Liverpool Care Pathway – The Death Criterion

The old, the weak, the vulnerable, the frail and the fragile, not necessarily close to death, but whom may easily trip or be tipped over the edge into oblivion; these, needing – requiring – that extra bit of care and attention, whose condition demands it, these are those most likely to be chosen to be placed on the death pathway.

These, most dependent upon society’s tolerance and compassion, most needing of care and attention, these are those most vulnerable to the attentions of those who, godlike, will gift what they regard merciful passage from this world without concern to want or wish or will.

The Death Pathway sets out to sanitise the human condition such that it becomes shallow, bereft of feeling, a uniform exit from this world. Perversely, when caring is most required it is withdrawn; when compassion is most wanted it is found wanting.

The priority of good palliative care is always to diminish pain, not to hasten death; it is paramount to keep in sight that the guiding purpose and principle is life, not death; that the intent is the one, even when and even though the outcome is the other. Caring is an obligation upon the human condition; it is a privilege of service; it is a catharsis for the soul. 

Liverpool Care Pathway – Compounding The Errors

The Liverpool Care pathway –

If it can happen to a journalist, it can happen to anybody.

This from Hold The Front Page.co.uk -

Family in dispute with hospital over journalist’s death

by Sarah Bould, last updated on January 6, 2012

The death of a former regional newspaper reporter who battled apartheid and once interviewed Enoch Powell has led to a dispute between his family and the hospital where he died.

Musosa Kazembe worked for the Swindon Advertiser in the 1970s and went on to work on various publications which saw him reporting from the front line of the fight against racism in Africa and Europe.

Following his death last week at the age of 74, his family gave an interview to the Advertiser in which they claimed he was condemned to die by Swindon’s Great Western Hospital.

Zimbabwean-born Musosa was in hospital for 28 days before his death. He had Parkinsons Disease and was believed to have been suffering from pneumonia.

His son Chim told the Advertiser his dad was left to ‘starve’ despite at one point being well enough to speak.

He said: “When he woke up he spoke to the nurse and said ‘how are you?’ in clear English,” he said.

“She said she was okay and asked how he was. Then he asked for food.”

The family claim a junior doctor administered what they were told was a mild sedative, which turned out to be a powerful mixture of morphine and diazepam.

Chim claimed the purpose was to make sure he slipped into a deep sleep despite the fact he had been ‘crying out’ for food.

He added: “I’m not saying if he had been treated he would have survived, but he would have got better, and he would have lived longer.”

Musosa fought against apartheid in South Africa and in his native Zimbabwe he helped freedom fighters escape Gonakudzingwa prison.

His activities led to him being expelled from his homeland and he settled in Swindon where he remained for most of the next 40 years.

During that time he interviewed Conservative right-wing politician Enoch Powell, notorious for his ‘rivers of blood’ speech on immigration.

He also worked for the Drum magazine in South Africa, the Times, the BBC and the defunct newspaper, The European.

Hospital bosses were due to meet with the family this week to discuss their concerns.

Elizabeth Daly, head of patient experience at Great Western Hospitals NHS Foundation Trust, told the Advertiser: “We would like to offer our condolences to Mr Kazembe’s family following his death on Wednesday.

“We have already been in contact with his family to discuss their concerns, and have invited them in for a meeting next week to discuss them further. The Trust takes all complaints very seriously and will be investigating the issues raised.

“Due to patient confidentiality, we are unable to comment further at this stage.”

This further report follows -

Family still seeking answers over journalist's death 

by Sarah Bould, last updated on January 12, 2012

The family of former regional newspaper reporter say they are still no clearer as to how he died following a meeting with the hospital where he was put on a treatment plan before his death.

Musosa Kazembe, who worked for the Swindon Advertiser in the 1970s, died at Great Western Hospital in the town on 28 December.

He had been put on a scheme designed to comfort the dying in their final days called the Liverpool Care Pathway.

Earlier this week we reported that his family were due to meet with hospital bosses following a dispute in which they claimed he was left to starve.

His three sons allege he was administered powerful sedatives and denied food or water despite at one point being well enough to cry out for something to eat.

His family have now requested his medical notes and are waiting for the hospital to release the information.

A spokesman for Great Western Hospital told the newspaper this week that it had been looking into the complaint since it was first raised but the investigation was not yet complete as it takes time to review all of the information to prepare a full response.

In a statement they said: “We have kept the family fully informed of the investigation, sharing information with them in an open manner and have had almost daily contact with them keeping them up to date.”

Musosa’s son Chim told the Advertiser: “When my father was admitted they said he was suffering from a virus. It took three days to carry out tests but by then they had already switched everything off, and we were never told the results.”

The family are also contesting whether his cause of death was pneumonia as stated on his death certificate or whether he starved.

The family want a post-mortem to determine the factors in Musosa’s death, but may have to pay for it to be carried out because the Wiltshire and Swindon coroner said the death had not been referred by the hospital.

In his journalism days Musosa reported on the fight against racism in Africa and Europe and once interviewed Enoch Powell.

This gentleman was a well-respected journalist. But,as Mickey Rooney says...

Liverpool Care Pathway - A Silence Of Errors

To live a long life was once an achievement. It once earned you respect - and even a telegram from the Queen if you turned the century. No more. It now makes you a target. And, as Mickey Rooney says:

"If it can happen to Mickey Rooney, it can happen to anybody."

Mickey Rooney has testified before the U.S. Senate Select Committee on Ageing in regard to how he became a victim to what has become known as elder abuse. Elder abuse has also entered into the argument against assisted suicide. This argument is not easily refuted.

Jeremy Prichard, criminologist at the University of Tasmania, writes in the Australian Journal of Law and Medicine update: March 2012 expressing his doubts that many people in the community will be able to give full and voluntary consent to ending their lives. He says that the growing prevalence of elder abuse suggests that the elderly could be easily manipulated.

“Such procedures may be safe for socially connected, financially independent individuals with high autonomy and self-efficacy,” 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).”

This article counters arguments made by Bartels and Otlowski in 2010 regarding euthanasia. It suggests that the authors over-emphasised the importance of individual autonomy in its bearing on the euthanasia debate. Drawing on literature concerning elder abuse as well as the “mercy-killing” cases reviewed by Bartels and Otlowski, the article contends that legalising euthanasia may increase the risk that some patients are pressured, inadvertently or deliberately, to request access. Safeguards to detect and deter pressure may be of limited effectiveness against such pressure.

BBC News Manchester, in the context of the fallout from the Shipman experience, reported on the government’s introduction of a more stringent cremation form nationally. But new tighter checks before a body is cremated do not apply to burials.

Dr Raj Patel, a colleague of Shipman, commented:

"The fact that the body is retrievable is an important factor for the process for burial to be more simple." 

"However, I certainly note that there could be potential for some wrongdoing by a healthcare professional or even a carer."

The article continued:

It is a fear echoed by Dame Janet Smith, the senior judge who chaired the Shipman Inquiry.

In an exclusive BBC interview, she said the inquiry, which concluded its reports in 2005, had still not achieved as much as she had hoped.

"We haven't moved at all on basic death certification. It's exactly the same. There hasn't been any further work done since I moved off it in 2003," said Dame Janet.

Assisted suicide is never an entirely autonomous decision; as with all decisions, it is always a decision taken in context. The context is the person's background, situation, social milieu or lack of it. These influences, these pressures, will persuade and contribute to the making and taking of such a decision.

In the context of the vulnerable, as Mickey Rooney says,

"If it can happen to Mickey Rooney, it can happen to anybody."

In the context of the Liverpool Care Pathway, it does happen to anybody.

Liverpool Care Pathway – An Unthinkable Error

The Romford Recorder headlined: Are they playing God?

The sub-line is: "Hospital stops food and medication for patients close to death".

That should read - "Hospital stops food and medication for patients chosen for death". After all, it is the doctor who has made the determination of the patient’s condition that it is terminal and that it is irreversibly so.

If it is ethical to consider withdrawing even the basic necessities of life – fluids and nutrition – is it then ethical to discount any form of resuscitation in any case? If the heart has stopped, the patient has stopped breathing then, ipso facto, the patient is dead. No, the medical practitioner – doctor, paramedic, first-aider – will employ CPR and any measure to ‘make that difference’ – unless there is a living will for which there is provision of access that requires otherwise.

In which case, it is the case that these particular patients have been chosen. They have been selected because certain criteria have been met and – but not necessarily – a ‘diagnosis’ of dying has been made. The ‘end of life’ pathway is a self-fulfilling conveyer belt to whatever it is your belief the next life holds, be that bliss or oblivion.

Ted Eden

 Cllr Ted Eden is quoted as saying: 

"Reports of the use of this pathway and its effects, including first-hand testimony I've heard, have been quite appalling. At precisely the moment [patients] need care, they are too often placed on what seems little more than a pathway to oblivion. In my view, this could easily be seen as playing God or even killing people off."

Yes, exactly that: At precisely the moment the patient needs care, that care is removed. In place of good palliative care, the patient receives a death sentence.

This following post is from the Care2 LCP petition  site:

23:40, Dec 02, Dr. Patrick Pullicino, United Kingdom
It is not scientifically possible to diagnose impending death as the LCP purports to do. The LCP is instead an assessment of the perceived quality of life of the patient by the medical team and as such is euthanasia.

Liverpool Care Pathway - A Policy Of Errors

A protocol is followed and adhered to with a casual assumption that adopted policy does not err. A protocol is not readily challenged. A protocol possesses an assumption of presumed correctness.

With official sanction a policy acquires a distinction which it may not elsewise deserve. It gains a respect and legality that earns it authority. Thus, what was a covert policy, of which the profession was aware but which no-one made mention of, is become a conveyer belt of quite ruthless efficiency – The Liverpool Care Pathway.

Such a protocol is readily extended beyond the 'diagnosed dying' to those whose 'life-prospects' are considered nil or worthless. This is documented in these pages.

In this post, blogged on 14 March 2012, no such diagnosis of 'dying' has been made; the decision to implement the LCP protocols is reached solely on an assessment of the patient's condition and perceived quality of life and, as has been confirmed in these pages by Dr. Pullicino and others, is - put plainly and simply - euthanasia.

Implementation of the LCP 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.

Granted the dynamics of a recognised government policy document, the prospects are become terrifyingly Orwellian and frightening.

Liverpool Care Pathway - A Practise Of Errors

This cutting is reproduced from the Romford Recorder –

Diagnosis is an area of notorious error in the medical field, as has been variously reported in these pages. This letter was submitted to the paper in response to a front page article which asked, ARE THEY PLAYING GOD? This is the article referred to by Joan Grant in her post on the GLPA  blog site.

Most certainly, some doctors do think they are God and act in accordance with that mistaken self-evaluation and assumption. Because they have the power of life or death they act as though it is a right, as with Shipman, for instance. And that is exactly how Shipman could get away with it for so long, because that mistaken self-evaluation is so pre-eminent in the BMA and on the GMC, and this, their colleague, was only acting in accordance with it.

Thus was our assessment of the situation at that time (2009) - that this was an institutionalised and covert practice of which the profession was aware but which no-one made mention of.

We know now, however, the full extent of this “horrific prospect” that is the Liverpool Care Pathway.

Liverpool Care Pathway - A Convenience Of Errors

From Careful -

2:42:59 PM

Mickey Rooney highlights the danger of elder abuse

by Michael Cook | 20 Apr 2012 | 

Mickey Rooney, the Hollywood icon who testified before the US Congress about his experience with elder abuse, stars in an 82-minute documentary, “Last Will and Embezzlement”. It has a certain relevance to bioethics: the growing incidence of elder abuse has been flagged as an important reason why it would be dangerous to legalise euthanasia. ~ cross-posted from BioEdge

Liverpool Care Pathway – 'An Horrific Prospect'

The following was posted in 2009 by the Greater London Pensioners Association on their blog site.

In that year, this family was still in the midst of a battle of wits with the PCT and the Healthcare Commission to dig out the truth behind what had happened to my mother whilst in the care of the NHS (National-socialist Health Service). We were finding the whole complaints process to be just a ruse to grind us down and send us on our way, our tail between our legs.

We were still, at that time, unaware of the complicity of the State in what we had assumed to be an institutionalised and covert practice, of which the profession was aware but which no-one made mention of. We now know the full extent, courtesy of PALS, of that complicity and this “horrific prospect” that is the Liverpool Care Pathway.

Monday, 16 November 2009

THE LIVERPOOL CARE PATHWAY 

An horrific prospect looms for all those souls nearing death or very ill such that they need intensive hospital care. Care is the operative word here. Thanks to a local pensioner colleague in Romford and the local Romford Recorder this 'pathway' (according to aforesaid local newspaper) encourages medics to remove treatment, including fluids, food and medication from patients who are considered close to death.

What boundaries does this cross? What frightening doorways does this open?

This method, apparently, was originally devised for the use of a Liverpool Hospice which sought a peaceful conclusion to a terminally ill person's life who was suffering and in pain. A Hospice's prime function (although this aim often gets overlooked and is often erroneously regarded as a means of substituted hospital treatment), is that where there is no hope at all of recovery, the victim/patient should be made as comfortable as possible and at peace in their last days on this earth, thus being able to pass away with all dignity, care and love. It can never and should never be a MEANS TO CONCLUDE that life whether taking place in a Hospice or Hospital, Residential Home or Nursing establishment of any kind.

This is one step from the ultimate abuse. What happened to the Hippocratic oath? Anything which invades that patient's safety or security is a dangerous practice in itself. To withhold treatment which would prolong life is tantamount to murder. Let there be no mistake about this.

We are now in an area in which the anti-euthanasia people battle strongly. There are some things in life where you are either for or against and cannot sit on any easy fence. This is one of them.

Let us consider the position of a patient in circumstances fulfilling the criteria of the Liverpool Pathway and, which position is exactly that, for which an anti-euthanasia supporter is so justly aware of. The line between compassion and ulterior motive can become fuzzed up. Where the continued existence of a patient appears to be blocking the advantages which friends and relatives might gain from that person's death, then it is not difficult to imagine those potential beneficiaries urging the shutting down of life support, sustenance and other life giving provisions, and not only kidding the authorities that they urge this murderous procedure for the benefit of the patient, society and those directly responsible but worse, kid themselves that they urge this from the finest of motives they hold personally.

Encouraging death can never be right, moral or ethical. We must not go down this path. One step along this way and we become something so horrible, so akin to the worst scenario depicted in Wells, Orwell and other prophetic writers, that we change our perception of all that is precious on this earth. We become like those justifying nuclear warfare, chemical attack, biological bombs and ethnic cleansing such as that which dirtied this World in Bosnia, Nazi Germany and several African States. The Prayer: "God Protect me from Myself" becomes frighteningly apposite here. We must save our hospitals, hospices and other places of care from notions of helping others towards peace. They must be saved from themselves if this is indeed the path of all.

What about those not threatened in this way but in near death circumstances and who make a miraculous recovery; who rally when there was apparently no hope. To 'assist' a closure in this way is not mercy but a convenient shutting down, a deadly playing of God.

You and I may quite soon find ourselves in a hospital bed alone, on life support, being fed, washed and toileted, helpless in fact. We would need to be able to trust those around us for protection and security. We must never find ourselves in a place of dread and fear should this "method" become the official one, then society (that's you and me) has gone down a road to darkness.

JOAN GRANT 

Contact details Email : glpa@capital5.freeserve.co.ukTelephone: 020 7209 3084

Liverpool Care Pathway – The People Rage!

These comments are taken from the petition sites -

13:47, Mar 06, Mr. Peter Dowling, United KingdomYou can tell a lot about a society by the way it treats its old people, the very young and the very sick. I was born very sick and one day I'll die, hopefully when I'm very old.Hopefully the same spirit of humanity and compassion that welcomed me into the world will see me out of it and into the next. BAN THE LCP

05:53, Mar 15, Paul Lucas, United KingdomI'm afraid it's no good medical people telling us that they wouldn't put patients on the LCP without consultation because it's patently obvious that they do. How can someone die with dignity when they are having all nutrients and fluids withdrawn, if a healthy person doesn't have water he will die in about 2 weeks and it wont be with dignity. The medical profession should hang its head in shame, even if it's a government authorised proceedure they should protest that it is against all they're supposed to represent. After all it's no good saying I was only obeying orders when you are causing people to die in pain and without any dignity whatsoever.

17:01, Apr 13, Ms. katherine wentworth, KSThe Catholic Church teaches us that "no commitment to a hoped for 'greater good' can erase or diminish the wrong of directly taking innocent human lives." As believers who recognize that each human life as the gift of an infinitely loving God, we insist that every human being matters to God.

john meehan

about 1 month ago

    statistics show many patients are dying, before it is time to go.

mrs

catherine prentice

mayland

essex

UK

View

Mar 05, 2012

...The people rage!

Liverpool Care Pathway – The Time To Rage

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...

Register your opposition here:           

care2 

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

Liverpool Care Pathway – Rage Against the Machine

A doctor reports in the Calgary Herald on assisted suicide in Oregon –

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.

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.

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

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.

…barbiturate overdoses "work very well" for patients like this

…she had done this many times before

It is surreal. There is no care or concern for the patient as a human being. It is a process, a formality. A procedure is become a brutal, callous, thoughtless conveyer belt devoid of feeling, sanitised by a cruel logic.

With every new case, the medical personnel become more case-hardened. It is obscene.

It is reported in these pages how one doctor’s timely intervention prevented a patient's life being taken on the Liverpool Care Pathway. The consultant in charge of this patient had been blinkered by the conveyer belt logic of the ‘end of life’ protocols. It took someone refusing to step inside the box and to continue thinking out of the box to step in and make the difference.

Making a difference… That used to be the reason for going into medicine. Sadly, that is no longer the case. Medicine, as practiced by the NHS (National-socialist Health Service) is become a machine against which we must all rage!