Saturday, 12 December 2015

Liverpool Care Pathway - Whether Shove Comes To Shovel, It's Still A Spade

When push comes to shove, it's still determining the cause to be the fall rather than the push.
The cult of death has taken root and become a means to define a culture.

That is Quebec today...
Liverpool Care Pathway - A 'Right' To Die?

Liverpool Care Pathway - Semantics, Semantics, Semantics
This is The College of Nurses of Quebec

This exercise guide is a collaboration of three professional colleges: Collège des médecins du Québec, Order of Nurses of Quebec and the Quebec Order of Pharmacists. It provides the standards to be followed to perform medical help to die (AMM). It is a guide for doctors and other health professionals or social services in the exercise of their practice, while respecting the spirit of the Act concerning the end of life care. This exercise guide target population major and capable people, for whom the only medical help to die is permitted by law. The document also addresses the issue of conscientious objection by health professionals in connection with the marketing authorization.
If your life has been ended by medical assistance, what goes on the death certificate....?
The Exercise Guide explains...
At the scene, the doctor must establish the décès21 finding (form DEC-101, a copy of which is for the director of civil status and the other in declaring the death) and fill out the death certificate (SP Form -3, which refers to the cause of death), for the benefit of the Institut de la statistique du Québec (ISQ) (Public Health Act, Art. 46), the coroner or medical records of the case, and Finally, the funeral director.

The doctor has to register as an immediate cause of death disease or morbid condition which justified the AMM and killed.

It is not the manner of death (cardiac arrest), but disease, trauma or complication that caused death.

The term medical assistance to die should not be included in this newsletter.

Indeed, such a statement, if known uninformed relatives could firstly go against the will of a patient wishing to keep this confidential information and, secondly, cause them harm. . .
Is the professional collegiate collaboration in denial of responsibility?

An act to take a life should surely be recorded, in part if not in whole, as the cause of death.

No, not at all. Those patients deemed dying did not have LKP put on their death certificates.

This happens as practice in the profession...

This is HSJ -

An independent investigation into the death of a three-year-old boy at Stafford Hospital in 2014 has called for a second inquest into his death and heavily criticised a “closed culture within the NHS”.

The report by consultant paediatrician Martin Farrier, released today, supported the parents of Jonnie Meek, who died at Stafford Hospital’s children’s unit last year, saying their suspicion that Jonnie died as a result of a reaction to a special milk feed was the most likely explanation for his death.

Although Dr Farrier concluded there was no evidence of a conspiracy, he added: “Throughout the story there is another narrative. It is one of convenience. The finding of pneumonia by the pathologist was convenient. It meant the professionals involved not needing to consider other issues. It was accepted by all those involved other than Jonnie’s family.”

Dr Farrier told HSJ he agreed the role of an independent medical examiner, a key recommendation from previous healthcare inquiries, could have made a positive difference.

“Two different trusts. Two different times. Neither trust had a reason to hide. Both responded in the same closed, unhelpful manner.

They are determining the cause to be the fall rather than the push.

So, what goes on the death certificate...? It goes without saying.

- Mail Online
Further considerations...

This is the National Post -

Quebec doctors will soon be given standardized kits with which to end the lives of patients seeking euthanasia — including drugs to calm the nerves and stop the breathing  — along with detailed instructions as the province prepares to usher in legalized aid in dying.

The Collège des médecins du Québec has developed a new guideline for doctors unlike any in the history of Canadian medicine: a step-by-step guide to follow before, during and after administering euthanasia to an eligible patient, including the type of drugs to be used, the dose, the injection site and what to do in the event of complications.

Bill 52 allows doctors to administer lethal injections to mentally fit patients suffering an incurable illness and in constant and unbearable physical or psychological pain. He or she must also be in an advanced state of irreversible decline and be at the end of life.

“It is clearly not euthanasia on demand,” Robert said. “It is clearly not that.”
When the genie is out of the bottle...?
- Bill 52
While the Supreme Court of Canada did not define “physician-assisted death” when it threw out the century-old Criminal Code prohibitions against the practice in February, legal experts say the court opened the door to both euthanasia and physician-assisted suicide — where the doctor writes a prescription for a life-ending overdose the patient then takes himself.

The Quebec guideline could become a model for all of Canada once the Supreme Court ruling comes into effect in February.

Modelled on a formula used in the Netherlands, the Quebec protocol calls for a three-phase approach to assisted death via lethal injection.

First, a benzodiazepine, a type of sedative, would be injected to help control anxiety and “help calm the patient,” Robert said.
This first line administration of benzodiazepines may give the objective appearance of calm which may not, subjectively, be present.

For a personal perspective, see...
No Midazolam
Benzodiazepines such as Midazolam are used in EoLC...
Liverpool Care Pathway - "No Midazolam"
Second line administration...
Next, a barbiturate drug would be injected to induce a coma. The third step would be a neuromuscular block, a derivative of curare that acts on the respiratory muscles to cause “cardiorespiratory arrest.”

The whole process, from beginning to death, “would probably take something around 15 minutes,” Robert said.

Some of the drugs are “thick,” he said, meaning they cannot be given by a “bolus” or “high-speed injection” and each require about five minutes to administer.

The guideline instructs doctors to watch for reactions, such as any allergic reactions or vomiting, and to be careful not to lose access to the vein. “If the vein is clotting, probably they have to remove the needle and find another route of entry,” Robert explained.
On the Communitarian balance sheet when the choice is there...

Recommendation will be made accordingly.
Robert said the cost of the medications “is something surely less than $100.”
Is Oregon a good place to die...?
He said the Quebec college of physicians looked abroad for guidance, including speaking with the first doctor in Oregon to prescribe a legal dose of life-ending drugs to a patient under the state’s Death with Dignity Act, which took effect nearly 20 years ago. “He told us there were some bad side effects,” Robert said.

Under the Oregon law, the life-ending medication has to be taken orally, and not injected. Patients have regurgitated the lethal drugs, or, in some early cases, “reawakened” hours, sometimes days, after swallowing them. In some cases, the time to death has taken far longer than anticipated.
Doctors, trained to preserve life, must be trained to end life.
Under the guideline, euthanasia could be performed in a hospital, a palliative care hospice or the person’s home.

“Nobody feels prepared,” Robert said. “We are exploring a new continent.”

“But we have to learn how to do this as best as possible,” he said. “There is a beginning for everything.”
Doctors must be trained to kill.

When the genie is out of the bottle then all mischief is let loose.

Blog supplemental –
Liverpool Care Pathway - Doing The Addition 
Liverpool Care Pathway - The Trailblazers

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