Sunday, 22 September 2013

Liverpool Care Pathway - Semantics, Semantics, Semantics

When is a murder not a murder...?
Give them a centimetre and they'll take a kilometre.

Canadian Social Services Minister Véronique Hivon insists that euthanasia "is not provided for…is not forbidden in the Criminal Code".

The Globe and Mail -
There are general provisions and there is something specific about assisted suicide but nothing on euthanasia,” Ms. Hivon said, insisting the bill was a health measure that falls under provincial jurisdiction.
Health might be described as a relative condition of being free from illness or injury. It would generally be accepted that to be restored to health is to be restored to a condition of well-being, mentally or physically. Euthanasia is to remove, finally, any possibility of that. This is nonsense.

Ms. Hivon continues -
Euthanasia is the act of a doctor taking someone’s life at their request, while, in assisted suicide, a doctor would provide the means of suicide that would be activated by the patient.
This has nothing to do with criminal matters and everything to do with medical care.
Matters medical are pertaining to medicine. Medicine is concerned with the treatment of diseases and injuries; of matters which affect well-being and health. It would generally be accepted that medicine is the science and art of dealing with the maintenance of health and the prevention, alleviation, or cure of disease. Euthanasia is the exact opposite of this. This is nonsense.

This is a world of Newspeak gobbledegook. This is an Alice in Horrorland world of everything turned on its head.

In the Wall Street Journal, The Coalition of Physicians for Social Justice recently released a Statement to the effect that what is lacking is provision of sufficient resources to live with dignity with proper care.

Take note: LIVE with dignity... 

The Statement reports on Dr. Humphrey who lives at home connected to a ventilator -
Dr. Saba said that Dr. Humphrey's condition demonstrates the intrinsic value of every life. Furthermore, his situation proves that more patients can live their last days in dignity with proper care. Before being connected to the ventilator, Dr. Humphrey clearly expressed his position against euthanasia which he now communicates by simple facial movements. He lives his last days at home surrounded by his family. For him, every human being is of value and should never be terminated intentionally. According to Dr. Humphrey, governments that pass laws will promote them. In the case of euthanasia, there is a serious risk that such a law would be promoted and increase the incidence of early termination of patients suffering chronic illnesses. Dr. Saba underlined the fact that the best guidelines governing euthanasia in the Netherlands, Belgium and the state of Oregon in the U.S. has failed to prevent medical errors on patient selection and consent, in particular, with the psychiatric population. 
Daria Humphrey, the wife of Dr. Humphrey, explained that there is a lack of support for patients on respirators. Although she praises and appreciates the expertise and support of the Montreal Chest Hospital, the 17 hours per week of home care is insufficient.
Dr. Humphrey is perfectly correct. If the State is empowered to do something, it will do it. If Officials are empowered with a law, they will use it - and do more besides.

The law will be used in ways other than that in which it was intended.

Such a law would only give encouragement to the caring killers on the wards. And does -
Nurses were more often involved in the administration of the drugs when there was no explicit request from the patient than in cases of euthanasia or assisted suicide.
Pain and the patient’s wish for ending life were more often reasons for carrying out euthanasia or assisted suicide, whereas family burden and the consideration that life was not to be needlessly prolonged were more often reasons for using life-ending drugs without explicit patient request.(Canadian Medical Association Journal)
They kill because they have no moral humility to guide them with restraint.

In this submission to the CMAJ, 'physician-assisted' deaths without request or consent is assessed -
Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient’s explicit request, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids.

Compared with drugs used in euthanasia and assisted suicide, opioids were used far more often in the ending of life without an explicit patient request, especially when used as the sole drug (Table 4). In these cases, the dosage was strongly increased in the last 24 hours in 45.8%, and the physician indicated it to be higher than needed to alleviate the patient’s symptoms in 46.8% (data not shown).
Another paper published in the CMAJ also determined
that -
By administering the life-ending drugs in some of the cases of euthanasia, and in almost half of the cases without an explicit request from the patient, the nurses in our study operated beyond the legal margins of their profession.
The law will be used in ways other than that in which it was intended and permit leeway to the caring killers on the wards to go about their work.

The Statement in the Wall Street Journal concludes -
In summary, Dr. Saba states that there is no reason to introduce euthanasia legislation for very sick patients who do not want aggressive medical care and/or who want to die. Currently all patients have the right to refuse treatment, the right to discontinue care, the right to refrain from specific care and the right to palliative care. What is lacking is access to supportive medical and palliative care to allow seriously ill patients to die with dignity and without pain. 
Presently, only 20 percent of Quebeckers have access to palliative care. What is required are resources to provide quality life and dignity in the last days for these patients and their families.
Victor Cellarius has written in the Journal of Medical Ethics of the trend of palliative care to include the care of patients who are not imminently dying. There is 'no reason to introduce euthanasia legislation' because there is already provision for those 'who want to die' to follow that course; that provision only requires to be extended. Adoption of EoLC Pathways such as the Alberta Provincial End of Life Care Pathway should accommodate this provision. 

These are rights to refuse care. What if care is denied? Are there corresponding rights to require and to expect that care shall be given?

It has been reported that Mr. Obama made criticism of the US Constitution in that, in its infinite wisdom, it confines itself to what the Government may not do rather than to what it may do. The weight of the document is to constrain the government and to state what it is not permitted to do; that is where the emphasis lies. That is exactly as it should be. Power must be confined else shall it be abused.
State Senator Obama asserted that the Constitution is a charter of negative liberties in that it states what the State and Federal government could not do to you. (The Political guide)
Better a charter of 'negative libertes' than a charter of negative rights.

Power must be confined else shall it be abused as it is being abused in the UK where Acts of Parliament passed ostensibly to protect the individual are used against the individual to deny treatment and to confine and imprison relatives seeking to aid their loved ones.

CJAD 800 AM News talk radio has this posted by Shuyee Lee -
The Quebec College of Physicians says it believes that people suffering from Alzheimer's in the final stages of their lives should be considered candidates for medically-assisted suicide. 
It's presented its brief before the Quebec government's public commission hearings on its proposed dying with dignity law.
The College pf Physicians says terminally-ill Alzheimer's patients or those with similar forms of dementia have guardians or family members who can help make the decision of resorting to medically-assisted suicide, adding that a large number of those afflicted are not apt to authorize consent. 
Dr. Paul Saba, co-president of the Coalition of Physicians for Social Justice, disagrees with that position, adding it's a slippery slope. 
"Who's going to say what's severely demented? Who's going to say what's severely, what's moderately, where's the line? We already know consent is not respected," Saba told CJAD 800 News. 
The College does say it should be a last resort after palliative care but Saba said they're concerned it may turn into an easy way out. 
In Quebec, 125,000 people suffer from Alzheimer's.
In England, the CQUINs are in place. The dementia bounty hunters have mounted their posses and ridden out to seek out their one percents.

Next year will see the new GP contracts. This is Pulse -
Speaking at a conference on the future of primary care at the King’s Fund think tank in central London, Mr Hunt said: ‘Without a profound reform of out-of-hospital care the NHS will be simply unsustainable, so this is an issue of critical importance.’ 
‘This is the first time I have pulled together a number of strands of the current Government’s thinking for reforms of primary care.’
- additional funding will be channelled to general practice to help support GPs’ new responsibilities, and will come from savings made by a reduction in unplanned admissions
- GPs’ new ‘named clinician’ role, which will initially cover vulnerable elderly patients from next April, will involve GPs taking overall responsibility for patients’ care, ensuring they have proper care plans, proactively managing their care and deciding how out-of-hours care should be managed in their area.
Mr Hunt also signalled that his planned contract changes would be tied to a rise in overall funding for general practice.
‘We need to recognise that if more proactive general practice is going to save the NHS money by reducing unplanned admissions to hospital, then some of that saving needs to go back into general practice to pay for the higher levels of care,’ he said. ‘Precisely how will be a matter for detailed negotiation later on in the year, but we need to be ready to go with a new approach for how we care for vulnerable older people for 2014.’
Asked by King’s Fund chief executive Professor Chris Ham whether he was confident he would be able to negotiate such far-reaching changes to the GP contract within just a few months, Mr Hunt said: ‘I am, actually.’
Responding to Mr Hunt’s speech, RCGP chair Professor Clare Gerada said: ‘We welcome the health secretary’s intention to shift the focus from hospitals to primary care, which is essential if we are to restore the NHS to a sustainable footing.’

Those savings in hospital admissions will come through scaling up the palliative response in place of the emergency response. Armed with the GSF and the SPICT and what other tool they can connive, the GPs will seek out their one per cent.

Patients over the age of 65 consume over 33% of all healthcare expenditure. Doctors have been told to select patients during routine consultations who show ‘indicators of frailty and deterioration’ and that ‘older people are a priority to consider’. Doctors have been advised to use the Barton method and ask themselves the 'surprise question'. They can tell, just by looking at you, if you're likely to kick the bucket any time soon.

"Swifter than he that gibbets on the Brewers Bucket..."
—William Shakespeare, Henry IV Part II
Euthanasia...? Physician assisted suicide...?

Groom them, gloom them, doom them; downsize their care expectations: that's much more sensible. They can't expect to live forever.

Give them a centimetre and they'll take a mile.

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