Wednesday, 18 September 2013

Liverpool Care Pathway - 'Newthanasia'

Though the line is blurred, the right and the wrong of it is more certain than ever. The essential truths do not go away.

Journal of Medical Ethics

It is a truism to say that guns don't kill people; people kill people.

Likewise, pain-killing drugs kill pain; pain-killing drugs don't kill people.

This paper by Sophie M Bruinsma, Judith A C Rietjens, Siebe J Swart, Roberto S G M PerezJohannes J M van Delden, and Agnes van der Heide investigates the life-shortening potential of continuous sedation until death.

The context of the study was that estimates of life expectancy cannot be relied upon. The conclusion of the study verified this to be the case.

Two methods were used. Both approaches, effectively, required that an estimate be made of potential life expectancy. Both approaches disagreed but produced a 51% plus estimate that life had been shortened.

The upshot of this study is that life expectancy cannot be reliably guestimated but that, based on those guesstimates, continuous sedation does curtail life.

Continuous sedation until death is very commonly practised on the EoLC Pathways, the highways and the by-ways...
Where do they go
Moving on their way
Putting patients on the highways and the by-ways
Where do they go
Moving on their way
The medics with their shy ways and their sly ways
The driver is set up and there they go, moving on their way!

This is a post made to
 Avvo, a US legal advice page -

The poster asks:
How can it not be called murder when an individual is in hospice, under terminal sedation, no food, liquids are medications?
An attorney responds:
Hospice is recognized and accepted end-of-life care in the medical community. Often, a spouse can assist in the decision-making process, but usually the actual referral is made by a doctor (family physician, etc.). Normally, a hospice referral would not be made unless terminal condition or factors were present. 
There may be facts involved which are not known to you. You should certainly request all of that information. 
A diagnosis of dying has been made. A medical decision is reached. The Pathway is commenced.

Another attorney responds:
There must have been a reason that your father was put into hospice care to begin with. He could not have been the picture of health despite his feisty nature. Unfortunately, when you are that age, your health can take a sudden an irreversible turn and then hospice tries to make the end of his life as comfortable as possible. I am sorry that yo have to experience this but it may have been your father's wish.
Not the picture of health...

An assessment of quality of life is acted upon.

How is it not murder...? It is hypocrisy to deny that it is and to claim that it is not.

This is a Hospice care pathway in Long Island, New York. Let's call it the Long Island Care Pathway -

Besides sedatives, patients may also receive other drugs, like painkillers and anesthetics, often in combination. 
At first, Ms. Scott fiercely resisted signing a "do not resuscitate" order, but in late November, she changed her mind and signed one with Dr. Shaiova. 
Ms. Scott died after 22 days.
Life expectancy cannot be reliably guestimated but continuous sedation can be guestimated to curtail life.

Victor Cellarius writes in the Journal of Medical Ethics -
Early Terminal Sedation (ETS)
Although terminal sedation has received widespread legal and ethical justification, the practice remains ethically contentious. 
It is clear that providing terminal sedation in combination with the withholding or withdrawing of life-prolonging treatments such as fluid and nutrition can foreseeably hasten death significantly.
There are ethical justifications for the use of sedation in palliative care and thus it would seem that ETS is an ethically and legally acceptable practice.
However, what emerges from the literature is the repeated assertion that terminal sedation must be restricted to use in imminently dying patients — the ‘imminence condition’ — and that therefore ETS is unacceptable. 
This restriction has taken on greater significance with the trend of palliative care to include the care of patients who are not imminently dying.

Dr. Michael Irwin - Humanist, one time Medical Director at the UN and the World Bank, Director of the World Federation of Right to Die Societies and chair of the British Voluntary Euthanasia Society, now known as Dignity in Dying - founded the Secular Medical Forum, which works closely with the National Secular Society.

This is much the same way that Dignity in Dying works with other agencies such as Age UK.

Here is the East London Advocacy page on Compassion in Dying -

Compassion in Dying is the charitable arm of Dignity in Dying. It is co-hosted by East London Age UK. It is funded by the National Lottery in association with the Daily Mail.

Irwin runs an escort and counselling service. He has personally escorted four people to Switzerland and counselled others, supplying "advice and encouragement" to end their lives.

Irwin maintained in Voluntary Euthanasia News (May 2001) -
"I believe it is important that we stress that terminal sedation, both voluntary and involuntary...... is widely performed in this country, especially in hospices and nursing homes, and as it is totally uncontrolled, this procedure is open to abuse."
Irwin's areligious Secular Medical Forum might be considered the opposite pole to Saunders' religious Christian Medical Comment.

It is a failure to grasp essential truths, of life and death and right and wrong. Neither Secularist nor Humanist may condemn morality for both formulate their own perspective of what is right and what is wrong, their own essential truths.

It has been previously stated in these pages that it used to be, you died and they said, depending on your particular religious or areligious predilection, 'God's called you home' or 'your number's up'. No more.

Doctors now 'decide' when it's time to go. They 'diagnose' dying; they use their 'intuition' to assist them in this, as is advised to GPs seeking their one percent. This is not scientific.

Almost rabid in their obsessive enthusiasm, LCP Trolls trawl the net to leave their posts. This is on this last weekend -
"The Liverpool Pathway is basically putting a different name to palliative care. Used well it's a wonderful thing and can help support a comfortable and dignified and to life. Sadly it's been given a lot of bad press for a few cases where it wasn't used properly.
When people reach the end of their lives they often stop getting the urge to eat or drink, it's a normal part of dying, rather than starving to death the body just stops 'needing' food."
"The LCP has been demonised for political reasons by the gutter press, it is designed to lessen suffering and preserve dignity at the end of life, it is not designed in any way to hasten death and, if it's delivered by people who know what they're doing, can bring a great deal of comfort not only to the dying person but also to their loved ones. I've nursed a lot of people on the pathway, and I've instigated starting people on the pathway, and hand on heart if it was me coming to the end, I'd want to be nursed on the LCP."
This is Dr. Gerard Daly. His full review may be read at Compassionate Healthcare Network.
In the present context of the widespread practice of withholding hydration from the dying, none of us can ignore the dangers this has for any of our elderly terminally ill loved ones. Most of us will only discover the reality behind the airbrushed image of hospice care when it is too late, after our loved one’s have been admitted and are placed, often without the knowledge or consent of the patient, family or guardian, on a regime of sedation without any attention to hydration. I discovered that the average time spent by a patient in a hospice before death was around two weeks. It can take this long for somebody to die a painful death by dehydration. The correlation is uncanny. 
The Liverpool Care Pathway, disgraced in name, continues in place, its protocols and purpose pursued with endeavour and enthusiasm. Other pathways have rushed forward to bear the Standard.

It is a judgement call to give up on their patients. They say they are being merciful; but it is more a case of putting their patients at their mercy.

Relatives have gone to court to overturn a decision by doctors to place their patient at their mercy. And have succeeded, only to have the good doctors go to court in their turn and overturn that decision to rescue the patient from their clutches.

Those who support these Pathways have tried to turn the debate into a political football to kick around.

It is not to be 'right-wing' to say that the courts are behaving like 'death panels'. It is not a matter of right and left; it is a matter of life and death and right and wrong.

Those who support these Pathways have tried to turn the debate into a religious football to kick around.

The doctors, certainly, possess a God Complex, wielding the powers afforded them by the Mental Capacity Act and the State to determine whose life is and is not worth saving and the life not worthy of living.

It is a sin to attack the sanctity of the NHS (National-socialist Health Service) but they do not shrink from attacking the sanctity of life. It is neither Left Wing nor Right Wing; it is more a case of Upwing and Downwing and of right and wrong.

Likewise, the debate on euthanasia has become a religious football to kick around. However, in the cold, hard light of logic, a view that holds that there is no God; that when life is done it is done and there is no more, no hereafter, should hold life all the more precious and dear. This is all a nonsense.

If the courts are death panels, then the almighty State has declared itself God, empowering its clerical class, the doctors, with a death charter, the Mental Capacity Act.

The Secularists, also, have their Supreme Being, but cursed with human frailty. And the Left, also, religiously follows its own banal philosophy blindly.

This has nothing to do with religion or politics and everything to do with life and death and right and wrong. It is not "a few cases". What a monstrous thing, to dismiss the taking of life, to brush it aside as if it means nothing! Lives have been taken. That is murder.

Now, Stephen Hawking comes out in favour of euthanasia.

news iafrica reports -
Stephen Hawking, the British theoretical physicist who suffers from motor neurone disease, has publicly backed the notion of assisted suicide for people with terminal illnesses. 
After suffering from pneumonia, he was once put on a life support machine which his wife was given the option of switching off. 
"There must be safeguards that the person concerned genuinely wants to end their life and they are not being pressurised into it or have it done without their knowledge or consent, as would have been the case with me." 
He was speaking in an interview aired on Tuesday ahead of the premiere of a new film about his life on Thursday, and after the release of a new book last week entitled "My Brief History".
Stephen is being optimistic. There are no safeguards. It is a Pandora's Box of woes that will be let loose on the world.

There are many medics, possessed of the God Complex, who would have adjudged  Stephen's quality of life and found it wanting. There are many medics, possessed of the God Complex, who might have pressed for the machine to be switched off, advising the lady that her husband stood no chance of leading a rewarding and worthwhile life.

The Pathways are euthanasia by proxy.

It is becoming clear, though the waters are well-muddied, that there is a programme to limit life - a 'newthanasia' - in place and a policy of 'changing minds' to groom opinion toward accepting death as a positive life choice..

Further reading -

Changing Minds

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