Predicting death ?

Jane`s Story:

Professor Pullicino -

"Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically. This determination in the LCP leads to a self-fulfilling prophecy. The personal views of the physician or other medical team members of perceived quality of life or low likelihood of a good outcome are probably central in putting a patient on the LCP."

"There is no data for telling if someone is in the last hours or days of life, so the actual decision is not a scientific one. The actual decision is an intuition by the group that's making the decision. If you start to say somebody has a poor prognosis, then you make a self-fulfilling prophecy."

Dr, Philip Howard –

 

"Patients are put on the LCP by multi-disciplinary teams rather than by physicians. This indicates management decisions supplanted medical judgements. It is a decision with an end in view. The patient is dying. Why? Because we say they are dying. Why? Because we have decided."

"On the wards there has been a change in attitudes with the introduction of terminal care pathways, the most familiar of which is the Liverpool Care Pathway (LCP)."

"We know that prognosis is not accurate and we often get our predictions of prognosis wrong. A tool based upon prognosis is therefore dangerous as it may become a decision that a person will die. Often on such pathways triple therapy is used (with morphine, midazolam a sedative and a hyoscine which is a drug to dry secretions). This means that the patient, who may or may not be dying, is given drugs that may hasten or even cause death. This is particularly true if hydration is also withdrawn. On such a regime the patient cannot survive."

"On The Big Question –

I think one of the problems with the Liverpool Care Pathway is it’s predicated on a false premise, namely that you can accurately diagnose death; you can make an accurate prognosis as to when that person is going to die, within the next few hours or days. And there’s no scientific evidence that we can do that. And I know of no calibration tools that we can use to say just how accurately we can make that prognosis. That’s the danger. Now, if you then sedate the patient, stop observations, stop interventions, and stop food and fluids, the patient must die. Whether or not they would have died anyway, they must die if you adopt that regime in full."

John Smeaton –
 

"Doctors are being pressurized to participate in the LCP even when they feel very uncomfortable about it, being told that the LCP is national policy. Some doctors are losing control of the clinical care of their own patients."

"The prognosis of imminent death may well be a self-fulfilling prophecy. The LCP's combination of narcotics and dehydration is ultimately lethal. In many cases it appears that there is a deliberate intention of hastening death."

"The LCP is usually applied without the knowledge or consent of the patient. The lack of assessment of mental capacity of patients and the lawful obtaining of informed consent are serious concerns..."

 

"My discussion of events leading up to the implementation of the LCP is documented and has been submitted to you. This aside, the issue does remain that the law and the Version 12 LCP does require informed consent by the patient and this did not proceed."

"Discussion with the family and the multi-disciplinary team should only have proceeded in the event that my mum was not competent to make this decision herself. As I have reported to you, on the very day that implementation proceeded, capacity was demonstrated when my mum remonstrated with the examining physician not to manhandle her in the manner that he did."

"You state at item 12. that the family had agreed but the decision of the patient should have taken precedent. That decision was not sought and no test of competency was made as is required."

"When mum declined intervention previously in regard to the treatment offered, that decision was respected. Why, then, in the respect of intervention via the LCP, was her decision not sought likewise?"

"You speak of ‘best interests’ but ‘best interest’ would have required the intervention she had declined. That could not proceed, obviously, because, without her permission, that would have amounted to an assault."

"Therefore, in not seeking her permission to do so and making no test of competency to give her permission to do so, enacting the LCP and putting my mum on a syringe driver for 18 hours also amounted to an assault. "

http://liverpool-care-pathway-a-national-sc.blogspot.co.uk/2015/02/liverpool-care-pathway-janes-story.html

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