Tuesday, 28 May 2013

Liverpool Care Pathway - Peeling Back The Layers Of Belief

When the tide is sweeping you away, should I even attempt to save you when the act of doing so is futile...? Is that even a morally justifiable question?

In the State of Washington, they are teaching doctors how to downsize care.

In the State of Washington, they are teaching doctors how to approach their discussions with patients.

They are being trained to groom patients to refuse life positive treatments.

This is a toolbox of teaching resources from Washington University for medical educators.

- Tough Talk

The Faculty must peel away the layers of resistance. The Learners must make themselves a blank page upon which the tutor may write the script...

  • Old habits are hard to break. It can take multiple discussions and attempts before the learner is able to let go of current beliefs and practices. Experiencing success will be the best reinforcement in this case.
  • Old models are pervasive. A learner is likely to be surrounded by others who also hold beliefs regarding DNR discussions as legally necessary. Developing the learners' confidence with the new approach will be the best way to have them become effective role models within their programs.

This is akin to L Ron Hubbard. This is akin to Maoist re-education.

When the call goes out to launch the lifeboat the RNLI volunteer crew do not falter but risk their lives to do all they can for as long as they can to accomplish a rescue.

In this learning module, the Learner is made aware to not offer choice, but certainty –

F: But you presented her with a choice.
L: Right [pause] And I guess you’re saying that that’s, uh…
F: Well, you know, you don’t really think in your heart of hearts that it is a choice. You really want to make strong recommendation. You don’t really think that one side of that choice is going to make any sense given where things stand. So, it is really not a choice in your mind. You presented it as there are two ways we can go. You certainly gave a recommendation, you said…
L: I didn’t really present, I gave a soft opinion rather than a strong opinion.

Other learning Modules in the toolbox include denying ‘futile’ therapies

The focus is on how to appropriately phrase what needs to be said to accomplish the desired outcome and to engage the patients and families in that decision process.

The focus is on how to downsize care expectations, but...

When the alternative is death, every option becomes an alternative.

Refusing or denying 'futile' treatment is seen as permitting death to occur in an 'appropriate' way; it is said that this is not the same thing as causing that death and, therefore, is not euthanasia.

Is such an ethical stance actually unethical and morally reprehensible?

The argument that a passive stance of omission does not have that causality of effect as the active stance of commission does not really stand up to scrutiny,

In fact, in plain language, to do nothing is indistinguishable; it is an act of euthanasia by omission.

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