Assisted Dying Bill

Here is an interesting post from `Christian Medical Comment` which discusses the House of Lords Assisted Dying Bill. `Leading parliamentary think tank says Lord Falconer’s ‘Assisted Dying’ Bill fails public safety test`

Living and Dying Well (LDW) is a public policy research organisation established in 2010 to promote clear thinking on the end-of-life debate and to explore the complexities surrounding 'assisted dying' and other end-of-life issues. It has just published a comprehensive report on Lord Falconer’s Assisted Dying Bill which was introduced into the House of Lords on 15 May.

Lord Falconer's Assisted Dying Bill [HL Bill 24] is the fourth of its kind to come before the House of Lords in the last ten years and seeks to authorise assisted suicide for mentally competent adults with less than six months to live.

None of its predecessors has made progress and the last one (Lord Joffe's Assisted Dying for the Terminally Ill Bill) was rejected in May 2006.

http://pjsaunders.blogspot.co.uk/2013/07/leading-parliamentary-think-tank-says.html


An article in the Telegraph  headed `We legalise assisted dying at our peril` puts forward a very balanced view against the proposed legislation. There are heated arguments in the commentary which follows the article indicating what an emotive topic this is.

Monetary incentives

"Dr Greaves said: ‘With an aging population the old models of dementia care are not sustainable. A tsunami of frail elderly is threatening to engulf and bankrupt the NHS. Carrying on in the same way is simply not an option."

`A consortium of 162 GPs at 41 practices scooped the NHS Innovation Challenge Prize for Dementia run in collaboration with Janssen Healthcare Innovation at the annual NHS Innovation Awards.`

 

The scheme has cut waiting times for diagnosis and detection rates have soared from 30% to 100% of anticipated local cases. It has helped more patients stay independent in their own homes, and saved the NHS around £500,000 per year across a population of 280,000. The service integrates dementia care by putting consultant-led clinics in the community and pulling together end-of-life care and social care services.

A GP-led dementia service that slashed diagnosis waiting times and boosted detection rates has won an £80,000 NHS innovation prize.

 

 They are pulling together end-of-life care and social care services  because someone has been diagnosed EARLY with dementia. Surely that is rushing it !

 

 

Here is another incentive:

 

 GPs in England are to get £30 000 a year for taking on board the `named person` role for the elderly. http://www.gponline.com/News/article/1225160/30000-per-practice-named-clinician-role/

 

 

Liverpool Pathway in Scotland

The last update in the Scottish Partnership for Palliative care is still singing the praises of the Liverpool Care Pathway:

 

It discusses misconceptions and explains how it works:

• Requires staff ensure all decisions to either continue or to stop a treatment are taken in the best interest of each patient. It is not always easy to tell whether someone is very close to death – a decision to consider using the Liverpool Care Pathway should always be made by the most senior doctor available, with help from all the other staff involved in a person’s care. It should be countersigned as soon as possible by the doctor responsible for the person’s care.

Read more http://www.palliativecarescotland.org.uk/content/lcp/

There is more collaborative work to be done with stakeholders (?) and in due course a report.  So there is no sense of urgency about getting end-of-life-care right and no acknowledgement that in thousands of cases it has gone horribly wrong. Nothing is said about patients who are placed on the LCP at the week-end when no senior doctor is available.


Given that these decisions involve the use of syringe drivers, anticipatory prescribing, use of sedation and narcotics and limitation of hydration and nutrition we really do need to know that the patient is actually dying. But that`s the problem.


Can we trust them ?

South Lanarkshire Council suing people who criticize them

South Lanarkshire Council are using taxpayers money in order to bring defamation claims against people who criticize them. In doing so they expose themselves ignorant of the law, vexatious and acting against the interests of free speech.


Read Morehttp://www.jonathanmitchell.info/2010/09/02/whats-wrong-with-south-lanarkshire/

Lverpool Care Pathway to be re-branded, not axed

An article in the Telegraph indicates that the Liverpool Care Pathway is not going to be abolished: In fact the new protocals could be worse for patients because doctors are going to be allowed to make the decisions regardless of whether the patient has the capacity to make their own decisions:

The discredited Liverpool Care Pathway is to be “rebranded” rather than abolished, senior doctors have said. In July ministers said the end-of-life protocals would be axed, after a damning independent review undercovered frequent and “heartbreaking” cases of patients being denied water and left desperately sucking at sponges used to moisten their mouths.

 

Instead, every patient would receive individual end-of-life care plans, following the review led by Baroness Julia Neuberger. However, doctors who led criticism of the pathway say new draft guidance, seen by the Daily Telegraph, outlining a replacement scheme will perpetuate many of its worst practices, allowing patients to suffer days of dehyration, or to be sedated, leaving them unable to even ask for food or drink.

Professor Pullicino points out the difficulties of making predictions about when a patient is near death:

 “There is no indication about how patients who are in the last days of life are going to be diagnosed as such. There is no mention of a research base to improve this prediction. This was a main central concern of the Neuberger report,” he said. Any replacement scheme should be studied before being introduced, or risked simply repeating the same problems, he said.

“The Liverpool Care Pathway not only produced many instances of suspected hastening of death but also repeated instances of poor care.”

“The fact is that little seems to have changed, including the use of syringe drivers, anticipatory prescribing, use of sedation and narcotics and limitation of hydration and nutrition by a ‘best interest’ team decision.

Read More http://www.telegraph.co.uk/health/healthnews/10487109/Liverpool-Care-Pathway-being-rebranded-not-axed.html

Starved to death on Liverpool Care Pathway

 This is an extract from an article in the Daily Mail:

The son of an elderly hospital patient who was 'starved to death' on the Liverpool Care Pathway has called for police to launch a murder inquiry.

 

Peter Tulloch believes the death of his mother, Jean Tulloch, was the result of 'negligent' and 'unlawful' care at the Western General hospital in Edinburgh.

 

The 56-year-old has urged police to take action after an independent medical report found Mrs Tulloch had gone without food or water for up to 30 hours in the weeks before her death.

Read more: http://www.dailymail.co.uk/news/article-2513136/It-murder-says-son-woman-starved-death-Liverpool-Care-Pathway-calls-police-inquiry.html#ixzz2mZlc5z8g

Living and Dying Well in Scotland

ACTION PLAN HERE

Living and Dying Well` aims to enable NHS Boards to plan and develop services. These services are about end of life care for patients and families.` Notice that LIVING AND DYING WELL is more about dying than living. The Government is encouraging NHS Boards to be on the hunt for vulnerable patients. It`s the same agenda as in Dying Matters who encourage GPs to look for their one percent.  Here is what they have to say:

We need to identify those who would benefit from it. [Benefit is not defined here]. Certain triggers will lead to an assessment or review of end of life care needs. [Needs appear to be physical, social, emotional and spiritual? But are some of these the business of the NHS?] The triggers for a review of end of care needs are:

diagnosis of a progressive or life-limiting illness [How limiting does it have to be? Not defined.]

critical events or significant deterioration during the disease trajectory indicating the need for a 'change of gear' in clinical management. [Change of gear? Stop thinking cure and start thinking palliative care.]

significant changes in patient or carer ability to 'cope' indicating the need for additional support. [What additional support?]

the 'surprise question' (clinicians would not be surprised if the patient were to die within the next 12 months)

onset of the end of life phase - 'diagnosing dying'.

[The problem is that diagnosing dying is not an exact science. So a change of gear may be inappropriate.]

 

 

Is the system being set up not more about cutting costs than providing care?

See The Liverpool Care Pathway - cost efficiencies



Why GPs are vital to end of life care

According to Dying Matters  HERE

On the Dying Matters website we read that GPs are the gate-keepers to health services in England. `If you do not plan community support for a dying patient, he or she will end up in crisis using emergency services.`

So in order to prevent these frail elderly from clogging up the system and costing the NHS a fortune it would make good economic sense to find the one percent of patients that statistics show die each year. Having identified them, patients can then be encouraged to have those sensitive conversations. Most will say they would prefer to die at home. It does not matter that many elderly will be shuffled off to care homes against their will - we`ll still call that a `home.` Let them die there.

Having found the GP`s 1% we can put theire names on a register and spread the information around the community. That includes the ambulance service who do not need to bother responding to emergency calls or giving these patients emergency treatment. After all, they`re on the register; they`re dying - maybe - and they wanted to die at home. So let them get on with it.

According to the website: `Caring for a patient right through to the end-of-life can be one of the most satisfying aspects of medicine.` !!

In other words GPs should not feel uneasy about what they are doing. After all, it`s satisfying.

Here is an example of an Ambulance Service which is prepared to deal with the frail elderly:

WMAS maintains an End of Life register for patients in Worcestershire to ensure that ambulance crews are aware of patients who are at the end of life and the arrangements that have been made between clinicians and patients. This means that patients’ wishes for their treatment are respected. [They may wish to die at home. Do not rescucitate or have guardians doing the `wishing` for them if someone says they lack capacity !! ] HERE

What is palliative care?

From: LIVERPOOL CARE PATHWAY - A NATIONAL SCANDAL

To a challenger that this was euthanasia, Baroness Finlay, an invited key speaker at the jubilee event, might have replied:

No, euthanasia is about intent. Palliative care intends to improvve the care when people are inevitably dying.

And Dr. Barton could tell her patient was dying...

This is from The Big Questions-

Jackie Leotardi - 
Yes. One hospital was paid £308,000 for reaching targets for putting people on what is basically a euthanasia programme. Baroness, it is euthanasia.

Baroness Finlay -
It… No, euthanasia is about intent. The Liverpool Care Pathway doesn’t intend to kill people. It intends to improve the care when people are inevitably dying. That’s quite different.

The lines are become so blurred they are imperceptible to see.
 

Read More

Golden Standards Framework

So there you are. You`ve just retired, looking forward to rounds of golf or more time with the grandchildren and getting into a more leisurely lifestyle. But No. The Golden Standard Framework insists you must think about death, make advanced decisions, and cut down your expectations about future treatment. All of this will make you feel better .

The Golden Standard Framework plays a part in Living and Dying Well in Scotland, so it would be a good idea to know what this is about.

Staff responsible for your care have been primed to have certain sensitive conversations with you and be warned that there are triggers when to have these conversations:

 Triggers

All residents on admission to care homes
Also life changing event e.g death of spouse
making or changing a will
retirement
following a new diagnosis of life limiting illness
assessment of patient need
in conjunction with prognostic indicators
multiple hospital admissions

The conversation will pressure you to make decisions about:

what you wish to happen and not to happen towards end of life (preferably what not to happen)
e.g do not rescucitate. Do not treat.
preferred place of care or death (preferably home, or homely setting, ie care home)
If you might lack capacity to make your own decisions,who is going to make these decisions on your behalf about these matters? Then think about setting up a power of attorney if you do not have one.(Because if you don`t have one we`ll make the decisions for you.)