The NHS kills 125,000 people a year. Let\’s change the name of this killing says Minister

The pluperfect of politics:

The Liverpool Care Pathway – the controversial set of clinical guidelines for those close to death – should undergo a name change, a minister has suggested.

People are just beginning to understand that the Liverpool Care Pathway is the method by which the NHS kills 125,000 people a year. In order to aid such understanding we must of course change the name of the Liverpool Care Pathway.

It is just the most perfect example of what politics is all about isn\’t it?

Anyway, my suggestion for the new name for the LCP: \”This is how the NHS killed granny and this it how it will kill you. Oh, and thanks for the lifetime of paying for all of this.\”

We could of course give it it\’s real and simple name. Euthanasia. But that seems to make some people uncomfortable for some strange reason. Can\’t imagine why: after all, it is good for the State that the old pop their clogs uncomplainingly and early, isn\’t it? And what\’s good for the State is the only worthwhile moral guide in existence.

50 thoughts on “The NHS kills 125,000 people a year. Let\’s change the name of this killing says Minister”

  1. If I were to be tipped into the darkness by a doctor, I’d much prefer a shot of potassium to a lingering death deprived of food and fluids.

    And I’ve always assumed the “Care” component of the LCP was a piss-take. The Liverpool Termination Programme would be more appropriate.

  2. People are just beginning to understand that the Liverpool Care Pathway is the method by which the NHS kills 125,000 people a year.

    This is simply a lie.

    People die, that’s the way things are. A lot of them die in hospital. The LCP is a protocol for managing dying patients. There needs to be a balance struck between giving any treatment that helps the patient and not giving treatment that makes the experience worse. It’s a good idea to have guidelines for making these decisions.

    There have been allegations of abuse. In so far as they are true, it’s not the fault of the LCP. The LCP does not tell carers to do any of the things it is accused of.

  3. “The LCP does not tell carers to do any of the things it is accused of.”

    Yes, and guns don’t kill people either. People do.

  4. “We could of course give it it’s real and simple name. Euthanasia.”

    Nonsense. Unless Euthanasia now involves allowing dying people to die. I always thought it implied actively killing them.

    “Can’t imagine why: after all, it is good for the State that the old pop their clogs uncomplainingly and early”

    No-one dies any earlier under the LCP than they would otherwise.

    Tim’s point can be extended to the conclusion that if you see a man in the street dying of a heart attack, and there’s nothing you can do for him, you ought to rip open his chest with your teeth and manually massage his heart. Of course, that’ll cause him a lot of pain, and has zero prospect of success, but it’s better to be seen to do something, even if it’s harmful, than to make the chap comfortable as he slips away.

  5. Dave and PaulB.

    The LCP is designed to kill people earlier than they would have otherwise. Only by a small amount mind.

    But the problem is that LCP was trialled in a small area where everyone could be trained properly. And it worked.

    But a small trial doesn’t necessarily equate well to a country wide policy.

    When you have thousands of people implementing the policy and who have various degrees of competence and pressures of time and budget impacts then there will be abuses. And there have been cases where people have been put on the “pathway” when they shouldn’t have been.

  6. “The LCP is designed to kill people earlier than they would have otherwise.”

    Nonsense. That’s utterly untrue. A fundamental tenet of the LCP is ‘nothing shall be done to hasten death’.

    “When you have thousands of people implementing the policy and who have various degrees of competence and pressures of time and budget impacts then there will be abuses.”

    More complete bollocks. The LCP is just a way of bringing hospice care into hospitals. Do you have a problem with the many hospices and hospice workers around the country?

    There may be abuses, and we need to be on the lookout for them, but the presumption of widespread evil and malice amongst medical staff is not supported by the evidence.

    “And there have been cases where people have been put on the “pathway” when they shouldn’t have been.”

    Yeah, like you would know. You don’t even know what the Pathway is, so your pretence of knowing whether someone should be on it or not isn’t going to fool a child.

  7. I can only assume the blog’s author has never worked on a ward and been involved in the decision making process behind managing a patient’s end of life using the LCP guidelines. If so, he would realise it is used for patients who several healthcare workers believe to be approaching imminent death regardless of any intervention and is designed very carefully to remove suffering. Withdrawing intravenous hydration (oral water is never, ever withdrawn – but terminal patients often are too unwell to drink) is a reflection not of cruelty not wanting to expedite death, but rather a recognition that the IV fluids won’t affect outcome and any thirst (rare in terminal patients) is best addressed with oral fluids, wetting the mouth and careful use of sedatives. Clearly the prediction of someone being imminently about to die doesn’t prove correct 100% of the time, because medicine is (shock!) imperfect. I would suggest the author shadow a hospital palliative team for a day to get a real idea of how/when/why the LCP is applied before repeating nonsense. Rants like these are a bit like farting.

  8. So Much for Subtlety

    PaulB – “This is simply a lie.”

    No it isn’t. People die, yes. But if people die a little earlier because I put sixteen rounds into their torso from an AR-15 we call that murder.

    “People die, that’s the way things are. A lot of them die in hospital. The LCP is a protocol for managing dying patients.”

    No. That’s a lie. It is a protocol for managing patients the doctors think are going to die. That is a very different claim. It is also utterly irrelevant. If I put fifteen rounds from an AR-15 into the skull of a dying cancer patient we do not say the cancer got him. It is not a protocol for managing people with cancer. Yet. So too people who die of thirst, die of thirst. Not of cancer.

    “There needs to be a balance struck between giving any treatment that helps the patient and not giving treatment that makes the experience worse. It’s a good idea to have guidelines for making these decisions.”

    Indeed. Who disputes this? Who makes the decisions? The doctors’ job is not to make this call as far as I can see. It is to do whatever is within their power to help the patient. It is for the patient or perhaps their next of kin to decide to have or not to have treatment. This is not what the LCP is doing.

    9 Dave – “Nonsense. Unless Euthanasia now involves allowing dying people to die. I always thought it implied actively killing them.”

    Really? So if I put a bunch of undesirables in the back of a truck and go for a ride, it is not my fault if they all die of CO poisoning? As long as I do nothing to actively kill them?

    Doctors and nurses have a duty of care above that of the rest of us. Giving someone dying of thirst a glass of water would, I think, fall into that category. Don’t you?

    “No-one dies any earlier under the LCP than they would otherwise.”

    Sorry but everyone dies earlier than they would have otherwise. That is the point.

    11 Dave – “A fundamental tenet of the LCP is ‘nothing shall be done to hasten death’.”

    Which misses the point. If you deprive a patient of consciousness – the first step on the pathway – the patient needs other people to do things for them. Like provide food and water. If you then decline to provide hydration – the second step on the pathway – the third step, death, will soon follow. You don’t have to take any active steps to cause death but you are causing death none-the-less. It is hypocritical to claim otherwise. You may as well claim that Belgium paedophile who left two girls in his basement to die of thirst didn’t kill them. Oh yes he did.

    “More complete bollocks. The LCP is just a way of bringing hospice care into hospitals. Do you have a problem with the many hospices and hospice workers around the country?”

    No it isn’t. It is a way of bringing a particular type of hospice care into hospitals – to hasten the deaths of people the doctors think are going to die anyway. Quietly and with a minimum of fuss. No more.

    “There may be abuses, and we need to be on the lookout for them, but the presumption of widespread evil and malice amongst medical staff is not supported by the evidence.”

    Actually all he said was that there were abuses. Which is to say in roughly half of all cases so far, no one has even told the relatives. Doctors are making decisions they have no right to make. And no one is accusing anyone of evil and malice. Just depraved indifference. That suggests a guilty conscience to me. What do you do for a living Dave?

  9. So Much for Subtlety

    PF – “If so, he would realise it is used for patients who several healthcare workers believe to be approaching imminent death regardless of any intervention and is designed very carefully to remove suffering.”

    No one is disputing any of this. The problem is that doctors are making this call and not actually telling the patients and their relatives. That is not acceptable.

    Although obviously withdrawing hydration is not about removing suffering. Nor is drugging people unconscious – that is more drugs than are usually needed to deal with pain. That looks like drugging them so they can’t make a fuss about dying of thirst.

    “Withdrawing intravenous hydration (oral water is never, ever withdrawn – but terminal patients often are too unwell to drink) is a reflection not of cruelty not wanting to expedite death, but rather a recognition that the IV fluids won’t affect outcome and any thirst (rare in terminal patients) is best addressed with oral fluids, wetting the mouth and careful use of sedatives.”

    Sorry but what do sedatives have to do with thirst? So, yes, some patients cannot drink but the pathway withdraws hydration anyway. So they will die in a few days of thirst all other things being equal. You read what you write? In such cases withdrawal does expedite death. A lot. Also given nurses can’t be arsed to give fluids to patients who are conscious and can complain, forcing unconscious ones to rely on nurses to notice when they need fluids is simply hastening their death through dehydration.

    “Clearly the prediction of someone being imminently about to die doesn’t prove correct 100% of the time, because medicine is (shock!) imperfect.”

    Although once you drug them into a coma and withdraw fluids, we can predict death with very nearly 100% accuracy. But you are still claiming this is not the point?

  10. @SMFS ‘Sorry but everyone dies earlier than they would have otherwise’

    Ha – that made me chuckle, actually. Very god and also true, of course.

    As I have bored before, my grandmother died in an NHS hospital in conditions in which, were they to be applied to a dog or horse, would have lesd to a prosecution.

    She died of thirst and malnutrition at the end of three weeks, during which she descended from poorly but coherent (and dying – she had heart failure) to rambling and vacant, with oral thrush and bedsores.

    I know it’s a cliche, but nurses literally chatted about their night out as she lay in her own urine.

    One of my life’s few regrets is that I didn’t do anything about it, beyond giving her water. (My aunts cleaned her in her bed several times.)

    When my grandfather recently died in the same hospital, it was made abundantly but subtly clear to the nurses and doctors that a number of his children and grandchildren were lawyers or otherwise likely and able to make trouble. He was cared for very well.

    It’s a great shame not everyone has that power.

  11. SMFS says it all, here’s a PS.

    Of course this is euthanasia.

    If you deny people water, they die. In the UK, doctors can do this because it’s classified as a medicine.

    Death by dehydration is painful and messy and the victim makes a fuss, croaking ‘Help!’ a lot. So they pump them up with opiates to keep them quiet. Apparently almost all die within 29 hours.

    Euthanasia.

  12. And what you have all overlooked is that the NHS PAYS the hospital for every patient put on the Liverpool Care Pathway.

  13. SMFS>

    “Really? So if I put a bunch of undesirables in the back of a truck and go for a ride, it is not my fault if they all die of CO poisoning? As long as I do nothing to actively kill them?”

    Seriously? You have a very odd definition of ‘doing nothing to actively kill them’ if it permits you to actively gas them to death.

    The rest of your nonsense is just lies and slander. The LCP is not what you say it is. It’s pointless repeating the same truths when you continue to assert untruths. Anyone who cares can go to the LCP website and read the facts for themselves.

    To reiterate, though, in case anyone cares:

    The LCP does not do anything to hasten death. Anyone who says it does is mistaken or, as in this case, lying.

  14. So Much For Subtlety

    Dave – “Seriously? You have a very odd definition of ‘doing nothing to actively kill them’ if it permits you to actively gas them to death.”

    I am not actively gassing them to death. I am driving a truck that happens to vent its exhaust into the rear cabin. Or if you like, I am sitting in a parked truck whose rear cabin happened to be sealed against air getting in and out and so every person therein is dying from their own CO2 output. Either way I am not actively assisting their deaths in any way.

    “The rest of your nonsense is just lies and slander.”

    And Dave concedes the argument. Thank you and goodnight.

    “The LCP is not what you say it is. It’s pointless repeating the same truths when you continue to assert untruths. Anyone who cares can go to the LCP website and read the facts for themselves.”

    And the facts on the LCP say exactly what I said it said, they just dress it up a little. Even Wikipedia refers to the “new sedation-and-dehydration regimes”. Does it provide for sedation? Yes it does. Does it provide for dehydration? Yes it does. Are doctors asking permission before putting people on this one way death to the morgue? About half the time.

    “The LCP does not do anything to hasten death. Anyone who says it does is mistaken or, as in this case, lying.”

    By definition sedation raises the risks of dying. It hastens the process. Doctors may do it, but only if their intent is to relieve pain. Drugging someone until they are unconscious is more sedation than pain management requires in the vast majority of cases. Even if they do not go that far, people who are sedated have depressing breathing functions. Which is often enough to kill the very sick.

    Someone who is actually unconscious cannot manage their basic bodily functions – like spitting or licking their mouth. Hence they need a (probably disinterested and uncaring) nurse to do it for them. By definition this will hasten death in some cases.

    Above all, withdrawing nutrition and hydration will kill people in very short order.

    It is what it is. I am not the one lying here Dave.

  15. It is what it is:

    1. The LCP is only as good as the people who are using it
    2. The LCP should not be used without the support of education and training
    3. Good communication is pivotal to success
    4. The LCP neither hastens nor postpones death
    5. Diagnosis of dying should be made by the MDT [multi-disciplinary team]
    6. The LCP does not recommend the use of continuous deep sedation
    7. The LCP does not preclude the use of artificial hydration
    8. The LCP supports continual reassessment
    9. Reflect, Audit, Measure and Learn
    10. Stop, Think, Assess and Change

  16. So Much For Subtlety

    PaulB – “It is what it is:”

    Paul, you just don’t get it. That is what it claims to be. Not what it is. See the difference?

    “1. The LCP is only as good as the people who are using it”

    No sh!t.

    “9. Reflect, Audit, Measure and Learn
    10. Stop, Think, Assess and Change”

    11. Don’t get caught

  17. SMFS: you just don’t get it. Whether or not the LCP exists, hospitals will have care of dying patients. Whether or not the LCP exists, hospitals will have to strike a balance over what treatments it’s right to apply.

    In so far as there’s a problem, it’s not with the LCP but with failures to adhere to it.

    Here‘s an article about terminal care written by someone who knows what she’s talking about.

  18. The next time there is an allegation of Police brutality, where someone gets a good kicking in the back of a Police van, or ‘falls down some stairs’ in the nick, I’m going to direct all the outraged Lefties to this thread. Because apparently if the correct procedures are all written down on a website somewhere then everything that happens out in the real world by definition is all OK, because all State employees never ever do anything they aren’t supposed to, and all regulations are adhered to 100% of the time.

    I’m beginning to wonder why we have a Police Complaints Commission, and numerous Ombudsmen. Surely if its all written down, there can never be anything wrong with what has occurred?

  19. Jim, no one has said that nothing ever goes wrong. Just that what may go wrong is not the fault of the LCP.

    If the police beat someone up contrary to regulations, we blame the police not the regulations.

  20. I’ve made this point before, but it doesn’t seem to have got through so I’ll make it again.

    Whatever its merits and demerits, the LCP is as much a standard procedure in private healthcare as it is in the NHS.

    This post could equally well read “the Liverpool Care Pathway is the method by which private healthcare kills (x number of) people…my suggestion for the new name for the LCP: “This is how private healthcare killed granny and this it how it will kill you.”

    The entire post is (deliberately?) misleading.

  21. “If the police beat someone up contrary to regulations, we blame the police not the regulations.”

    And where are the prosecutions for incorrect implementation of the LCP then? Where are the struck off doctors and nurses? Where are the murder enquiries? Or has every single person who was put on the LCP been given 100% absolutely correct care, even the ones who have survived being put on it, or only taken off of it after determined opposition from family members? Do you agree that if the LCP is not adhered to in practice as it should be in theory that a criminal act has occurred?

  22. So Much for Subtlety

    PaulB – “Whether or not the LCP exists, hospitals will have care of dying patients. Whether or not the LCP exists, hospitals will have to strike a balance over what treatments it’s right to apply.”

    Of course they will. People die. But I am not sure it is the hospitals’ job to strike a balance over what treatments it is right to apply. That ought to be a decision for the patient, their family and NICE. Which all too often it isn’t.

    But they will have their own death panel that will decide what treatments to offer. I will agree with that. So what sort of treatments should they offer? Let’s agree that they should offer as much opiates as are needed to deal with pain. Are we in agreement that in most cases putting someone into a coma is more opiate than is needed to deal with the pain? That is, a lot fewer than 125,000 people a year have such pain they need to be unconscious. But let’s also agree that their job is to provide food and water. If artificial hydration through a drip is cheap and easy to do, why aren’t they doing it? Why are they instead relying on the expensive and unreliable oral hydration by nurse? Why is it routine in the LCP to drug people into a coma and then deny them water?

    By all means, people will die. Let’s deal with the pain – even to the point of unconsciousness if need be – but let’s not hasten that death through thirst.

    “In so far as there’s a problem, it’s not with the LCP but with failures to adhere to it.”

    I see no evidence of that at all. It looks to me that they are doing precisely what they have been told to do. It would be hard to explain why across the entire country so many NHS Trusts so happened to start drugging people into a coma and then letting them die of thirst if they did not think that is what the LCP wanted.

  23. So Much for Subtlety

    PaulB – “If the police beat someone up contrary to regulations, we blame the police not the regulations.”

    Yet I don’t see you blaming anyone. You are defending the regulations. But you are not condemning the doctors and nurses who are, it seems, killing people. No calls for their arrest and prosecution. No demands people be fired.

    You are simply defending the status quo and reassuring is there is nothing to worry about.

  24. Do you agree that if the LCP is not adhered to in practice as it should be in theory that a criminal act has occurred?

    No, the LCP does not have legal force. A criminal act has occurred when there’s a breach of criminal law.

    It’s not usually a bad thing if a patient is taken off the LCP. It’s the procedure being followed as it should be – “The LCP supports continual reassessment”.

    Most of the complaints about the LCP seem to amount to no more than inadequate communication with relatives. I’d like them to do better, but I don’t think doctors should be struck off or prosecuted for that.

    Are we in agreement that in most cases putting someone into a coma is more opiate than is needed to deal with the pain? That is, a lot fewer than 125,000 people a year have such pain they need to be unconscious.

    Strange question. Here’s a doctor who works in palliative care of the elderly:

    …We are also accused of heavily sedating patients at the end of life. This is not the case. We use small doses of medicines such as morphine or midazolam to help relieve distressing symptoms such as pain, breathlessness or agitation. Studies of the use of medication prescribed to patients on the LCP have found that very conservative doses are used and patients are certainly not ‘heavily sedated’. My intention when prescribing at the end of life is wholly to relieve suffering and definitely not to hasten death.

    If artificial hydration through a drip is cheap and easy to do, why aren’t they doing it?

    The same doctor:

    Sometimes we continue fluids subcutaneously if there are concerns about a patient suffering from thirst or if the family has very strong views on withdrawing artificial hydration. The problem with continuing intravenous fluids in these patients is that it involves inserting intravenous cannulae in order to administer them. This is painful, often very difficult and sometimes near impossible in patients that have been in hospital for a number of weeks. I know that when I reach the very final days of my life I certainly do not want to have multiple cannulation attempts and would much prefer that someone offered me good mouth-care to keep my lips and tongue moist.

    To which I would add that in some cases intravenous hydration is the opposite of what the patient needs, because their body can’t handle the fluid. They just need their lips and mouth kept moist.

    But you are not condemning the doctors and nurses who are, it seems, killing people.

    What do you mean, “it seems”? If you mean that the Daily Mail makes up stories about it, then no, the only people I’d condemn for that are the journalists.

  25. “No, the LCP does not have legal force. A criminal act has occurred when there’s a breach of criminal law.”

    Well if the LCP is not adhered to rigorously then death may have been accelerated. Too much sedation may have been given, too little hydration, or indeed the wrong diagnosis of imminent death in the first place. In such a cases has a criminal offence taken place?

  26. It’s a criminal offence (murder or assisted suicide) if a doctor gives a patient treatment with the primary purpose of making them die sooner. Mistakes are not usually criminal.

    Should George V’s doctor have been charged with murder (or high treason), had the facts been known?

  27. “It’s a criminal offence (murder or assisted suicide) if a doctor gives a patient treatment with the primary purpose of making them die sooner. Mistakes are not usually criminal.”

    What should happen to the people making the mistakes then? Or are you saying there are none?

    And as for King George V’s doctor – I have always thought that what he did exceeded his authority as a physician. The point is in the absence of the LCP any doctor tempted to take the ‘George V route’ is risking his career and maybe his freedom. With the LCP a doctor can be much more blase about who is going to imminently die. After all, its all written down, its all part of the job now. Patient is diagnosed as about to die, patient goes on LCP, patient dies, job done. No-one can prove whether the patient might have lived considerably longer if they hadn’t been put on the LCP, they’re dead, so the counterfactual cannot occur. Its all so nice and circular. This patient is about to die, so we’ll put them on the LCP, quelle surprise, they’ve died. So we were obviously right.

    I mean, why not just shoot them? They’re going to die anyway, a doctor has said so. So it must be true. Quick bullet to the back of the head, save a fortune in health care costs. How is it any different to the LCP?

  28. Everyone makes mistakes, including doctors. The appropriate way to deal with mistakes depends on all the circumstances, for doctors as for anyone else.

    There are three possible aims for treatment: cure sickness, slow down the progression of sickness, and alleviate the symptoms. A decision to put a patient on the Liverpool Care Pathway constitutes a decision that, in the face of imminent death, treatment will be directed only at alleviating symptoms. I don’t think anyone here is arguing that that’s a decision that should never be made. Some may think that it’s a decision that should be made only by the patient, or perhaps by close relatives if the patient is unable to express a view: if so, I disagree. I think it would be wrong to require doctors to provide any treatment demanded of them, and medical praxis has never done so.

    Your latest comment, and some earlier ones, seem to be based on an understanding that heavy sedation is routine under the LCP. That is clearly contrary both to what the LCP says “The LCP does not recommend the use of continuous deep sedation” and to what doctors using it say “We use small doses of medicines such as morphine or midazolam to help relieve distressing symptoms such as pain, breathlessness or agitation.”

    But let’s suppose that there are patients, no longer able to give or refuse consent, who are likely to die in hours or days, for whom effective pain control would diminish their slight chance of rallying for a few weeks. Are you saying that in such cases painkilling drugs should be withheld?

    I could answer your question about shooting people, but I suspect that as a caring human being you know the answer already.

  29. The point is there is zero control of this system. There is no-one overseeing the doctor’s decisions (and its not always doctors making the decisions either) and screwing a few of them to the wall for overstepping the mark pour encourager les autres. As it stands no-one knows whether there is de facto euthanasia being practised in the NHS because there is no-one policing it. We have given the power of life and death over very vulnerable people to a large group of individuals and assuming that they all have motives as pure as the driven snow. And that will not be the case in every hospital in the UK, or in every case of LCP recommendation. Given the numbers involved it is a dead cert that at least one person has been murdered by the NHS and the LCP.

    At the very least no doctor should have the authority to place someone on the LCP without the agreement of the relatives. In my opinion any medical person who did so should be struck off and possibly jailed.

  30. Given the numbers involved it is a dead cert that at least one person has been murdered by the NHS and the LCP.

    I think it very probably true that at least one person has been murdered by an NHS doctor claiming to be following the LCP. However, I doubt that the NHS or the LCP were causative: after all we know that George V was murdered by a doctor long before either existed.

    The implication of your last paragraph is that doctors should withhold pain control from dying patients unless the relatives all agree to it. That doctors should attempt to resuscitate dying patients unless the relatives all agree that they shouldn’t. That doctors should be legally required to inflict pointless suffering on dying patients unless the relatives all agree that they shouldn’t.

    If it’s true that doctors are engaged in a conspiracy to murder us all, that may well be a good idea. Otherwise, it’s going to cause a lot of suffering and put a lot of good doctors off getting involved in terminal care.

  31. The implication of my last paragraph is that we are assuming that doctors always 100% have the best interests of the patient at heart. And I would argue that human nature is such that will not always be the case. And equally human nature is such that the relatives are more likely to have the best interests of their family member at heart, than a random stranger. And thus if one has to get the consent of the relatives it provides a buffer to any doctor tempted (for whatever reason) to make an unconsidered diagnosis. There are a myriad of scenarios where a doctor might choose the LCP at a given point when to do so might assist him or his team of staff, because he ‘knows’ the patient is going to die fairly soon anyway, so its not going to ‘harm’ anyone if the process starts now, or next week is it? Having to get consent would force doctors to be 100% sure of their ground before approaching relatives. Otherwise you have given the power of life and death to doctors (who you seem to think are some sort of uber-humans who can do no wrong, and never make decisions for personal reasons), with no oversight. To me that’s totally wrong, and I fail to see how anyone can think it correct.

    I have to say that if it were private doctors (in the US for example) who had this power, you’d be hopping up and down like a mad thing denouncing the prospect of doctors ending people’s lives potentially for financial gain. But because its in the State run NHS its suddenly all OK.

  32. Are you suggesting that relatives should be able to force doctors to give treatment they think is bad for the patient? Because I strongly disagree with that.

    However, we do provide for a Lasting Power of Attorney for Health and Welfare which bestows on a nominated attorney, typically a relative, the authority to give or withhold medical consent in the event of the donor’s incapacity. Currently this is cumbersome and quite expensive to arrange. I see no reason why the procedure should not be made much easier – the patient fills in a simple form and lodges it with their GP, and it becomes the GP’s duty to pass it on to the hospital in the event of terminal illness.

    The effect would be that doctors would have to get consent from the nominated relative before administering opiates or sedatives (or any other treatment, time permitting).

    I note what you say about my attitude to the NHS, but I think the unequal approach is on your part. Your disapproval of Dr Dawson’s murder of George V was remarkably mild compared with your desire to imprison NHS doctors for lesser sins.

  33. “Nonsense. Unless Euthanasia now involves allowing dying people to die. I always thought it implied actively killing them.”

    If your job is to care for someone, and you knowingly deprive them of food, and even of water, then without doubt you are guilty of gross negligence manslaughter at the very least. Without doubt.

  34. Power of Attorney would make no difference because the LCP is not considered to be a course of action requiring consent. The doctor has the ultimate decision. That is clear from the LCP documentation. They ‘should’ consult with relatives (but quite often do not) but they do not have to obtain consent for the patient to be put on the LCP. They can place someone on the LCP in the face of opposition from the relatives if they so choose.

    The basic issue is this – who has the power over the patient – the doctor or the patient himself (or his nominated proxy)? Imagine a world where there was no State run medicine. All medicine was pravately contracted and paid for. Do you consider doctors should have the power of life and death in those circumstances? Or should the doctor be considered as any provider of a service – subservient to the person paying for that service?

    I believe you are blinded by the nature of the NHS – because it is State run, you seem to consider that gives doctors a power over patients that I do not think one human should have over another. Doctors are human beings, not all knowing supermen. As such they should not be given the power to choose life or death for their patients. It is immoral to consider otherwise.

  35. Jim, the issue here is not the LCP – no one has raised any real objections to what the LCP says – but the actual treatment being given.

    First, doctors are not and never have been required to give any particular treatment on demand. This is nothing to do with the NHS, it’s the way medicine works, and rightly so.

    Second, doctors are required to get a patient’s consent for any treatment they administer, if the patient has the mental capacity to make the decision. The LCP can not and does not change that. If the patient does not have mental capacity, then the decision-making responsibility depends on whether the patient has given legal authority to an attorney. If there is no attorney, the doctor should consult close relatives if available, but has the duty to make the decision. But if there is an attorney, then treatment cannot be given without the attorney’s consent.

    The one meaningful concern expressed here is that doctors may push a patient into a downward spiral by administering opiates and sedatives. A patient has the right to refuse this treatment. If a patient lacks mental capacity to refuse the treatment, his attorney can do so.

    In practice, few patients have created a Lasting Power of Attorney for Health and Welfare, so usually it falls to the doctor to make the decisions. I am suggesting that we should make it much easier to create such an LPA. What concerns do you have that this suggestion does not address?

    The law on this treats NHS doctors exactly the same as doctors practising privately. Are you saying it shouldn’t?

    You can read the GMC’s guidance for doctors here.

  36. As I pointed out to you on a previous thread the LCP is not a treatment and therefore does not require the consent of the patient or his/her nominated Power of Attorney.

    http://www.liv.ac.uk/media/livacuk/mcpcil/documents/LCP%20FAQ%20August%202012.pdf

    Legally speaking it is perfectly in line with the LCP if a doctor decrees that a perfectly healthy (but perhaps incapacitated) patient is going to die and places them on the LCP and they die, its all been done according to the paperwork. The whole thing relies on the medical team making the right decisions 100% of the time, and never making decisions for non-medical reasons, with zero oversight. That is not acceptable in my view.

  37. Yes I know the LCP is not a treatment – that’s what I’ve been trying to tell you. And since it’s not a treatment it’s not going to kill anyone – there’s no magic curse to make the patient stop breathing. It’s treatment decisions that matter. What do you want to change about the way those decisions are taken?

  38. Its like arguing with a jelly.

    Look the LCP is in reality a treatment, but legally speaking, as far as the medical professionals are concerned and possibly the lawyers too, though I’ll bet the doctors wouldn’t want to take it to court) it isn’t. So they can legally take the decision to implement it on any given patient they like with no consent from anyone required. Do you accept that?

    Let us take an extreme example. Imagine a doctor has an elderly patient who he knows (relative or close family friend). Who is wealthy, and plans to leave his entire fortune to this doctor. And this doctor has large debts, which he needs to pay off urgently. The patient is very sick and will probably die within a few weeks, but not immediately. Now if our indebted doctor decides to place the patient on the LCP a bit earlier than might otherwise be necessary, what safeguards are in place to prevent it? Does an independent doctor have to review the case and agree with his diagnosis? Does he have to obtain the consent of the relatives? Indeed does he even have to inform them of the decision? The answer to that is certainly no for the the first two, and while the LCP says that relatives should be informed, there appears to be no sanction against any doctor who fails to do so (multiple cases of this have been documented). So how exactly does the system prevent our putative Dr Shipman from claiming his first victim? Is there anything in the practical way the process is implemented that would catch him out? Or could he get away with it quite easily? And if he could get away with such an egregious case, how many more subtle cases do you think would never even cause a flicker? The dying cancer patient put on the LCP because beds are needed urgently? The extra person put on it because the hospital hadn’t reached its target of using the LCP that month?

    You are being incredibly naive if you think such a God-like process will never be abused by those implementing it.

  39. Oh, and I suppose this guy doesn’t know what he’s talking about either:

    http://www.dailymail.co.uk/news/article-2161869/Top-doctors-chilling-claim-The-NHS-kills-130-000-elderly-patients-year.html

    Well he’s only a consultant neurologist with practical experience of how the LCP is implemented on the ground in the NHS, so why take any notice of him eh? Far better to just read the LCP website and assume everything is tickety-boo. After all the alternative is to have to admit the NHS is practising de facto euthanasia, and we can’t have that for the ‘envy of the world’ now can we?

  40. I’m aware of three consultants who’ve expressed reservations – Patrick Pullicino, Peter Hargreaves, and Mark Glaser. But none of them has said anything like the claim in the Daily Mail headline about killing 130,000 patients. (The Daily Mail is a disgusting lying rag.)

    I’m not aware of any doctors actually working in terminal care who’ve expressed similar concerns, not even anonymously. If you know of any, I’d be interested to read what they have to say.

    LCP targets where they exist are for the proportion of patients who die in a hospital who are on the LCP. They do not give an incentive to accelerate death.

    The decision to put a patient on the LCP is not made by a single doctor: “Diagnosis of dying should be made by the MDT ”

    I’d be surprised if there were no occasions on which opiates are deliberately used to hasten the death of elderly, demented, and suffering patients. That is, I think it likely that there is a small amount of euthanasia going on. I think this is something that has always happened, independent of the LCP, or the NHS, ever since doctors had opiates to use, because some doctors think it the right thing to do.

    You’ve ignored all my questions about what it is you actually want to change.

    I may not look at this thread again. If you want me to see any further comments you make, please email me.

  41. Peter Hargreaves is (or was, the article I found about him dates to 2009) a consultant in Palliative medicine at the Royal Surrey Hospital Guildford, and Mark Glaser is a consultant oncologist at Imperial College. As such I think they probably have pretty good knowledge of terminal care in the NHS.

    I agree with you about the Daily Mail headline, it is utterly incorrect. But the truth (that of the 130,000 people who die annually on the LCP we have zero knowledge of how many deaths were accelerated) is just as shocking.

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