Wednesday, 18 December 2013

Liverpool Care Pathway - This Is The Way It Slides, With A Slither...

This way have we trod before and have sworn not to tread again. How seductive is the box, we must open the lid to peer inside...

It is a duty incumbent upon every medical person to protect life and to do no harm. And yet, through the LCP, a policy was set in place across the NHS to make no great effort to intervene to preserve life, to let them go and even to help them on their way. Clearly, the LCP and other EoLC protocols were intended to provide legal cover to a practice that has gone on for decades, covert, unspoken and referred to, euphemistically, as TLC.

A culture of death is pervading the NHS. A dark shadow is stalking our hospitals and care homes and every facet of society. The right to death is becoming paramount over the right to life. 

Lord Davies of Stamford has said this past week - and it is on record in Lords Hansard - that, in recent years, the more usual practice has been to withdraw treatment, food and water until the patient dies...

This is the End of Life debate in the Lords 
More frequently in recent years, the patient has been referred to a hospice and there a clinical decision is taken steadily to withdraw the necessary means of life support: resuscitation, ventilation, antibiotics and dialysis will be denied or withheld. In the case of someone who was very close to me, liquids were denied. The only thing that was administered was a sufficient amount of opiate to keep the poor patient comatose, presumably on the grounds that if she was killed by an overdose of the opiate that would be against the law, but if she was killed by dehydration that would not be against the law. She actually took two weeks to die. I cannot think of a more cruel fate.
What is here being described is the LKP LCP. What has occurred in adopting EoLC Pathways is that people 'diagnosed' as dying have had their lives cut short, who would not otherwise have died.

This is the End of Life debate in the Lords. This is being freely spoken in the upper chamber of the British Houses of Parliament. This is not the Daily Fail.
At the heart of the debate there is, unfortunately, an illusion or a self-deception: the suggestion that under the present regime the medical profession does not get
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involved in determining the timing or circumstances of the death of its patients. In fact, as we all know, for a number of generations it has been pretty widespread practice for doctors who have a patient who is in distress right at the end of life to accelerate the process. One doctor put it to me as, “helping the patient on his way”, generally by administering a lethal dose of an opiate or perhaps a barbiturate. This is not talked about because of course it is against the law, so there is a great deal of hypocrisy here, but we should not have any illusion about the truth.
The Honourable gentleman is speaking in support of Lord Falconer's Bill being promoted by The Euthanasia Society Dignity in Dying and its charitable organ, Compassion in Dying, which has actually worked alongside Age UK in the East End.
I support the Bill of the noble and learned Lord, Lord Falconer, for three reasons. First, it would liberate the patient and give the patient a choice; it would give the patient a vote in the important matter of his or her demise. Secondly, it would liberate the medical profession from these agonising dilemmas—the conflict between the law and the duty to do the best for the patient. The third reason goes to the heart of the responsibilities of this House. The law in this country—in any country worthy of the name of a country living under the rule of law—ought to be clear, unambiguous, respected and upheld. The law in this area is none of those things in this country. The law is cruel, anomalous and nobody takes it seriously. The previous Director of Public Prosecutions said that he would not prosecute in certain cases under this law, as has already been referred to.
The Honourable gentleman speaks of 'liberating' the patient, of  'liberating' the medical profession and restoring respect for the law.

The Honourable gentleman is in grave error.

On the first count, assisted dying/euthanasia respects neither the person nor life. It devalues the person; it devalues life. Death does not liberate life; it surrenders life. On the second count, when care is responsive care, responsive to the circumstances of the individual, there is no such conflict between the law and the primacy of duty of care. The third count is cancelled out by the second count in that responsive care is always by measure and respects life, the patient and duty of care.

It is putting the cart before the horse to say that to oppose euthanasia is to deny others the right to terminate their lives. An Assisted Dying Bill places an onus on others to accept such a possibility as an option for themselves, obliged by group pressure and social disapproval and denunciation that they are acting selfishly to place the burden of care for themselves onto others and make themselves a drain on finite resources.

Once Assisted Dying/euthanasia becomes the norm - as it will should this Bill be passed - the pressure to act selflessly and to do the right thing and die will follow in its wake, sure and true. No safeguard or measure put in place will prevent this.

This has nothing to do with Right and Left; this is everything to do with right and  wrong. This is Irene Ogrizek

The elderly are the most vulnerable to the unethical use of “voluntary” euthanasia. They have financial and material wealth younger relatives may covet, and they are more likely to be nudged into this kind of “beyond hope” scenario. A little Benadryl or Dilaudid is all it would take. (Benadryl has been cited in the deaths of children under the care of unscrupulous caregivers.)

These problems will touch the rest of us. I keep hearing over and over again, from supporters of euthanasia, how “It’s my life; I have a right to take it if I want.” It’s true people have a right to commit suicide. However, what I object to is the involvement of healthcare staff. As someone who has seen abuse in the system, I do not want a doctor who believes in euthanasia. I do not want this because if I am given a bad diagnosis, he or she may push me toward it and away from a more expensive life-saving option.

And there are more complications.

Given the protectionism I’ve seen among most (although not all) doctors, I don’t think it likely Quebecers will be told which doctors are practicing euthanasia. I suspect the doctors who choose to do it will not, perhaps for reasons of safety, be putting their names out in the public sphere. Despite the fact that users of the system have a right to know, I doubt we will.

So for all the cries of “It’s my life; I can do what I want with it,” I say this: involving a doctor, a doctor in a pool of doctors we all use, contaminates and compromises their decision-making and contaminates and compromises our ability to trust them. In a sense, by insisting on your rights to such an individualistic extent, you are peeing in our pool.

Another argument I keep hearing is this: why would you insist on making someone suffer through unimaginable pain? How can you truly know what another person is feeling? Here’s my answer: I believe my mother was deliberately under-treated by a physician who tried to make a life and death decision for her. Perhaps it’s because he heard my mother had been athletic and decided she should not live out her years in a wheelchair. I suspect important procedures had been postponed — too often — because he had prioritized younger patients and de-prioritized her. Ironically, those postponements are what led to her poor condition in the end.
What is described in this last paragraph is downsizing care options. Please take the time to read the entire article; it is essential reading.

Michael Wenham speaks on Yahoo! News

Michael has some concerns about Lord Falconer’s private member’s bill in support of a change in the law. The bill would enable terminally ill adults who meet certain criteria to be able to legally take life-ending medication. The person would have to be terminally ill with six months or less to live, they would have to be mentally competent and have made a clear and settled intention to end their own life which is persistent, well informed and voluntary.

Michael feels the safeguards, are inadequate and he worries about the impact on the vulnerable and the pressure they might feel. He fears the ‘right-to-die’ may become a ‘duty to die’.
“Most domestic abuse happens within families,” he says. “Disabled people do not want assisted suicide to be legal, because they’re aware that families could see them as a burden. Now, it’s expensive to look after a disabled person if they can’t do it themselves.
“I’m concerned about the people that are vulnerable. People that might be depressed, people suffering from Alzheimer’s. There are disabled people who don’t have the resources to speak up for themselves.”

He says suicide can also leave families with a lot of mixed feelings. “Like guilt, like denial. Did I not love them enough? Did I not care enough? Did I not do enough for them?”

2013, the Chinese Year of the Snake, and this is the way our standards slide: with a slither...

This is the creeping spread of euthanasia in Belgium. In 2012, the number of recorded cases of euthanasia was up by 25% on the previous year.

In the ten plus years of euthanasia in Belgium, the number of recorded cases of euthanasia is up by more than 500% on the first full year.

This includes, this year, the euthanasia of Nathan Verheist following a botched sex-change operation. The 44 year-old grew up in a family in which she was despised for being a girl. (- Mail Online )
A culture of death is being fostered. One in five teenagers in Belgium has thought about committing suicide. One in ten has actually proceeded with the act.

There are, inherent, related dangers on this course we choose... 

This is Organ Donation Euthanasia -
Options for increasing the number and quality of organs from LSW donors
Option 1 – Changes to organ consent processes
Option 2 – Organ Donation Euthanasia: Removal of organs from patient under general anaesthesia. Death would follow removal of heart.
Option 3 – Cardiac euthanasia followed by organ donation: Euthanasia by administration of anaesthetic and cardioplegic agents. Removal of organs after cessation of circulation.
Option 4 – Neuro-euthanasia followed by organ donation: Euthanasia by occlusion of blood vessels to the brain. Removal of organs after brain death certified.
Option 5 – Organ donation prior to natural death: Removal of non-vital organs prior to withdrawal of LST.
Option 6 – Non-brain ante-mortem ECMO: Cardiopulmonary bypass to support organs other than the brain and heart prior to withdrawal of LST.
Option 7 – Reduction in asystolic period prior to certification of cardiac death.
Although there are a few jurisdictions where euthanasia is permitted, most societies hold that doctors should not kill their patients. On the other hand it is almost universally accepted that doctors may withdraw or withhold LST [Life Support]in patients who are dying or who have a very poor prognosis.

A number of countries have moved to, or are considering proposals for, opt-out consent systems for organ donation.
The Senate in Belgium has now approved measures to permit the euthanasia of children...

The Belgian Senate voted last Thursday to approve a Bill that extends euthanasia to minors. The vote went with a substitution majority of 50 votes (socialists, liberals, greens and N-VA) to 17 (Christian Democrats & V, Vlaams Belang, CDH, and MR senators Armand De Decker and Gérard Deprez).

Christian Democrats & V had another plenary submitted with three amendments, but these were rejected. The party wanted an age limit of 15 years to replace the notion of mental competence, a concept that Els Van Hoof says has neither legal nor scientific basis.
Like Pandora do we peer into the Box of Delights, intrigued, absorbed, oblivious to the dangers and evils to be let loose on the world.

Required reading -
Liverpool Care Pathway - Changing Minds

Liverpool Care Pathway - Whither Responsive Care?

Liverpool Care Pathway - It's Not the Crisis, It's What You Do With The Crisis

Liverpool Care Pathway - Of Persons and Non-Persons, Of “Worthless Lives” and “No Best Interests”

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