that hospital, I don't ever, ever [voice breaks with emotion] I'm sorry...want to go in there. They left him. They took everything away from him. They didn't tell us what they were doing. And er, he just laid there for a fortnight dying. He was on that plan. That's not, that's not riight. You wouldn't let a dog die the way he did.

Julia George -
Did they tell you that he was on...?

Joyce -
No, no...

Julia George -
Okay. How did you realise that, I mean, had they withdrawn some of his treatment? Were they feeding him, giving him...

Joyce -
They'd taken everything away. They took his drip, they took his medication. They wasn't feeding him. I went in one night, one teatime, and his food was on the side and I said, to one of the nurses, can I feed him, because he couldn't swallow again No, she said, because if you do he might choke.

Julia George -
And they hadn't put a feeding tube in or anything?

Joyce -
Nothing, nothing, they just took everything away.


Julia George -
Was he able to talk to you?

Joyce -
No, no, he was more or less unconscious. His eyes were wide open, his mouth was wide open. In..inside his mouth was black. Asked me to see if I could get some of the stuff out of his mouth. I, do you, I never seen anybody die... I seen my mum die of cancer, but not like that.

Julia George -
Were you able to put some moisture in his mouth, to keep his mouth moist for him? 

Joyce -
No, no, they never give us anything. He just lay there and then, one day, I looked at his sheet and I said, what's that? I pulled his sheets back and he was absolutely soaked.

Julia George -
It's not just a question of allowing him to die, it's the, sort of, lack of care by the look of it...

Joyce -
Well, it was terrible, terrible... I'm still crying over it.
[Joyce weeps]

Julia George -
Was he ready to die?

Joyce -
No, no he was not. I mean, the day he went in, the consultant he was under,,, He had a job to walk, and he said, come on Mr. Kent, you can walk. And my brother said,  no, I can't. And he said, I'm sorry. So, he got hold of him, he pulled him along; in the end, he knew he couldn't walk, the consultant saw he couldn't walk, so he put him down in the armchair. Now, we went in one day, he was in the armchair, he was nearly on the floor because nobody was there attending to him. And I ran to her and I said to the nurse, look Mr. Kent, he's nearly on the floor. he's sliding out the chair, and that's how they left him. But, what is, you know, we can't get over the way he died. I mean, my son, he went with him every night because I didn't want him left. He went and sat with him every night. And he was a fortnight dying like that. And em... I said to my son, I'm not ever going into a hospital...

Julia George -
What, what are you frightened of, Joyce?

Joyce -
[Sighs] Terrified...

Julia George -
What do you think happens to elderly people in hospital?

Joyce -
I think, I think what the trouble is, they're fed up with us old people. I'm 80 myself and If I get an illness, I'll tell you what I'm not going into hospital, I'd jump off a bridge first; I'm not going in and give them the satisfaction that they've killed me.

Julia George -
You know there are some wonderful doctors and nurses, don't you?

Joyce -
[Sighs] Yeah, where? Where?

Julia George -
You've completely lost faith in the medical profession?

Joyce -
I have. I mean, I watched that programme last night. That tried to help me understand. I mean there was one bloke there, he didn't agree with it. i didn't know whether he was, if he was a consultant or... He didn't agree with it. Why do they do it to us?

Julia George -
Do you think there's ever an excuse, if somebody's in terrible pain and..

Joyce -
He was not in pain, though...

Julia George -
No, no...

Joyce -
He was not in pain.

Julia George -
So, if somebody was. Is there ever an excuse for doing this?

Joyce -
Well, I say, if er, you know, they've only got a few days to live, but my brother, he wasn't ready to die. If you'd seen him, you would have agreed yourself. He was, he was, you know... It was just what they'd done to him

Julia George -
And we're supposed to trust the doctors, aren't we?

Joyce -
No, I don't trust any doctor. I wouldn't trust... there you are, put it this way, I'm never, never going to a hospital.

Julia George -
Joyce, thankyou for calling us this morning. Ta/ke care of yourself, won't you

Joyce -
Yes. Thankyou very much

Julia George -
Take care. Joyce in Stroud. Dorothy's in Maidstone. Dorothy, has that brought back memories for you this morning listening to Joyce.

Dorothy -

Mine is a different case, actually. Em, he'd never been in hospital, really, he was quite a good going man. He was getting... he did have emphysema when he died, but em, he kept falling, he fell over twice, once, and er Barbara said, why don't you get him assessed, mum? So I said okay, then. So we brought the doctor up and a doctor we'd never seen. And she said go onto my phone... And I said , how long will he be gone? An, Oh, she said, only two days. She said just pick enough stuff up for two days. And I said, alright? And he said yes and he'd just had his tea. And they went out in the ambulance, and my neighbour came out, and he said, See you later, and, well, that was it. I went up the next day. They'd got him on every drip you could find. And I went back to my Barbara and I said do you know he’s going to die. Quite upset I was at the time and er…

Julia George -

Did they, someone told you that or did you just think that when you saw him… 

Dorothy - 

Yeah, I imagined it, because he went away, he’d just had his tea – he loved his tea – and em, he was talking and chattering and to the doctor who said would you like to go in for a couple of days. And he looked at me and I said it’s up to you Ron. He said okay then, he said, I’ll see what’s wrong making me fall over. And when I did go in next morning, I thought  I don’t see him, because I was so shocked. She said, what’s wrong. I said, what’s wrong with him, I said, you’ve got everything on him you can find…

Julia George -

And what was wrong?

Dorothy -

Well, em, actually I never did find out. Because,em, I said, I said to somebody… and next day, now take this. Next day I went in with Barbara, of a night-time, and he was out of bed sitting up. We found him his dressing gown. He said where’s Barbara, Dorothy, I said she’s just gone to find your slippers. So, I gave him some sweets, and I said…

Julia George -

That must have been very reassuring to come back and find him sitting up?

Dorothy -

Yes, yes, and I should have took him home that night because a nurse came along and said we can’t get him to take his medicine, not for us, she said and he ought to take this pill. So I said shall I take you the pill, Ron, and he said, alright, Dorothy. Well, I shall never live that day out because I’ve always said I gave him the drug. Are you with me?

Julia George -

So, because…

Dorothy -

The next day, he didn’t know anybody. And from then on, he was sort of laying in that bed, struggling, and I said, have you fed him? And she said yes. There were two yoghurts on the bottom of the bed, never been used, never been used, and I went to the sister and I said, what’s the matter with Ron. She said, well, they ought to have told you. He keeps getting out of bed, she said, he’s a nuisance. She said we’ve got to do something. Serves you right. Anyway, we kept going up to see him, and they put a mask on his face and said he couldn’t breathe through it. Well, my daughter went to undo that mask, and it was so tight. Anyway, we managed to undo it a bit for him. And then we got taken into the office about saying that em he hadn’t got long to go. And I said what do you mean he hasn’t got long to go? I said he was alright when he came in. So, he said, a couple or three hours, And I said, oh. And he was saying something about a pathway to death, they called it?

Julia George -

Yes, that’s right.

Dorothy -

Well, I said, are you in charge, I don’t want to know nothing about this I said cause, as far as I’m concerned he should be with us. And I should have taken him home that night, shouldn’t I? Anyway, we left it that they had spoke about it and they said, alright then you know about it. So, we came out and, er, went home and, and em, spoke about it, and we didn’t do any more because we didn’t, when we went back again, he was out, just out of it, could not talk to me whatsoever…

Julia George -

Did, did your daughter say it was okay to put him on this pathway?

Dorothy -

No, no, we were both together as it was explained to us, you know, and em, anyway, when we finally went, oh, it must have been a week or more and I said if he was going to die, he’d have been dead by now. And it must have took a week or more. And one day we went in and everything had gone, everything was quiet, and we said what’s going on here? There wasn’t a thing going on him, not a thing. So, obviously, what they had done, they had taken everything away, unbeknowing to everything what was going on, ready to die.

Julia George -

What did he die of?

Dorothy -

Well, in the end, they put down, pneumonia, emph… and blood poisoning, where he got that from, I don’t know.

Julia George -

But, as far as you’re aware, he didn’t go into hospital with either of those conditions…

Dorothy -

No, no. No, no, no. He’d been a very fit man. As far as I was concerned , apart from emphysema…

Julia George -

Joyce says she… Sorry to interrupt you, darling. Joyce says she doesn’t trust doctors. She would rather throw herself under a bus than go into hospital. How do you feel?

Dorothy -

Any… Anyway, he finally passed away in the early hours of the morning and I said, can I see him, and they said, no, not for two days, so they were doing something and I said what the hell are they doing that I can’t see my husband now he’s dead? So, I went to take the children to see him in a chapel of rest, okay? And you know what, the man said to me, be careful when you go in, and when we went in, his mouth was as wide open as you could find, nobody had been with him and hadn’t closed his mouth up. So what do you think about that?

Julia George -

Dorothy… Dorothy, what do you think…

Dorothy -

Horrible.

Julia George -

about hospitals and doctors…

Dorothy -

Horrible. I think they are, well, I don’t think it should happen. Patients should be allowed to die on their own. He always wanted to die at home and he would’ve done. No way should hasten death in any way, I don’t think so, anyway.

Julia George -

Dorothy, thankyou very much for your call. What do you think? Should death ever be hastened? Can somebody ever be in so much pain and so close to the end of their life anyway that it is kinder to withdraw the treatments that are just keeping them going and suffering? If you work in a hospital, how would you defend yourself, your profession against people like Dorothy and Joyce who have been frightened and disturbed by what they have seen happen to  their elderly loved one? Should doctors and Nurses ever play god. Has someone in your family been allowed to die in hospital? Were you asked if it was okay to withdraw certain elements of their treatment? Were you told they were dying and that they were on some sort of pathway? Was that language used? Is it cruel or is it kind?

To be continued…

These are My Lord, Earl Howe's anecdotal people. This cannot continue.