Monday, 10 March 2014

Liverpool Care Pathway - The Cost Of Living

The silence of the Lamb is broken...
Well, well, there's a surprise.

The body crumples; the training kicks in.


Assess the scene; assess the victim; act fast to save a life. The rules for the first responder are to practice to get it right until it becomes second nature.

No more; now, there are additional and urgent provisos to taking action...

Is there a DNR bracelet or necklace?
- Maryland DNR tag
- Maryland EMS DNR Order
Is there evidence of a DNACPR advance directive or order being in place?

Is the person elderly or frail as described in the Lakhani Recommendations...?

To comply with a ‘Last Wishes’ document and to maintain dignity; to retain the dignity of this dignified person, is it best to...

Let them go? Is it better to stand back and just watch them die?


The mind crumples; the training kicks in.


Assess the background; assess the person; act fast to save a life. The rules are the same: get it right to give that support that will save a life...

Question, Persuade, Refer.

This is QPR -

- The QPR Institute
QPR stands for Question, Persuade, and Refer -- 3 simple steps that anyone can learn to help save a life from suicide. Just as people trained in CPR and the Heimlich Maneuver help save thousands of lives each year, people trained in QPR learn how to recognize the warning signs of a suicide crisis and how to question, persuade, and refer someone to help. Each year thousands of Americans, like you, are saying "Yes" to saving the life of a friend, colleague, sibling, or neighbor. QPR can be learned in our Gatekeeper course in as little as one hour.
CPR stands for cardio pulmonary resuscitation, an emergency medical intervention created by Peter Safar and first described in his 1957 book the ABC of resuscitation (A for airway, B for Breathing, C for Circulation).

QPR stands for Question, Persuade and Refer, an emergency mental health intervention for suicidal persons created by Paul Quinnett, and first described in 1995 in a number of presentations and publications by the QPR Institute.
The mind crumples; the training kicks in.


No more; there are in place, or are proposals to set in place, additional and urgent provisos to action...

- Mail Online
Is the person set on ending their life? Is there a moral duty to respect that desire?

Is the person elderly or frail as described in the Lakhani Recommendations...?

Should we respect their dignity as a dignified person and just...

Let them go? Is it best to stand back and just watch them die?

Is it better to provide means and assistance in this pursuit to seek death...?

This is RSA 

RSA Replay: Assisted Dying -- Who Makes the Final Decision?

Streamed live on 20 Feb 2014
Should there be a change in the law to permit physicians and others to assist death in terminally ill, mentally competent people who have expressed a wish to die? A panel of expert commentators, including philosopher and author Raymond Tallis, address one of the most challenging questions of our times.

Should we, when they are standing on the parapet contemplating oblivion, give them just a gentle tip over the edge?

What shall define a ‘legitimate’ wish to die? Is the experience of the life that is being led considered ‘undignified’ or is the treatment that is being administered undignified? What criteria shall determine such legitimacy and that defines dignity?

Further, as such judgement upon whether a person is considered to have a legitimate wish to die is external to the person, how can it be said that a person’s autonomy is being respected?

Who shall determine legitimacy and will there be right of appeal? It is reasonable to suppose that, over time, the bounds of ‘legitimacy’ will be pushed back; that grounds for legitimacy must surely be extended.

We are already seeing active killing. As recorded in these pages, we are already seeing the interests of scientific investigation take precedent over personal interest.

We are redefining longstanding and historical law on physical assault and the criminal act of taking life – murder.

However little long you have left, that little may affect everything and that is why your continued life and its value means everything.

You are more important in more ways than you can possibly know. It really does make all the difference in the great scheme of things if you live or if you die. These choices have consequences for society.

A ‘heartful’ and compassionate and selfless society is being turned on its head. The self-sacrificing care doted on an ailing loved one by a carer will translate as the self-sacrifice of the loved one to end it all so that the carer need themselves not be put to such inconvenience and self-sacrifice.

The capacity to care is being diminished by the removal of the opportunity to care. The foundations of a heartless, self-serving and selfish society are being laid. An onus and expectation is being set. The vulnerable are being placed at risk.

The economic benefits of euthanasia have been given serious consideration in The Canberra Times...

And David Harradine  in The Mercury considers that the 'Dying with Dignity' slogan could become the new 'Do The Right Thing' 

THE "Do The Right Thing" anti-littering campaign of the late 1970s is widely acclaimed as the most successful behaviour-change campaign in Australian history. 
The brand and messaging remains instantly recognised and understood, with research confirming that 81 per cent of people equate the slogan with "put your rubbish in the bin".
A campaign being waged right now by the Tasmanian Premier and the Leader of the Greens has a message of equal simplicity, with the potential to change the culture of the state, if not the nation. 
To ensure that people can "die with dignity" is something that everyone would regard as the right thing to do. 
So it is unfortunate that it has become a political slogan aimed at binning those whose lives appear to have no value. 
Before the release of "Do The Right Thing", Australia faced a perfect litter storm.
The power of the campaign was in a simple yet strong message that could deeply penetrate the psyche of its audience. 
So powerful was it that long after the ads ceased, the messaging ingrained in my mind means that I will never forget where my litter belongs. 
The campaign's marketing team honed in on the evident lack of social pressure on people to do the right thing and released a series of compelling advertisements that were witty and uplifting, but at the same time delivered a serious social conscience check to viewers. 
In the political dying with dignity campaign we see similar tactics. 
There is no doubt about the potency of its simple slogan, its appeal to the core value of human dignity and the images of helpless people tormented by pain and despair that it evokes. 
But unlike the anti-litter campaign, this simplistic message turns the community's sense of the right thing to do on its head. 
The idea that people are not dying with dignity suggests that Australia has the equivalent of a litter problem in its hospitals and care homes. 
Instead of providing care to people to the end of their natural lifespan, as we have done until now, we are meant to feel moral revulsion at the prospect of people dying gradually of terminal illnesses or becoming helpless through physical and mental frailty. 
Worse, the infirm themselves are getting the message that if they want to do the right thing by society they should cease being economic, financial and emotional burdens and opt for an early death. 
In this way we end up with the very opposite of respect for the dignity of every person, no matter what their condition. 
In truth, the political momentum of the euthanasia movement (to call it by its correct name) has little to do with human dignity and much to do with pragmatic concerns. 
With economic headwinds and financial and demographic convection currents, Tasmania faces its own perfect storm.
Pertinent reading –
Liverpool Care Pathway - The Hollow Man
Liverpool Care Pathway - After The Review, After Everything, They're STILL Killing People

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

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