The UK uses what is called a “Liverpool Care Pathway“, also called the “death pathway“. It is intended for patients on a path toward euthanasia, which is imposed death without patient knowledge or consent. They are placed on the path by medical staff because of the nature of their illness or hospital forms they or caregivers signed in the course of their illness that authorize DNR and the withholding of extraordinary means (which may now include food and water, CPR, antibiotics, or other life-giving interventions).
Originally, the LCP was designed only for patients who had days or hours to live, and to ensure that they received the proper care, even in busy hospitals, until the time of death. Though well intentioned, it seems to have become misused. Doctors and medical professionals report that the criteria for patient referrals to the LCP has changed, and:
– people are being placed on it who have longer to live or
– who are not dying at all (such as patients coming out of a stroke).
The concern is that hospitals/doctors are using this to hasten death in massive numbers, for what is believed to be economic reasons. The first report below, April 2013, mentions approximately 130,000 cases per year of hastened deaths. This is not good policy for one person, and certainly not for 130,000. As a result, independent investigations or probes were commissioned to determine the use or misuse of the LCP.
There are concerns that the United States could similarly migrate to use of this kind of poor policy — that healthcare ‘rationed treatments‘, palliative care, and physician assisted suicide in Oregon and Washington can combine with economic pressures and shortages in healthcare professionals to influence misuse and gradual changes in policy over time by medical practices or law to hasten deaths.
Probes into the Liverpool Care Pathway (LCP) / Death Pathway:
“Norman Lamb, the Care minister, announced an independent review of the measure in November after an audit showed a significant minority of patients and their families were unaware they were being put on the pathway.”
“An estimated 350,000 patients with chronic illnesses need palliative care each year but fewer than half (170,000) receive it, of whom 130,000 are placed on the pathway“*
For the UK: Over eight years, that means approximately
1.4 million patients go without palliative care pain management and
over 1.2 million experience hastened deaths (through no food and
water or other means) with a population of 63,182 million in 2011.
For the US: If the US were to replicate the UK’s Euthanasia patterns,
the approximate numbers with a US population in 2012 of 313,914,040,
over eight years, using UK rates and rounding off, gives 1.4 million patients
x 5 = 7.0 million would go without palliative pain management and 1.2 million
x 5 = 6.0 million would experience hastened death (through no food and
water or other means)
How many people did Hitler kill?
These numbers are before the UK and other countries expand
Euthanasia to new population segments, such as the 18 year olds
and under, the mentally ill, and those with depression, dementia or
patient’s who lack psychosocial skills (such as a lack of social skills,
financial resources, and social network).
Is this a band wagon we want to get on? Plan to give these numbers to
your friends, co-workers, and legislators.
“The audit last year by the Royal College of Physicians and Marie Curie Palliative Care Institute in Liverpool of 178 hospitals found 44 per cent of patients who were conscious and a third of families were not consulted before the decision was taken.”
“Families have come forward saying they were not consulted when their loved ones were placed on the pathway, which aims to provide comfort during the final days and hours by avoiding unnecessary medical procedures.”
“They have warned that dying patients have been denied food and drink and placed on the pathway when they were not dying. Leading doctors have also warned that the pathway is being used to ‘hasten death’ and is based on ‘guesswork‘.”
“Now the NHS will lead a series of projects to talk to family members of those who have died on the pathway, looking into complaints and talk to clinicians delivering the care.”
“It sounds like a well-worked-out schedule for providing the best possible approach to treating a patient.”
Accordingly, when relatives have been asked to sign up to the Liverpool Care Pathway (LCP), that’s precisely what they thought they were agreeing to.
“And, in theory, that’s what it is supposed to be. Devised by the Marie Curie Palliative Care Institute in the Nineties and adopted nationwide in 2010, its aims are laudable and appropriate.”
“For its objective is to ensure that a dying person is treated in his or her last days with as much dignity and comfort as possible. Accordingly, it rules out potentially ‘distressing’ interventions aimed at prolonging the dying process. ” [Note: By 2012, ‘distressing’ interventions had come to include withholding food and water.]
“One of its ten ‘key messages’ is that it ‘neither hastens nor postpones death’. But, on the contrary, many examples have emerged where it has, indeed, been used to hasten death. Terminally ill patients have been heavily sedated and deprived of essential nutrients and fluids in order to make them die more quickly.”
UK – Several Case studies
New expanded criteria for euthanasia
Criteria to justify euthanasia of patients (imposed death) in Netherlands has been expanded, as reported by the Royal Dutch Medical Association, to now include:
A UTRECHT, Netherlands, October 24, 2011 (LifeSiteNews.com) editorial reads: The Royal Dutch Medical Association (KNMG) has released new guidelines for interpreting the 2002 Euthanasia Act that now includes “mental and psychosocial ailments” such as “loss of function, loneliness and loss of autonomy” as acceptable criteria for euthanasia.
The guidelines also allow doctors to connect a patient’s lack of “social skills, financial resources and a social network” to “unbearable and lasting suffering,” opening the door to legal assisted death based on “psychosocial” factors, not terminal illness…. In a June 2011 position paper, titled “The Role of the Physician in the Voluntary Termination of Life” it was concluded that the “concept of suffering” is “broader” than its “interpretation and application by many physicians today.”
“In the view of the Royal Dutch Medical Association (KNMG) such cases are sufficiently linked to the medical domain to permit a physician to act within the confines of the Euthanasia Law.” … Alex Schadenberg, Executive Director and International Chair of the Euthanasia Prevention Coalition committee responded to the new guidelines, saying that in his view “the expansion of euthanasia and assisted suicide has been constant and deliberate.”
Again, there is concern that in the United States, rationed treatments, palliative care, and physician assisted suicide in Oregon and Washington can become changed by medical practices or law to accomplish the same thing — hastened death — by limiting treatments for patients with these conditions.
Overview – Euthanasia in the Netherlands
For a Good Overview of Euthanasia in the Netherlands, see:
Belgium Looks to Expand Euthanasia to Minors.
Belgium became the second country in the world to legalize euthanasia after the Netherlands, but the law has only applied to those individuals who are 18 or over.
In 2011, Belgium’s chairman of the Federal Committee on Euthanasia, Wim Distelmans, sent an open letter to Prime Minister Elio Di Rupo last month “asking him to re-open a national debate on euthanasia” and update the parameters that qualify a person to be euthanized. Belgium’s most aggressive pro-euthanasia advocacy group, Humanistisch-Vrijzinnige Vereniging (Humanist-Liberal Association), wants the 2002 law further liberalized to allow euthanasia to include persons with dementia and minors (under 18). A recent poll revealed that two-thirds of Belgians approve euthanasia for minors.
[Note: Promoters of hastened death often initiate polls to influence legislators]
The letter to the prime minister calls for the following:
1). At the moment, advance directives are only valid for five years. This limit should be removed.
2). Doctors who oppose euthanasia should be required to refer patients to a willing colleague.
3). Assisted suicide should be permitted.
4). It should be permitted to euthanase people with dementia who have written a living will.
5).There should be no age limit for euthanasia.
In the below article, Wesley J, Smith, an attorney who is an expert on end-of-life issues, commented on the news.
“Belgium has jumped head-first off a vertical moral cliff with its euthanasia law. As I have documented here and elsewhere, the Belgians have permitted joint euthanasia deaths of an elderly couple and now couple organ harvesting with the euthanasia killings of people with disabilities and even, mental illness,” he said. “Now, the country looks poised to expand the category of killables to minors and Alzheimer’s patients.”
Smith continued: “Is anyone surprised? Once a culture accepts killing as an acceptable answer to human suffering, the culture of death is never satiated. It is never enough.” See: http://www.lifenews.com/2012/12/19/belgium-looks-to-expand-euthanasia-to-minors-even-after-abuses/ http://www.lifenews.com/2012/12/19/belgium-looks-to-expand-euthanasia-to-minors-even-after-abuses/
In the below article, Attorney Wesley J. Smith discusses why he believes euthanasia has been spreading widely in Europe.
He suggests that once people begin to perceive being dead as better than dying, it opens the door to more ways to hasten death including assisted suicide, euthanasia and misuses of palliative care.
When Killing Yourself Isn’t Suicide http://www.nationalreview.com/articles/220141/when-killing-yourself-isnt-suicide/rita-l-marker
Nurse Refused to Give CPR
to Elderly Woman Who Later Died http://latimesblogs.latimes.com/lanow/2013/03/nurse-refuses-to-give-cpr-to-elderly-woman-who-later-died.html
Case study – Of Euthanasia in the United States
of Dr. James E. Mungas, a Respected Surgeon in Great Falls
Against His Will and Struggles
My husband, Dr. James E. Mungas, was a respected physician and surgeon here in Great Falls. He developed amyotrophic lateral sclerosis, and I took care of him. His mind was clear and thought processes unimpaired. He was against assisted suicide and euthanasia.
I needed to travel out of town for a day and a half. We agreed he would stay at a local care facility in my absence. Once there, nurses began administering morphine. After the first dose, my husband knew that he had been overdosed and typed out a message to call respiratory therapy. None came that day. Over the next few days, he struggled to breathe and desperately struggled to remain conscious to communicate, but the nurses kept pushing the morphine button and advised our children to do the same. My children and I did not understand the extent morphine would repress the respiratory system until later. This was neither palliative care nor managing pain; this was hastening death. He was effectively euthanized against his will. He did not get his choice. It is traumatic, still, to realize his last communications were attempts to get help.
As illustrated by my husband’s case, doctors and nurses already misuse or abuse the power they have. The stakes are too high to consider expanding their power by legalizing assisted-suicide. The recent guest column by Dr. Stephen Speckart and other doctors claims that assisted suicide is already legal. For that reason, I support House Bill 505, which clearly states that assisted suicide is not legal.
Carol Mungas, Great Falls Montana – See the article at: http://www.greatfallstribune.com/article/20130313/OPINION/303130037/On-our-minds-Fires-suicide-bill-breweries-plus-today-s-editorial-cartoons
Last Moment Robot http://www.patientsrightscouncil.org/site/last-moment-robot-end-of-life-detected/
Forced DNR Coming to Texas? http://www.nationalreview.com/human-exceptionalism/340364/forced-dnr-coming-texas
Some Quebec Doctors Resisting Drive for Euthanasia http://www.bioedge.org/index.php/bioethics/bioethics_article/10402
Video/Article: United State Catholic Conference of Bishops —
Suicide is Always a Tragedy.
In summary, the version of palliative care as specified by the AMA is recommended as a strong alternative to physician assisted suicide. However, care must be taken to avoid any of the variations that permit the hastening of death or euthanasia.
The “Report of the Council in Ethical and Judicial Affairs” on “Sedation to Unconsciousness in End-of-Life Care” 2008, by the AMA clearly defines palliative care through all stages of a patient’s disease with a great deal more information on pain management at the very end of life, in the last days and hours, through sedation to unconsciousness — yet with the patient’s choice every step of the way. In other words, patients may opt not to have pain medication increased to handle increased pain. The patient is in control. A doctor who respects life and the patient will inform the patient when the level of medication is approaching higher thresholds of tiredness or nearing unconsciousness. There is no “imposed death” with the right form of palliative care and the right doctors and staff.
Legislators: This definition of palliative care can be used as a baseline in the evaluating variations of palliative care, policy making and in constructing bills. See it at: http://www.ama-assn.org/resources/doc/code-medical-ethics/2201a.pdf
Palliative Care and the Elderly, Functional
Summary – Feb 22, 2009
The below articles seek to provide information to enhance palliative care in accordance with the vision of the AMA and “Report of the Council in Ethical and Judicial Affairs” (not the Hemlock Society which promotes various forms of hastened death including physician assisted suicide and a form of palliative care which enables hastening death and imposed death/euthanasia.)
“The TLC Model of Palliative Care in the Elderly:
in the Assisted Living Setting” http://www.annfammed.org/content/2/1/54.abstract
Annals of Family Medicine
We can definitely generalize this to most situations where the elderly would benefit from palliative care. Basically, the
5 barriers to palliative care for them are:
* the perception that palliative care is only terminal care.
* palliative care is defined as mutually exclusive of cure directed treatment.
* the decision if palliative care should be the sole form of care is not ” … negotiated among patients, family members, and providers … “
* making treatment choices is given more importance than discussing the reality of life with a chronic debilitating illness
* palliative care is treated as an either/or decision instead of an integrated part of the treatment plan.
In a nutshell, palliative care is appropriate and possible regardless of which disease process a person has, what the prognosis is or what cure directed treatment choices a person makes. Palliative care should be interwoven concurrently with cure directed treatment. It can either be used with treatment intended to cure or as the sole form of treatment. Palliative care (regardless of other treatment plans being used) optimizes quality of life and when your energies are not spent coping with pain, nausea, breathlessness, fatigue and the immobility (among other things) resulting from this, there is more energy to cope with the manifestations of the disease.
When a person is comfortable, they eat more, sleep better, not as fatigued, not as depressed and at least have the possibility of enjoying their day.