End of Life Guidelines
Following serious complaints about the Liverpool Care Pathway (LCP), which claimed to ensure that end-of-life palliative care was compassionate and ethical, the National Institute for Health and Care Excellence (NICE) is working on a replacement document. In August it sent draft guidelines out for consultation but, according to one clinician, the new guidelines are even worse in some respects than the LCP. It is solemn if those who are responsible for caring for patients are actually causing their premature death.
Professor Patrick Pullicino, Professor of Clinical Neuroscience at Kent University, was one of the first doctors to raise concerns about the LCP, stating that it was “pushing elderly NHS patients to a premature death”. In January 2013, much as a result of his criticism and of alarming stories in the media about the care of the elderly in acute hospitals, the then Care and Support Minister, Norman Lamb, asked Baroness Julia Neuberger to chair an independent enquiry into the practice of the LCP. The LCP supposedly developed from a model successfully used in hospices – “a generic approach to care for the dying, intended to ensure that uniformly good care is given to everyone thought to be dying within hours or two or three days”. However, after Baroness Neuberger gathered evidence widely, it was found that the LCP was very often failing to deliver a good standard of care.
The review panel indicated that the word “pathway” was dangerous. Many were apparently put on it with no clear diagnosis that death was imminent. Once on the pathway, there was often a marked deterioration in treatment and care. Baroness Neuberger reported that “examples included leaving patients without adequate nutrition, hydration and inappropriately sedated. . . . There is a lack of care and compassion”. This should be regarded as professional misconduct, the panel warned. The panel reported back to the Government in July 2013, recommending that the LCP be phased out and replaced by a personalised end-of-life care plan with “a clinically sensitive approach” and that the term end of life should replace pathway.
In recent comments to the Daily Telegraph, Dr Pullicino states, “One of the most dangerous aspects of the LCP was “anticipatory prescribing”, where the physician wrote up sedatives and narcotic medication ahead of time. The result was a rapid increase of medication and a quick death for many LCP patients.” He continues, “The LCP was in operation for so long that it has changed accepted practice in the NHS and, even after it has been removed, similar practices continued under different names. I regularly receive reports from desperate relatives of individuals, being treated in an LCP-like fashion, who are trying to get active care for relatives who have been determined to be ‘dying’.”
Initial reports on the new NICE guidelines did appear positive and seemed to be an improvement on the LCP. They claimed to be calling “for basic daily checks to make sure patients are well hydrated and nourished . . . a radical departure from the LCP”. NICE states that families should be encouraged to become more involved in caring for loved ones if appropriate and safe, for example, “helping to give loved ones sips of water” and making relatives more involved with decision making about patients – which had not been happening, in many cases, under the LCP.
However, Professor Pullicino has looked more closely at the NICE guidelines and is dismayed. He argues, “Diagnosis of who is imminently dying was the core problem of the LCP and is no better in the NICE document. It includes a cookbook list of features that may suggest someone is dying, but is totally inadequate to make a diagnosis and is not evidence-based. So we are back at the LCP in terms of the risk of putting patients who are not dying onto inappropriate and potentially lethal treatment. This is so crucial that no new attempts to set up this sort of pathway should be made until we have research showing it is possible to accurately diagnose impending death. Until then, as Baroness Neuberger said, good quality compassionate care should be given without any pathway”. In this context Christian Voice writes. “The whole idea of a pathway leads one to question its destination. And if doctors are just guessing, or are under pressure to free up beds, the alarm bells should be ringing”.
In spite of NICE’s claims to the BBC, Dr Pullicino goes on to say, “The section on hydration is a disaster of misinformation, distortion and ambiguity with at least one major error. It says that ‘death is unlikely to be hastened by not having clinically-assisted hydration’. This is completely untrue.” Despite denials to the contrary, he continues, “Dehydration was a central mechanism of the deaths on the LCP”. Although the LCP has been removed, he says, “I still frequently witness severely-dehydrated elderly patients on hospital wards. Unless it becomes standard, and monitored by the Care Quality Commission, that hospitals are obliged to give nutrition and hydration adequate for patients’ physiological needs at all times, and regardless of prognosis, end-of-life care is going to remain lethal.”
It all makes sombre reading, yet there may be some seeds of hope. When visiting hospital, we are sometimes surprised by the degree of compassion and kindness shown by staff, especially some of the younger nurses, to older people – perhaps more so than, say, ten years ago. It may not represent the national picture, as we see our land degenerating morally, but the Lord can, in His great mercy change such restraining grace to saving grace. For us as individuals and as a people, He “is able to do exceeding abundantly above all that we ask or think” (Eph 3:20) – and for His cause also.
KHM
Gambling
An Aberdeen woman was jailed for a year recently for embezzling £39 500 from her employers over the course of 16 months because of an online-gambling addiction. Doubtless she deserved to be punished for the stealing, but what about the gambling? And what about the people who profited from her gambling? Do they simply keep the money and wait to take advantage of the next gambling addict who comes along? Are they not even partly responsible for her crime by providing the temptation and the means of her running through such a large sum of money? The newspaper report does not say how much of the money was spent on gambling, but presumably a substantial proportion of it was, in which case the people overseeing the gambling must have been surprised at how much money she had, and perhaps had doubts as to where it was coming from.
Rulers ought to “execute wrath upon him that doeth evil” (Rom 13:4) and that should include gambling outfits which heartlessly exploit the sin and folly of others, and which to some extent induce crime, and profit from it. A first step would be the abolition of the national lottery.
DWBS
Manchester Homosexual March
An interesting report by Rev David Carson describes a Christian witness at a recent homosexual parade in Manchester. The parade was very large, with numerous policemen, fire engines, and ambulances taking part in it. With so much backing from the authorities, one wonders what the ostensible purpose of the parade was. If homosexuality is so “normal” and so widely supported, why does it have to be so ostentatious? The impression is almost that the march was an organised demonstration against God and against Christianity. This impression is strengthened by the conduct of the marchers when they reached the tiny Christian witness. The police blew their whistles, the fire engines and ambulances set off their sirens, and the police band halted and played for several minutes to drown out the open-air preaching. The defiance and hatred of God was very evident.
Unwittingly, the marchers provided a powerful confirmation of the truth and accuracy of the Word of God. Alas for them! That Word condemns sodomy and unbelief and hatred of the people of God; and God is stronger than they are, and can and will prevail against them. “The Lord said unto My Lord, Sit Thou at My right hand, until I make Thine enemies Thy footstool” (Ps 110:1).
DWBS