guide

Guidance

Catholic Church teaching on Euthanasia  

Pope Pius XII, who witnessed and condemned the eugenics and euthanasia programs of the Nazis, was the first to explicate clearly this moral problem and provide guidance. In 1980, the Sacred Congregation for the Doctrine of the Faith released its Declaration on Euthanasia which further clarified this guidance especially in the light of the increasing complexity of life-support systems and the promotion of euthanasia as a valid means of ending life. The new Catechism (No. 2276-2279) provides a succinct explanation of our Catholic teaching on this subject.

Before addressing the issue of euthanasia, we must first remember that the Catholic Church holds as sacred, both the dignity of each individual person and the gift of life. Therefore, the following principles are morally binding: First, to make an attempt on the life of, or to kill an innocent person, is an evil action. Second, each person is bound to lead his life in accord with God’s plan and with an openness to His will, looking to life’s fulfilLment in heaven. Finally, intentionally committing suicide is a murder of oneself and considered a rejection of God’s plan. For these reasons, the Second Vatican Council condemned “all offences against life itself, such as murder, genocide, abortion, euthanasia and wilful suicide” (Gaudium et Spes, No. 27).

UK:  Clinically-Assisted Nutrition and Hydration for non-imminently dying patients

The BMA’s new Interim guidance would enable doctors to dehydrate and sedate to death large numbers of non-imminently dying patients with brain injury, dementia, stroke, Parkinson’s, permanent vegetative state (PVS) and minimally conscious state (MCS) . The only two circumstances when clincally-assisted nutrition and hydration (CANH) is provided are if there is a decision by an authorised health and welfare attorney or following a clinician-led best interest process which supports the use of CANH.

The categories exclude those who are not considered to be imminently dying unless CANH is withdrawn or withheld. All the categories of patients lack mental capacity to make decisions for themselves so that the guidance is concerned with the circumstances CANH can be withheld or withdrawn in order to bring to an end the life of the patient.

The Nurse’s Code (NMC 2015) expects nurses to do no harm, conduct holistic needs assessments, be evidence-based in their practice and act as an advocate for the vulnerable.

Patients have reported feeling terrible thirst and other effects when being denied hydration. Additionally, the following dehydration- associated symptoms cannot be dismissed as just unfortunate:

Delirium, Restlessness, Agitation. Lowering of the pain threshold

 Diminishing of the analgesic properties of opioids and opioid neurotoxic side effects

At the same time, a report from the American Academy of Neurology updating their own guideline for managing prolonged disorders of consciousness was published in August this year, and contains some startling conclusions that are highly relevant to the BMA consultation, specifically:
• Four in ten people who are thought to be unconscious are actually aware
• One in five people with severe brain injury from trauma will recover to the point that they can live at home and care for themselves without help (Neurology August 2018).

We believe the new BMA guidance fails adequately to recognise the complexity and difficulty of diagnosis and prognosis, removes safeguards that, for all its shortcomings, the practice of referral to the Court of Protection provided. The BMA proposals will enable euthanasia ‘by stealth’.

Dr Shipman’s patients were murdered en masse and Dr Barton’s patients (so very many of whom died after being prescribed completely inappropriate opioid doses at Gosport Memorial hospital) did not, it seems, linger for days and weeks suffering the effects of starvation and dehydration which is a very cruel and unethical way to inflict death on anyone. Condemned prisoners are not expected to suffer where execution is legal and the ethics in such situations are being carefully considered these days.

How can innocent patients with conditions with or without potential for recovery become victim blamed for surviving inconveniently for those (family members and even health professionals) who may have at best a defeatist attitude to rehabilitation and at worse a deadly agenda where finance may, of course, be a lurking factor?

We have seen Eugenic ideology before.  The Guidance appears to have no regard for truth, and it is chilling to instruct doctors to basically falsify the death certificate, recording the death as due to the underlying condition (from which a patient would not have died in the time-frame) rather than as a result of dehydration, starvation and  sedation. Ethically-minded Coroners, knowing of such ‘guidance’ in medical deception will not accept falsified death certification, being mindful of not so distant European history.

Ideologies are dangerous, particularly for the most vulnerable people who require most protection.
• ‘Those who cannot remember the past are condemned to repeat it.’
(George Santayana)• ‘This saying ought to guide our public and private policy’
(Clairmont 2016)

The panel members of the Liverpool Care Pathway (Neuberger Review, More Care, less Pathway,) which had resulted in many terrible deaths, recommended the following:

Specialist Services, Professional Associations and the Royal Colleges should    hold and evaluate: Education, Training and  Audit programmes.

The aim of this recommendation was to teach health care professionals how to discuss and decide with patients, relatives and carers, the management of hydration needs at the end of life. Equally important, surely, in the name of compassion and humanity is true care for people who are not dying?  A non- defeatist, compassionate approach to their possible recovery is needed. The Supreme Court Ruling in July 2018 over the case of ‘Y’ is curiously-timed to coincide with this guidance and needs to be over ruled.

The education that the Neuberger important Inquiry recommended, cannot be supplanted by BMA guidance. Numerous submissions to the Liverpool Care Pathway Review from relatives and carers were critical of the common occurrence of fluid and nutritional needs being disregarded.

The BMA guidance has naturally to be interim and open to wide consultation, in line with the human rights of all, patients, relatives and professionals.
This BMA guidance if approved, will not stop health professionals’ right to conscientious objection, which will be exercised, in line with the expectations of nurses’ and doctors’ professional codes and their own regard for truth, true ethics and humanity.

USA : New guidelines seek to address misdiagnosis of disorders of consciousness

About four in 10 people who are thought to be unconscious are actually aware, according to new clinical guidelines for disorders of consciousness published in the journal Neurology.  The article in Neurology  2018 notes that, while the prognosis of patients with this condition differs greatly, some will eventually be able to function on their own and some will be able to go back to work. According to the guideline, approximately one in five people with severe brain injury from trauma will recover to the point that they can live at home and care for themselves without help.

The guidelines, which outline best practice for managing patients in vegetative and minimally conscious states, are the product of an extensive consultation process with members of three speciality societies — the American Academy of Neurology (AAN), American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living, and Rehabilitation Research.

Among its key recommendations, the document advocates for a careful evaluation of patients by a clinician with specialized training in management of disorders of consciousness, such as a neurologist or brain injury rehabilitation specialist. The evaluation should be repeated several times early in recovery—especially during the first three months after a brain injury. More via this link:

https://www.bioedge.org/bioethics/new-guidelines-seek-to-address-misdiagnosis-of-disorders-of-consciousness/12770

UK Royal College of Nursing

END OF LIFE CARE:

https://www.rcn.org.uk/clinical-topics/end-of-life-care

NUTRITION:

http://DHSSPS (2011) Promoting Good Nutrition – a strategy for good nutritional care for adults in all care settings in Northern Ireland http://www.dhsspsni.gov.uk/promoting_good_nutrition-2.pdf

The care of dying adults in the last days of life (QS144) has been published on the NICE website 3/3/2017. You can view the quality standard by following this link:

Care of dying adults in the last days of life (QS144)

All consultation comments were considered by the Quality Standards Advisory Committee (QSAC) and the minutes of this meeting are now available: https://www.nice.org.uk/guidance/QS144/documents/minutes-2

A summary of the consultation comments, prepared by the NICE quality standards team and the full set of consultation comments are also available: https://www.nice.org.uk/guidance/QS144/documents/consultation-summary-report

 Care Quality Commission – Standards

Organisations that provide care must meet standards required by law

The information on this page tells you what standards you should expect, and what you can do if you are worried about the quality of the care that you or the person you look after receives:

http://www.carersuk.org/help-and-advice/practical-support/getting-care-and-support/care-standards-and-cqc?gclid=CM-_j5WcvdICFcfgGwodyEAEoA

Royal College of Nursing updates guidance for nurses on ” I want to die” requests.

The updated version of guidance via the following link, first published five years ago, contains new and additional resources to help guide nursing staff to undertake and navigate these difficult conversations, says the RCN:

file:///C:/Users/User/Downloads/005822.pdf