Monday, 9 April 2012

Liverpool Care Pathway – The Alternative Exit Route

The NHS (National-socialist Health Service) has always had to juggle available resources and financial constraints still determine, now more than ever, the decision to favour best outcomes. Executive decisions are taken accordingly, weighing any gain by treatment against the quantitative and qualitative arguments against such provision of treatment -

Whether, quantitatively, it is worth the inordinate cost and expense to the public purse
and, qualitatively, that it is not deemed overly a burden or strain on the family or support network in place.

The medical establishment (e.g. the Scottish BMA) already favours further rationing of available resources. Medical ethicists and commentators have recommended a life-limiting approach to further ration available resources while the proponents of euthanasia and assisted suicide grow daily more outspoken in exhorting society to follow their lead.

Those who urge caution are increasingly sidelined. Still, lone voices are raised, consistent and certain in their belief.

This is from Bioedge.org -

Monday, April 09, 2012

How voluntary is “voluntary”?

by Michael Cook | 2 Apr 2012

Respect for autonomy is one of the most convincing arguments for euthanasia. It was the theme of a strong defence of legalising it in Australia in the Journal of Law and Medicine by Margaret Otlowski and Lorana Bartels in 2010. They concluded that “ in a secular society with an ageing population” legalisation is inevitable.

However, in the latest issue of the JLM a criminologist at the University of Tasmania has made a vigorous response. Jeremy Prichard doubts that many people in the community will be able to give full and voluntary consent to ending their lives. He contends that the growing prevalence of elder abuse suggests that aged people could easily be manipulated.

“Such procedures may be safe for socially connected, financially independent individuals with high autonomy and self-efficacy,” he writes, but “circumstances may be entirely different for isolated patients with low self-efficacy who represent an unwanted burden to their carers, some of whom may benefit financially from the death of the patient (even just in a reduction of financial pressure).”

Sometimes the request for euthanasia may be genuine, but it has been prompted by subtle pressure. Carers may easily convince a patient that death is the best option for everyone. Dr Prichard cites some disturbing anecdotes from research into elder care in Tasmania. In one, a woman describes how she is treated by her husband:

“I had the stroke a few years ago, I’m absolutely helpless to do anything myself ... [My husband] gets annoyed because I have to go to the toilet all the time and he has to help me. ... In his own selfish way he cares for me too, it’s just that he’s so disagreeable, he’s a real disagreeable old grump, he doesn’t like anyone around ... He talks about he’ll be glad when he dies all the time and I say “well what will I do?” He says “I just hope my time will hurry up and come.” That’s my life and I’ve got to put up with it ... I couldn’t get anyone else to look after me.”

Very little research has been done on pressures that could be exerted on the elderly and disabled. “Research on the risks of voluntary euthanasia or physician-assisted suicide is in its infancy,” he writes.” So far as this article could ascertain, only one qualitative study has investigated the issues of pressure on patients to access voluntary euthanasia or physician-assisted suicide.”

Michael Cook comments in his closing paragraph that very little research has been done on pressures that could be exerted on the elderly and disabled. These 'pressures' have been surfacing for years in statements floated by ethicists and other persons of note to groom, manipulate and shape public opinion into the mindset of 'a duty to do the right thing' and to end it all.

The article asks - How voluntary is "voluntary"? Euthanasia and assisted suicide are not on the statute books - yet - although cases are given the 'nod' and pass unchallenged.

The LCP, the alternative exit route, is tried and tested. How voluntary is "voluntary"? It is completely involuntary. It is the doctor's decision. It is a legal document which gives cover and protection to those 'doctors of death' and 'angels of mercy' who always knew best and determined, godlike, who should be given assisted passage into the next world and when.

This was always something that 'went on' but which no-one spoke of. No more. It is a legal protocol; it may be initiated even without informing the patient or the patient's kith and kin. It is the Liverpool Care Pathway.

Sunday, 8 April 2012

Liverpool Care Pathway – A Point In Question

The NHS (National-socialist Health Service) has always had to juggle available resources. Financial constraints have determined the decision to favour best outcomes and so it was hardly a matter of surprise to read the following in The Scotsman:

BMA: Let patients die 'to save cash'

Published on Saturday 25 June 2011 13:55

THE leader of Scotland's doctors has questioned whether society can afford to pay thousands of pounds to keep terminally-ill people alive for weeks or months when health service budgets are under unprecedented strain.

Dr Brian Keighley, chairman of the British Medical Association Scotland, said in some cases tens of thousands of pounds were spent on drugs to extend cancer patients' lives for relatively short periods.

‘Quality of life' assessments are considered in tandem with the financial cost to maintain such a life and the appropriate executive decision is taken.

The Calgary Herald has reported a doctor's comments upon what is recorded as the cause of death and what was the actual cause of death. Thus:

His death certificate, filled out by this doctor, listed the cause of death as melanoma.

The public record is not accurate.

My patient did not die from his cancer, but at the hands of a once-trusted colleague.

The doctor is an internal medicine doctor, practising in Oregon, where assisted suicide is legal.

The question arises, consequent upon these comments: What is recorded as the cause of death and what was the actual cause of death in regard to patients who die on such end of life protocols as the Liverpool Care Pathway?

According to the Daily Mail,

Figures released by the Office for National Statistics revealed that in 2009, 816 hospital patients were listed on death certificates as having died suffering from dehydration.

Elsewhere, the Mail reported,

Rhonda Smith, of malnutrition charity Bapen, said the death certificates massively underestimated the true extent of the problem – and that the real figure ran into thousands a year.

Question: LCP protocols include withdrawal of fluids. Do these statistics include patients who had their lives terminated on the LCP?

Question: What do doctors record as the cause of death on the death certificate in the case of patients who have their lives terminated on the LCP?

Saturday, 7 April 2012

Liverpool Care Pathway – Protecting The Victim

On the manner of Shipman's death, Wikipedia reports:

Death Harold Shipman committed suicide by hanging in his cell at Wakefield Prison at 06:20 on 13 January 2004, on the eve of his 58th birthday, and was pronounced dead at 08:10. A Prison Service statement indicated that Shipman had hanged himself from the window bars of his cell using bed sheets.^[24]

The Guardian headlined -

How do you protect the living dead?

Some hope of release might have prevented Dr Shipman's suicide
____________________________________________________________________

David Ramsbotham

The Guardian, Wednesday 14 January 2004 09.25 GMT Article history

___________________________________________________________

Yesterday's terse announcement from Prison Service headquarters, that the convicted mass murderer Dr Shipman had hanged himself in his cell at Wakefield prison, prompts many more questions than the simple one of "How could it happen?" We have been told that, at the time, the authorities at Wakefield did not believe there was any risk that he might commit suicide. Instead of being put under special suicide watch every 15 minutes, he remained at the standard one-hour's watch for all high-risk category A prisoners. No prison in the system is more experienced at looking after high-risk prisoners than Wakefield. Therefore, it must be presumed that staff acted in good faith, and on the best available advice.

Some hope of release? These are commendable concerns. The quality of mercy is not strained; it is a boon offered freely and without compunction.

The Guardian continues -

Coming on top of the suicide of Fred West and the near suicide of Ian Huntley before they were brought to trial, Shipman's death is bound to come as an embarrassment to the Prison Service. Inevitably, it will conduct its own internal inquiry to determine whether any indication may have been missed. However, from the point of view of the public as a whole, it is wholly good that the government has announced that, in future, the prisons and probation ombudsman, Stephen Shaw, will conduct independent inquiries into all deaths in custody. People are naturally suspicious of closed inquiries in which no one is held to blame, because it makes it appear that there is something to hide. The number of issues around the suicide of such a notorious prisoner as Shipman demand that the public is told the whole truth. All those who acted in good faith can have nothing to fear.

The writer asks: How could it happen? We are assured that 'All those who acted in good faith can have nothing to fear'.

A society which does not care is not worthy to be called a society; it is a jungle of each for themselves and be damned to everyone else. Thus, The Guardian headline is commendable and fitting, in accord with that merciful and enlightened attitude of the great social reformers of the 19th century - Elizabeth Fry, Charles Dickens.

And yet, whilst it is well to safeguard the lives of those held in our gaols, what safeguard was there in place to protect their victims?

Would that such measures had been in place to protect them, but it is only possible to know that a victim is a victim after the fact. Only the perpetrator is in a position to control events to bring about a different outcome.

It is well and it is commendable to express compassion - compassion and consideration that these ‘lifers’ serve a life sentence - but their victims have been served a death sentence…

And the enormity of their crimes prompts questions which do require answers.

The Guardian comments -

There can be nothing more soul-destroying than total and utter hopelessness. In many respects, a natural life tariff is little more than a living death sentence.

The enormity of their crimes prompts questions which do require answers. It cannot be emphasised enough that they have already served their victims just that - a death sentence!

Assuming these persons are not complete psychopaths, do they have insight into what they have done? Is there some recognition of the magnitude of their crimes?

With recognition, is there remorse?

If there is remorse, is there contrition?

Only through contrition can come redemption, may the victim forgive and might release be considered. Yet, if the perpetrator possessed true insight, would they, could they forgive themselves sufficiently to desire release?

It is the Christian ethic to forgive or to offer forgiveness even in the face of a terrible wrong. Jesus pleads: Father forgive them, for they know not what they do.

Mahatma Gandhi, who forgave his assassin even as he was dying, says: The weak can never forgive. Forgiveness is the attribute of the strong.

Gandhi also says: When I despair, I remember that all through history the ways of truth and love have always won. There have been tyrants, and murderers, and for a time they can seem invincible, but in the end they always fall. Think of it--always.

These murderers are also tyrants that they may snuff out a life in like manner as they might crush a flower in the palm of their hands. The Guardian leader writer might well consider that in his pleas and exhortations.

What is done is done and cannot be undone; the wrong cannot be righted, but it can be addressed and balanced with charitable acts and works in recognition of the wrong. The desire to follow such a course is a hopeful sign, that there is such recognition.

Such a desire might also be a machination, an act of the clever psychopath to manipulate and to engineer their release.Thus did Hindley manipulate Longford.

Such a desire might not be present.

If there is no such desire and there is only a selfish concern for self and the plight and condition of the self, such as the leader writer himself describes, how may such a person be considered for release back into the community? By implying some complicity or guilt on the behalf of the warders, the writer diminishes the complicity and guilt of the ward.

If these suicides are acts of hopelessness or guilt, the current Death Culture might well soon be urging a program of safe, secure and assisted suicide in our Gaols. In the Case of Shipman, however, we now know that he was a proponent of euthanasia and that his decision to take his own life was a selfless one to make financial provision for his family!

Shipman made 'quality of life' assessments of his patients, considered the financial cost to maintain such a life, and took the appropriate executive decision. The only extraordinary thing about Shipman was the extraordinary dedication with which he did so.

What compassion is there for the innocents who are served a death sentence on the LCP?

How many erroneous 'diagnoses' of dying go unreported? All those, certainly, which are pursued unto death.

How many are put on the LCP without 'benefit' even of a diagnosis of dying?

Those who take such executive decisions to end a life they do not consider as possessing worth or that might cause strain and burden on the family have done so for years prior to its implementation and now do so under the protocols and the protection of the LCP.

Who are these petty executive decision makers that they remove and deny the opportunity to care to family members? What they deem a burden and a strain is a lesson in mercy; it is a privilege, not a burden. It was always a privilege to return to my mother in her elder years the love and the care that she offered me in my junior years.

My mother was not dying. She was not terminally ill. She went in for a period of respite care. But we now know that, even the lack of a 'diagnosis' of dying does not disallow being placed on an end of life protocol such as the LCP...

Wikipedia:

Despite The Sun's celebration of Shipman's suicide, his death divided national newspapers, with the Daily Mirror branding him a "cold coward" and condemning the Prison Service for allowing his suicide to happen. The Independent, on the other hand, called for the inquiry into Shipman's suicide to look more widely at the state of Britain's prisons as well as the welfare of inmates.^[28] In The Guardian, an article by Sir David Ramsbotham (former Chief Inspector of Prisons) suggested that whole life sentencing be replaced by indefinite sentencing as these would at least give prisoners the hope of eventual release and reduce the risk of their committing suicide as well as making their management easier for prison officials.^[28]

Saturday, 31 March 2012

Liverpool Care Pathway – And The Death Culture

How many deaths on Shipman's hands...?

How many deaths on the hands of these Doctors of Death in Oregon...?

An estimated 20,000 patients die each year while receiving care under the Liverpool Care Pathway...

care2

Change.org

GoPetition

Please register your opposition here now:-

e-petition

Please register your opposition here now:-

e-petition

To stand by and do nothing while a wrong proceeds unchallenged is to make yourself complicit in it.

Liverpool Care Pathway – And The Shipman Phenomena

If Shipman was callous and totally lacking in any sensitivity to the enormity of his deeds, then the attitude of this doctor must be judged in like manner. The doctor is calmly discussing the taking of a life:

Rather than taking the time and effort to address the question of depression, or ask me to talk with him as his primary care physician and as someone who knew him, the specialist called me and asked me to be the "second opinion" for his suicide.

She told me that barbiturate overdoses "work very well" for patients like this, and that she had done this many times before.

The apparent 'normality' of this telephonic exchange is not just surreal, it is alarming.

More from the Calgary Herald -

Don't follow Oregon's lead--say no to assisted suicide

I am an internal medicine doctor, practising in Oregon, where assisted suicide is legal and would like to commend the Jan. 10 column by Licia Corbella, entitled: "If doctors who won't kill are 'wicked,' the world is sick.' "

BY THE CALGARY HERALD JANUARY 17, 2009

I would also like to share a story about one of my patients.

I was caring for a 76-year-old man who came in with a sore on his arm.

The sore was ultimately diagnosed as a malignant melanoma, and I referred him to two cancer specialists for evaluation and therapy.

I had known this patient and his wife for more than a decade. He was an avid hiker, a popular hobby here in Oregon. As he went through his therapy, he became less able to do this activity, becoming depressed, which was documented in his chart.

During this time, my patient expressed a wish for doctor-assisted suicide to one of the cancer specialists.

She told me that barbiturate overdoses "work very well" for patients like this, and that she had done this many times before.

I told her that assisted suicide was not appropriate for this patient and that I did NOT concur.

I was very concerned about my patient's mental state, and I told her that addressing his underlying issues would be better than simply giving him a lethal prescription.

Unfortunately, my concerns were ignored, and approximately two weeks later my patient was dead from an overdose prescribed by this doctor.

His death certificate, filled out by this doctor, listed the cause of death as melanoma.

The public record is not accurate.

My patient did not die from his cancer, but at the hands of a once-trusted colleague.

This experience has affected me, my practice, and my understanding of what it means to be a physician.

What happened to this patient, who was weak and vulnerable, raises several important questions that I have had to answer, and that Canadian citizens should also consider: - If assisted suicide is made legal in Canada, will you be able to trust your doctors to give you and your family members the best care? I referred my patient to specialty care, to a doctor I trusted, and the outcome turned out to be fatal. - How will financial issues affect your choices? In Oregon, patients under the Oregon Health Plan have been denied coverage for treatment and offered coverage for suicide instead, which saves the plan money. See KATU TV story and video at http://www.katu.com/home/video/26119539.html (about Barbara Wagner). Do you want this to be your choice? - If your doctors favour assisted suicide, will they let you know about all possible options or will they simply encourage you to kill yourself?

Suicidal ideation is interpreted as a cry for help. In Oregon, the only help my patient received was a lethal prescription, intended to kill him.

To the citizens of Canada, is this where you want to go? Please learn the real lesson from Oregon.

Despite all of the so-called safeguards in our assisted suicide law, numerous instances of coercion, inappropriate selection, botched attempts, and active euthanasia have been documented in the public record.

Protect your health care. Don't let legalized assisted suicide come to Canada.

Charles J. Bentz, Md, FaCP, is a Clinical associate Professor of Medicine, Division of General Medicine and Geriatrics at Oregon Health & Sciences University, Portland, ore.