Sunday, 28 December 2014

Liverpool Care Pathway - Difficult Questions; Reasoned Answers...

When dignity in death takes precedence over dignity of life...

In determining that this unborn child may have little or no prospect of a positive outcome to life and that, therefore, that diagnosed outcome shall be pre-empted with a determined act to produce an outcome of death, are they actually performing an act of illegal euthanasia?

This is the Irish Times -

A young pregnant woman declared clinically brain dead more than three weeks ago may be taken off life support because there is no genuine prospect of her baby being born alive, a three-judge High Court has ruled. 
Due to the woman’s rapidly deteriorating condition, the prospect for the unborn is “nothing but distress and death”, the court said. 
After giving the court’s ruling, the President of the High Court, Mr Justice Nicholas Kearns, said he was “grateful” to be told there will be no appeal to the Supreme Court.
The child may not answer, may not come to their own defence, and those so appointed will not pursue it.
Mr Justice Kearns, sitting with Ms Justice Marie Baker and Ms Justice Caroline Costello, said the court was awarding costs of the case to the woman’s family, and to the lawyers representing the interests of the woman and unborn, as it had raised issues of “great public importance”. 
The woman is 18 weeks pregnant and was at 15 weeks gestation when she was declared clinically dead on December 3rd at a Dublin hospital as a result of a brain trauma suffered at a hospital outside Dublin on November 29th, two days after she was admitted there complaining of severe headaches. 
This was not a case where the woman had ever indicated she wanted an abortion, he said. On the contrary, she had apparently posted a scan of her unborn on her Facebook page to share her pleasure and excitement about her pregnancy. From the available evidence, the court believed she would “have fought long and hard to bring her unborn child to term”.
The woman suffered "catastrophic" brain injuries in an accidental fall in the hospital where she initially sought treatment. She was transferred to a specialist Dublin hospital where she was placed on life support. On December 4, 2014, she was declared brain dead by doctors.

Is liability to be considered for the fall?

Lawyers representing the interests of the woman made the argument that the treatment should continue. Issue was raised that, given she was a full-time mother devoted to her children, she would have wanted her child to have the chance of life [The Irish Times].

Lawyers on the family's part said that the prospect for the unborn is “nothing but distress and death”. That is the most certain prospect if life support is withdrawn. This argument, then, is one of futility and not for concern for the unborn.

The matter of significance in this case for the Justices, however, extends further for they proclaim that it has raised issues of “great public importance”. The debate on the rights of the unborn are now certain to proceed.

There is concern expressed for the awful predicament and distress of this poor family who have witnessed this.

The language of the EoLC Programme and Strategy was always couched in phraseology that demonstrated most concern for how a death is perceived to be by those who witness it than how it is actually experienced.

Dame Cicely Saunders, one of the pioneers of the Hospice movement, said: “How people die remains in the memory of those who live on.”

Then does concern for the interests of the stricken take secondary place to that of those who must witness the predicament of the stricken...?
Liverpool Care Pathway - "No Midazolam"
These are all valid questions to ask.

The PROMs (Patient Reported Outcome Measures) for EoLC are among the Quality Markers to document quality of care. Patients on the death pathways may not respond upon their experience for they will be dead. It is the 'Friends and Family' then who will report how smoothly it all went.

The perception of the dying, likewise, might be misleading and misinformed. It is wholly a subjective view, reported by the perceiver of the death and not by the person who has died. A sedated patient is not in a position to complain. A dead patient cannot complain.

Knock them out with Midazolam and they will be pliant, compliant and uncomplaining.

Archbishop of Dublin Diarmuid Martin is reported as saying that, “A woman isn’t simply an incubator.”

That is evident. A woman is a person, whole and complete with personal interests and attributes that Nature, God or evolution have bestowed upon her. One of these attributes is the continuity of the species.

A woman is not simply a vessel to bear children. Neither is any person simply a vessel from which to harvest organs for transplant, but many promote that concept through presumed donor consent.

The Archbishop is also reported as saying that, “From the point of view of Catholic teaching in general medical ethics, there is no obligation to use extraordinary means to maintain a life." That simplistic argument will be taken up and be used as a cudgel against him.

The Justices have plainly considered it a matter of import to consider the argument of the family and to respect and understand what they must be going through.

There are, however, issues of “great public importance” which have also been raised.

Health Minister, Leo Varadkar, has said the constitutional rules around abortion are “too restrictive” and have a “chilling effect” on doctors.

“Difficult decisions that should be made by women and their doctors, a couple or next-of-kin… on the basis of best clinical practice, are now often made on foot of legal advice. That is not how it should be.”

"Difficult decisions..."

In May 2012, David James walked into Fazakerley Hospital, Liverpool, with a stomach complaint. He became critically ill after contracting hospital acquired pneumonia that led to multiple organ failure.
"This is one of the terrible things. Aside from the pneumonia, we’ve never really had a diagnosis. All we know is that from the moment he went into hospital, he went catastrophically downhill." (May James)
Mr. James ended up on life support and the good doctors of Fazakerley went to court to fight the family's wishes to keep David on life support...
Liverpool Care Pathway - In Whose "Best Interests"?
Liverpool Care Pathway - A Bad Decision Left To Stand
The wishes of next-of-kin in this particular "difficult decision" were not to be respected.

It would appear that the 'right to life' of a brain-live child is, apparently, secondary to the 'right to life' of a brain-dead child...
Liverpool Care Pathway - Cold, Cruel, Callous, Heartless, Without Pang Of Remorse
Curiously, in each of these cases a possible harm has occurred in which liability may be attributed to the hospital concerned.

Does that have some weight of significance? In the Dublin case, all that stood the doctors' hands in withdrawing life support was the contentious Eighth Amendment and legal action.

In this case, the parents and partner of the woman filed lawsuits asking for the hospital to switch off her life support.

Historically, hospitals in the republic have kept pregnant women on life support in hopes of saving the unborn.

Should apparent futility sway us in determining should a life be saved or abandoned? Is it not human instinct to rush in against all peril to attempt rescue?

This is the The Telegraph -

A baby boy has been delivered by Caesarean operation to an Italian woman who was declared clinically dead two months ago.

The 36-year-old woman from Milan suffered a massive brain haemorrhage in October, during her 23rd week of pregnancy.

After being taken to hospital, she was pronounced clinically dead and there were fears for her unborn child.

But doctors at San Raffaele hospital in Milan managed to keep her on life support, feeding the developing foetus through a tube inserted in the mother's stomach.

Against all the odds, the baby boy was born on Thursday by Caesarean operation, in the woman's 32nd week of pregnancy.
Last year in Mail Online -

A baby which was 15 weeks old when its mother was declared brain-dead was delivered by Caesarean section at 27 weeks, after doctors kept the mother alive on life support.

The Hungarian doctors who delivered the baby in July believe the birth is one of only three such cases in the world.

The child was born three months after its 31-year-old mother suffered a stroke. Her life support machine was switched off two days after the Casearean section.

In the spring, she had been rushed to hospital, operated on but was declared brain-dead. She was kept on life support and doctors were able to see through an ultrasound that the foetus was moving.

‘In the first two days we struggled to save the mother’s life and it was proven... that circulation and functions stopped,' said Dr. Bela Fulesdi, president of the University of Debrecen Medical and Health Science Centre.

There are many twits on Twitter...

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