U.K. ‘Death Pathway’
Allegations of Illegal Euthanasia Taint British Public-Health System
BY Celeste McGovern
September 23-October 6, 2012 Issue | Posted 9/17/12 at 5:05 PM
Thousands of elderly and ill patients are being drugged and dehydrated to death in the United Kingdom, dying prematurely on a public health-care "pathway" supposed to alleviate end-of-life suffering, British physicians have alleged.
Dr. Patrick Pullicino, a senior neurologist at East Kent Hospitals, said that the Liverpool Care Pathway, a program "developed to provide a comfortable death to those in their last hours and days is a pathway that hastens death."
And it is being used on some who are not in danger of imminent death.
The Liverpool Care Pathway was introduced in a Marie Curie hospice for the dying in Liverpool to lessen the "overmedicalization" of dying patients, allowing doctors to withhold food, water and medicine, while heavily sedating patients with opiate drugs.
The government’s health-scrutiny organization, the National Institute for Clinical Health and Excellence (NICE), adopted it as a model in 2004 — and now it is used in hundreds of hospitals, hospices and care homes throughout the U.K.
It is implemented in about a third of all British deaths — 130,000 — annually.
"Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick or dying persons," the Catechism of the Catholic Church states. "It is morally unacceptable. Thus an act or omission which, of itself or by intention, causes the death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his creator."
It goes on to say, "The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded. Discontinuing medical procedures that are burdensome, dangerous, extraordinary or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘overzealous’ treatment. Here, one does not will to cause death; one’s inability to impede it is merely accepted" (2277-2278).
One of the biggest problems with the Liverpool Care Pathway, said Pullicino, is the subjectivity of identifying dying patients: "Prediction of death is not a science. Even the best have a 50% serious error rate."
In June, Pullicino addressed the Royal Society of Medicine on the issue and related a personal example. One of his patients, a 71-year-old with epilepsy and pneumonia, was put on the Liverpool Care Pathway by a covering doctor on a weekend shift.
When Pullicino returned to work on Monday, "I removed the patient from the LCP, despite significant resistance," he said. "His seizures came under control, and, four weeks later, he was discharged home to his family."
The patient lived another 14 months before he contracted pneumonia again and died within five hours of being put on the LCP a second time.
Many accounts of apparent abuses of the Liverpool Care Pathway are easy to find on the Internet.
"My dad died with horrible cracked lips and a tongue like cracked leather. There is nothing caring about it," wrote Dagmar Spencer on a petition site to have the Liverpool Care Pathway withdrawn from the National Health Service.
"This is a picture of me and my lovely mum, murdered by the NHS," wrote another blogger. "Her life was taken without her permission."
"My nan was still able to eat and drink small amounts — until a syringe driver was placed in her arm," wrote another woman. "Her eyes popped open, and she was unable to close them — they were so badly bloodshot."
Told not to give her anything to drink, the woman was eventually allowed to give her mother a sponge stick dipped in medicated water.
"Her mouth had been open for three days; her jaw was really low; she clamped down on the sponge stick. We were horrified. It is a very cruel, agonizing way to die. My nan was not terminally ill."
Physicians endorsed Pullicino’s statements about the Liverpool Care Pathway as well. In July, The Telegraph of London published a letter signed by six doctors that says: "He is not wrong to say that there is no scientific way of diagnosing imminent death. It is essentially a prediction. Other considerations may come into reaching such a decision, not excluding the availability of hospital resources."
The doctors added: "The combination of morphine and dehydration is known to be lethal, and four-hourly reassessment is pointless if the patient is in a drug-induced coma. No one should be deprived of consciousness except for the gravest reason, and drug regimes should follow the accepted norms, as laid down in national formularies."
The Department of Health replied to the allegations, stating: "The Liverpool Care Pathway is not euthanasia, and we do not recognize these figures. The pathway is recommended by NICE and has overwhelming support from clinicians — at home and abroad — including the Royal College of Physicians."
"I have no doubt that there are some patients who are not imminently dying who are being placed on the LCP inappropriately," remarked Dr. Peter Saunders, head of the Christian Medical Fellowship and director of the anti-euthanasia group Care Not Killing. "However, this is not the fault with the pathway itself, but, rather, relates to its inappropriate use. The overwhelming majority of people on the LCP are experiencing much better care at the end of life than they would have had if it had not been used."
However, a good death is a subjective thing. "Dignity in dying is being equated with dying in your sleep or with heavily clouded consciousness," said Pullicino, a Catholic. "But real dignity in death is being able to put your soul right."
"Since the Lord wanted to undergo death in full knowledge, the Christian desires to imitate him in that," wrote Pope Pius XII in his 1957 "Allocution to Doctors on the Moral Problems of Analgesia."
"The Church asks that the dying should not be deprived of consciousness" if possible, so that they can make peace with God, say a last prayer and last words to loved ones, etc. "To frustrate them is an act repugnant to Christian sentiments. It is even simply inhuman. The anesthesia employed at the moment of death with a sole aim of avoiding from the patient a conscious death would be a remarkable acquisition of therapeutic modern medicine, but a really deplorable practice."
However, he added: "But if the dying has done all his duties and received the last sacraments, if clear medical indications suggest anesthesia, if one does not exceed in the quantity of the dose, if one carefully measures the intensity and the duration and that the patient consents to it, nothing then is opposed to it: The anesthesia is morally allowed."
Pope John Paul II helped shed light on the spirit that is necessary for making such medical end-of-life decisions. "The respect that we owe the elderly compels me once again to raise my voice against all those practices of shortening life known as euthanasia," he said in a 1998 address on care of the elderly.
"In the presence of a secularized mentality that does not respect life, especially when it is weak, we must emphasize that it is a gift of God which we are all obliged to protect. This duty particularly concerns health-care workers, whose specific mission is to become ministers of life in all its stages, especially in those marked by weakness and illness."
"The temptation ... of euthanasia," he added, "appears as one of the more alarming symptoms of the ‘culture of death’ which is advancing above all in prosperous societies."
This is the second time doctors have complained publicly about the Liverpool Care Pathway. In 2009, national headlines referred to problems with the "death pathway."
In the United Kingdom, some patients are now carrying cards expressing their wish to opt out of the Liverpool Care Pathway.
When asked about what he thinks of those who see the same scenario emerging in an American publicized health system, Pullicino, who has worked in an American hospital, said, "I agree 100%. In the current climate, where governments don’t have any ethical compass, in combination with an aging population and a diminishing budget, this is the first thing that will happen. It’s just asking for this to be introduced."
writes from Scotland.
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