Liverpool Care Pathway - Terminal Sedation: Backdoor Euthanasia?

Honest and unbiased archived BBC Radio 4 recording still available. Listen while you can...





BBC Radio 4 - Terminal Sedation: Backdoor Euthanasia? (From 2010 - EXCELLENT PROGRAMME)

Terminal Sedation: Backdoor Euthanasia?
Duration: 30 minutesFirst broadcast: Thursday 18 February 2010
Author Terry Pratchett has argued that assisted suicide should be legal in the UK - but there is already a medical technique widely used in the NHS which some campaigners claim is euthanasia by the backdoor. Called terminal sedation, it's used to ease the pain and suffering of the very sick. But critics say it can hasten death. Linda Pressly investigates the extent of terminal sedation and examines if it is always in the interests of patients and their families.

Thu 18 Feb 2010
20:00BBC Radio 4

Summary of extracts -

 The very last thing that my dad said to me was, 'Help me, son, they’re killing me.' And I thought, actually, at that time, he was probably scared. I didn’t realise that, in actual fact, what he was telling me was exactly true. Those were the very last words I had with dad. 

 The pressure of caring for her husband exhausted Rachel’s mum and it was agreed that he would spend some time in the local hospice to give her a break. But, according to Rachel, her dad wasn’t given fluids and was soon attached to a syringe driver, a pump used to deliver continuous medication under the skin.

“I took him in the first day and he was okay and was quite strong, actually, in himself because he didn’t really want to go there. He, also, you know, was talking and he was compos mentis and was aware of everything around him. The next time I’d seen him, he completely wasn’t."

And how soon after he went into the Hospice was he sedated?

“I would say probably on the second or third day.”

And did he steadily then become more sedated on the days he was in the Hospice?

“I think so. I think from when he had a drive – a syringe driver I think it’s called – put into his chest, that was when he was definitely completely sedated but, apparently, he could still hear us.”

That’s what you were told by the Hospice staff?

“Yes.”

And during the time he was sedated, was he being hydrated?

“No, not at all, in fact, we asked if he could be put on a drip and they said, ‘No, we don’t do that; we are a Hospice, not a Hospital’.”

After several days, Rachel’s Dad died without ever speaking again. 

 It's troubling that a fifth of doctors continuously sedating a patient had used a drug like morphine to do it. This is bad clinical practice because, although these drugs have a sedative side-effect, they are basically pain-killers. Incorrect dosage can lead to respiratory failure. An overdose will kill.

The factor that links claims of abuse we've looked at is age. All of them involve allegations of inappropriate sedation in elderly people. 

 Jane: I think the old-fashioned nursing which I was trained for with the preservation of life, the gentleman could have lived for quite a while. 

 Dr. Bill Noble, president Association for Palliative Medicine of Great Britain and Ireland: Sedating continuously so that the patient is unable to take fluids may cause the patient to die prematurely from dehydration. 

 Clive Seale: "16.5% of patients receive continuous deep sedation until death." 

 Dr. Ian Johnson, now-retired supporter of Dignity in Dying, who treated around 20% of his patients using continuous deep sedation: "The intention is always to make a person who is dying as comfortable as possible and you could argue that you could do that simply by controlling their symptoms, but actually that’s not always possible. Occasionally, doctors are faced with patients whose problems are so horrendous it would be better if they died today rather than tomorrow and it may be in some cases where the patient has repeatedly said, ‘Look, I don’t want to prolong my life, I really want to get out of this as soon as possible’ and many doctors will give sedation with the intention of making the person not live so long."

That would be euthanasia, wouldn’t it?

"That would be euthanasia, yes." 

Liverpool care Pathway - Another Stafford...?

When trust is not trust when it is a Trust, when care is not care when it is a Pathway and nice is not nice when it is the NICE...

- Mirror

Mother, Bella, had her life taken at Stafford Hospital.

And daughter, Julie Bailey, set out to 'cure' the NHS.

Mother, Bella, laid to rest, has had her grave desecrated.

Still, Julie Bailey genuinely believes the NHS can be 'cured'.

Then fiction is become faction and K has changed his name to Winston Smith.

There must be genuine, responsible and devoted healthcare workers at Stafford who still view their jobs as a vocation and a chance to 'make a difference'. They must look upon such a vile and disrespectful act with that same disgust they once reserved for those colleagues whose litany of vile acts are recorded in the investigation of what happened at Stafford.

- The Express 

Each death is someone’s  husband,

wife, mother, father or child

Julie Bailey, Cure the NHS

They must permit that disgust to erupt into an anger against those vile perpetrators who stand amongst them and hide, cowering in their giant shadows. These few good men and women must take courage and give them up and turn them over for prosecution for what they have done and what they may yet do.

Yes, blame the managers. There are too many chiefs and not enough indians. And when you write to a hospital and are told to address your letter to 'The Business Partner' or 'The Managing Director' that only underlines that fact!

But those chiefs are responsible and to be held to account for the situation which developed and permitted these cruel acts to take place; they are not responsible for carrying them out.

Those who carried out those vile acts, whether by omission or by commission, cannot shrug off responsibility for what they did.

Bella was afraid of the staff.

Those genuine, responsible and devoted healthcare workers at Stafford who do view their jobs as a vocation and a chance to 'make a difference' must make that difference and report those colleagues who have brought shame  and disrepute and condemnation down upon them.

- Birmingham Mail

What other Staffords are there out there?

What once mattered was the reality of the care. What now matters is the image of the brand.

The Mirror reports -

The report concluded: “Patients had not received care, treatment or support that met their needs. There were not enough qualified and experienced staff. People were not protected from the risks of unsafe or inappropriate care and treatment because accurate records were not maintained.”

The report also puts further pressure on outgoing NHS boss David Nicholson. Patients’ groups reacted with fury last week when it emerged the former manager of Stafford Hospital will leave with a £2million pension pot.

The two-day spot check on Cumberland Infirmary in March is one of a string the Commission will carry out in the next few months.

Chris Platton of North Cumbria University Hospitals NHS Trust said: “We are taking urgent steps to ensure appropriate actions are taken.”

Shadow Health Minister Andrew Gwynne said: “The report by Robert Francis into Mid Staffordshire made over 200 recommendations, but the Government has delayed implementation. Jeremy Hunt needs to get a grip.”

Perhaps, John Reid began to lose it. Perhaps, Patricia Hewitt and Alan Johnson totally lost it... Had they had a grip, perhaps Mid-Staffordshire would not have happened...

- Chronicle Live

These are the killing wards:

The widow of a college lecturer has demanded an inquest into his death. 

Patricia Heard’s husband George was admitted to Rake Lane Hospital, in North Tyneside, in June last year complaining of uncontrollable shaking and jerking. 

Despite efforts in intensive care, the 65-year-old, from Cramlington, Northumberland, died in July 2012 more than a month after he was diagnosed with a “severe infection”. 

In a four-page document submitted to Northumbria Healthcare NHS Foundation Trust, Mrs Heard has now demanded answers and claimed her husband did not receive the treatment he required. 

Jim Mackey, the trust’s chief executive, replied saying his members of staff had carried out a “thorough investigation” but indicated the nurses had done everything in Mr Heard’s best interests. 

Since her husband’s death, Mrs Heard has written to a coroner to give her account of her husband’s treatment in hospital and is calling for a full investigation into his death. 

She has also contacted clinical negligence solicitors TLW Solicitors.

- News & Star

These are our hospitals:

Forty-year-old Michael Parke, from Gote Road in Cockermouth, died in the hospital in Whitehaven on December 6. The force was alerted to the death by the coroner, David Roberts, the next day.

No details of how Mr Parke died have been released. 

His cousin, Ross Parke, said the family did want to say anything about the investigation. He was not prepared to say why Mr Parke was in the hospital. 

When an inquest was opened into Mr Parke’s death last year no cause of death was listed. 

News of the police probe comes after it was revealed last month that a national health team is expected to come to the West Cumberland and Cumberland Infirmary in Carlisle to investigate their “higher-than-expected death rates”. 

Last year, North Cumbria Hospitals University NHS Trust had the second-highest mortality figures using the Hospital Standardised Mortality Ratio (HSMR). Now a ‘rapid review team’ is being brought in to support the trust – which runs the hospitals – in a bid to get the numbers down. 

The action, and similar intervention at 13 other trusts across the country, comes in the wake of the Mid Staffordshire health scandal where poor care led to 1,200 needless deaths. 

However, the north Cumbria trust started looking into death rates last year after the Dr Foster research group revealed it was one of 12 in the country with death rates higher than expected.

          First published at 16:58, Tuesday, 02 April 2013

          Published by http://www.newsandstar.co.uk

These Trusts deserve no trust.

The only care they have to offer is on a Care Pathway applauded and lauded by NICE

...and the impossibility of the surreal is only too real.

Liverpool Care Pathway - Every Life Worthy Of Life

Another positive talking point for your next Life Cafe...
Inspire and be inspired.
See beyond your horizons.



Don't downsize your care options. Don't give up.

This man refused to downsize his expectations and saw past his horizons to upsize his care.

Scott needs the aids he has to live. With them, he has surpassed all expectation and made himself an example to us all to live up to and to follow.

Don't downsize your expectations.

They want to downsize expectations because they want to downsize care because they want to save money and you are expendable and expensive.

Isn't  that so,  Cllr. Collin Brewer?

"If you stop trying, you lose" - Scott Belkner

Words to live by...

That's right up there with "It ain't over till it's over" - Yogi Berra!

This is You Tube - 

It just take me little longer - Scott's story

It just take me little longer - Scott's story

 Eli G

It just take me little longer - Scott's story

518,321 views

Scott's last name is Belkner.

Reddit AMA: http://www.reddit.com/r/IAm...

Lots of people are asking what the songs are:

First song is "Movement I: In the Countenance of King

Second song is "Year of the Ox"

Third song is "The Perpetual self" or "What would Saul Alinsky D ...

First song is "Movement 1: In the Countenance of Kings

Secind song is: "Year of theOx".

Third song is: "The Perpetual Self, or "What Would Saul Alinsky Do?"

All three of them are by Sufjan Stevens...

Comments on Reddit -

[By Request] I'm Scott, the guy with Cerebral Palsy who works out like a badass. AMA. (self.IAmA)

submitted 4 days ago* by ciscomd

whatliesinside 72 points 4 days ago

Your words in the video were very inspiring. I couldn't help but marvel at the technology that let you communicate with all of us; if that tech didn't exist, we might not have received your gift. Thank you.

My question is this: what is the name of the device you use to speak with us, and what other assistive technology do you use? How important is that technology to you?

ciscomd[S] 102 points 4 days ago
The speaking device is called Vantage. I also used a motorized chair and sometimes a cane. These are of the utmost importance to me. I need them to live.

Dunkinize 132 points 4 days ago

My 11 year old nephew was diagnosed with CP when he was born (severely premature). He has broken all the rules, just like you have.

I will be sharing your story with him this weekend, and I know it will bring a sense of pride to him, as well as helping his desire to do more for himself.

Thank you for just being yourself, and also for posting such uplifting information for people with CP.

ciscomd[S] 326 points 4 days ago
Tell him don't give up, keep trying new things. If you stop trying, you lose.

tillicum 174 points 4 days ago

"If you stop trying, you lose". Words to live by.

Rashnet 30 points 4 days ago

Awesome quote

orvane 36 points 4 days ago*

I have tourettes and the offshoot of that is OCD and anxiety/depression. While it pales in comparison, I have had a few months of it being really hard to cope in every day situations. Lately I've been waking up, kicking morning in the balls and making it my bitch. Your video is exactly what I needed to see to reiterate that anyone, no matter the illness can be a part of something and enrich their lives.

Thank you very much, I may carry the memory of your video with me for the rest of my life.

edited "my video" to "your video", I blame tourettes

- i.imgur.com

And on Yahoo -

‘It Just Take Me Little Longer’: Man’s inspirational video about living — and thriving — with cerebral palsy

By Nadine Kalinauskas | Good News – Mon, 27 May, 2013

Scott, 29, from Glendale, Arizona, has cerebral palsy.

He can't talk. He needs a mobility device to get around.

And he is unstoppable.

Watch his inspirational video, "It just take me little longer," below.

Warning: You won't have an excuse to ever skip the gym again.

Scott spends two hours a day, four days a week at the gym.

"It won't stop me doing what I want to do," Scott says of his disability through a speech assistance device.

Following the success of his video, Scott participated in an "Ask Me Anything," or AMA, onReddit the next day.

"The speaking device is called Vantage. I also used a motorized chair and sometimes a cane. These are of the utmost importance to me. I need them to live," Scott shared on Reddit.

Redditor Dunkinize asked what Scott would say to encourage his 11-year-old nephew with cerebral palsy.

"Tell him don't give up, keep trying new things. If you stop trying, you lose," Scott said.

He added that because of his documentary, he might now have a job offer.

Liverpool Care Pathway - Peeling Back The Layers Of Belief

When the tide is sweeping you away, should I even attempt to save you when the act of doing so is futile...? Is that even a morally justifiable question?


In the State of Washington, they are teaching doctors how to downsize care.

In the State of Washington, they are teaching doctors how to approach their discussions with patients.

They are being trained to groom patients to refuse life positive treatments.

This is a toolbox of teaching resources from Washington University for medical educators.

- Tough Talk

The Faculty must peel away the layers of resistance. The Learners must make themselves a blank page upon which the tutor may write the script...

• Old habits are hard to break. It can take multiple discussions and attempts before the learner is able to let go of current beliefs and practices. Experiencing success will be the best reinforcement in this case.
• Old models are pervasive. A learner is likely to be surrounded by others who also hold beliefs regarding DNR discussions as legally necessary. Developing the learners' confidence with the new approach will be the best way to have them become effective role models within their programs.

This is akin to L Ron Hubbard. This is akin to Maoist re-education.

When the call goes out to launch the lifeboat the RNLI volunteer crew do not falter but risk their lives to do all they can for as long as they can to accomplish a rescue.

In this learning module, the Learner is made aware to not offer choice, but certainty –

F: But you presented her with a choice.

L: Right [pause] And I guess you’re saying that that’s, uh…

F: Well, you know, you don’t really think in your heart of hearts that it is a choice. You really want to make strong recommendation. You don’t really think that one side of that choice is going to make any sense given where things stand. So, it is really not a choice in your mind. You presented it as there are two ways we can go. You certainly gave a recommendation, you said…

L: I didn’t really present, I gave a soft opinion rather than a strong opinion.

Other learning Modules in the toolbox include denying ‘futile’ therapies

...and Advance Care Plans.

The focus is on how to appropriately phrase what needs to be said to accomplish the desired outcome and to engage the patients and families in that decision process.

The focus is on how to downsize care expectations, but...

When the alternative is death, every option becomes an alternative.

Refusing or denying 'futile' treatment is seen as permitting death to occur in an 'appropriate' way; it is said that this is not the same thing as causing that death and, therefore, is not euthanasia.

Is such an ethical stance actually unethical and morally reprehensible?

The argument that a passive stance of omission does not have that causality of effect as the active stance of commission does not really stand up to scrutiny,

In fact, in plain language, to do nothing is indistinguishable; it is an act of euthanasia by omission.

Liverpool Care Pathway - Responses Will Be Answered

A response has been left on these pages which requires to be answered... A response has been left on these pages which demands a response...

1. 
   Walker Miller27 May 2013 09:00

   I am sorry for your loss. However, even looking at the facts as you present them; the argument that May was killed by the NHS doesn't bare up to scrutiny. 1) You say she was a "frail and fragile lady". Frail and fragile people with pneumonia tend not to survive; 2)You said she stopped eating at home. Therefore, that's not the NHS starving her to death, that's herself starving her to death; 3) She refused the biopsy. This is her right, but if she won't let us find out what the matter is, we can't do anything to make it better; 4) She may have asked for a PEG, but this is a major operation. If she is frail and fragile, she is likely to die on the table. The doctors were right to refuse to do an operation that would kill her; 4) Nurses don't, as rule, put IV fluid along lines that have come out of the vein, they ask the doctors to put new lines in. If she had big blobs and oedema under the skin, it is most likely that she was having subcutaneous fluids which, as the name suggests, are meant to go under the skin. The fact that she got oedema is common side effect of subcutaneous fluids, which is why often don't use them. However, in May's case the hospital obviously tried to get fluids into her and save her life in the face of her refusing to drink; 5) If you have a frail and fragile person who is refusing to drink and potentially has cancer that they are refusing treatment for, and has a pneumonia; they are likely to die. I don't like it, you don't like it; but these patients tend to die. Is it not better that we are honest with ourselves and recognise that, rather than sticking our fingers in our ears and pretending it will all go away?

It is one month since May was taken on the LCP.

It is one month since the post was made upon which Walker Miller has chosen to leave a comment.

A subsequent post presenting further facts has since appeared.

I am responding to you courteously, Walker Miller. I find your response insensitive and ignorant. You haven't even taken the trouble to absorb what you have read. That is a matter of concern.

You have misrepresented facts as presented and made wrongful assumptions from your deductions.

Frankly, I find your fanatical adherence to a flawed protocol frightening.

The point is that May was an elderly lady frightened by her situation.

May needed time and reassurance. One daughter attempted to provide this. 

The rest of the family forsook her.

The grooming process had already begun. The Macmillan team had done their work.

The point is that this lady may well have had a malignant cancer. She may not have. She may well have died from this cancer, but she did not die when she did from this cancer.

This lady had the presence of mind to decline the biopsy when she did.

This lady had the presence of mind to discuss her wishes with the one daughter who would listen.

This lady had the presence of mind to demand of the doctor who man-handled her and thumped her chest -

"What are you doing!"

The doctor did not respond but declared to the family she had pneumonia.

The doctor left and returned to say he had spoken to his LCP team and that May was dying. The family agreed she should go quietly on the LCP.

No-one asked May!

Even you will conceed that your protocol was broken by that single act, Walker Miller.

Flawed protocol?

Walker Miller, is your attention so deficit that you do not pay attention to 'Current Affairs', as the subject was called when I was at school and you were not even a twinkle in your mother's eye.

The current Review of the LCP is all about saving the reputation of the LCP.

The current Review of the LCP is all about rescuing the LCP from the catastrophic catalogue of errors perpetrated by your colleagues that caused its good name to be brought into disrepute.

The current Review of the LCP is proceeding because there is an acceptance and acknowledgement amongst government ministers and amongst your colleagues that monstrous wrongs have been perpetrated in the name of this protocol.

Flawed protocol?

Yes, flawed protocol.

Diagnosing dying has no scientific basis.

Yet, there are those among your colleagues, Walker Miler, on Facebook and on Twitter, who claim to 'know' when someone is dying.

The "three triggers", the "surprise question" - How scientific is that?

Yes, flawed protocol.

The doctor saw a change in her patient...

"There was a marked deterioration, she was dying. She was being unresponsive, she was not eating or drinking. She had a haunted, harrowed expression. She just wasn't just frail, she was dying."

The doctor appears to be applying both her experience and the protocols of the GSF Prognostic Indicator Guidance to determine a diagnosis of dying for her patient to good effect.

Who is this doctor...?

Who is her patient...?

The doctor's name is Dr. Jane Barton.

Her patient's name is Mrs. Gladys Richards.

Yes, flawed protocol.

May died when she did because of 

• an initial failure to engage with her appropriately to provide a simple solution to provide her with the sustenance she required to survive.
• A subsequent and inappropriate determination that she was dying and the consequent decision to place her on the LCP which caused her death.

May was going to die, but she would not have died when she did. That is euthanasia. Euthanasia is unlawful in this land.