Liverpool Care Pathway - A Dying Scandal

When it comes down to it, it’s much simpler, less bother and cheaper to just let them go...




It was a single and singular decision. The fact, de facto, could not be undone.

The domino tumbled.

This is ENCA –

PRETORIA - The Departments of Justice, Health and the NPA plan to challenge Judge Hans Fabricius’ decision to grant a terminally ill cancer patient the right to die.

Judge Fabricius last week gave advocate Robin Stransham-Ford the right to end his life with the help of a doctor. He said his decision related only to this particular case.

But the NPA and the health minister still believe it could open the floodgates on euthanasia.

They say the judgment not only contravenes the right to life entrenched in our constitution, but also compromises doctors' ethics.

“Doctors signed a Hippocratic oath which talks about life, life, and life. I won't give up to allow another arm of government to change the ethics and direction of doctors in the way that ruling is going to," said Minister of Health Aaron Motsoaledi.

Judge Fabricius is not prepared to withdraw his judgment.

“As I handed down the ruling on the 30th of April, the applicant had died that morning shortly after 8 apparently, I certainly didn't know that and nor did counsel. The result is that the application that I recall my order in terms of rule 42 is not granted," said Fabricius.

- ENCA

Dignity SA has its foot in the door...

The landmark case which presided in the North Gauteng High Court, was the first of assisted suicide in South Africa.

The case is a significant one as it could determine whether local doctors can in future assist terminally-ill patients to die.

The dominoes are tumbling...

Is South Africa to follow the same treacherous and uncertain path being followed by Canada?

Dr. Kenneth Stevens, an Oregon Professor Emeritus and former Chair of the Department of Radiation Oncology, Oregon Health & Sciences University in Portland, called Bill 52 a licence to kill.

- CBC News

The non-partisan Bill 52, also known as an act respecting end-of-life care, passed Thursday afternoon in a free vote at the National Assembly in Quebec City.

Bill 52 allows for and outlines under which conditions terminally ill Quebecers can request to receive medical aid in dying.

Liberal Christine St-Pierre was one of the 22 who voted against Bill 52.

"I don't believe it's right to give [anyone] the power to kill somebody," St-Pierre said.

 Further reading -

Liverpool Care Pathway - A 'Right' To Die?

In CNW Newswire, Dr. Stevens is named as a guest speaker at a conference of the Coalition of Physicians for Social Justice...

Dr Stevens will describe how hundreds of so-called "hopeless cases" with treatment can go on to survive many profitable years or be cured. He will explain how other people are encouraged to give up on care because of the existence of the assisted suicide law. The message of the proponents of assisted suicide is that "doctors can do a better job of killing you than caring for you."

Present at the conference and giving her testimony is a patient of Dr Stevens, Jeanette Hall. She was diagnosed in 2000 with lower bowel cancer and told that she had six months to a year to live. She asked for assisted suicide as provided by the state of Oregon. Dr Stevens disagreed with her decision for assisted suicide and was able to convince her to undergo radiation and chemotherapy. She is now thrilled to be alive 13 years after undergoing cancer therapy and not killing herself with a lethal dose of barbiturates.

Dr Stevens will discuss how financial incentives in Oregon's government health plan steers patients to assisted suicide. Dr. Stevens will warn that if assisted suicide or euthanasia is legalized in Quebec, then the Quebec government health program could follow a similar pattern limiting coverage for cancer care and thus encouraging euthanasia.

Dr. Paul Saba, a family physician and co-president of the Coalition of Physicians for Social Justice will explain how Québec's proposed euthanasia law would encourage people, including young adults 18 and over with treatable conditions such as depression, chronic lung and heart disease, diabetes, rheumatoid arthritis and fibromyalgia to agree to euthanasia and end their lives.

This already sounds like EoLC UK:

“Hopeless cases” diagnosed as dying and placed on EoLC Pathways;

The elderly and vulnerable signing away treatment intervention with an ACD and signing up to non-intervention with a DNR;

Lives cut short;

Others, escaping, removed from the Pathway, surviving months or years;

Financial incentive payments.

Baroness Greengross OBE, vice-chair of the All-Party Parliamentary Group on Choice at the End of Life, said:

‘Palliative care and assisted dying legislation share many common values: the alleviation of suffering, patient choice and a patient focused process. They should not be seen in isolation.’

There you have it. The linkage is established. Euthanasia is but one step further along the Pathway, not at all the one step beyond it.

The culture is already cast without any legislation put in place to take life.

When it comes down to it, it’s much simpler, less bother and cheaper to just let them go...

And profitable if there is either de jure presumed consent or de facto written consent in place for organ donation to proceed.

This is Mail & Guardian –

On May 27 four Durban surgeons are due to stand trial for their part in South Africa’s kidney trafficking scandal.

But evidence in the Mail & Guardian‘s possession suggests that top Netcare executives are fortunate not to be standing beside them.

“Kidneygate” is the long-running saga of how—between about 2000 and 2003—about 200 Israeli patients with kidney disease were brought to South Africa to receive organs from living donors who were presented as their relatives.

The donors were in fact poor Brazilians, Israelis and Romanians who were recruited by international organ traffickers and paid a relatively modest sum to give up a precious kidney—a criminal offence under South African law.

To make matters worse, at least five of the donors are now known to have been legal minors at the time of the operations.

The four doctors—John Robbs, Ariff Haffejee, Neil Christopher and Mahadev Naidoo—are bitter at finding themselves at the short end of a chain of ethical dissimulation.

In theory, the buck stops with the doctor doing the cutting, but in reality, the transplant surgeons were little more than skilled mechanics dealing with bodies on an assembly line, maintained, paid for and legally underwritten by the big healthcare factory that is the Netcare Group.

Illegal organ donation by Notcare Netcare. What scope for legal profit is there?

Once the dominoes tumble...

In Oregon, Death prescriptions have increased by 500% in number from those written during the 1st year of Oregon’s assisted dying legislation -

- Oregon Public Health Division

House Bill 3337 will spread the net of eligibility still wider.

Organ harvesting of euthanased patients is well organised, almost to a factory precision, across europe via Eurotransplant -

- Eurotransplant

Notcare Netcare is a NHS provider -

- NHS Choices

Once corporate suppliers - whether private or third sector - network with the State there is a scope for almost anything to proceed. It is the medical equivalent of the Military Industrial Complex.

This is NCBI  (National Center for Biotechnology Information) –

Initially, in the 1970s and 1980s, euthanasia and pas advocates in the Netherlands made the case that these acts would be limited to a small number of terminally ill patients experiencing intolerable suffering and that the practices would be considered last-resort options only. By 2002, euthanasia laws in neither Belgium nor the Netherlands limited euthanasia to persons with a terminal disease (recognizing that the concept of “terminal” is in itself open to interpretation and errors). 

In 30 years, the Netherlands has moved from euthanasia of people who are terminally ill, to euthanasia of those who are chronically ill; from euthanasia for physical illness, to euthanasia for mental illness; from euthanasia for mental illness, to euthanasia for psychological distress or mental suffering—and now to euthanasia simply if a person is over the age of 70 and “tired of living.” Dutch euthanasia protocols have also moved from conscious patients providing explicit consent, to unconscious patients unable to provide consent. Denying euthanasia or pas in the Netherlands is now considered a form of discrimination against people with chronic illness, whether the illness be physical or psychological, because those people will be forced to “suffer” longer than those who are terminally ill. Non-voluntary euthanasia is now being justified by appealing to the social duty of citizens and the ethical pillar of beneficence. In the Netherlands, euthanasia has moved from being a measure of last resort to being one of early intervention. Belgium has followed suit, and troubling evidence is emerging from Oregon specifically with respect to the protection of people with depression and the objectivity of the process.

The United Nations has found that the euthanasia law in the Netherlands is in violation of its Universal Declaration of Human Rights because of the risk it poses to the rights of safety and integrity for every person’s life. The UN has also expressed concern that the system may fail to detect and to prevent situations in which people could be subjected to undue pressure to access or to provide euthanasia and could circumvent the safeguards that are in place.

Once the dominoes tumble...

The net is being trawled. The moral guard has dropped.

A sea of debt averts the gaze. Cost ties the purse strings. Profit blinds moral restraint. Whither are we bound?

The Pathway is treatment and death is therapy...

"Last month the chairman of the Royal College of General Practitioners expressed himself "horrified" by the discovery that many of the 114 British "clients" of Dignitas had not been suffering from terminal illnesses at all."

(Dominic Lawson: Death, dignity and the darker side of family dynamics - The Independent)

Would the chairman of the Royal College of General Practitioners express himself equally "horrified" by the discovery that many of those placed on the Liverpool Care Pathway had not been suffering from terminal illnesses at all?

The linkage is established. Euthanasia is but one step further along the Pathway, not at all the one step beyond it. The culling of the vulnerable, the elderly, those assessed living a life not worthy of living further establishes this link.

The net has been cast wide in all directions to permit more and more and to remove all restraint.

It is now more than eight years the net was cast to trawl in the incurably mentally ill. This is Medscape –

Now, a recent decision by the Swiss Federal Supreme Court threatens to undermine yet another longstanding taboo in the debate over assisted suicide and euthanasia. In its ruling on November 3, 2006, the high tribunal in Lausanne laid out guidelines under which, for the first time, assisted suicide will be available to psychiatric patients and others with mental illness.

The case was that of an unnamed fifty-three-year-old manic depressive with two prior suicide attempts who sought a prescription for fifteen grams of sodium pentobarbital in order to end his own life.He claimed a right to self-determination under Article 8 of the European Convention on Human Rights and alleged that no physician would prescribe him this lethal dose for fear of legal or professional repercussions. Dignitas, a Zurich-based advocacy group, supported his suit. The Swiss high court responded with a sweeping opinion upholding the right of those suffering from "incurable, permanent, severe psychological disorders" to terminate their own lives.

It has been a circuitous route but are we already on the pathway back to T4?

Depression used to be cited as a reason why the desperate might seek suicide.

Is depression also a reason to seek suicide...?

This is all very messy.

Where does this leave those who seek to step in and lead the suicide back from the brink?

Do they, in doing so, infringe upon the suicide's human rights?

A messy Assisted Suicide Bill is to go before the Scottish Parliament -

The Pathways have EoLC Facilitators. This messy bill has licensed Suicide Facilitators...

The role of the licensed facilitator

Support for the role of ‘licensed facilitator’

232. The creation of the role of ‘licensed facilitator’ has been widely welcomed by supporters of the Bill. It has been described in written submissions from supporter organisations as  “a welcome measure”, “a large step forward” and  “one of the main merits of the Bill”. Supporters point to several potential advantages.

233. First, the role of facilitator places a degree of distance between medical professionals and the direct act of assistance; this may be necessary given the reported reluctance among members of the healthcare professions to be involved in facilitating assisted suicide (discussed above); in the words of Rob Jonquière of the World Federation of Right to Die Societies, it "takes away a burden from the shoulders of the treating physician".

234. Second, the role of licensed facilitator is described by several supporters‘organisations as a "safeguard" for the person committing suicide. In their written submission, for example, Friends at the End suggest that the facilitator role  “offers additional protection for the vulnerable”.

235. References to the role as a ―safeguard‖ seem to refer to two things: first, the fact that assistance would be provided by a trained individual, thus allowing for “a safe and careful execution of the (assisted) suicide”; and second, the fact that the assister would have no personal connection to the person being assisted, unlike friends and family members who may feel motivated to try to interfere with the autonomous decision of the individual (either by encouraging someone to commit suicide or by attempting to dissuade them from doing so).

There is to be a “safe and careful execution of the (assisted) suicide”. Is this not, already, an unfortunate choice of words?

The Facilitator is an Executioner.

And this in this Saturday's Daily Mail -

Dignitas is sending people who want to die to a banned British doctor for approval they need for an assisted suicide, the Mail can reveal.

The clinic is telling patients to get a report from a controversial psychiatrist struck off nine years ago for serious misconduct. They say that Colin Brewer – who has helped at least 12 patients to die at Dignitas – is prepared to support cases even where the patient is not terminally ill.

Brewer has previously spoken openly about how he helps people without terminal illnesses to die. He co-edited a book, I’ll See Myself Out, Thank You, which horrified opponents of assisted suicide. In it he detailed the cases of seven patients he has written assessments for, who went on to die at Dignitas. Only one had a terminal illness. Speaking about Jacques, a retired academic in his seventies who suffered arthritis, heart disease and high blood pressure, Dr Brewer said: ‘It sounds no worse than in most people of his age. But he dreaded the possibility of a sudden deterioration… that would deprive him of the mental capacity to decide on the manner of his death.’

Brewer says a third of the patients who contact him are referred by Dignitas. Others find him from campaign groups such as Friends At The End, who yesterday said they were ‘proud’ to recommend him.

Brewer's victims find their way to him via Friends at the End who are "proud to recommend him."

Friends at the End back the role of the Executioner as a "safeguard".

Perhaps, Brewer should consider applying for the job when it comes up.

And legal killing is not yet even legal in this land.

With the final word, this is Eric Chevlen in The Sacramento Bee –

People with terminal illnesses do not seek suicide, assisted or otherwise, because of pain. Patients in pain seek pain control, not death. Fortunately, modern medicine can reduce pain to ordinary levels that we all have experienced. The terminally ill do not seek suicide, assisted or otherwise, because of the burden of treatment. Patients who find treatment burdensome rightly have the option of simply discontinuing treatment.

Rather, without exception, those patients who have asked me to hasten their death did so out of despair. They despaired of having lives of value, of being the object of the loving care of others. They mistook being dependent for being a burden, or mistook being a burden for being contemptible. They were sick and weak, and mistook uselessness for worthlessness. Despair is indeed the sickness unto death.

A doctor whose response to a request for assisted suicide is a scribbled prescription for a lethal drug does his patient the terrible disservice of abandonment. It is a tacit admission that the doctor agrees that the patient’s life is of no value. It is hard to imagine a more contemptuous act.

And some final reading –

Liverpool Care Pathway - Presumptuous And Arrogant 

Liverpool Care Pathway - So Readily Do Perceptions Change... 

Liverpool Care Pathway - There Are Always Consequences 

Liverpool Care Pathway - The Sum Of All Fears