Doctors: NHS 'pathway' may be shortcut to death

This is a worst-case scenario come true. The Liverpool Care Pathway guidelines have been recommended by the NICE board and are in widespread use in English hospices, nursing homes, and even private homes. Once a patient is identified as being near death, he may be put on the "pathway." Says Prof. Millard, “If they are sedated it is much harder to see that a patient is getting better.” Hydration and treatments are discontinued. Death ensues.

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

But this approach can also mask the signs that their condition is improving, the experts warn.

As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others.

“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong.[. . .]

The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours. [. . .]

Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor.

They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication.

However, doctors warn that these signs can point to other medical problems.

Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance.

When a decision has been made to place a patient on the pathway doctors are then recommended to consider removing medication or invasive procedures, such as intravenous drips, which are no longer of benefit.

If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention.

Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition.

He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.

He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in.

“It is supposed to let people die with dignity but it can become a self-fulfilling prophecy. [. . .]

[Dr. Hargreaves] said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.

Read it all.

Wesley Smith comments:

Here’s the thing: Every hospice expert I have spoken with say that palliative sedation is rarely necessary to stop suffering. If some 16% of dying patients die under sedation as the story states, something is very wrong.

I am sorry, but this is a direct consequence of the rejection of human exceptionalism and the embrace a quality of life ethic. Indeed, it shows where utilitarianism leads, where in the drive to stop suffering we end up turning on the sufferer. Think about it: How often these days do we hear bioethicists bemoaning the “drawing out of the dying process,” when what we are really discussing is extending life?

Not coincidentally to our discussion of Obamacare, it was pushed by the NICE utilitarian bioethics board–the very kind that the highly influential former Sen. Tom Daschle wants for America–which could arise from the proposed cost/benefit boards in the current health care plans . . .

[. . .]

If these allegations are true, it is a scandal of virtually unprecedented proportions: A detailed investigation should be conducted. And if people were truly sedated and dehydrated to death without consent before their time, heads should, figuratively roll, medical licenses should be revoked, and–if the facts warrant–criminal charges filed.

Comments welcome.

Most recent posts here.