Liverpool Care Pathway – If The Facts Fit...

Carruthers and Ormondroyd found in their report that, although much of the discrimination they were told about was indirect, it was still detrimental to patients and carers. "When the shadow of age discrimination hangs over a health or social care organisation … the quality of the service is affected," they wrote. The report noted that the UK has a higher death rate from cancer than the rest of western Europe and the US in over-75s, and that despite progress in reducing mortality levels, younger people had benefited disproportionately.

It quoted research showing that women over 80 had markedly poorer access to investigation and treatment than women aged 65 to 69.

"The United Kingdom has a higher death rate from cancer than the rest of  Western Europe and the United States in people aged seventy-five years and over, and while there has been progress across all ages in reducing cancer mortality, that progress has been faster among younger people."

"...women over 80 have markedly poorer access to investigation and treatment than women aged 65 to 69."

(Achieving equality in health and social care)

This is from First Things -

Krugman Admits Rationing (Death Panels) From Obamacare

Friday, April 2, 2010, 11:11 AM

Wesley J. Smith

The clip below requires a little unpacking: In answering a flip, but it turns out quite good, question about “death panels,” Paul Krugman claims accurately that the cost/benefit board established over private medicine by Obamacare will be able to impose “more or less binding judgments” refusing care, and moreover, that these refusals will save “a lot of money” in the context of treating the elderly (and others, such as people with disabilities and terminal illnesses).  He says that the panel will prevent treatment that isn’t “medically” useful. But private insurance companies already do that. So do Medicare and Medicaid.

No, the money won’t be taken out of the hide of patients who want physiologically useless treatment, it will come at the lethal cost to patients whose treatment will be refused because it could work, based on the invidious judgment that the patient’slife is not worth the money to support.  In short, Krugman has admitted that contrary to the many mendacious denials by Obamacare supporters, the new regimewill impose rationing–just as in the UK with NICE, which is why I bring it up all the time.

This is akin to imposing a duty to die because when we reach a certain point in life, we will not be able to obtain treatment we want that could keep us going. Indeed, for me, this centralized federal control over what will and will not be provided in medicine–and to whom–is the biggest reason (among so many) why Obamacare is wrong.  Repeal. Reform. Replace.  First target–putative death panels.

Why should the US want to adopt a system which, according to the Carruthers and Ormondroyd report, cannot compete with a comparative standard of care for its elder citizens? If it’s all about the money, it’s all about the money. Be it the US or the UK, cost matters more than care.

What is Medicare / Medicaid?

Medicaid and Medicare are two governmental programs that provide medical and health-related services to specific groups of people in the United States. Although the two programs are very different, they are both managed by the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services.

Medicare is a social insurance program that serves more than 44 million enrollees (as of 2008). The program costs about $432 billion, or 3.2% of GDP, in 2007. Medicaid is a social welfare (or social protection) program that serves about 40 million people (as of 2007) and costs about $330 billion, or 2.4% of GDP, in 2007. Together, Medicare and Medicaid represent 21% of the FY 2007 U.S. federal government.

Both Medicaid and Medicare were created when President Lyndon B. Johnson signed amendments to the Social Security Act on July 30, 1965.

And that’s a lot of money. 

Liverpool Care Pathway – The Perfect Fit Solution

More on ‘diagnosing death’ and ‘assessing quality of life’.

The old and the disabled, by mental or by physical impairment, are at risk.

Michael, a former chief executive of Guy's and St Thomas's hospital trust in London, found "convincing evidence that people with learning difficulties have higher levels of unmet need and receive less effective treatment". 

Accusing the NHS of breaking the law in relation to those with learning difficulties, Michael added: "It was shocking to discover that the experiences of the families described in Mencap's report are by no means isolated, despite a clear framework of legislation against discrimination."

 In the article which follows, published in the Guardian, the NHS is accused of “institutional discrimination”

NHS starts inquiry into deaths of patients with learning difficulties

• Denis Campbell, health correspondent
• The Guardian, Monday 19 January 2009

An official investigation is to examine why people with serious learning difficulties have died while under NHS care, after alleged neglect led to at least six fatalities, ministers will reveal today.

The health secretary, Alan Johnson, is setting up an inquiry which will look at whether the quality of treatment that doctors, nurses and other health service staff gave to such vulnerable patients contributed to their dying unnecessarily early.

Johnson will announce the formation of a confidential inquiry, a form of investigation used in healthcare to see if there are any common links between deaths in similar patients or circumstances.

"Things that happened in the past in the NHS weren't acceptable. We want to look back at cases where people have died prematurely and learn the lessons of those deaths," said a senior Whitehall source involved in setting up the inquiry.

The move is part of an overhaul of how the NHS treats those with learning difficulties after a government-commissioned independent inquiry last July uncovered evidence of serious failings in care. Led by Sir Jonathan Michael, it followed the publication of a report in 2007 by the charity Mencap, called Death by Indifference. It accused the NHS of "institutional discrimination" against such people and highlighted six individuals who it claimed died after their health needs were ignored by NHS staff as a direct result of their learning difficulties.

Other measures being unveiled today include improved training for all NHS staff; annual health checks for anyone with a mental disability, funded by an extra £20m a year into family doctors' contracts; and personal health action plans for them.

The Department of Health estimates that there are 210,000 people in England with a severe or profound learning difficulty and a further 1.2 million with a mild or moderate mental impairment.

Michael, a former chief executive of Guy's and St Thomas's hospital trust in London, found "convincing evidence that people with learning difficulties have higher levels of unmet need and receive less effective treatment".

Accusing the NHS of breaking the law in relation to those with learning difficulties, Michael added: "It was shocking to discover that the experiences of the families described in Mencap's report are by no means isolated, despite a clear framework of legislation against discrimination."

The heath service ombudsman, Ann Abraham, will deliver her verdict in the next few weeks on the standard of care which the six people in the Mencap report received. The charity has also referred to her six other cases which it says illustrate scandalous treatment of, and attitudes by, NHS staff.

A Mencap spokesman, David Congdon, said: "We hope that the ombudsman will find that these people all got a pretty poor deal from the health service. There were three recurring failings: a failure to diagnose what was wrong with someone, especially when they couldn't communicate; lack of treatment of pain; and a failure to listen to parents or carers. If you ignore people, or think they are fussing too much, you aren't going to properly diagnose what's wrong with someone, which can lead to people dying unnecessarily."

So, what’s changed…? Three years later, here is the Mail -

NHS accused of putting ‘do not resuscitate’ notices on patients with learning disabilities without consulting with their families

By DAILY MAIL REPORTER
UPDATED: 13:52, 15 February 2012

A leading charity has accused NHS staff of thinking patients with learning abilities are not worth treating, often giving them 'do not resuscitate' notices without telling their families.

A Mencap report said the deaths in NHS care of 74 people with learning disabilities could have been avoided - and were a direct result of institutional discrimination. 

Mencap said the staggering number of deaths had occurred in the past decade, and it called on the Government to 'make the NHS safe for people with a learning disability'.

Its report - titled Death By Indifference: 74 Deaths And Counting - found continued discrimination in the NHS, and examined the progress made since the publication of its original Death By Indifference report in 2007. 

'Not worth treating': A report by charity Mencap said there was evidence of 'institutional discrimination' against patients with learning disabilities

The charity said that, although some positive steps had been taken in the NHS, many health professionals were still failing to provide adequate care to those with learning disabilities. 

In particular, it pointed to the inappropriate use of 'do not resuscitate' (DNR) orders on such patients.

The report said: 'The inappropriate use of DNR orders has remained a constant feature of many Mencap cases. There have been circumstances where DNR notices have been applied without the knowledge or agreement of families, and applied hastily in inappropriate situations, solely on the basis of the person’s learning disability.'

Report authors said they uncovered common errors made by healthcare professionals, including failure to abide by disability discrimination law, ignoring crucial advice from families, failing to meet even basic care needs, not recognising pain and distress, and delays in diagnosing and treating serious illness. 

Do not resuscitate: Mencap says there are 74 cases in ten years where deaths of patients with learning disabilities could have been prevented

Mencap said it believed this was underpinned by an assumption by some healthcare professionals that people with a learning disability were not worth treating. 

Mark Goldring, Mencap chief executive, said: 'The report confirms that, five years on from our landmark Death By Indifference report, many parts of the NHS still do not understand how to treat people with a learning disability. 

'At Mencap we continue to hear heartbreaking stories of unnecessary deaths and pain. Sadly we believe that these cases are just the tip of the iceberg.'

A Department of Health spokeswoman said: 'This Government has made very clear its commitment to improve the health of people with learning disabilities.

'We share Mencap's concerns that some people with learning disabilities may not be receiving the high-quality healthcare that they should expect.'

In the conclusion to its report, Mencap says: People with a learning disability have a right to the same quality of healthcare as those without a learning disability. Getting it right for them will also mean getting it right for all vulnerable people, such as older people and those with dementia.

'The government must act to make all the changes necessary to make good healthcare a right for all. 

HOSTILITY AND DISRESPECT: MENCAP CASE STUDY

Lister Hospital: The family of Alan MacDonald claim they had to 'beg' staff at Lister Hospital to treat him

Included in the report are case studies typical of what Mencap believes to be institutionalised discrrimination in the NHS: 

'Alan MacDonald died suddenly in Lister Hospital, Stevenage, on 20 December 2009, aged 53. 

'He had lived independently with his wife, supported by carers. 

'Alan had Down’s syndrome and a moderate learning disability, and was considered by his family to have a "full and active life". 

'Three days before admission to hospital, Alan was noted by his family to be "in fine form". However, on December 15, 2009, he was admitted to hospital with abdominal pain and diarrhoea. 

'From the time Alan was admitted, his family felt they had to "beg" staff to treat him, only to be met with "hostility".

'A member of Alan’s family who is a doctor... said: “I felt the nurses on the ward did not respect a gravely ill patient with special needs and a grieving family. Instead of using respect, tact, care and understanding, I and the rest of Alan’s family were faced with hostility, disrespect and no consideration for the distressing situation".

'The cause of death was multiple organ failure, sepsis and bronchopneumonia.

'After a protracted complaint against it by Alan’s family, the hospital has finally apologised for the attitude of some of its nursing staff. But, for the family, the lack of respect shown for their loved one is something that will never be forgotten.'

Liverpool Care Pathway – In Place Of Ageism

Nearly three years ago, the following report appeared in the Guardian -

Equality bill takes aim at 'institutional ageism' in NHS

• Older patients face 'rooted' healthcare discrimination
• Most prejudice accidental, critical report concludes

• 
  
  Rachel Williams
• guardian.co.uk, Thursday 22 October 2009 21.45 BST

Elderly people. Photograph: Toby Melville/Reuters

Ageism within the NHS and social care is set to be made illegal after a review of the treatment of older people found discrimination was "rooted" in the attitudes of staff and organisations.

The health secretary, Andy Burnham, said the services would be bound by the equality bill currently being debated in parliament from 2012,earlier than had been expected.

The announcement came as Sir Ian Carruthers, the chief executive of NHS South West, and Bristol council chief executive Jan Ormondroyd unveiled the findings of their investigation into the barriers facing the elderly, which was launched amid a spate of ageism claims against health services earlier this year.

Researchers had found that elderly stroke patients received less adequate care than younger sufferers, and a watchdog warned that the over-65s lost out on mental health services. A poll found almost half of doctors who cared for older people believed the NHS was "institutionally ageist".

Carruthers and Ormondroyd found that although much of the discrimination they were told about was indirect, it was still detrimental to patients and carers. "When the shadow of age discrimination hangs over a health or social care organisation … the quality of the service is affected," they wrote. The report noted that the UK has a higher death rate from cancer than the rest of western Europe and the US in over-75s, and that despite progress in reducing mortality levels, younger people had benefited disproportionately.

It quoted research showing that women over 80 had markedly poorer access to investigation and treatment than women aged 65 to 69.

While most examples of ageism were based on thoughtlessness and misplaced assumptions, rather than being the product of avowed prejudice, this meant many of those involved did not recognise their behaviour as discriminatory.

Addressing the National Children and Adult Services conference in Harrogate, Burnham said the timetable for outlawing ageism was ambitious but achievable. "It's vital if a central tenet of the national care service – the pursuit of fairness and equity – is to be upheld," he told delegates.

The equality minister, Harriet Harman, said: "People are not over the hill at 60 – they shouldn't be discriminated against in healthcare or in any other way … with the number of people over 85 set to double in the next 20 years it is essential that older people are not written off because of their age."

Officials made clear that the new rights would still be subject to clinical decisions on questions such as prioritising which patients should get vaccines first, and restrictions would also apply in areas such as fertility treatment.

The deputy director of policy at the NHS Confederation, Jo Webber, said: "The NHS has always cared for older people and will continue to do so but the pressures of an increasingly elderly population, greater expectations of what modern medicine can achieve and a tightening financial situation mean ageism is an issue the service has to think hard about and tackle.

"However, it does need to be understood that a real change in attitudes cannot be achieved without wider changes in society as a whole and the role older people play in it – the NHS does not exist in isolation from the rest of the community."

Burnham told the conference that Labour's proposed national care service, which would integrate heath and care services, was necessary to end the "cruel lottery" faced by the elderly. "In the current care system, people play a random game of chance – with their long-term financial wellbeing as the stake."

So, what’s changed…?

"The NHS has always cared for older people and will continue to do so but the pressures of an increasingly elderly population, greater expectations of what modern medicine can achieve and a tightening financial situation mean ageism is an issue the service has to think hard about and tackle.

"However, it does need to be understood that a real change in attitudes cannot be achieved without wider changes in society as a whole and the role older people play in it – the NHS does not exist in isolation from the rest of the community."

And here is Savista Magazine - 

    Issue: August 2012

Report Suggests NHS Is Suffering From Ageism

A review of the NHS by the King’s Fund has suggested that elderly people are being “passed around hospitals like parcels” because of a culture of ageism.

Older patients are often not being given the same cancer and heart disease tests that those younger get, whilst ageist language has also increased, with terms like “bed blocker” being used more by staff.

This report is just the latest from the last few weeks to be critical of the way elderly people are treated by the NHS. It was put together by surveying patients and interviewing staff, and it has prompted the Royal College of Nursing for higher minimum staff levels for elderly care.

The King’s Fund agrees with this assessment, concluding that work volumes and pressure on meeting targets was to blame, and that better training was needed.

Jocelyn Cornwell, who wrote the report, said that the whole system needs “a rethink from top to bottom.

"The health and social care system has failed to keep pace with changing health needs,” she added.

In a BBC interview, Michelle Mitchell from Age UK said of the report, "Health services cannot deliver high-quality services unless older people are treated as individuals and their care is co-ordinated. This is what a modern health service needs to deliver.

When you’re of a certain age, you’re a nuisance; you’re better off out the way, for your own sake as well as those who have the chore of looking after you. And what ‘quality of life’ do you have left..?

The very word ‘geriatric’ is used by some as a slur, a term of abuse.

A Pathway of Care seems the perfect fit solution. And the old, already suffering terminal illness by their very condition, are the perfect candidates for the perfect fit solution.

Liverpool Care Pathway – A Fallacy And A Folly

On the fallacies and follies of ‘diagnosing death’ and ‘assessing quality of life’.

Here is The Guardian -

'I'm bossy. I'm ambitious. I love ideas. And I love life'

Doctors gave Lady Campbell a year to live when she was born. Three years ago they put a 'do not resuscitate' notice on her medical records, as if her life was not worth living. This week she proved just how wrong they were. By Dea Birkett

• Dea Birkett
• The Guardian, Saturday 11 July 2009

"Let's go into my study," says Lady Campbell, the moment I arrive at her suburban bungalow. "This is where I do all my plotting."

Jane Campbell's plot is to turn our assumptions about disability upside down. The life peer has spinal muscular atrophy, a degenerative condition which means she uses a wheelchair and is increasingly reliant on a ventilator to breath. Three years ago, doctors put a "Do Not Resuscitate" notice on her medical records, considering her life not worth living. This small, sunny garden room is full of photographs of her campaigning against such assumptions: there's the younger Campbell under a "Rights Not Charity" banner ("My first big demo. I took hundreds of wheelchair users on to Westminster Bridge, stopping the traffic. Here were the poor disabled breaking the law - the police couldn't get their heads around it!"), and there's Campbell in 2004, holding a "Not Dead Yet" placard. "Even friends say to me, 'I couldn't live like you, I'd rather be dead.' I still get people coming up to me in the street and telling me how wonderful I am going out to the shops." Campbell has little time for shopping. "I'm too busy changing the world," she quips.

Next to the photos, there's a grim etching of a hunched man, a gift from her first driver. "He'd served 16 years for armed robbery - I gave him his first job," she boasts. "Best driver I've ever had. Drove for the Richardsons [contemporaries of the Krays] - used to drive their getaway cars. Then I had him! Isn't that wonderful? Because of my situation, I've met the most interesting people, far more interesting than you." She's inviting me to be jealous of her, a woman who has very little use of her limbs.

Campbell, recently made Baroness of Surbiton, is cheery, having just celebrated her 50th birthday - a milestone she was told she'd never reach. And this week in the House of Lords, her powerful speech was credited with squashing an amendment to the coroners and justice bill which would have granted those accompanying people going abroad for assisted suicide immunity from prosecution. Does she feel victorious? "No. I just thought they had to hear the truth."

It's all about giving another perspective, she says. "Some of the debaters talked about how terrible it must be to have someone else take you to the toilet. That's my life, mate! And I hate the term 'vulnerable people'. It sets the image up before they find out what you're really like. Really I'm bossy, I'm ambitious and have ants in my pants, and am excited about things and people. I love ideas. I love life."

When she was born, the doctors gave her a year to live. That threat of death at any moment has been with her throughout her life, giving others the excuse not to invest in her. "I was very young when I realised that things weren't right in the world. I went to a special school, segregated. In those days, you didn't educate disabled children very much.

"I left school with no qualifications, hardly able to read and write. I was 16. But I was quite intelligent. I was very lucky - a college for disabled students had just been opened in Coventry. I did six O-levels and three A-levels in three years. That's how hungry I was."

She met her husband Graham Ingleson in Coventry; they married when she was 27. He had haemophilia, and at that time young people with his condition were not considered for mainstream education. He contracted HIV from a blood transfusion; they found out six weeks before the wedding. "He was wonderful, my rock in life. It's now 15 years since he died," says Campbell. "I've had an extraordinary life."

She often ends her thoughts on such a positive note. It reminds me of something, but I'm not sure what. Then I remember: it is the language of the obituary writer. It's as if she's writing her own.

From Coventry, she went to Hatfield Polytechnic and on to an MA on Sylvia Pankhurst at Sussex. She's always been as passionate about women's as disabled rights, and believes this is reflected in her work as commissioner of the Equality Rights Commission. "I feel that our movement, the disability movement, is an emancipation agenda. I see it like apartheid. It's not just ramps and access, it's deeply rooted in attitudes."

There is, however, one important difference: "Most of us will have to face up to terminal illness before we die," she says. "You can hate women or hate black people, but you can't hate what you might one day become. It's more complex and dangerous. They know, deep down inside, they're going to become that which they loathe and fear."

After Graham, she met Roger Symes. They live together in Tolworth, greater London. "He's my second husband," she says mischievously, used to having people presume she's never had a husband at all. "He saw me making a speech and thought, 'There's a bossy redhead. I'll take her out for a drink.' My speeches have an effect on people."

Her loves are Roger, books, music (she's a Nick Cave fan) and her garden. She takes me on a tour, pointing in through the French windows to the bed where she lies when she needs her ventilator, from which she can admire the view. And then there's another of those extraordinary moments, when she paints a scene in that room that confounds preconceptions. "I can't have children, but I have an eight year-old-girl living next door who comes round all the time. If I'm on my ventilator, that's what she sees, and it's just Jane. She sits on the bed and gets me a cup of tea. She loves the idea that she feels important, as well as me. I make sure that severe disability is normalised."

Campbell has few secrets. "I want to be open with the world that next year, or the year after, I'll probably be on a ventilator full-time. That I won't be able to swallow." But her openness only goes so far; like most disabled people, she sometimes disguises the true extent of her disability. In the Lords debate, she began by informing the house that "the usual channels" might have to be invoked, and another member finished the speech for her. Such channels have never been allowed before. "If I'd made that demand before entry, they might have thought, it's just not worth it."

Her impact has been profound. When she said in the debate, "If I should ever seek death - there are several times when my progressive condition challenges me - I want to guarantee that you are there supporting my continued life and its value. The last thing I want is for you to give up on me, especially when I need you most," a rare thing occurred: the noble lords were moved.

Would she ever consider ending her life? Just last year, she says, she became dangerously ill with septicemia. "I could have stopped. But I looked at my husband's face. I couldn't do that to him." But what about those people who don't have anyone? It's our role, as a caring society, to be that someone, she says.

Towards the end of our time together, she asks if I'll consider writing her autobiography. She wants to do this because she's had such an extraordinary life - expected to die young, living so fully. So what would I write up as her legacy? "I'd like to think I helped people to think again." Adding, as if from nowhere: "Life is sweet."

Liverpool Care Pathway – A Design For Death

This is ‘our’ NHS (National-socialist Health Service) today?

The Telegraph reports that new 'opt-out' cards are being issued to ‘terminally ill patients’. However, as victims families can attest, it is not just ‘terminally’ ill patients who fall foul of LCP!

Here is The Telegraph -

'Advance refusal' cards for patients fearing 'death pathway'

Terminally ill patients are being issued with special cards warning doctors not to place them on a controversial “death pathway” amid fears the practice is becoming routine.

'Advance refusal' cards for patients fearing 'death pathway' Photo: ALAMY

By John Bingham, Social Affairs Editor

6:30AM BST 24 Jul 2012

The “advance refusal” notices operate like an organ donor card, enabling people approaching the end of their life to make their wishes clear to while they still have capacity.

It comes amid a growing backlash against overuse of the “Liverpool Care Pathway” which allows medical staff to withhold fluid and drugs from a patient while they are heavily sedated, actively speeding their end.

Supporters of the technique say that it is the kindest way of letting people slip away rather than die in pain.

But leading doctors have voiced fears that hospitals are hastening the deaths of elderly patients to cut costs and free up bed space amid claims it has become a “standard” alternative to euthanasia.

The number of patients put on the pathway has risen sharply in recent years, and opponents estimate that it is now said to be associated with almost a third of hospital deaths – or 130,000 people.

Earlier this month a group of doctors wrote to The Daily Telegraph in conjunction with the Medical Ethics Alliance, a Christian medical organisation, arguing that the technique could be being abused to save costs.

They said that many members of the public had contacted them with examples of inappropriate use of the pathway, with some doctors failing to seek informed consent.

Now the anti-euthanasia charity Alert is distributing cards to patients themselves ensuring that they can opt not to be put on the pathway if they do not wish to.

Simple printed cards read: “Please do not give me the Liverpool Care Pathway treatment without my informed consent or that of a relative.”

The initiative is designed to work in a similar way to so-called “living wills” or advance directives which give patients a right to refuse treatment under the Mental Capacity Act 2005.

Elspeth Chowharay-Best, the honorary secretary of Alert, said the cards were being produced to answer “an urgent need”.

Among those who have requested a card is Leslie Burke, a former Lancaster postman who has suffered from cerebellar ataxia, a degenerative disease of the central nervous system with follows a path similar to multiple sclerosis, since 1982.

“All I want is to live my life from end to end and not have it ended prematurely under any circumstances,” he said.

In 2005 Mr Burke was defeated at the Court of Appeal after he had earlier successfully demanded that doctors continued to treat him with artificial nutrition and hydration (ANH) once he lost the ability to communicate.

Lord Phillips, the head of the panel of judges, assured him at the time that “any doctor who deliberately brings that patient’s life to an end by discontinuing the supply of ANH will not merely be in breach of duty but guilty of murder”.

But Mr Burke, 52, said that he was no terrified that starving and dehydrating patients to death in the NHS was now “becoming the norm”.

Liverpool Care Pathway – A Euphemasia!

It has already been reported that elderly people in the Netherlands, fearful of falling foul of the clutches of euthanasia laws, carry anti-euthanasia cards.

Kevin Fitzpatrick, a researcher with the pressure group Not Dead Yet, has claimed that relaxing the law on euthanasia in this country would threaten old and disabled people as it would allow “moral judgments” that their lives were not worth living.

Fitzpatrick argues that -

“disabled people, like others, and often with more reason, need to feel safe” and that legalising assisted dying would threaten disabled people's “well-being, continuing care and management, and life itself.”

He cited the experience of Baroness Campbell of Surbiton, the disabled founder of Not Dead Yet, who was once told by doctors that they “presumed” she would not want resuscitation if she experienced complications during treatment.

Clearly, there are issues in rolling out a scheme of general euthanasia. The LCP, a 'care pathway' adopts euphemism (euphemasia!) to get around the term 'euthanasia'!    

However, it has already been reported here, in regard to the LCP, that -

".. doctors say that this has led to an increase in patients carrying a card stating that they do not want this 'pathway' treatment in the last days of their lives."

And here, The Mail reports -

Terminally ill patients who fear being placed on 'routine' death pathway issued with opt-out cards by charity

• Anti-euthanasia charity distributes cards to patients telling doctors not to place them on controversial 'care pathway'

By CLAIRE BATES

PUBLISHED: 10:13, 24 July 2012 | UPDATED: 10:17, 24 July 2012

Terminally ill patients have been issued with special cards telling doctors not to place them on a 'care pathway' that would hasten the end of their lives.

It comes after doctors warned that hospitals may be routinely withholding food and drink from very ill patients so they die quicker to cut costs and save on bed spaces.

In response the anti-euthanasia charity Alert is distributing cards to patients to prevent this happening. The cards simply read: 'Please do not give me the Liverpool Care Pathway treatment without my informed consent or that of a relative.'

Warning: Hospitals may be withholding food and drink from elderly patients so they die quicker to cut costs and save on bed spaces (file picture)

The Liverpool Care Pathway, which got its name as it was developed at the Royal Liverpool Hospital in the 1990s, withholds fluids and drugs in a patient's final days and is used with 29 per cent of hospital patients at the end of their lives.

The practice is backed by the Department of Health.

However, in a recent letter to the Daily Telegraph, six doctors who specialise in elderly care warned hospitals across the UK could be using the controversial practice as routine to ease the pressure on resources.

They added that in the elderly, natural death was more often free of pain and distress.

The group warned that not all doctors were acquiring the correct consent from patients and are failing to ask about what they wanted while they were still able to decide.

Claims: Experts say in the elderly natural death is more often pain free (file picture)

The doctors say that this has led to an increase in patients carrying a card stating that they do not want this 'pathway' treatment in the last days of their lives.

One of the letter's signatories, Dr Gillian Craig, a retired geriatrician and former vice-chairman of the Medical Ethics Alliance, told the newspaper: 'If you are cynical about it, as I am, you can see it as a cost-cutting measure, if you don't want your beds to be filled with old people.'

The new opt-out cards are designed to work like a 'living will' to give the patient more say over their future treatment before they become too ill to communicate their wishes.

Elspeth Chowharay-Best, the honorary secretary of Alert, told the paper that the cards were being produced to answer 'an urgent need'.

A Department of Health spokesman said: 'People coming to the end of their lives should have a right to high quality, compassionate and dignified care.

'The Liverpool Care Pathway (LCP) is not about saving money. It is an established and respected tool that is recommended by NICE (National Institute for Health and Clinical Excellence) and has overwhelming support from clinicians at home and abroad.

'The decision to use the pathway should involve patients and family members, and a patient's condition should be closely monitored.

'If, as sometimes happens, a patient improves, they are taken off the LCP and given whatever treatments best suit their new needs.

'To ensure the LCP is used properly, it is important that staff receive the appropriate training and support.'

Liverpool Care Pathway – 'The End Of The Line'

Here follows a report in the Mail which Dr. Rita Pal cites in her post featured on Huffington Post -

Fury as doctor of death is told: Carry on practising

By SAM GREENHILL
UPDATED: 03:06, 30 January 2010

Grieving families reacted with horror yesterday as a doctor who gave lethal cocktails of drugs to 12 elderly patients 'to keep them quiet' was allowed to carry on working.

Relatives of the dead pensioners walked out in disgust as GP Jane Barton escaped being struck off the medical register despite being found guilty of serious professional misconduct by a General Medical Council panel.

But in an unprecedented move, the chief executive of the GMC stepped in to challenge the verdict of the independently-appointed panel.

Iain Wilson pictured outside the General Medical Council after the ruling. To his left is Ann Reeves and her daughter Bridget Reeves. Both families lost relatives because of an overdose of painkillers

Dr Jane Barton escaped being struck off the medical register despite being found guilty of serious professional misconduct

He said Dr Barton should have been 'erased' from the register and that the decision could be reviewed.

In highly-charged scenes inside the hearing, relative Iain Wilson, whose 74-year-old father Robert went into hospital with a broken shoulder but died of an overdose of painkillers, yelled at the panel members: 'You should hang your head in shame.'

Another relative shouted: 'You have done nothing at all to protect the public.'

Dr Barton's frail patients at the Gosport War Memorial Hospital in Hampshire were given cocktails of painkillers six times the recommended dose and lapsed into comas, the hearing in Central London heard.

She told one patient 'it won't be long now'. When patients became 'agitated'

they were given drugs in increasing quantities until 'they were agitated no more', Tom Clark, the lawyer for the GMC, said.

The panel had previously heard that Dr Barton gave the patients the drugs 'to keep them quiet' and that the two wards she ran became known as 'the end of the line'.

It has taken 12 years to reach a decision on the case. 

At one stage police examined 92 deaths, although no criminal charges were brought, and an inquest last year into ten of the 12 deaths concluded that five pensioners died after being given excessive doses of morphine. 

But Dr Barton remained free to practise, subject to restrictions on prescribing certain drugs, and has been working at the Forton Medical Centre in Gosport.

The GMC's fitness to practise panel found her guilty of 'multiple instances of serious professional misconduct' and said her behaviour was 'inappropriate, potentially hazardous and/or not in the best interests' of her patients.

Yet it allowed her to continue practising, subject to 11 restrictions including banning her from prescribing opiates by injection for three years

Panel chairman Andrew Reid said: 'Dr Barton failed to recognise the limits of her professional competence.' He said she was ' convinced that her way had been the right way and that there had been no need to entertain seriously the views of others.'

Elsie Devine, 88, and Robert Wilson, 74, both died from overdoses of painkillers
But he added: 'The panel was greatly impressed by the many compelling testimonials which detailed Dr Barton's safe practise over the last ten years and the high regard in which she is held by numerous colleagues and patients.' 

Niall Dickson, the GMC's chief executive, said afterwards: 'We are surprised by the decision to apply conditions in this case. Our view was the doctor's name should have been erased from the medical register following the panels finding of serious professional misconduct.

'We will be carefully reviewing the decision before deciding what further action, if any, may be necessary.' The panel was made up of four lay members and a doctor. 

The Council for Healthcare Regulatory Excellence, which is charged with overseeing the actions of professional bodies, is considering an official review. A decision on whether to appeal to the High Court could be made within a month.

The inquest was held more than a decade after concerns were first raised over the deaths at Gosport War Memorial Hospital in Hampshire

Hampshire Police also said they were reviewing the case and may bring criminal charges. 

Yesterday Ann Reeves, whose mother Elsie Devine, 88, was one of the patients who died, said: 'Let a judge and jury deal with it now, and let it all be exposed. The NHS has done its best to cover it up. 

People don't realise, but what goes on in hospitals is absolutely horrific.' Dr Barton, of Gosport, faced 15 charges relating to her treatment of 12 patients, record keeping and a failure to assess patients properly before prescribing opiates.

Chief Medical Officer Sir Liam Donaldson commissioned a clinical audit to examine death rates at the hospital, but the report has never been made public.

Dr Barton said in a statement that she was 'disappointed' with the conditions. 'I was faced with an excessive and increasing burden in trying to care for patients at the Gosport War Memorial Hospital,' she added.

The two wards that Dr Barton ran became known as 'the end of the line'. Are such wards uncommon, an exception, or are they to be found across the NHS (National-socialist Health Service)?

In 2003, my mother was in a ward with other elderly patients. She had collapsed at home. They said she had suffered a mini-stroke. 

Mum commented to me: “They’re all dying in here. I don’t want to stay on this ward.” Just that morning, she said, they had wheeled out the poor woman in the adjacent bed with whom she had been conversing the day before. It was most upsetting for her.

Although I forced myself to question her comment, I found I could not disagree with her observation. Each day I went in to visit her, I observed an empty bed there where a patient had been. A fresh occupant would soon follow. It was as she had said.

She told me that one ‘old girl’ had fallen out of bed. Mum had kept calling for someone to come but no-one came. They were “all stuck in their cubby hole,” she said. I looked across and, by my own observation, they were. Eventually, a nurse had come, apparently, not shocked or concerned, but offended by the nuisance of it.

And that is the long and the short of it. When you’re of a certain age, you’re a nuisance; you’re better off out the way, for your own sake as well as those who have the chore of looking after you. What ‘quality of life’ do you have left, after all..? But whose decision is that? What right do they have to play God?