Terminal Ill are being Made To Die Prematurely Under Brit NHS Scheme

[Just Win]

Terminal Ill are being Made To Die Prematurely Under Brit NHS Scheme

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across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.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

[Sasquatch]

Would this be considered a "death panel"? 

[Just Win]

Would this be considered a "death panel"?  

a rose by any ohte name...




Obama Administration Socialized Medicine Czar Zeke Emanuel

[Dementia_Madness]

To be fair I think Zeke has gotten a bad rap. I do not think he is "pro-euthanasia" as it is claimed, I could be wrong about this however.

Do I believe that socialized medicine leads to euthanasia, no doubt. Even a republican supposed pro-life republican government leads to euthanasia...look at legalized abortion, brought to us and maintained by republicans.

[Just Win]

To be fair I think Zeke has gotten a bad rap. I do not think he is "pro-euthanasia" as it is claimed, I could be wrong about this however.

Do I believe that socialized medicine leads to euthanasia, no doubt. Even a republican supposed pro-life republican government leads to euthanasia...look at legalized abortion, brought to us and maintained by republicans.

I disagree wih you on this one DM. I have followed his wriings and some of the work he has done at NIH and I think he is for rationing health care to the elderly and infirm (bo the cognitively and physically). His style of  rationing health care in effect leads to a "forced euthanasia for those who are the most in a position of weakness." I know many do not like to hear such analysis but we need to be bold and face the facts and understand the players on this one. You might also want to look into Dr. Emanuel's (he is a PhD. D as well as an M. D.) ideas on changing the wording in the Hippocratic Oath. It might give you a more clearer understanding of what he envisions future health care to be in these United States.

[Dementia_Madness]

Truthfully JW (like I said I could be wrong on this) I know little about him, just what I read on Wikipedia (and we all know easy it is to "create" facts there) and Democrat and MSM web sites (and right wingers as well). I have not followed his career, and although I did submit http://spsboard.com/SPS/index.php/topic,3424.msg43602.html#msg43602

I will be glad to revue any evidence that may prove my conclusion unfounded. This is one I will have to say as of yet is still open to debate.

Do I believe that socialized medicine leads to euthanasia, no doubt. Even a republican supposed pro-life republican government leads to euthanasia...look at legalized abortion, brought to us and maintained by republicans.

[Just Win]

Truthfully JW (like I said I could be wrong on this) I know little about him, just what I read on Wikipedia (and we all know easy it is to "create" facts there) and Democrat and MSM web sites (and right wingers as well). I have not followed his career, and although I did submit http://spsboard.com/SPS/index.php/topic,3424.msg43602.html#msg43602

I will be glad to revue any evidence that may prove my conclusion unfounded. This is one I will have to say as of yet is still open to debate.

DM,

This link to the Wall Sreet Journal article below does a good job of explaining this topic much better than I. Let me know what you think after reading about Dr. Zeke and the elderly dearth chart mentioned in the article.

note on zeke emanuel in the wall street journal editorial = http://online.wsj.com/article/SB10001424052970203706604574374463280098676.html  


The Reaper Curve: Ezekiel Emanuel used the above chart
in a Lancet article to illustrate the ages on which health
spending should be focused

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

[Dementia_Madness]

Okay I gotta admit that pretty much verifies what you said....

"Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."

Okay NC, let's see what you have for me now, what is your response to this article? ( I know that article is by BETSY MCCAUGHEY....but the words you read above are a direct quote.)

[NCVol]

They are a direct quote, without the context and without the words that the ellipses (...) indicates are missing.

I've read some of his writings and they deal with cases such as with transplants where there MUST BE A CHOICE between Person A OR Person B.  If you have ONE kidney, and TWO people, only one person gets treated.  How do you decide.   If this flu gets really bad or in fact becomes a deadly pandemic, and there is enough vaccine for 10,000,000 people and we have 300,000,000 what do you do.  What if there are enough ventilators for 100 ppl in Knoxville, and 1000 need the machine - I heard this morning of a 7 year old that within 24 hours after getting swine flu was on a ventilator, if that spreads and your choice is an 87 YO grandmother or YOUR child, who gets saved?  Addressing those situations is uncomfortable, but Betsy pretends that we don't have to make those decisions.  WE DO. 

And let's be honest further.  If you spend $100,000 on a person in his last month, that is a choice that DENIES that resource for someone else.  We can, again, pretend that there isn't a choice made to deny someone care by spending 100k on this other person, but that's dishonest.  We do not have an unlimited pot of money.  The private insurance companies embrace this reality - one way by routinely denying payment for "experimental" treatments.  The idea is we cannot fund "unproven" strategies without making insurance prohibitively expensive, which means more uninsured and more who DIE for lack of care and lack of resources. 

As to the WSJ article, 1) Betsy is a proven liar, and 2) she has been proven incapable of writing honestly about health care, and 3) without context only a FOOL would trust her writings.  It's a confirmation of why I no longer read the WSJ editorial page that this serial proven liar was given a forum. 

When I see the context of those quotes, I'll feel confident that proven liar Betsy McCaughey put them into a proper context.  Otherwise, I'd bet 100 against your 10 that the words are out of context and any reasonable person would find that Zeke was discussing the type issues that society MUST address, whether it's comfortable to do so or not. 

[Dementia_Madness]

Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years.

Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years."
 -Lancet, Vol 373 June 31, 2009
 
"Services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia."
 -Where Civic Republicanism and Deliberative Democracy Meet Author(s): Ezekiel J. Emanuel Source: The Hastings Center Report, Vol. 26, No. 6, .
 
"When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated."
 -Lancet, Vol 373, January 31, 2009, 428
 
"Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years."
 -Lancet, Vol 373 June 31, 2009
 
"Strict youngest-first allocation directs scarce resources predominantly to infants. This approach seems incorrect. The death of a 20-year-old woman is intuitively worse than that of a 2-month-old girl, even though the baby has had less life. The 20-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects....
 -Lancet, Vol 373, January 31, 2009   425,
 
Adolescents have received substantial substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments.... It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies, and worse still when an adolescent does."
 -Lancet, Vol 373, January 31, 2009, 428
 
"Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change. Savings will require changing how doctors think about their patients. Doctors take the Hippocratic Oath too seriously, as an imperative to do everything for the patient regardless of the cost or effects on others."
 -Health Affairs: The Policy Journal of the Health Sphere, 2008
 
"Every favor to a constituency should be linked to support for the health-care reform agenda. If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."
 -Health Care Watch, November 2008

Seems like an awful lot of quotes taken out of context..I could understand one or two but this....amazing!

http://www.americanthinker.com/2009/08/will_you_still_need_me_when_im.html

[NCVol]

I'm about sick and damned tired of fact checking proven liars - guess what, they LIE!!!  Too bad we didn't have a bet! 

Here's the actual article. 

http://www.factcheck.org/UploadedFiles/emanuel_lancet.pdf

Here is the introduction

Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We
evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring
the worst-off , maximising total benefi ts, and promoting and rewarding social usefulness. No single principle is
sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined
into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points
systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the
complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates
prognosis, save the most lives, lottery, and instrumental value principles.

Well intentioned people can disagree about HOW to discriminate when you have ONE kidney and EIGHTY SEVEN candidates, but only fools and blowhards and born liars and propagandists take a discussion about that real issue and claim that the person is advocating euthanasia.  Which makes Betsy McCaughey a liar etc. and the WSJ and unforgivable hack organization for giving her a forum.  The American Thinker (cough, cough, gag,) doesn't have a reputation to protect....   

And look, if you and JW don't like "complete lives" fine.  In a real world situation, there might be a choice, there is ONE life saving vaccine (or kidney or ICU bed or respirator, etc.) and your 87 YO grandmother, you, your newborn OR your teenager gets that resource.  ONLY ONE CAN GET THE SCARCE RESOURCE.  The issue being dealt with is how to make that decision.  How would you do it? How do your rank them 1-4, since only one at a time can possibly get treated.  Oldest first, the sickest, the one with the most potential, you as the provider for your children AND your grandmother (if you don't survive all are at risk), your grandmother as thanks for her sacrifices?  What would YOU do. 

[NCVol]

BTW it's pretty darned unbelievable to see "conservatives" argue for an unlimited Medicare government mandate like that article in American Thinker (cough, cough, gag). 

It's great that the 60-97 Trillion unfunded mandate depending on the estimates isn't a problem anymore and all "free market capitalism" conservative republican hands are on deck to formalize a mandate for the government to pay any bill for any senior regardless of prognosis, chance of recovery or cost or value added.  Resources are now apparently unlimited and we can borrow unlimited amounts to fund this new unchecked, guaranteed Medicare mandate.  Brilliant "thinking" from that crew of conservative fiscal hawks.