Elderly patients 'helped to die to free up beds', warns doctor

[markomalley]

From the Telegraph:

Professor Patrick Pullicino has claimed that doctors are using a care pathway designed to help make people’s final days more comfortable as an equivalent to euthanasia.

The Liverpool Care Pathway (LCP) is used in hospitals for patients who are terminally ill or are expected to die imminently. Under the pathway, doctors can withdraw treatment, food and water while patients are heavily sedated.

Almost a third of patients - 130,000 - who die in hospital or under NHS care a year are on the LCP.

So i was just curious about peoples’ opinions on this. Britain, of course, has one of the premier health systems in the world. In fact, a lot of folks he hold it up as an example for Americans to follow.

What are the ethics of this? Send that if the is a shortage of hospital rooms available, drastic actions like this might be needed to free up the rooms for the common good, right?

But what about the right to life and rapidly the dignity of the human person?

Which should take priority?

 

[St_Francis]

From the Telegraph:

So i was just curious about peoples’ opinions on this. Britain, of course, has one of the premier health systems in the world. In fact, a lot of folks he hold it up as an example for Americans to follow.

What are the ethics of this? Send that if the is a shortage of hospital rooms available, drastic actions like this might be needed to free up the rooms for the common good, right?

Some of what they are doing is immoral: ETA: If what the professor alleges is correct
…The Liverpool Care Pathway (LCP) is used in hospitals for patients who are terminally ill or are expected to die imminently. Under the pathway, doctors can withdraw treatment, food and water while patients are heavily sedated.
It is morally permissable to withdraw *extraordinary *treatment, ventilators, kidney machines, and the like.

However!!! It is not moral to withdraw food or water before a patient’s body starts shutting down itself in the process of dying. Withdrawing food and water before that is causing the patient to die of starvation or lack of water and is murder.

Additionally, patients are not to be kept sedated for any reason other than pain relief. If a patient is in pain and requires an amount of painkiller which will cause sedation, that’s all right. However, it sounds like patients are normally kept heavily sedated, and this is *not permissable. *

And furthermore!!! It is certainly *not at all *permissable to keep the dying patient heavily sedated so as to make it more convenient for the hospital staff to kill them by withdrawing food and water!!!

What should take priority is hospital staff *not committing murderous acts. *It is no sin to be murdered, but it is a sin to murder…

 

[SaintPatrick333]

My great grandma just passed away yesterday. She was 105 years old (God Bless her). She stopped eating almost a week ago and they never fed her again at her retirement home. When hospice came to be with her she stopped receiving water and her medicine. All they did was give her morphine and some other drug to help her be calm towards the end. It was a remarkable experience because despite heavy sedation she came too a couple times and had moments of clarity and awareness where she would speak with us before drifting back to sleep. She called out a few times to her husband Russel and her brother Walt who had preceded her in death decades earlier. God was with her and so was her family. While she lingered a little longer than I would have liked, she died a holy and mostly peaceful death.

But the point is, they used something similar to help her at her end. The same thing with both my grandparents on my dads side in the last few years before. They all stopped receiving food and water and were just given drugs to keep them asleep until they passed.

 

[Lifesong]

It is one thing to withhold food and water when it is the time in the dying process where the body shuts down. That is totally appropriate. However what I fear is happening and am starting to see this as a nurse case manager and life care planner is a move towards hastening the process. It is a fine line between death with dignity and passive euthanasia, and what was described in the article appears to be closer to the latter.

 

[Lifesong]

My great grandma just passed away yesterday. She was 105 years old (God Bless her). She stopped eating almost a week ago and they never fed her again at her retirement home. When hospice came to be with her she stopped receiving water and her medicine. All they did was give her morphine and some other drug to help her be calm towards the end. It was a remarkable experience because despite heavy sedation she came too a couple times and had moments of clarity and awareness where she would speak with us before drifting back to sleep. She called out a few times to her husband Russel and her brother Walt who had preceded her in death decades earlier. God was with her and so was her family. While she lingered a little longer than I would have liked, she died a holy and mostly peaceful death.

But the point is, they used something similar to help her at her end. The same thing with both my grandparents on my dads side in the last few years before. They all stopped receiving food and water and were just given drugs to keep them asleep until they passed.

That was my experience with hospice with my mother and father in law and it was very positive, just wanted to also say I am thankful that the experience was peaceful for all for your grandmother and family and it sounds like the Lord received her with open arms. I will pray for her and your family.

Blessings,

Val

 

[losh14]

If a shortage of beds is the problem, why not send the patients to hospice? Does Britain not have the capacity to do so?

 

[JackyB]

I am so pleased that this issue has been raised. Recently I started work for the NHS in a ward where the pathway route has been used. I have no medical training whatsoever nor have I much knowledge about the NHS having come to the UK fairly recently. I look forward to this discussion to help me see what is happening and why. So far in my limited knowledge it appears to be used in cases that justify the route. Thank you.

 

[St_Francis]

I am so pleased that this issue has been raised. Recently I started work for the NHS in a ward where the pathway route has been used. I have no medical training whatsoever nor have I much knowledge about the NHS having come to the UK fairly recently. I look forward to this discussion to help me see what is happening and why. So far in my limited knowledge it appears to be used in cases that justify the route. Thank you.

The article said that the professor said it was happening, but that others in the NHS denied it was happening. They did admit to sedating the patients, which is immoral if it is not necessary to ease the pain of the patient. Suppose someone would call for a priest at the end, but was sedated for the convenience of the caretakers?

 

[TheRealJuliane]

Great Britain has one of the premier health care systems in the world??? LOL :dts:

It’s called “rationing.” Happens every day in the UK and even here in the US. Don’t like it? Don’t live until you are old and considered of no value.

 

[Maryann_C]

Great Britain has one of the premier health care systems in the world??? LOL :dts:

So glad someone questioned that quote…certainly not what was the case when I left England but that was 20 years ago. I remember people complaining about dying on waiting lists for what we would call ‘routine surgery’ in the US.

The facts are that rationing happen where ever and under whatever system you are in . The ‘rationing’ may happen because of your lack of ability to pay for all and every medical need possible because the government can’t pay ,because the taxes have run out. Since we are in a medical world now where it seems like there is medicine or a procedure for everything, what the expectation in the US seems to be is that they are entitled to EVERY procedure. In the days before heart transplant surgery ( I remember the first successful one) people simply died because of the lack of that ‘cure’ I call that God’s way of rationing. Call me heartless but then again I am the legally emigrated , hard working, tax payer who can hardly afford premier health care ,on the back of whom those who are here illegally or who can not afford any health care get anything and everything available all they have to do is show up to an ER. I have worked with nurses who work in a hospital maternity ward where there are alot of medicaid recipients who get rides to the hospital in the Ambulance simply because there was no room in the family vehicle ( because the whole family and the cat HAD to go too) because people are too afraid to say no…well rationing will happen when the money runs out and America looks like Greece today …soon to be followed by Italy and France perhaps… Interesting that Greece and Rome were once a grand and mighty Empires!
OK getting off my soap box…I still think it is morally unacceptable to with hold food and water unless of course the patient can no longer tolerate either but there are such things as feeding tubes.

 

[markomalley]

Great Britain has one of the premier health care systems in the world??? LOL :dts:

It’s called “rationing.” Happens every day in the UK and even here in the US. Don’t like it? Don’t live until you are old and considered of no value.

Well, Juliane, it seems that whenever I post an article on this board about the nightmare that is the NHS, it always devolves into a discussion about how wrong I am about it and that the news sources I cite are wrong, I am a stupid Yank and can’t possibly understand how wonderful NHS is, and so on…so I figured that, since I am obviously too stupid to comprehend NHS, I would just concede the point so that the larger ethical question could be dealt with and not be lost through derailment.

The bottom line is that those who advocate single payer health insurance or direct nationalization of health care don’t ever deal with the issue of limited resources. This article points out, in a cover fashion some of the decisions that have to be made when demand exceeds supply and there its no way to quickly ramp up supply.

And here you have the very real question about what to do…do you free up beds, in, what I,as a stupid Yank, would consider to be a totally unethical manner, or do you possibly deny or delay service to somebody else because there is no bed space?

And then more to the point, who gets to make that decision? The patient (or his family) or the institution/government?

 

[TheRealJuliane]

Well, Juliane, it seems that whenever I post an article on this board about the nightmare that is the NHS, it always devolves into a discussion about how wrong I am about it and that the news sources I cite are wrong, I am a stupid Yank and can’t possibly understand how wonderful NHS is, and so on…so I figured that, since I am obviously too stupid to comprehend NHS, I would just concede the point so that the larger ethical question could be dealt with and not be lost through derailment.

The bottom line is that those who advocate single payer health insurance or direct nationalization of health care don’t ever deal with the issue of limited resources. This article points out, in a cover fashion some of the decisions that have to be made when demand exceeds supply and there its no way to quickly ramp up supply.

And here you have the very real question about what to do…do you free up beds, in, what I,as a stupid Yank, would consider to be a totally unethical manner, or do you possibly deny or delay service to somebody else because there is no bed space?

And then more to the point, who gets to make that decision? The patient (or his family) or the institution/government?

People are in denial because it’s all they have. But those Brtis who have the means, come HERE to the US for medical treatment. At the very least, they go to private doctors in the UK although there aren’t many of those either. It doesn’t take a genius to understand that if there is no incentive for research, and for doctors to go into practice, the best and brightest practitioners won’t be trained. And as for medical care…don’t even get me started. The only thing that can be said for it is that the patient doesn’t pay out of pocket, but they’ve already paid in taxes more than what it is worth. Substandard care is not free.

 

[Kaninchen]

Well, Juliane, it seems that whenever I post an article on this board about the nightmare that is the NHS, it always devolves into a discussion about how wrong I am about it and that the news sources I cite are wrong, I am a stupid Yank and can’t possibly understand how wonderful NHS is, and so on…

Well, as you know, I think it would be much better if Europeans didn’t comment on American issues or Americans on European issues - partly because the ‘usual suspects’ on both sides end up saying that the other hasn’t the vaguest idea of what they’re talking about and this particular ‘usual suspect’ (thinking that both sides are probably right about that, if nothing else) says she hasn’t the slightest interest in what Americans think or do about anything, anyway.

While you may have had the best intentions about discussing ‘ethics’, your track record on medical issues might well be getting in your way.

 

[Maryann_C]

People are in denial because it’s all they have. But those Brtis who have the means, come HERE to the US for medical treatment. At the very least, they go to private doctors in the UK although there aren’t many of those either. It doesn’t take a genius to understand that if there is no incentive for research, and for doctors to go into practice, the best and brightest practitioners won’t be trained. And as for medical care…don’t even get me started. The only thing that can be said for it is that the patient doesn’t pay out of pocket, but they’ve already paid in taxes more than what it is worth. Substandard care is not free.

As an English woman I can say you are correct. BUT I also add a link to this article I just stumbled across today which I thought was interesting

For those who hate to click on links here is a clip for you as published today .
" Belfast, N. Ireland – A strike by doctors affiliated with the United Kingdom’s National Health Service was to begin here Thursday, …Anyone wishing to predict how a nationalized health care system would work in the United States should look no further than the one that has existed for many years here in the UK.

Long waiting periods for routine surgeries such as knee and hip replacements are the norm. More serious procedures can take months just to get on a schedule. People here often envy stories from Americans of how we can get quick appointments with our primary care physicians, noting they often have to wait weeks just for an appointment and then even longer for treatment. There are legions of stories reported by the newspapers of people who have died while waiting for surgery.

Read more: foxnews.com/opinion/2012/06/21/what-uk-national-health-care-mess-tells-us-about-obamacare

Kind of backs up what I said I remember going on when I left England 20 years ago…sounds like things have not changed.

 

[Viki63]

What are the ethics of this? Send that if the is a shortage of hospital rooms available, drastic actions like this might be needed to free up the rooms for the common good, right?

But what about the right to life and rapidly the dignity of the human person?

Which should take priority?

We in the US have hospice, You can be in hospice care in your own home, which is actually preferable. My mother was enrolled in hospice when she passed, and it was helpful although it was started a little late. The hospice nurse interceded with the nursing facility where she lived, who were withholding pain medication because they didn’t want her to die on Christmas eve, so the family wouldn’t have bad memories of Christmas.
I called the hospice nurse at midnight and got my mother the pain medicine she needed. We didn’t care what day it was, just that she was comfortable.
The British program sounds like a similar program to hospice, which of course like anything else can be misused.
But hospice can free up beds by sending patients home to die in familiar, comfortable surroundings.

 

[Contarini]

And then more to the point, who gets to make that decision? The patient (or his family) or the institution/government?

Or the insurance company, as is effectively the case in America now.

Edwin

 

[Contarini]

As an English woman I can say you are correct. BUT I also add a link to this article I just stumbled across today which I thought was interesting

For those who hate to click on links here is a clip for you as published today .
" Belfast, N. Ireland – A strike by doctors affiliated with the United Kingdom’s National Health Service was to begin here Thursday, …Anyone wishing to predict how a nationalized health care system would work in the United States should look no further than the one that has existed for many years here in the UK.

Long waiting periods for routine surgeries such as knee and hip replacements are the norm. More serious procedures can take months just to get on a schedule. People here often envy stories from Americans of how we can get quick appointments with our primary care physicians, noting they often have to wait weeks just for an appointment and then even longer for treatment. There are legions of stories reported by the newspapers of people who have died while waiting for surgery.

Read more: foxnews.com/opinion/2012/06/21/what-uk-national-health-care-mess-tells-us-about-obamacare

Kind of backs up what I said I remember going on when I left England 20 years ago…sounds like things have not changed.

Well, I have a lot of British relatives (I was born there and go back every couple of years to visit) who are baffled by the lack of universal care in America, and seem quite happy with their system.

Of course it’s not perfect–no system is–but it tries to cover everyone.

American “conservatives” seem happy with a system that “rations” as long as the rationing is done by the great god Mammon.

Some conservatism!

OK–I have a personal stake in this. I was laid off my job recently and face trying to get by on “adjunct” teaching (part-time jobs cobbled together to make ends meet) with no health insurance. I have been half-seriously considering moving back to Britain for this if no other reason.

Now to the OP: of course the situation being described is appalling, if the professor is right. And I’d be inclined to trust him over the NHS.

I also find it disturbing, as a C. S. Lewis fan, that there is actually an organization called NICE!

Edwin

 

[markomalley]

Or the insurance company, as is effectively the case in America now.

Edwin

True. And that is essentially why i don’t care for any kind of a third party payer system at all.

The only difference being is with a commercial third party payer system, you generally have a choice on the level of coverage you have (or your employer has that choice). You want better coverage, pick a different plan (our get a different employer)

Doesn’t eliminate the defects inherent in the third party payer system, but at least you have some choices.

 

[Viki63]

True. And that is essentially why i don’t care for any kind of a third party payer system at all.

The only difference being is with a commercial third party payer system, you generally have a choice on the level of coverage you have (or your employer has that choice). You want better coverage, pick a different plan (our get a different employer)

Doesn’t eliminate the defects inherent in the third party payer system, but at least you have some choices.

You don’t have choices if you are laid off, or unemployed, as in the situation Contarini faces. He is certainly not alone.
There’s COBRA, but that’s extremely expensive - I think mine was $800/month. I got catastrophic insurance for $200/month while I was job searching.

 

[markomalley]

You don’t have choices if you are laid off, or unemployed, as in the situation Contarini faces. He is certainly not alone.
There’s COBRA, but that’s extremely expensive - I think mine was $800/month. I got catastrophic insurance for $200/month while I was job searching.

True.

But, again, that is the fallacy of a third party payer system.

You are not paying for your health care. You (or you plus your employers, if employed) are contributing to a pool and then the manager of that pool pays for your health care out of the pool.

Therefore, your concerns are, rather than the cost of the health care, the cost of:

A) your contributions into that pool
B) the amount of your copayments
C) whether a service you desire is covered within the costs of that pool

You don’t care what the service provider charges (you care about your copayment…which is generally the same regardless of the service provider’s fee). Service providers know that…and adjust their fees accordingly. And they do everything they can do to increase the amounts they are reimbursed for providing their services.

In the case of COBRA, the reason why it is so expensive is that you are required to pay for the entire contribution into that pool…you don’t share that contribution with your employer (the other point is that those who are willing to pay that amount are those who likely are going to need to use the services while unemployed).

A single third party payer (e.g., State-run health insurance), rather than multiple third party payers (e.g., commercial health insurance) won’t fix the fundamental problem. Service providers structure their pricing based upon reimbursements, not the market…and they would still do the same thing they do now…work to increase the amount authorized for reimbursement (look at what they do with Medicare, as an example).

Completely nationalized healthcare (i.e., State run healthcare, as opposed to State run health insurance) won’t fix the problem, as the State will provide a finite, limited amount of resources through the appropriations process to fund healthcare. When the budget is used up, it’s used up…and then very difficult decisions would have to be made.

If, as a rule, people were to pay for the services themselves (i.e., first party payer), they would be very concerned with the price of those services. That would drive the overall price of those services way, way down. There are too many independent service providers out there for them to form cartel-like prices like there are with other markets.

Yes, there are some for whom that model would be challenging, but not as many as one would think. And some sort of assistance from intermediate bodies could provide assistance, as required, for those folks.

But when 85% of the consumers in this country receive services without directly paying for those services, the market, itself, will be utterly distorted…leading to the situation where we find ourselves today. Increasing central control will just make it worse.