Sunday, 26 May 2013

Liverpool Care Pathway - The Shadows That Precede

Pathfinders for change test the water and push the boundaries. Thus are rules tested and modified and does the evolution of ideas proceed.

This is the LCP...
The GSF Prognostic Indicator Guidance
1. The Surprise Question: ‘Would you be surprised if this patient were to die in the next few months, weeks, days’?
2. General indicators of decline - deterioration, increasing need or choice for no further active care.
3. Specific clinical indicators related to certain conditions. 
This is Dr. Jane Barton, LCP Pathfinder...
Dr Barton saw a change in Mrs Richards.She said: ‘There was a marked deterioration, she was dying.‘She was being unresponsive, she was not eating or drinking.‘She had a haunted, harrowed expression.‘She just wasn’t just frail, she was dying.’On August 18, it was decided Mrs Richards would be given diamorphine.Dr Barton told the court the syringe driver was ‘not the act of promoting or hastening death’ or the ‘instrument of death’.Mrs Richards died on August 21, the cause of death was put down to bronchopneumonia.Dr Barton said the use of the syringe driver did not impact this.
 - The News
Distancing doctors from their patients' deaths -
New guidelines for NHS nurses –

Nurses will be able to decide that a dying patient should not be resuscitated.Guidance issued by the British Medical Association will allow 'suitably experienced nurses' to make this crucial decision.The rules, published by the BMA in conjunction with the Royal College of Nursing and the Resuscitation Council, aim to help medical staff decide whether to resuscitate patients if their heart or breathing stops.It says medical staff should use their judgment over whether there is any point in using the most common resuscitation method - chest compression, or 'cardiopulmonary resuscitation'. The RCN said only consultant nurses or senior nurses who have a supervisory role would be able to make these decisions.General secretary Dr Peter Carter said: 'This joint guidance recognises the important part that nurses play in decisions related to resuscitation.But for the first time, this includes 'suitably experienced nurses'.In the past, nurses faced with such a situation would have carried on until a GP or a consultant made the decision to give up hope.- Mail Online
Patients' groups criticised the move, calling it 'another nail in the coffin' of the safety of the elderly and vulnerable which would condemn many to an 'early death sentence'.

SOS-NHS Patients in Danger, a group formed by relatives who believe a loved one died because of deliberate starvation, dehydration or with-holding of medication, have criticised the guidelines.

Spokesman Julia Quenzler said: 'This sounds like yet another nail in the coffin for vulnerable elderly patients.

'By giving a senior nurse this power, is it yet another means of distancing doctors from their patients' deaths?'

Mail Online

Distancing doctors from their patients' deaths -
NNPs took verbal orders for medicines from doctors over the phone to save them coming to the ward. They also administered morphine and other opiates intravenously. Neither was allowed under hospital or professional regulations. Grigg-Booth, and at times other NNPs, also prescribed opiates such as pethidine and diamorphine for patients. This was risky and unlawful as they can hasten or cause death.- The Independent
Nobody has ever faced trial or been struck off as a result. One nurse at the heart of the inquiry, Sister Anne Grigg-Booth, was charged with three murders, one attempted murder and more than a dozen lesser, related charges but died of an overdose in 2005 before the case came to trial. Her death meant the allegations against her were never tested. No motive has ever been suggested for her actions.
The Independent

The doctors were complicit in giving verbal orders over the phone, but it was the Night Nurse Practitioners who were charged.

They acted outside the rules.

Drugs that were administered outside the rules may hasten death but, administered as part of a protocol, do not.

The "Caring Killers" went about their work to "alleviate distress".

Thus do the "Caring Killers" gain credibility.

Euthanasia and the long walk to assisted suicide -
Action was finally taken only after one senior nurse inadvertently spotted the suspicious drug prescriptions while carrying out an internal audit of patient notes in December 2002. The nurse noticed that diamorphine given to Annie Midgley, 96 – to alleviate her distress – was illegally prescribed by Grigg-Booth two hours before Mrs Midgley died. This triggered the police investigation and Grigg-Booth's suspension.- The Independent
This is what is coming. Face it...

We are member states of the European Union. We inhabit these off-shore islands of the European mainland -
European Court Leads Europe Closer Towards a Right to be Killed 
by Paul Coleman 
For several decades the European Court of Human Rights (ECHR) has taken an evolutive approach to the meaning of the European Convention on Human Rights, and the notion that the Convention is “a living instrument” now appears to be uncontested. Nevertheless, the Court’s evolutive approach towards assisted suicide and euthanasia is remarkable.Before last the recent decision in the case of Gross v Switzerland (2013), the clear case-law of the Court had been that there is no right to assisted suicide or euthanasia under the Convention, nor are there any positive obligations on the State in regard to these issues. In fact, the Court had unanimously ruled on the issue of assisted suicide in the very similar case of Haas v Switzerland in 2011, holding that restricting access to lethal drugs was not in violation of the Convention. Even with the evolutive approach in mind, finding a violation of the Convention in Gross v Switzerland seemed farfetched. But the Court found one. - The Bell Towers
The US Constitution and the European Convention on Human Rights are both now conceived of as being "a living instrument".

Is this really what we want for ourselves?

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