Liverpool Care Pathway - The Bee Wee Protocol

There have been deaths as a result of admitted catastrophic failures in implementation of training. Is no-one responsible and to be held to account?


Everyone has been moving ahead with their own 'Designs for Death'. Using the Trotskyist tactic, the Bee Wee Alliance now assumes charge.

This is NHS England –

Following publication of the Review, a so-called Leadership Alliance was set up with Dr. Bee Wee as acting Chair. The member organisations of this Alliance all gave unfailing, uncritical support of the discredited LCP.

The member organisations of this Alliance all acted under or were associated with the NCPC EoLC umbrella; all were thoroughly dismissive of every and any criticism of and allegation made against the Death Pathway.

There are no independent persons or organisations in this Alliance. It is almost as if they have been found out and are closing ranks. They are all tarred with the same brush.

The prior 2012 versions permitted them to act without consent. That is manslaughter.

Supporters and apologists dismissed as anecdote and hearsay that lives have been cut short, that those not 'dying' have been condemned to death. Abuse and wrong-doing have been compounded by abuse and wrong-doing.

The Review highlighted failures in training. Both the Review and Dr. Bee Wee have blamed the failures in training for the catastrophic failures in implementation of the Death Pathway. Dr. Bee Wee was responsible for this disastrous training.

Dr. Bee Wee, acting chair Leadership Alliance, President of the Association for Palliative Medicine of Great Britain and Ireland and a Consultant/Senior Lecturer in Palliative Medicine at Oxford University Hospitals NHS Trust and the University of Oxford, was National Clinical Lead responsible for e-training in the Liverpool Care Pathway.

Whether it is the Pathway or the training, is someone not to be held to account? Is Dr. Bee Wee not to be held to account? People have died!

This is the Engagement Document – 

Ring out the old:

A diagnosis of 'dying' is made. LCP is implemented.

Ring in the new:

A. People who have a progressive, life-limiting illness have been offered the opportunity to develop, document, review and update a personalised palliative care plan at different stages in their illness or condition.

Palliative care sets out to relieve the symptoms of a condition, not to cure a condition. Care is downsized.

Ring out the old:

Patients should be supported by the LCP when they are in their last days or hours of life and there is no treatment available that will reverse their condition.

It can be difficult to tell how long someone has left to live. The LCP recommends that doctors and nurses regularly assess a patient. Some patients will improve, and then the use of the LCP to guide their care will stop.

Ring in the new:

B. People, including those thought to be in their last days of life, whose condition changes, are identified in a timely way, receive good care that is reassessed at least daily (or more frequently as their condition requires), receive timely appropriate medication and have their emotional, psychological, social and spiritual needs addressed.

The net is trawled wider. "People, including [as well as] those thought to be in their last days..."

Addressing of "social and spiritual needs". The same 'Holism' of the Death Pathway.

The Document continues:

C. Regular, pro-active and responsive communication takes place between professionals and the person who is approaching the last days of their life and their family and carer. The content and outcomes of these discussions are clearly documented and shared with others involved in this person’s care.

D. There are arrangements in place, with which the individual is in agreement, to share key information about his/her care, treatment and preferences between professionals, service providers and others relevant to the person’s care.

E. Local governance arrangements are explicit about the role of ‘senior responsible clinicians’, delegation arrangements when the person’s usual GP or consultant is not on duty, information sharing arrangements to enable timely decision-making, and how people who are approaching their last days of life, and their families and carers know who are their ‘senior responsible clinician’ and nurse responsible for leading their nursing care.

This is all rolled out or being rolled out already with the local registers or Death Lists with such beneficent names as "My Wishes".

F. People who are approaching their last days of life, and their families and carers, receive the benefit of specialist palliative care (see glossary – Annex B) advice and support in a timely manner.

G. Families and carers feel supported, including knowing how to seek urgent help when this is needed for the dying person whatever time of day or night, and having their own needs addressed or signposted to sources of help and support.

Here, NHS Scotland may well be steaming ahead, hoisting some extra sail in the rigging...

Ten years before the mast!

All the more reason for the Bee Wee Alliance to step in and take charge.

This is Airedale NHS –

This is the hotline to hel(p) for those in their last year of life.

Wow, they're so good at diagnosis and prognosis now, aren't they?

Dr. Barton 'knew' her patient, Mrs. Richards, was dying just by looking at her.

Now, using this same Barton Method, your doctor can look at you and 'know' you're going to die within the next 12 months. Medicine is advancing by leaps and bounds! Care can be downsized to palliative much sooner and huge savings made in the stretched and straining, bulging NHS budgets, thus securing the service "now and for future generations".

The Document, further, asks:

Questions for engagement/feedback:
4. If you agree with the proposal to offer a personalised palliative care plan, do you agree with calling it a ‘Personal Palliative Care Plan’?

If not, what should it be called?

A Sunstein Nudge in the right direction is being proposed.

5. If personalised palliative care plans are to be introduced, it raises a question of how and where this should be kept. If it is kept in the person’s home, he/she would be able to look after it more easily. However, it may delay the ability of health and social care professionals (such as a doctor, nurse or ambulance staff) to take appropriate action on behalf of the person if the professional is not able to easily get hold of the information when needed. Do you have any ideas for how to find an answer to this practical question?

These 'personalised' plans are in place. Care is being 'coordinated'. They will all clamour to the Bee Wee Alliance and Bee Wee will take charge...

A true master of the Tactic. Congratulations Comrade.

Chairman Ellershaw...?

Additional reading -

Liverpool Care Pathway - The Dust Has Settled. All Change! Nothing's Changed.

Liverpool Care Pathway - As If We Didn't Know

Are these quality decisions that determine 'quality' and 'futility' of life?





When care is downsized, the glass is seen half empty, lives are in danger, deemed not worth saving. When cost-saving steps into the picture, all moral restraint is removed.

This is allacademic -

1. Catenacci, Michael., Saussy, Jullette. and Hill, Eric. "Estimated Cost-Savings of a Pre-Hospital Traumatic Arrest Do-Not-Resuscitate Protocol" Paper presented at the annual meeting of the National Association of EMS Physicians, Registry Resort, Naples, FL, <Not Available>. 2013-11-03 <http://citation.allacademic.com/meta/p55914_index.html>

Publication Type: Abstract

Abstract: OBJECTIVES: Surviving traumatic pre-hospital cardiopulmonary arrest(TPA) is a rare event. Futile resuscitations contribute to increased healthcare costs and put medical personnel at risk. Previous research has shown that TPA and initial cardiac electrical activity <40 bpm is prognostic in identifying those patients that cannot be revived. Many EMS systems have implemented TPA termination of resuscitation protocols. We hypothesized there would be significant cost-savings associated with implementation of a new TPA ‘Do Not Resuscitate’(DNR) protocol in our region. METHODS: A new TPA DNR protocol was put into place by the Orleans Parish Medical Society on June 1, 2003 that allowed issuance of a DNR order for adult patients(≥18 years) that were pulseless, apneic and had a initial cardiac rhythm of asystole or PEA less than 40 bpm. Data was collected on victims of TPA over a 14 month period from August 1, 2003 to September 30, 2004. All TPA patients that were resuscitated were prospectively followed and cost of hospitalization and measures of survival were recorded. Additionally, all TPA DNR orders with patient demographics were recorded by an online medical control physician in a centralized file. RESULTS: Over the 14 month study period, there were a total of 75 patients that suffered TPA that were resuscitated. The total cost of resuscitation for these patients was $465,270.36 with a mean cost of $6083.60(95% CI $1960.42-$10,206.79) per resuscitated patient. Nine patients(12%) survived to hospital admission, the average length of hospitalization was 3.0 days(95% CI 0.69-5.31), and there were no survivors to hospital discharge. There were 132 DNR orders recorded, 25 of which were excluded from analysis due to missing field data(eg initial cardiac rhythm). Estimated cost-savings was calculated as $650,945.71 (107 patients x $6083.60 per patient). CONCLUSIONS: Traumatic pre-hospital arrest protocols that allow issuance of ‘Do-Not-Resuscitate Orders’ for medically futile cases result in substantial estimated cost-savings. This cost-savings may have been underestimated in our study due to exclusion of 25 DNR orders secondary to missing data.

Of course. As if we didn't know...

A TPA DNR protocol was established. Effectively, an experimental trial on non-voluntary patients was commenced that denied those deemed 'futile' the chance, the opportunity - however slim - of life.

When budgetary constraint stands shotgun on the ward and steps out into the community, this moral peril brings us all to the brink of the precipice.

This is Commissioning End of Life Care, a document jointly written by the National Council for Palliative Care and the DoH National End of Life Care Programme –

The next two years provide a unique opportunity for new commissioning organisations to position themselves in the best clinical and financial position before they begin business as legal entities, for some at least as early as April 2013. 

By targeting end of life care, emergent commissioners can place themselves in a strong position for one of the major required areas of improving quality and safety of care; improving patient and carer experience and making care more cost/resource efficient. 

Tackling end of life care early can offer a number of significant ‘quick wins’ in improving the quality of care in your locality. People should be supported to be cared for and to die in their preferred place of care, which is usually their home (End of Life Care Strategy 2008). It may also include other community based settings such as a care home or sheltered housing. This means commissioners should ensure there is planned 24/7 provision of community support, including care co-ordination, nursing and symptom control. 

End of life care accounts for a high proportion of NHS spending. The Demos think tank has estimated it as at least a fifth of NHS costs and a total of about £20 billion 

There is considerable scope for improvement using interventions such as early identification triggers, advance care planning, co-ordination of care and effective multi disciplinary team (MDT) working.

There are a number of "significant 'quick wins'" to be made. EoLC costs £20 billion...

Additional reading –

Liverpool Care Pathway - A Data Bonanza

Liverpool Care Pathway - The Micawber Principle

These are assessments of 'quality' and 'futility' of life.

This is a post on a MND Association Forum -

           25th October 2013, 13:13

        not what i wanted to hear.

hi peeps, i had a conversation with my gp this week, about a do not resuscitate form. i am a bit miffed at the way it was put across, as though it wouldnt be fair on everyone else if was brought back and my feelings dont matter as much. i know i have to take others into account, but i am only 32 and even though ive had mnd for 4yrs i am mostly enjoying my life. i am still able to enjoy watching my kids grow up, who i love with all my heart. i have a great wife and family. i am just not ready to give that up yet no matter what, i will enjoy my life whatever it throws my way. am i being selfish,  just after the thoughts of others and honesty is welcome. thanks  mik

And this is a familiar tale...

Repeat prescription medication either not administered or withdrawn; a complaints process designed to grind you down, send you home and make you want to give up...

This is the Blackpool Gazette -

Ms Robles' father Reginald Iliffe was admitted to Alexandra Hospital in Redditch, Worcestershire, with problems swallowing, three days after being diagnosed with cancer.

The great-grandfather, who had worked for the NHS all his life as a dental technician, died of a heart attack nine days after he was admitted in April 2005, despite the fact that his cancer specialists had said they expected him to live for 18 months.

His family later learned that during his stay he had not been administered any of his heart medication - which he had been taking for more than 20 years.

Because Mr Iliffe had been admitted with a lump on his oesophagus, his medical notes indicated that he was "nil by mouth", so his oral medication was not administered, Ms Robles said.

His daughter said that because no-one bothered to change Mr Iliffe's medical notes so his medication was delivered intravenously, he did not receive any of the crucial drugs.

The family pursued a complaint that ran them through the wringer of the Healthcare Commission and the PHSO. Eight years later, it took a solicitor to wring an apology out of them.

Complaints are not new to the Alexandra. BBC News reported Jeremy Hunt to be "disgusted and appalled" at the accounts of neglect there.

'Learnings' are taken, of course, but they are never learned. And why should they be when deaths are but "shortcomings" and a life, on average, is worth a paltry £10 grand?

This is the Mail Online reporting in January 2012 –

 

Early this month Mr Cameron announced that nurses would have to undertake hourly ward rounds to check whether patients are hungry or thirsty, need help going to the lavatory or are in pain or discomfort. 

And last year similar guidance was issued by the General Medical Council reminding doctors that care does not begin and end with clinical treatment. 

Reports by the Care Quality Commission, the Health Service Ombudsman and the Patients Association have all highlighted poor care. In October, a review by the CQC watchdog found that half of 100 hospitals visited by its inspectors were not doing enough to ensure elderly patients had enough to eat or drink. 

In Alexandra Hospital in Redditch, Worcestershire, doctors had resorted to prescribing patients with drinking water to ensure nurses did not forget.

This is the Mail Online reporting in August 2013, a year and a half later –

 

The family of Sandra Aston, 79, have told how they smuggled ice lollies in to Redditch Alexandra Hospital after nurses left her so thirsty her lips cracked and bled.

Mrs Aston was ‘treated like an animal’ by nurses, who claimed they could not help when her family begged them to act as she became increasingly dehydrated.

While she was too weak to drink from a cup, her thirst could have been quenched with oral sponges. But staff did not provide these, leaving her family to feed her ice lollies they bought outside.

...Redditch Alexandra Hospital.

Compaints, complaints...

The Government issued a press release last week which has proposed a 'revolution' in the way complaints are handled -

This discusses the history and determining factors behind the commissioning of a report from Ann Clwyd into the gruelling NHS complaints process and the prejudiced and biased and dismissive attitudes of the various regulatory bodies.

The press release includes contributory comments from Ann Clwyd, Jeremy Hunt, and Tricia Hart. Has Ann Clwyd succeeded? Will her proposals succeed?

A link to her report is provided. This is A Review of the NHS Hospitals Complaints System - Putting Patients Back in the Picture -

The problem of communication is raised. A Nudge in the right direction is proposed:

Recommendations 

● Patients should be helped to understand their care and treatment. While written information is helpful, it is always important to discuss diagnoses, treatments and care with a patient. Patients frequently need to revisit topics already addressed. Where appropriate, their relatives, friends or carers may be included in discussions.

A bit of friendly advice from someone on the receiving end...

With the appropriate preemptive grooming, all issues may be stopped in their tracks before they brew into an intractable problem. Remember: If it may be circumvented, it may be prevented!

This is The Telegraph on the subject of that report -

NHS complaints review 'will be rendered useless’ 

The NHS is braced for fresh criticism about the way it handles complaints from patients as safety campaigners accuse the Government of “legitimising cover-ups” by deciding to limit a new proposed legal duty of candour.

The Mail Online reported -

Hospitals must investigate allegations of medical blunders – even if it exposes them to the threat of legal action.

Health Secretary Jeremy Hunt said the NHS was obliged to respond to all patient complaints of poor care.

The guidance came as it emerged some hospitals have refused to investigate concerns or halted inquiries, even if the aggrieved parties only sought legal advice.


It has 'come to light'...?

The first thing we were asked at the Healthcare Commission stage and the PHSO stage was were we considering legal action. The implication was plain that if we were the complaint could not proceed.

A similar implication was made by the N&MC. 

Will there be a legal Duty of Candour (Robbie's Law)?

Earl Howe, who infamously dismissed the reports on the Death Pathway as being 'anecdotal', now comments in the Lords that any duty of candour would be limited to cases resulting in death or serious injury. This is counter to the recommendations made by Robert Francis QC in his Final Report on the Mid Staffs scandal.

There will also be another parameter of limitation or plausable denial...

The Worcester News reported in January 2012, long before the flawed Review into the LKP was mooted by Norman Lamb -

A county MP is determined that a care pathway for the dying does not become “euthanasia by the back door”.

West Worcestershire MP Harriett Baldwin has welcomed new guidance in the county’s NHS acute team to improve a care programme for terminally ill patients. 

She first learned about the pathway three years ago when it was mentioned in the medical notes of a woman who had died at Worcestershire Royal Hospital in Worcester with dehydration. 

Mrs Baldwin was in contact with the woman’s niece and contacted the hospital trust for answers. 

When the damning report into care at two wards at the Alex by the CQC was published, Mrs Baldwin was concerned that this was linked to interpretations of the Liverpool Care Pathway. 

She said: “It’s important the hospital has the right training process and safeguards because I would hate to see any suspicion that it was euthanasia by the back door.” 

Mrs Baldwin requested the Liverpool Care Pathway be considered as part of the acute trust’s review of the failings identified by the CQC report. 

Mrs Baldwin has raised concerns with trust management on several occasions about the use of the LCP after hearing from constituents. 

She said: “I have been urging the acute trust to take another look at the way it uses the Liverpool Care Pathway for some time and I am pleased that these steps have been taken. 

“It can of course be difficult to define the moment when a patient becomes terminally ill and it can be upsetting if all relatives see is that nutrition and hydration are no longer being given.”

It IS of course difficult to define the moment when a patient who is not diagnosed with a terminal illness is terminally ill. It IS upsetting to see nutrition and hydration withdrawn.

Nurses, reportedly, said they ‘could not help’ when family begged them to act as Mrs Aston became increasingly dehydrated...

 

How many deaths from dehydration were LCP related? The GLA Conservative report demonstrated that Trusts just do not have, or have conveniently ‘lost’, the records.

The Worcester News report continues -

Jenny Garside, end-of-life care facilitator for Worcestershire Acute Hospitals NHS Trust, said the trust had been participating in the Liverpool Care Pathway for a number of years and the latest – version 12 – was now being used in the county’s three acute hospitals.

She said: “The updated pathway contains a detachable leaflet for relatives and friends about the use of the LCP and issues such as hydration and nutrition that are often a major concern during the end-of-life phase for patients.

“The new pathway also gives clearer guidance to medical and nursing teams about identifying and placing a patient on the LCP, multi-disciplinary team (MDT) review and issues such as hydration and nutrition.

“The trust has two end-of-life care facilitators – one based at Worcestershire Royal Hospital and the other at the Alexandra Hospital, Redditch.

“They visit all ward areas to arrange training on the new document and offer advice and support. Staff can also access an online e-learning package.

The trust takes part in the Marie Curie National Care of the Dying Audit to benchmark the use of the document in the trust against a national standard. The training in the trust is then tailored to identified areas of need.

The e-learning package will be the shameful Bee Wee package reported in these pages. Dr. Bee Wee is pictured in a Macmillan Newslettter having 'fun' at a promotional photoshoot...

Liverpool Care Pathway - The Sneak In The Waiting Room

Liverpool Care Pathway - An Arrogance Of Infallibility And Denial Of Error

The Audit mentioned was selective and not comprehensive.

A medical holocaust has proceeded. A Programme to Limit Life is ongoing.

Further reading -

Liverpool Care Pathway – "So This Is Christmas..."

Liverpool Care Pathway - A Failure Of Care

Liverpool Care Pathway - They Do Not Have The Paperwork

Liverpool Care Pathway - A Decision With Many Outcomes

These doctors had a particular duty to this man's welfare; in this, they betrayed him miserably.

May it please the Honourable Bench to be so advised: the Good Doctors, duty-bound by Oath so they are, did permit Mr. James to fall into harm's way whilst in their care and to contract such mal-afflictions that brought him to his sickbed; thence sought they to cover up a wrong with a wrong, that Mr. James' life was not a life worth living. (Apologies to Ben Franklin)

This is BBC Newsnight –


Newsnight   30/10/2013

The Supreme Court has completed its deliberations. May James is interviewed on Newsnight by Jeremy Paxman. Watch from 22 minutes into the programme.

Jeremy Paxman 

Now, the highest court in Britain decided today that a hospital had been right to withhold treatment from a very sick man despite the wishes of his family. This important judgement in the complicated area which many of us may visit where ethics and humanity and institutions and families may collide is expected to cast a long shadow.

The dying man’s family had wanted doctors to continue treatment; the Supreme Court decided that they had been within their rights to press for that and that lower courts had been entitled to rule in favour of the hospital, too.

Report

Mr. James, grandfather and professional musician, was admitted to intensive care after contracting an infection in hospital. His condition deteriorated leaving him unable to speak or breathe unaided. The hospital asked the High Court for permission to withhold some treatments if his condition got any worse. The court refused, forcing them to continue treatment. The hospital then appealed and, as Mr. James became increasingly ill, they won the right to withhold treatment. Just ten days after that verdict, Mr. James died. Despite his death, the family brought his case to the Supreme Court hoping to have the verdict over-ruled. This afternoon, in a complex ruling, the Supreme Court decided that, on the evidence available, both of the decisions of the lower courts were correct.

Jeremy Paxman

Well, we’re joined now from our studio in Liverpool by David’s widow, May James. Em, May James, even after your husband showed no prospect of recovery, you continued this legal fight. Why?

May James

Because he still was showing life, a life worthwhile living.

Jeremy Paxman

And you continued the legal fight even after he had died

May James

Oh, yes, to the Supreme Court, well, em, because in the appeal court there was a precedent set that em doctors, if they felt that treatment was futile, invasive treatment was futile, well, they didn’t really have to give it to the patient. Now, that meant any hospital in the country, which no… I, I carried it on because I wanted to help other people with family, loved ones, that may end up in the position like my husband ended up. And, it was horrendous. I just would not like anybody to go through what I went through. I went through it for the love of my husband and, when he died, I felt no well it’s got to go on to help other people. And that’s why.

Jeremy Paxman

It must take a real depth of conviction to reject doctor’s advice, doesn’t it?

May James

Well, when the doctors started saying about withdrawing treatment, it was quite a few months down the line. It was em around about July, last year, that they first said to me they, that if he should have a cardiac arrest they didn’t want to resuscitate, would I agree? And I said… They said to me we don’t expect him to have a cardiac arrest. So I said, well, if you don’t expect, why are you asking me this? Well, just in case he does. So I said, no, well I can’t agree with that because you can’t tell me what is wrong with my husband. You can’t diagnose what is wrong with my husband. Tell me that he has cancer; tell me that he has TB, and I then may go along with your wishes. But until you can diagnose what is wrong with him you should not be asking me this.

Jeremy Paxman

What do you make of the Supreme Court’s judgement today which seems to… It, it’s extremely complicated; it seems to come down on both sides, that both the hospital was right and that you were right.

May James

Yeah, yeah, yeah. Em, what they said was that at the particular time… See, when we were at the Court of Protection, Judge Jackson would not grant the hospital what they wanted. But then, by the time we got into the appeal court, Dave had deteriorated again. So, at that particular time, the Supreme Court said today that it was right. They felt that the appeal court was right in passing for the hospital to not give the treatment. Em, but then… Well they didn’t give the treatment and he died.

Jeremy Paxman

What do you think ought to be the guiding principle in cases like this?

May James

Well, like what was passed today, I mean, the fact… What happened at the Appeal Court, because they granted, there was the… there was a precedent set which went against what Judge Jackson said so, therefore, the law had changed. Now, what I wanted was that law changing back. So, what happened today is that the hospital were told that they did the right thing; the appeal court was right at that particular time. Em, and I was told that, em, the appeal judges heard they did not follow those mental capacity rules right. Em, and that what was passed on that day at the appeal court was not to carry on. They now… it has, more or less, gone back to what it was. The law’s been changed back, which was what I wanted it to, and doctors now have got to take a different approach towards patients and stop and think more about the Mental Capacity Act.

Jeremy Paxman

Thankyou very much for taking the time to join us; thankyou very much indeed.

The Liverpool Echo reports–

The Supreme Court has ruled that appeal judges were right to allow doctors to withhold treatment from a “gravely ill” guitarist from Liverpool. 

David James, who was in his late 60s, died 10 months ago shortly after the Court of Appeal decided that withdrawal of treatment would be in his best interests.His widow May had asked the Supreme Court - the highest court in the UK - to overrule that decision.But a panel of Supreme Court justices ruled against Mrs James after analysing the case at a hearing in London in July. 

Doctors at Aintree University Hospitals NHS Foundation Trust in Liverpool initially asked a High Court judge sitting in the Court of Protection for a declaration that withholding treatment would be in Mr James’s best interests should his condition deteriorate. 

Mr James’s relatives were against the idea and Mr Justice Peter Jackson refused the trust’s application. 

But his decision was overturned by the Court of Appeal after the trust appealed.The Supreme Court heard that Mr James - a grandfather and father of three - had undergone surgery for colon cancer. 

Mrs James said Mr Justice Peter Jackson’s decision was right and suggested that the Court of Appeal ruling undermined the “protection” given by “legal presumption in favour of preservation of life”. 

Trust bosses said the appeal court was right. 

Bosses say Mr James was “critically ill and steadily deteriorating”. They say he had been in an intensive care unit for seven months and had a range of problems, including multi-organ failure. 

The Court of Protection, which is part of the High Court, analyses issues relating to sick and vulnerable people.

May James, a brave and resilient lady, firm and uncowed still, has stood firm in her good fight for justice and for families in like position to her own. This is a decision with many outcomes, however. Effectively, it is a fudge. It has reduced everything to 'technicalities'.

The Appeal Court was wrong to:

• Adjudicate upon "treatment" without consideration of 'quality of life'.
• Adjudicate upon there being "no prospect of recovery" and equate "recovery" with a return to a condition of "good health".
• Claim the "past and present wishes and feelings" of Mr James had been considered, when he was unable to express them.

Effectively, it has been ruled that the right decision was reached, but for the wrong reasons.

Effectively, the primacy of the prior status quo has been reasserted which, in any case, was what May James had set out to achieve and this has been achieved.

Doctors are now on warning to act with more caution but doctors are, in any case, empowered to act in 'best interests'...

This is The Telegraph –

1. The Supreme Court heard that Mr James, a father of three, had undergone surgery for colon cancer.

Mrs James, a civil servant, said the Court of Protection’s decision was right and suggested that the Court of Appeal ruling undermined the "protection" given by "legal presumption in favour of preservation of life". 

The Supreme Court justices ruled that Mr Justice Jackson applied the "right principles". 

But they said appeal judges were also right to reach the conclusion they did on the basis of fresh evidence that Mr James’s condition had deteriorated. 

Lady Hale, one of the justices, said that, while the appeal was dismissed, the James' family had "won the argument" on "principle". 

Danielle Hamm, director of Compassion in Dying, a charity providing information on the rights of people to a “good death”, said the ruling was an “important judgment” which showed that patients should make an advance decisions in writing about whether they wanted to be denied treatment.

Danielle Hamm is the Director of Compassion in Dying. She has the bare-faced audacity to paddle her grubby oar into this debate? Compassion in Dying is the 'charitable' organ of the pro-euthanasia political lobby, Dignity in Dying.

This pro-euthanasia 'charity' actually duped East London Age UK to join them in conning the National Lottery to fund a local EoL Advocacy project.

Read - 

Liverpool Care Pathway - Changing Minds

Hamm advises making 'advance decisions'...

Where none has been made, there should ALWAYS be a bias toward life and an assumption made that chooses life.

Hamm advises making 'advance decisions'.

Death List patients, such as those recruited to the Invicta 'My Wishes' register for instance, are encouraged to make such 'decisions'. They are diagnosed for EoL with GSF and the Barton Method, groomed to downsize care expectations and given the Sunstein Nudge.

Hamm would set us on a course that would lead us into perilous and treacherous waters. These matters are not for courts nor for doctors to determine.

Further reading -

Liverpool Care Pathway - "You Think You're Gods But You Are Not" 

Liverpool Care Pathway - It's For You To Decide, None Other