Monday, 5 November 2012

Palliative Care, Negligence Or Murder?

The older I become the more aware I am of my own mortality.

It's not just the increase in the number of funerals I attend or hearing of friends who are no longer able to do tasks they could do ten years ago (that includes myself), but it's a deepening knowledge that I'm in the 'danger zone'. In the past five years two close friends have died and although one had been ill for some time, the other died suddenly in the night.  Not even his retired wife, a highly qualified senior nurse, could save him and each day she is haunted by her perception that she could have done more.  The knowledge that her husband of 44 didn't suffer for more than a few minutes is of slight comfort, but every little crumb of comfort matters in situations where death is involved.

The Liverpool Care Pathway was developed at the Royal Liverpool University Hospital and the city's Marie Curie hospice, to relieve suffering in dying patients.  It sets out principles for terminally ill people in their final days and hours and the method is widely backed by doctors and many health charities.

Now a prominent oncologist, Professor Mark Glaser, has spoken out and said the LCP 'is employed by Health Service managers to clear bed spaces and to achieve targets that bring more money into their hospitals.'  He added he would go to America because he doesn't trust the NHS and that he has removed 'dozens' of his own patients from the Liverpool Care Pathway.

A few years ago, after a court case, a medic I knew was struck off the medical register for professional misconduct.  Dr Martin believed if one of his patients wished to die with dignity at home then it was his job to make their suffering as minimal as possible.  He was suspended for five years while police investigated him yet I doubt if there will be any police investigation into the case mention here and others like it.  That's because the patient was put on the LCP by her doctors who are supported by the BMA and other medical organisations.

On the Marie Curie website the LCP is described as 'an integrated care pathway tat is used at the bedside to drive up sustained quality of the dying in the last hours and days of life'.  Fluid, food and medication is withdrawn from the patient and they're left to succumb to a death which may be horrific for the patient.  It has yet to be scientifically proved whether dying patients suffer pain once unconscious.

The fact that hospitals have targets and receive financial incentives for patients associated with the Liverpool Care Pathway is obscene.

Last week the Department of Health's End of Life Care Programme opened an inquiry into the LCP.  The result of the investigation should be a halt to this treatment of the dying and a study of how patients can be sent home, if possible, to die in familiar surroundings with local nurses attending to their needs. That is palliative care.

I've placed a poll in the sidebar about this issue.


Apogee said...

Listening to BBC 5live this morning it seems that a number of patients put on this "Liverpool Care Pathway" were taken off it on the family's insistence when they realised what was actually going on and the patient subsequently survived and continued living a reasonable life, and returned home.
This "pathway",without the patients "informed consent" or for that matter the relatives, would seem to be murder by neglect,or if the patient consented, assisted suicide,again illegal. Why has there been no criminal prosecutions by the authorities? The medical profession do make mistakes, reading the newspapers, plenty of them ,and this "pathway"is a perfect illustration why "assisted suicide"is illegal. Like it or not, doctors are the same as tradesman, in some cases extremely highly skilled, in other cases, not so, and can misread the situation with a patient.And how many old people are in the condition they are, due to the side effects of the drugs they are being given,sometimes to alleviate the side effects of other drugs.The effects of drugs on a patients cognitive functions is often ignored, not mentioned, although well known to the medical profession, but this can result in a patient appearing to be considerably worse than is the case.This all needs thinking about.
With the vested interests being carefully watched.This could very quickly turn into euthanasia. Do we really want that?

Demetrius said...

Probably the way it is being managed in many places is murder. Apparently, Zyklon B came with a fragrance effect. Didn't we fight a war against this kind of thing?

Hamish said...

Old peop[le are selfish. That is how they get to be old. Always first into the lifeboats, always jumping the queue.
There are exceptions: I'm one of course, and I rather think you are too Rosie. But they are few.

When the time comes when I am no longer of any use to anyone, I hope a GP of the old school will do the right thing.

Joe Public said...

Another though-provoking topic Rosie, thanks for giving it an airing.

I have mixed feelings on the subject, from two different aspects of recent personal experience.

Visiting a Hospital, and Care Homes observing the contrasting differences of their residents. Some in little more than vegetative state, others full of the joys of life - neither of which are entirely age-related.

Some were simply 'kept alive' by their medication; others 'lived' their life.

Personally, I would not want to degenerate into the former, being a very expensive burden upon my descendents. The trouble is, knowing when to self-extract the life-support. Ironically the later one leaves it, the less-rational one can be about pulling-the-plug.

We all know the tremendous financial black-hole facing the NHS - caused in significantly by mankinds ability to sustain 'life' with ever-more-expensive drugs, treatment & care.

24-hour round-the-clock care takes by maybe 3 or more nurses/workers for each old person.

The reality is, this & future generations simply cannot afford that expense.

One 'old' person; 3 x 'non-productive' workers, all supported by less than one 'productive' tax+NI payer.

Half-decent Care Homes are charging £100+ per day per resident. How many of the current elderly have savings of £70,000 cash for just two years sustenance? Man + Wife (OK partner + partner for the PC) = £70k each year.

Note that those are statements of fact & reality, not just my subjective opinions.

Crinkly & Ragged Arsed Philosophers said...

The difficulty with this issue, as with many others, is we cannot in this day and age trust the content and intent will not be transmuted into PR spin to the benefit of confetti statistics and economics.

One slip and we are on the path to eugenics and our only safeguard from that is the trust held by our medical professionals.

My personal view is, they can take parts of me away chunk by chunk but if my personality goes I no longer want to be part of the chunk that's left.

subrosa said...

Appreciate your contribution Apogee.

No, we don't want that but it seems as if we have little choice.

I've left instructions that I must be brought home if at all possible, for my last days, and not have them in the hands of anonymous strangers.

subrosa said...

We did Demetrius, only this time it's publicised and still the majority of the public accept it.

subrosa said...

You're too kind Hamish. :)

Yes, I'd prefer someone who knows my feelings to see to my final comforts.

subrosa said...

Excellent comments Joe. I'm not too worried about the financial problems of the NHS. Many of them are of the organisation's own making and finances could be saved to invest in drugs to save those who do have a good chance of a lengthy survival.

Joe, in many hospitals 24 hour care in limited. My mother had 24 hour care at home for a few weeks and it was excellent. It was private though and the nurses involved had all left the NHS because they weren't 'allowed' to give the quality of care they wanted.

Indeed the cost of care in Care Homes is frightening and it won't decrease. It's sad that so many council homes have closed because they did provide a good quality of care, but councils decided new wheelie bins were more important.

subrosa said...

I have lost my innocent trust in medics Crinkly, but I do hope I'm of sound enough mind to recognise when my time comes.

Brian said...

Compare the LCP with the medical and legal professions' opposition to Tony Nicklinson's battle to die when he wanted in the way he chose. The lawyers and medics want to keep their monopoly of killing the rest of us in ways convenient to their morality.
If animals were denied food and water instead of injected with the appropriate drugs to kill them, the person responsible would be rightly prosecuted by the RSPCA yet starving humans is more humane than overdosing them.

subrosa said...

Ah, but Tony Nicklinson. according to doctors, wasn't terminally ill Brian. That's the medics excuse.

Can't agree more about the comparison with animals.

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