Sentenced To Death on The NHS

Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors warn today.

By Kate Devlin, Medical Correspondent
Published: 10:00PM BST 02 Sep 2009

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across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.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

“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients.”

The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.

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

Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions.

It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004.

It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system.

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.

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”

He added: “What they are trying to do is stop people being overtreated as they are dying.

“It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.”

He 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.

Prof Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours.

In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.

“If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said.

Katherine Murphy, director of the Patients Association, said: “Even the tiniest things that happen towards the end of a patient’s life can have a huge and lasting affect on patients and their families feelings about their care.

“Guidelines like the LCP can be very helpful but healthcare professionals always need to keep in mind the individual needs of patients.

“There is no one size fits all approach.”

A spokesman for Marie Curie said: “The letter highlights some complex issues related to care of the dying.

“The Liverpool Care Pathway for the Dying Patient was developed in response to a societal need to transfer best practice of care of the dying from the hospice to other care settings.

“The LCP is not the answer to all the complex elements of this area of health care but we believe it is a step in the right direction.”

The pathway also includes advice on the spiritual care of the patient and their family both before and after the death.

It has also been used in 800 instances outside care homes, hospices and hospitals, including for people who have died in their own homes.

The letter has also been signed by Dr Anthony Cole, the chairman of the Medical Ethics Alliance, Dr David Hill, an anaesthetist, Dowager Lady Salisbury, chairman of the Choose Life campaign and Dr Elizabeth Negus a lecturer in English at Barking University.

A spokesman for the Department of Health said: “People coming to the end of their lives should have a right to high quality, compassionate and dignified care.

“The Liverpool Care Pathway (LCP) is an established and recommended tool that provides clinicians with an evidence-based framework to help delivery of high quality care for people at the end of their lives.

“Many people receive excellent care at the end of their lives. We are investing £286 million over the two years to 2011 to support implementation of the End of Life Care Strategy to help improve end of life care for all adults, regardless of where they live.”

Click here for direct link to source article.

Commence the posts about how this is all lies from a far-right, radical, bomb-throwing newspaper, doesn’t really happen anyway and even if it does, NHS is way better than the US system, so there!  (Insert rasberry sound here.)  Keep in mind, dear reader, that when its Anthropogenic Global Warming, we have to believe leading scientists.  I wonder if these leading scientists/doctors will be afforded the same reverence?  As the Brits themselves would put it:  “Not bloody likely.”

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Tags: Cancer Centre, Cancer Charity, Cancer Patients, Care Experts, Close To Death, Daily Telegraph, Emeritus Professor, Health Care, Health Care Agenda, Health Care Debate, Health Care Plan, , Health Care System, Health Plan, Health Reform, Healthcare Reform, Inexact Science, Letter States, Liverpool Care Pathway, Marie Curie, Medical Correspondent, National Institute For Health, National Wave, Nhs Patients, , Palliative Medicine, Patients Association, Peter Millard, Single Payer System, Staff Deal, Terminal Illnesses, Universal Health Care

3 Responses to “Sentenced To Death on The NHS”

  1. Bruce Johnson
    September 8, 2009 at 11:06 am #

    The article is interesting, but the purported application to the American health care debate seems a logical non sequitur. The point is that several prominent British doctors (involved with that country’s health care system) are concerned that a particular course of treatment for dying patients may be hastening their deaths and should be changed. Given the credentials of the doctors and the points they make, I think they are probably right. But there is no suggestion anywhere that there is a cause and effect relationship between British public funding or management of health care and the use of this course of treatment. It seems no more or less likely that publicly funded or managed health care would lead to following such procedures than privately funded ones – if the contributor of this piece on-line is suggesting that perhaps there is an ulterior motive in hastening deaths so as to reduce costs, if there are people malevolent enough to do such a thing intentionally, it’s not clear why they’d be more or less likely to be found in public health departments or private insurance companies. In any event, I suppose if one wanted to be cynical, one could suggest that Americans without health insurance won’t have to worry about their deaths being hastened, they will simply die without medical treatment. While I think that it certainly makes sense to fine tune health reform to make it as good as we can, I wish people would stop carping so much about the details and try to get something passed so all our people can be covered, and any conservative, competent or otherwise, shoudl support that, as health care is a prime component of the social stability that conservatism promotes. Let’s not forget that public health care – and social welfare – were invented in Germany in the Nineteenth Century by Otto von Bismarck, and I don’t think anyone’s ever questioned Bismarck’s conservative credentials.

  2. September 8, 2009 at 12:25 pm #

    Bruce, Mitt Romney was able to create a better health care plan in MA that didn’t constitute a government take over. Granted, unlike Otto Von Bismarck, his conservative credential have been, unfortunately by some, brought into question.

    The concern is not “health care reform” but rather “health care stuffing” wherein a plan far less than it could ,or should be, is being crammed down the throats of the American people without any real effort to “reform” the seriously flawed bill. Not even the President really understands everything within that bill. He would have had to read the entire 1000 pages of it.

    We have cause to be alarmed. The man from Massachusetts who is, so far, the only one capable enough to have crafted a successful plan that got nearly every one of their residents insured, has my vote come 2012. In one sentence Obama said that debate is good cause it will help us get it right(a purely political statement) but the time to act is now. How can there be time for debate and sorting out what is in the 1000 page bill if “the time to act is now”?

    It would naturally cause Americans to ask, suspiciously, “why are they trying so hard to get this bill through so fast”? Furthermore, why, when the economy is the crisis issue, are we so hell bent on ramming this health bill through? Would this behavior not be cause for the people being suspect about the the bill’s advocates?

  3. Mark Dixon
    September 8, 2009 at 12:43 pm #

    From the article: “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.”…”It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004.”

    In other words this course of treatment was prescribed by NHS. NICE is the UK’s medical care rationing board; they decide what is “cost effective” and what is not. The NHS follows their recommendations. The Left in the US wants our government to run our healthcare like they do in the UK, France and elsewhere. So, is it not logical to ask if government care in the UK has these kinds of lapses in judgment why would we expect any better here in the US?

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