The Liverpool Care Pathway has finally made the headlines in Malta. However, the instances of helpless patients being denied the basic necessities needed to sustain life have been increasingly in the news in the UK since 2000.
There are strict guidelines for the proper use of LCP but these are hardly followed- Miriam Sciberras
The Liverpool Care Pathway (LCP) for the dying patient is one of the key programmes within the Marie Curie Palliative Care Institute Portfolio and was recognised as a model of best practice in the NHS Beacon Programme (2001). It was subsequently recommended in the End of Life Care Strategy DH2008, the aim being to improve care of the dying in the last hours or days of life for the terminally ill.
However, a lot of questions need to be asked regarding its increasingly widespread application for those with incurable diseases (including dementia) or those defined as “probably dying”. There are strict guidelines for the proper use of LCP but these are hardly followed. In 2009, it was reported that LCP was being gradually adopted nationwide and that more than 300 hospitals, 130 hospices and 560 care homes in England were using this system.
The main problem with LCP is that the consent of the patient is not even required. In fact, in the UK, since the 2005 Mental Capacity Act, doctors are allowed to withhold all “treatment”, including food and water, from patients who are judged to be incapable of making decisions for themselves. Under this law, doctors, and not the family and not the patient, have the last say in whether a patient is judged mentally capable. Once this judgement has been made, withdrawal of fluids can be ordered on grounds that it is in the patient’s “best interests” to die.
It is pertinent to point out that, in England and Wales, food and water administered by a doctor count as “medical treatment”. This is leading to patients, mostly the elderly, being left in the dire predicament of losing their lives prematurely.
Anti-euthanasia groups and various competent physicians have been speaking out against the increasing misuse of this protocol. In 2008, Adrian Treloar, a psycho-geriatrician and senior lecturer at the Greenwich Hospital and Guys’, King’s and St Thomas’s hospitals in London, had warned that the national health service has an unofficial system in place to authorise the killing of vulnerable disabled patients with an unwritten policy of “involuntary euthanasia” by deep sedation and dehydration.
Another physician, Philip Harrison, whose elderly father was put under continuous deep sedation without being consulted in August 2009, wrote this: “I’ve seen euthanasia once but I’ve never seen anybody being put to death without consent. It was as near to a form of murder that I had come across”.
Medical sociology professor Clive Seale also confirmed that, from his research, the use of continuous deep sedation across the UK is far from “uncommon”.
Peter Millard, emeritus professor of geriatrics at St Georges, University of London, maintains that the LCP encourages some doctors to give up on patients too quickly and place them on the death pathway when they might otherwise have survived. According to Prof. Millard, “Diagnosing imminent death is one of the most difficult decisions a serious physician has to make”.
Prof. Millard was one of a group of six, including Anthony Cole, Peter Hargreaves, David Hill, Elizabeth Negus and Dowager Lady Salisbury (chairman, Choose Life), who claimed that some patients were being wrongly judged as close to death. To this end, they signed a letter together in September 2009 against the prevalent misuse of LCP. The following is an extract from their letter: “Forecasting death is an inexact science. If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death.
“As a result, a nationwide wave of discontent is building up as family and friends witness the denial of fluids and food to patients. Syringe drivers are being used to give continuous terminal sedation without regard to the fact that the diagnosis could be wrong. It is disturbing that, in the year 2007-2008, 16.5 per cent of deaths came about after terminal sedation.”
This was recently confirmed by Patrick Pullicino, the Maltese consultant neurologist at East Kent Hospitals. Prof. Pullicino made the headlines claiming that the UK’s NHS kills off 130,000 elderly patients every year. He maintains that, in this way, hospitals are using end-of-life care to help elderly patients die because they are difficult to look after and take up valuable beds.
Despite such a number of highly esteemed medical specialists among numerous others that have been raising the alarm regarding the LCP, there have been no definite declarations from the health authorities to put people’s mind at rest. This is making the elderly patients and their families in Britain fear going to hospital in their old age.
The elderly, especially 80-year-olds, with chronic conditions like Parkinson’s, dementia or respiratory disorders are among the unfortunate candidates put on LCP, dismissed as dying when they could still live for some more time. Patients with diminished mental and physical capacities are also very vulnerable candidates.
The elderly are at a very vulnerable stage of life and need our compassion, respect, care and support. At this time, the state cannot shrink from its duty to care for these people nor should it see them as burdens. With the declining birth rate in most countries, there will be increasing pressures on an already overburdened socialised health care system to make hospital beds available at the expense of premature termination of lives.
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