Liverpool Care Pathway - A Decision With Many Outcomes

These doctors had a particular duty to this man's welfare; in this, they betrayed him miserably.

May it please the Honourable Bench to be so advised: the Good Doctors, duty-bound by Oath so they are, did permit Mr. James to fall into harm's way whilst in their care and to contract such mal-afflictions that brought him to his sickbed; thence sought they to cover up a wrong with a wrong, that Mr. James' life was not a life worth living. (Apologies to Ben Franklin)

This is BBC Newsnight –


Newsnight   30/10/2013

The Supreme Court has completed its deliberations. May James is interviewed on Newsnight by Jeremy Paxman. Watch from 22 minutes into the programme.

Jeremy Paxman 

Now, the highest court in Britain decided today that a hospital had been right to withhold treatment from a very sick man despite the wishes of his family. This important judgement in the complicated area which many of us may visit where ethics and humanity and institutions and families may collide is expected to cast a long shadow.

The dying man’s family had wanted doctors to continue treatment; the Supreme Court decided that they had been within their rights to press for that and that lower courts had been entitled to rule in favour of the hospital, too.

Report

Mr. James, grandfather and professional musician, was admitted to intensive care after contracting an infection in hospital. His condition deteriorated leaving him unable to speak or breathe unaided. The hospital asked the High Court for permission to withhold some treatments if his condition got any worse. The court refused, forcing them to continue treatment. The hospital then appealed and, as Mr. James became increasingly ill, they won the right to withhold treatment. Just ten days after that verdict, Mr. James died. Despite his death, the family brought his case to the Supreme Court hoping to have the verdict over-ruled. This afternoon, in a complex ruling, the Supreme Court decided that, on the evidence available, both of the decisions of the lower courts were correct.

Jeremy Paxman

Well, we’re joined now from our studio in Liverpool by David’s widow, May James. Em, May James, even after your husband showed no prospect of recovery, you continued this legal fight. Why?

May James

Because he still was showing life, a life worthwhile living.

Jeremy Paxman

And you continued the legal fight even after he had died

May James

Oh, yes, to the Supreme Court, well, em, because in the appeal court there was a precedent set that em doctors, if they felt that treatment was futile, invasive treatment was futile, well, they didn’t really have to give it to the patient. Now, that meant any hospital in the country, which no… I, I carried it on because I wanted to help other people with family, loved ones, that may end up in the position like my husband ended up. And, it was horrendous. I just would not like anybody to go through what I went through. I went through it for the love of my husband and, when he died, I felt no well it’s got to go on to help other people. And that’s why.

Jeremy Paxman

It must take a real depth of conviction to reject doctor’s advice, doesn’t it?

May James

Well, when the doctors started saying about withdrawing treatment, it was quite a few months down the line. It was em around about July, last year, that they first said to me they, that if he should have a cardiac arrest they didn’t want to resuscitate, would I agree? And I said… They said to me we don’t expect him to have a cardiac arrest. So I said, well, if you don’t expect, why are you asking me this? Well, just in case he does. So I said, no, well I can’t agree with that because you can’t tell me what is wrong with my husband. You can’t diagnose what is wrong with my husband. Tell me that he has cancer; tell me that he has TB, and I then may go along with your wishes. But until you can diagnose what is wrong with him you should not be asking me this.

Jeremy Paxman

What do you make of the Supreme Court’s judgement today which seems to… It, it’s extremely complicated; it seems to come down on both sides, that both the hospital was right and that you were right.

May James

Yeah, yeah, yeah. Em, what they said was that at the particular time… See, when we were at the Court of Protection, Judge Jackson would not grant the hospital what they wanted. But then, by the time we got into the appeal court, Dave had deteriorated again. So, at that particular time, the Supreme Court said today that it was right. They felt that the appeal court was right in passing for the hospital to not give the treatment. Em, but then… Well they didn’t give the treatment and he died.

Jeremy Paxman

What do you think ought to be the guiding principle in cases like this?

May James

Well, like what was passed today, I mean, the fact… What happened at the Appeal Court, because they granted, there was the… there was a precedent set which went against what Judge Jackson said so, therefore, the law had changed. Now, what I wanted was that law changing back. So, what happened today is that the hospital were told that they did the right thing; the appeal court was right at that particular time. Em, and I was told that, em, the appeal judges heard they did not follow those mental capacity rules right. Em, and that what was passed on that day at the appeal court was not to carry on. They now… it has, more or less, gone back to what it was. The law’s been changed back, which was what I wanted it to, and doctors now have got to take a different approach towards patients and stop and think more about the Mental Capacity Act.

Jeremy Paxman

Thankyou very much for taking the time to join us; thankyou very much indeed.

The Liverpool Echo reports–

The Supreme Court has ruled that appeal judges were right to allow doctors to withhold treatment from a “gravely ill” guitarist from Liverpool. 

David James, who was in his late 60s, died 10 months ago shortly after the Court of Appeal decided that withdrawal of treatment would be in his best interests.His widow May had asked the Supreme Court - the highest court in the UK - to overrule that decision.But a panel of Supreme Court justices ruled against Mrs James after analysing the case at a hearing in London in July. 

Doctors at Aintree University Hospitals NHS Foundation Trust in Liverpool initially asked a High Court judge sitting in the Court of Protection for a declaration that withholding treatment would be in Mr James’s best interests should his condition deteriorate. 

Mr James’s relatives were against the idea and Mr Justice Peter Jackson refused the trust’s application. 

But his decision was overturned by the Court of Appeal after the trust appealed.The Supreme Court heard that Mr James - a grandfather and father of three - had undergone surgery for colon cancer. 

Mrs James said Mr Justice Peter Jackson’s decision was right and suggested that the Court of Appeal ruling undermined the “protection” given by “legal presumption in favour of preservation of life”. 

Trust bosses said the appeal court was right. 

Bosses say Mr James was “critically ill and steadily deteriorating”. They say he had been in an intensive care unit for seven months and had a range of problems, including multi-organ failure. 

The Court of Protection, which is part of the High Court, analyses issues relating to sick and vulnerable people.

May James, a brave and resilient lady, firm and uncowed still, has stood firm in her good fight for justice and for families in like position to her own. This is a decision with many outcomes, however. Effectively, it is a fudge. It has reduced everything to 'technicalities'.

The Appeal Court was wrong to:

• Adjudicate upon "treatment" without consideration of 'quality of life'.
• Adjudicate upon there being "no prospect of recovery" and equate "recovery" with a return to a condition of "good health".
• Claim the "past and present wishes and feelings" of Mr James had been considered, when he was unable to express them.

Effectively, it has been ruled that the right decision was reached, but for the wrong reasons.

Effectively, the primacy of the prior status quo has been reasserted which, in any case, was what May James had set out to achieve and this has been achieved.

Doctors are now on warning to act with more caution but doctors are, in any case, empowered to act in 'best interests'...

This is The Telegraph –

1. The Supreme Court heard that Mr James, a father of three, had undergone surgery for colon cancer.

Mrs James, a civil servant, said the Court of Protection’s decision was right and suggested that the Court of Appeal ruling undermined the "protection" given by "legal presumption in favour of preservation of life". 

The Supreme Court justices ruled that Mr Justice Jackson applied the "right principles". 

But they said appeal judges were also right to reach the conclusion they did on the basis of fresh evidence that Mr James’s condition had deteriorated. 

Lady Hale, one of the justices, said that, while the appeal was dismissed, the James' family had "won the argument" on "principle". 

Danielle Hamm, director of Compassion in Dying, a charity providing information on the rights of people to a “good death”, said the ruling was an “important judgment” which showed that patients should make an advance decisions in writing about whether they wanted to be denied treatment.

Danielle Hamm is the Director of Compassion in Dying. She has the bare-faced audacity to paddle her grubby oar into this debate? Compassion in Dying is the 'charitable' organ of the pro-euthanasia political lobby, Dignity in Dying.

This pro-euthanasia 'charity' actually duped East London Age UK to join them in conning the National Lottery to fund a local EoL Advocacy project.

Read - 

Liverpool Care Pathway - Changing Minds

Hamm advises making 'advance decisions'...

Where none has been made, there should ALWAYS be a bias toward life and an assumption made that chooses life.

Hamm advises making 'advance decisions'.

Death List patients, such as those recruited to the Invicta 'My Wishes' register for instance, are encouraged to make such 'decisions'. They are diagnosed for EoL with GSF and the Barton Method, groomed to downsize care expectations and given the Sunstein Nudge.

Hamm would set us on a course that would lead us into perilous and treacherous waters. These matters are not for courts nor for doctors to determine.

Further reading -

Liverpool Care Pathway - "You Think You're Gods But You Are Not" 

Liverpool Care Pathway - It's For You To Decide, None Other