Liverpool Care Pathway - Ethics For A Brave New World

 

We are seeing this enacted before our eyes and blind are we to all...?

And are these those we should trust? In their own self-audit, they could find nothing wrong, only much to praise...

The Generic Report 2008/2009 was cited as gospel and clung to as the spoken and incontestable word of the Prophet, John Ellershaw.

How flawed were its self-congratulatory expoundings...

Now, a Leadership Alliance is formed under the tutelage of Dr. Bee Wee. And whither does this go?

The iceberg is hit. The ship is going down. The call is to abandon ship...

Is not the cry, "Women and children first!" and, in that number included, are not the weak, the frail, the fragile, the elderly...?

Don't they also evacuate the wounded and the injured first from the field of battle?

No more... Chivalry belongs to another age and ethical considerations are given a new dimension.

Here is discussed the problem of instituting and enacting such plans without the prior grooming of those expected to deliver them...

A 'reverse triage' will be used to identify “too sick patients”. Traditional triage is described as an 'ethical trap'.

This is Altered Standards Of Care: An Analysis Of Existing Federal, State, And Local Guidelines –

There is an unspoken assumption that all healthcare personnel in an emergency or crisis situation will essentially share the utilitarian perspective of each plan. Philadelphia and TPC plans casually declare that any newborn or infant with a genetic disorder that is likely to be fatal before the age of two should be treated in the same way as an adult who requests a “do not resuscitate” (DNR) order. There is no discussion regarding how different individuals will be able to comply with this directive. There are no plans or templates for holding discussions with all healthcare personnel as part of the preparedness stage of crisis management or medical surge management. There is only an assumption that during a moment of crisis all personnel will know what to do and will do it in the most ethical and moral way possible.

The ethical issue is utilitarian in its approach to resolving problems. The ethical concern is presented as the welfare of the community over the welfare of individuals, and the unspoken guideposts are a need to foster the greatest good for the greatest number of people.

The 'utilitarian' ideal of the greatest good for the greatest number of people will take primacy. Patients will be identified as 'too sick' for treatment.

This is the stark logic of Communitarianism and Zeke's Complete Lives System.

It is exactly this course which is being followed in the 1% campaign, downsizing healthcare options and the DoH EoLC programme. There are 'too many' old ones; there is what the Harvard Gazette has referred to as a global "demographic nightmare"; they have to be dealt with by process of elimination.

It is the financial impact on the fiscal budget that is the focus of concern and is expressed in Parliament – 

Public spending and older people

Much of today’s public spending on benefits is focussed on elderly people.  65% of Department for Work and Pensions benefit expenditure goes to those over working age, equivalent to £100 billion in 2010/11 or one-seventh of public expenditure.  Continuing to provide state benefits and pensions at today’s average would mean additional spending of £10 billion a year for every additional one million people over working age.

The financial constraints were among those that set the world on the road to another holocaust.

Dr. Anna Pou has been involved in the writing of laws to provide legal protection to health care professionals acting under the provision of such plans. Pou has further acted in an advisory capacity on disaster preparedness. She has lectured at conferences and addressed military medical trainees. She promotes changing the standards of medical care at times of extraordinary necessity. She has said that doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have DNR orders.

Who is Dr. Anna Pou...?

- Alaska Report

The Naval Post-Grad School Thesis above discusses Dr. Pou -

"Criminal and civil liability remains a major concern among healthcare providers. Although Anna Pou and her legal and civil problems in Louisiana are never mentioned in any plan, the underlying causes of Pou’s difficulties are expressed in all documents. It may be that liability is a particular worry for American physicians and that this fuels concerns with altered standards of care. The absence of altered-standard-of-care protocols may also be due to an American political divide on what constitutes the sacredness of life. During the debate on President Obama’s healthcare reform plan, many opponents of the plan pointed to provisions they claimed created “death squads,” concerned with saving costs over saving lives. Given the intense and often highly contentious debates over healthcare, the question of liability is a genuine one for physicians and other healthcare personnel."

"For those who would work under such circumstances, the fear of potential legal action is not unfounded, given the charges filed against nurses and Dr. Anna Maria Pou for failure to care and inappropriate use of medication in New Orleans following the flooding associated with hurricanes Katrina and Rita (Okie, 2008, p. 4)."

"The ethical imperatives of deciding what to do with “too sick” patients and whether proactive lethal medication, such as that practiced by Dr. Pou in New Orleans during Katrina and its aftermath, is an option in certain crisis situations."

"The concept of altered standards of care was not introduced until recently, and there is still much to be learned. The benefits are not yet completely known, but those benefits that have been documented cannot be ignored. Additionally, the paucity of literature supports the importance of continued research in this area, especially in the development of triggers, guaranteed minimums of care, and liability protection for healthcare providers."

In an interview with Sheri Fink, Irene Ogrizek discusses what happened at the Memorial and Dr. Anna Pou.

This is Sheri Fink in her own write in the New York Times Magazine –

Investigators pored over the evidence, and in July 2006, nearly a year after Katrina, Louisiana Department of Justice agents arrested the doctor and the nurses in connection with the deaths of four patients. The physician, Anna Pou, defended herself on national television, saying her role was to “help” patients “through their pain,” a position she maintains today. After a New Orleans grand jury declined to indict her on second-degree murder charges, the case faded from view.

Pou and others cite what happened at Memorial and Pou’s subsequent arrest — which she has referred to as a “personal tragedy” — to justify changing the standards of care during crises. But the story of what happened in the frantic days when Memorial was cut off from the world has not been fully told. Over the past two and a half years, I have obtained previously unavailable records and interviewed dozens of people who were involved in the events at Memorial and the investigation that followed.

The interviews and documents cast the story of Pou and her colleagues in a new light. It is now evident that more medical professionals were involved in the decision to inject patients — and far more patients were injected — than was previously understood. When the names on toxicology reports and autopsies are matched with recollections and documentation from the days after Katrina, it appears that at least 17 patients were injected with morphine or the sedative midazolam, or both, after a long-awaited rescue effort was at last emptying the hospital. A number of these patients were extremely ill and might not have survived the evacuation. Several were almost certainly not near death when they were injected, according to medical professionals who treated them at Memorial and an internist’s review of their charts and autopsies that was commissioned by investigators but never made public.

Patients were injected with the LKP protocol drugs, Morphine and Midazolam.

"Doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have Do Not Resuscitate orders..."

Downsizing of care expectations via an elaborate grooming process of the groomer and the groomed.

A programme to limit life.

We are seeing this enacted before our eyes and blind are we to all...?

Further reading -

Liverpool Care Pathway - When The New Is Not The News

Liverpool Care Pathway - The Action Plan

Liverpool Care Pathway - A Utilitarian Pathway