The "Liverpool Care Pathway," Hospice and Palliative Care Abuse

The "Liverpool Care Pathway" (LCP)  is a system of hospice/palliative care in the UK.  In the last few years, the system has come under fire as "stealth euthanasia" in which patients are put on the LCP "without consent" and without "being allowed, food, fluids and medication."  See the BBC article set forth below: “Liverpool Care Pathway: Your experiences.”

I periodically receive similar complaints from people in the US and Canada.  Consider, for example, this letter by an elder care facility owner in Washington State where assisted suicide is legal:

"Since the [assisted suicide] act passed, we have . . . noticed that some members of the medical profession are quick to bring out the morphine to begin comfort care without considering treatment.  Sometimes they do this on their own without telling the client and/or the family member in charge of the client's care." 

http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html

Consider also, this letter published in a Montana newspaper:

“If these terrible deaths happen when aid in dying (assisted suicide and euthanasia) is not legal, what will happen if these practices are made legal? Doctors will have even more power to take away patient choice."

http://www.montanansagainstassistedsuicide.org/2013/04/dont-give-doctors-more-power-to-abuse.html

Margaret Dore, Attorney at Law
President, Choice is an Illusion, a nonprofit corporation

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"Liverpool Care Pathway: Your Experiences"

http://www.bbc.co.uk/news/health-23301360

The LCP was developed to support dying patients

 

The Liverpool Care Pathway (LCP) should be phased out, an independent review is expected to say.

The system was designed to allow terminally-ill patients to die peacefully and with dignity.

However, the LCP has come under criticism with some believe it is being used to speed up the process of dying. There have been some reports of patients being put on it without consent and not being allowed, food, fluids and medication.

Here, [three] family members of those who have been on the Liverpool Care Pathway, share their experiences of the programme. [There are two unfavorable views and one favorable view of the LCP]

Kayleigh Hollobone

Two years ago, when I was 22, I lost my 56-year-old mother to cancer.

During the six months from her diagnosis in January 2012 until her death, she was unknowingly to us put on the LCP. She was deprived of fluids and any source of nutritional supplement without even the slightest consent or conversation with me or my family.

It was only after my absolute insistence and persistence that my mother received fluids and that was after over 36 hours without any.

It scares me that people who do not have bossy and demanding families, like me and mine, to fight for them will be left or even encouraged to die via the LCP.

My mother survived another three months. We got to hear her laugh and joke again and importantly my mother got to say her goodbyes. Had the enforced LCP been allowed to continue, those few important months of time with my mother would have without a doubt been taken away from me and my family.


I can't stress how important me and my family feel about the process of the LCP. It needs to be readdressed - the memories it could have deprived me of are invaluable. She wrote me a letter that I will have forever and it will always be the most treasured item I possess.

Helen Redshaw

"The Liverpool Care Pathway aided her in a gentle and thoughtful way”

My mother passed away from cancer just three months ago. The Liverpool Care Pathway was used and I have nothing but praise for it. We had help from night nurses through the NHS Beacon program, Marie Curie and Macmillan, all of which gave exemplary care. Leaflets on the LCP were given to us and time was taken by all to fully explain why and how it would work. 

Towards the end, my mother couldn't swallow and didn't want food - this was her body getting ready to die. It was slow and peaceful, and she was my mother until about the day before when we all knew she was leaving.

There was no prolonging of life. She was ready to go and the Liverpool Care Pathway aided her in a gentle and thoughtful way. It wasn't the refusal to give her food and drink; she no longer wanted it.

She had as natural an early death as can be and I am thankful as it helped me and my family cope as we saw her slip away. This is something that should be offered and explained to patients and family and I have nothing but support for it.

William Hughes

My father Professor Robert Hughes was subjected to this technique without my or his consent. When it became clear that his cancer of the prostrate became untreatable I was asked what I wanted to do and I told them clearly that I wanted him to die with dignity.

I was assured by the staff at the hospital that would happen, that he would have died a dignified death. He didn't. He was sedated, unconscious and died within three days looking like something from Belsen concentration camp.

He was not given water or food but instead put on a driver syringe containing diamorphine, midazolam and cyclizine. The first two of those drugs would down a horse. . .

Sadly there is no going back. I didn't know that once started, it's irreversible.

No one makes this clear. This is the main part, if not for some the final part, of the LCP.

In the new scheme when that comes out, if they allow these two drugs to be continued to be used, it is euthanasia, plain and simple.

UK govt agrees to investigate "death pathway"

Article below regarding abuse of the Liverpool Pathway, from Michael Cook of Bio Edge.

A problem also in the US and Canada.  See, for example, Kate Kelly's article about her mother and "VSED" by clicking here

With some doctors abusing the power they already have with the Liverpool Pathway, etc., why would you give them more power to effect patient death, i.e., by legalizing assisted suicide and/or euthanasia?

The problem will only get worse.

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http://www.bioedge.org/index.php/bioethics/bioethics_article/10293
by Michael Cook | Oct 27, 2012 |

Pressure from the British media has forced an investigation into the controversial Liverpool Care Pathway by National Health Service and the Association of Palliative Medicine.

The medical establishment appears very reluctant to question the LCP. Only a few days ago 22 organisations signed a consensus statement supporting it. It quoted the Parliamentary Under Secretary of State for Health, Earl Howe:

"The Liverpool Care Pathway has sometimes been accused of being a way of withholding treatment, including hydration and nutrition. That is not the case. It is used to prevent dying patients from having the distress of receiving treatment or tests that are not beneficial and that may in fact cause harm rather than good."

But the campaign by the Daily Mail and the Telegraph has been relentless. "When well over 100,000 are dying on the LCP each year, the suspicion inevitably arises that the pathway is being used to hasten death and free up beds," said the Daily Mail in an editorial.

Neurologist Patrick Pullicino contends that the LCP has made euthanasia a "standard way of dying on the NHS". He and his supporters were scathing about the consensus statement: 

"It is self-evident that stopping fluids whilst giving narcotics and sedatives hastens death... The median time to death on the Liverpool Care Pathway is now 29 hours. Statistics show that even patients with terminal cancer and a poor prognosis may survive months or more if not put on the LCP."

The investigation coordinated by the NHS will examine poor experiences under the LCP, which everyone acknowledges do happen. The NHS will talk to family members of people who have died on the pathway, investigate complaints and speak with clinicians. "Poor experiences must be explored, acknowledged and learnt from," says Professor Mayur Lakhani, Chair of the Dying Matters Coalition.

Will the investigation result in a thorough revision of the LCP? Even though the medical establishment admits that there are problems, it may not admit that they are due to the basic framework. The Consultant Nurses in Palliative Care Reference Group is already interpreting criticisms as dangerous and offensive. "Counter-productive comments", it says, are "deeply offensive to public servants who abide by clear codes of conduct and the law".

What about the seriously ill or disabled people who want to live?

http://doughtyblog.dailymail.co.uk/2012/10/what-about-the-seriously-ill-or-disabled-people-who-want-to-live.html

The "Liverpool Pathway":  "It comes down to this: there are a lot of people who believe that, rather than trying to help their loved ones, hospitals have been keen to kill them off."

What about the seriously ill or disabled people who want to live?

By Stephen Doughty, 12 October 2012 6:56 PM

We have heard an awful lot about the suffering of people who bear terrible afflictions or disabilities and who wish to die. We have heard very little about the desperately sick who want to live, and the families who stand by them in hope.

It is looking like we have got this the wrong way round.

The highly organised campaign for assisted dying has brought together pressure groups, think tanks, celebrities like Sir Terry Pratchett, and some fairly prominent politicians, notably in recent years Tony Blair’s Lord Chancellor and one-time flatmate, Lord Falconer.

It has been based around a brilliantly conceived series of legal cases in which the judiciary have been presented with deeply affecting hard cases. Each one has asked for a modest legal concession, usually involving human rights and the 1961 law that makes helping with a suicide a serious crime.

The individuals who have brought these cases are sometimes merely sympathetic and at others pitiable, as in the recent instance of Tony Nicklinson, the 58-year-old victim of 'locked-in syndrome' who lost his call for help from his doctor to die in the High Court in August. Mr Nicklinson died a few days after his legal defeat.

Occasionally the legal campaigns have scored successes. The most notable was that of multiple sclerosis sufferer Debbie Purdy, who persuaded the Law Lords that the Director of Public Prosecutions should provide guidance on whether her husband might face prosecution for assisted suicide, were he to help her travel to the Dignitas clinic in Zurich to die.

As a result of the Purdy case, DPP Keir Starmer QC introduced rules on assisted dying prosecutions that mean no-one is likely to be prosecuted, with the risk of a 14-year-jail term, if they help in the death of someone who is a suffering relative or friend, and if they act out of compassion rather than malice or greed.

However you paint it, this is a major change in the law as set down by Parliament, a law which takes no account of the motives of the individual aiding and abetting the suicide.

Indeed, Mr Starmer has brought no prosecutions against anybody from the trail of stricken families who have helped members travel to Switzerland to die.

What is interesting is that, despite all the campaigning, all the high-profile court cases, all the BBC interviews, all the endless hand-wringing about the cruelty of keeping those who are suffering alive against their will, few people seem to want to take advantage of the new right to die.

We do not have very recent figures, but I would guess that no more than 200 British people have died at Dignitas since the clinic became well-known here in 2003.

It is a number small enough to raise the question of how big, really, is the demand for assisted dying?

The campaign for assisted dying has certainly been effective in influencing care of the incapacitated in the Health Service.

It was surely a factor in the successful passage of the Mental Capacity Act, pushed through by Lord Falconer in the teeth of a rebellion by backbench Labour MPs, which gave legal status to living wills. These mean people can leave orders for their doctors to kill them by withdrawing nourishment and fluid by tube if they become too sick to speak for themselves.

The assisted dying campaign formed the background to the introduction of the Liverpool Care Pathway into hospitals across the country. This, for those who have not noticed, is the system by which medical staff withdraw treatment from those judged to be close to death, in the cause of easing their passing. It often involves heavy sedation and the removal of nourishment and fluid tubes.

I do not wish to try to step into the shoes of those medical professionals and care workers who deal every day with people at the extreme end of life and in the depths of the worst illnesses. I have no qualifications or knowledge to second guess their decisions, and no intention of criticising those who work with great professionalism and compassion in jobs that are far beyond my capability.

But all the indications suggest there are many families who are unhappy with the way in which their relatives have died in hospitals, and that they are increasingly willing to complain about it.

Many of these people may be speaking out of misdirected grief. As one well-informed MP put it to me this week, very few expect a loved one who goes into hospital to die, but people do have the habit of dying. Some of those complaining may be troublemakers, some inspired by political or religious agendas.

Nevertheless there seem to be a lot of them. And they are not celebrities or legal grandees or Westminster faces. They are little people, people like you and me, not the kind you usually hear on the radio or see on the TV.

The courageous Professor Patrick Pullicino, the hospital consultant who defied the NHS consensus to speak out against the Liverpool Care Pathway this summer, reckoned it is used in around 130,000 deaths each year. That is a number that dwarfs the assisted dying lobby.

I think we are going to hear a lot more about the Liverpool Care Pathway, and I think the medical professions, the Department of Health, and a number of politicians are going to have to put some time into considering what has been happening.

It comes down to this: there are a lot of people who believe that, rather than trying to help their loved ones, hospitals have been keen to kill them off.

They believe that, while the assisted dying lobby has been parading in the courts and publicising itself on the BBC, assisted dying has quietly become a reality in our hospitals.

Kate Kelly on the "Liverpool Pathway"

If you think the "Liverpool Pathway" is painless, gentle, and/or dignified, think again. My mother had a mild stroke in a Canadian care facility. The relative with power of attorney, along with a doctor who had never seen my mother before, decided she would have morphine only, although she was conscious, trying to speak, and indicating she wanted water. She moaned for days, had blisters inside her mouth, had to be given suppositories to prevent convulsions, and clamped her lips on a dampened cloth, which provided only the illusion of moisture. After 6 days without food or water, she finally died.

 
We already have abuse of authority by some doctors. Assisted suicide will give them even more power. The push for suicide as a "cure" indicates a society gone mad.


To read my mother's story, see http://www.choiceillusion.org/p/vsed.html