Liverpool Care Pathway - Terminal Sedation: Backdoor Euthanasia?

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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."