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The LCP's objective is to ensure that a dying person is treated with as much dignity and comfort as possible.
For relatives anxious about a frail loved one in hospital, few things could surely sound more reassuring than a 'care pathway'.
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.
Certainly, it is an important principle of medical ethics that dying should not be artificially prolonged, since this is as pointless as it is degrading and even cruel.
In practice, however, the LCP has turned into something quite different. For while in some cases it has been used properly as intended, with numerous others it has become, instead, a backdoor form of euthanasia.
Precious
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.
And there are claims that it is increasingly being applied without the knowledge of patients' families, and when such patients still have a chance of recovering for a few more precious weeks, months or even years of life.
One report last year found that as many as 2,500 families were not even told that their relatives had been put on the LCP.
In other cases, relatives have suddenly discovered that a 'do not resuscitate' notice has been issued against the wishes of patient and family.
Professor Patrick Pullicino said doctors had turned the use of a controversial 'death pathway' into the equivalent of euthanasia of the elderly
One cancer patient who had suffered a heart attack and been put on the LCP had all his tubes and drips removed, including hydrating fluids, on the false grounds that he was dying.
Once his horrified family realised what was going on and took steps to guard him in order to ensure he was nourished and treated, he recovered and lived for another month.
Earlier this year, Patrick Pullicino, a consultant neurologist and professor of clinical neurosciences at Kent University, told a conference that the LCP had become an 'assisted death pathway' for than 100,000 patients each year.
'Very likely, many elderly patients who could live substantially longer are being killed by the LCP,' he said.
Horrifyingly, the LCP has become a self-fulfilling prophecy. When people are put on it, they are said to be dying. But they may not be dying at all — not, that is, until they are put on the 'pathway', whereupon they really do die as a result.
In other words, they are killed. What's more, they are killed in a most cruel and callous way through starvation or dehydration. And this in a health service that is supposed to be a national byword for compassion!
This really is an obscene abuse of people who expect the NHS to care for them, not kill them.
And how appalling that this has made patients terrified that the hospitals supposedly taking care of them may try instead to kill them — and that their relatives feel they must defend their loved one from the medical staff.
Indeed, in these circumstances it's not just the patients who are vulnerable and open to abuse, but also their families, who may be in a state of shock over their relative's condition and in no fit state to understand just what the doctors or nurses are saying or doing.
Suspicions
So how can this awful situation have been allowed to develop? How can hospitals governed by the ethical imperative to 'first do no harm' be killing patients in their care? How can the NHS have been turned in these circumstances into a National Death Service?
How can hospitals governed by the ethical imperative to first do no harm be killing patients in their care?
The first and most cynical reason — believed by a number of deeply concerned doctors — is that it is being done to save money. There are suspicions, based on much circumstantial evidence, that such patients are being dispatched via the LCP because — simply and crudely — the hospitals need their beds to meet overwhelming demand. This callous disregard for the most needy is of a piece with the all too frequent abuse of patients who are elderly, confused or difficult to manage and who may be treated in hospital with indifference, neglect or even cruelty.
Indeed, the abuse of the LCP is not just about economics. More fundamentally, it has arisen from a profound confusion in society caused by a collapse of moral absolutes and a resulting inability to make the key distinction between dying and killing.
This confusion lies at the heart of the powerful campaign to legalise euthanasia.
It was graphically illustrated by the decision of the Voluntary Euthanasia Society to change its name to Dignity In Dying, which deliberately muddled dying with the taking of life — thus playing on people's fears and sympathies around dying in order to sanitise euthanasia.
It is precisely this corruption of language that has sent us hurtling down this most slippery pathway to killing.
Suffering
The Liverpool Killing Pathway is driven not just by crude economic calculation but by a wider brutalisation of our culture
First, the word 'dying' has been applied to people suffering from terminal illness or who are considered by doctors or other experts to have lives that are not worth living, even when they are not dying at all.
The second stage in this abuse of language has been to re-label actions designed to end the life of someone who is not dying by calling this 'helping them to die'.
Such actions include the withdrawal of food or water. But that is starving or dehydrating someone to death. And that is not helping them to die, but killing them.
Yet that is precisely what has been happening, ever since the courts ruled in 1993 that the feeding tubes could be removed from the Hillsborough stadium disaster victim Tony Bland, who was in a persistent vegetative state, because such artificial nutrition and hydration were deemed to be 'treatment'.
The judges disingenuously claimed then that this was not killing, but allowing Tony Bland to die. But he was not dying.
With his case a fateful legal line was crossed. And so 'dying' has become a euphemism for killing.
The fundamental driver of all this is the belief that certain people are better off dead because their lives are deemed worthless, a drain on the public purse, or both.
The Liverpool Killing Pathway is driven not just by crude economic calculation but by a wider brutalisation of our culture, at the heart of which lies the erosion of respect for the innate value of human life.
And that way lies not just the degradation of the NHS, but a society devoid of humanity itself.
We are all dying from the day we are born. Society needs to start talking about death and not pretending it doesn't exist, stop pretending that medical science can cure everyone because otherwise the dilemma of the LCP will never be resolved. People have to start realising that whilst it may be good for them to have. A relative live a few weeks more its not always good for the patient to endur a few weeks more pain and indignity. Death is not about the relatives it is about the person dying it is about helping them to die in a dignified as pain free way as possible Of course the LCP should not be used to "kill" patients but I don't believe it is, it is that grieving relatives want someone to blame that is a totally natural part of the grieving process but let's not inflict pain and suffering on our dying relatives because it's not going to change the feelings it will just be something else we blame. Death is as natural as living and we need to talk about it
- Just one little cog , North of Watford, 15/10/2012 02:15
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