Guidance
The Good Samaritan Nurse in a Secular Age
Grosvenor House Publishing. Author: Teresa Lynch
This detailed work has been written for the nursing profession. As such,
it offers a great deal of wisdom about the background to the profession
as it is now and, in particular, its Christian inspiration and commitment.
It also highlights the moral dilemmas faced by professionals in this area
and suggests compassionate but principled responses to these. It alerts,
both professionals and others, to developments that may work against
the welfare of patients and the cornerstone principles of doing good
and not harm in the practice of medicine. The traditional commitment
here of respect for the person and the valuing of life at all its stages is
congruent with the teaching of the Catholic Church and Catholics and
other Christians should uphold it in every way that they can.
There is an emphasis on the wholeness of approach in both the
curative and the caring aspects of the profession. The nurse, especially,
must be seen to be one who values patients as persons, who keeps their
best interests in mind and who intercedes for them both with the divine
and with authority in the medical world.
Teresa has not been afraid to tackle the most difficult issues in her
extensive work and always with her loyalty to the best in the nursing
tradition and to authentic Christian teaching.
Those not in her profession, such as clergy, moral theologians,
seminary teachers etc, will also benefit from the thoroughness of this
book which will become a compendium not only of good nursing
practice but also of serious moral issues to be addressed in the world of
medicine. For this service, we should all be grateful to her”.
Msgr Dr Michael Nazir-Ali.
OXTRAD: Oxford Centre for Training,
Research, Advocacy & Dialogue.
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 fulfilment 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 willful suicide” (Gaudium et Spes, No. 27).
UK: The BMA’s new guidance: Clinically-Assisted Nutrition and Hydration for non-imminently dying patients (2018).
The guidelines 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 where CANH can be withheld or withdrawn in order to bring to an end the life of the patient.
The Nurse’s Code of Conduct (NMC 2019) 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 and 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 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’ (2013,) which had resulted in many terrible deaths, recommended that 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 BMA 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.
This BMA guidance 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 (2018).
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:
UK Royal College of Nursing
END -OF- LIFE CARE:
https://www.rcn.org.uk/clinical-topics/end-of-life-care
NUTRITION:
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
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