News & Opinion
THE STATE AND THE NHS vs PATIENTS’ RIGHT AND WILL TO LIVE
Medical futility is a vague concept which is often surrounded by confusion. Conflicts persist regarding how to determine what futile means in particular circumstances.
The explosion of medical technology and the intense media focus on real-life cases (promoting public outcry and dissenting views) only serve to foster this perplexity (Angelucci, 2006).
The Good Samaritan’s example in the Lord’s famous parable is today in danger of being replaced with the following question in too many cases: is this a ‘futile’ life not warranting ‘futile’ treatment, care and costs?
This is an emerging and increasingly fraught concept. It might be more correctly termed ‘futile treatment’, which inescapably morphs into care, then perceived as ‘futile’. Futile treatment and care concepts include questions of ethics, justice and autonomy for patients, doctors, nurses and patients’ families. Treatment and prognosis are the province of doctors and nurses provide care. It would be wrong, however, to suggest that doctors do not ‘care’ for their patients.
Futile care: old vs new concepts
Ethical questions are debated by bioethicists (often with no medical qualification or clinical experience). The reality of what may be considered as ‘futile’ treatment and care can cause ethical difficulty for many healthcare professionals.
The old concept of futile care
Traditionally, this concept was considered as giving inappropriate/
ineffective or intrusive treatment to the dying person.
The new version of futile care
This is based upon the beliefs of secular, ‘modern’ bioethicists that some patients have ‘a duty’ to die because the quality of their life is not worth the ‘costly’ finite medical resources.
It must be understood that often cost is not a barrier to good care and appropriate treatment. Decisions on expenditure may be based on discriminatory judgements. Further treatment, other than ‘comfort’ care, can be deemed ‘futile’, regardless of the desires of the patient or family. Families today, can be told by some doctors that the state of their loved one is hopeless, and that all treatment should be withheld or withdrawn to allow them to die. This may happen within hours, days, or weeks of a person suffering a brain injury, stroke, or critical illness. Additionally, some families may not want to fight for their relative’s possible recovery. So, the patient’s survival and rehabilitation chances are slim. They are then reliant on a Good Samaritan practitioner who is prepared to offer them a fighting chance to survive.
Angelucci P. (2006) Grasping the concept of medical futility. Nurs Manage. 37(2): pp. 12–14.
SCOTLAND – Assisted Suicide
Public Consultation concerns
On 8 September, 2022, the office of Liam McArthur, MSP, published a summary of responses to a public consultation from both organisations and private individuals about a change in the law for assisted suicide. ‘Our Duty of Care’ CEO, Dr Gordon MacDonald, reports that Mr McArthur’s office has claimed that 76% of the 13,957 individual responses received were in favour of his proposal. But worryingly, this was only after at least 3,352 responses from supporters linked to the Right to Life campaign group had been discounted. Over 17,000 individual responses were received, and only about 61% were supportive of a change in the law. So, the figure of 76% not only does not reflect the actual responses received, but it is also heavily weighted in favour by the activists who wish to see the law changed to allow assisted suicide. The campaign groups wanting a change in the law were also active in mobilising their supporters to respond to the consultation. If the law changes in Scotland, this will add fresh momentum to the campaign to push through similar legislation at Westminster, thereby impacting many more people who are vulnerable in England and Wales too (Macdonald, 2022).
Mental Health issues
Kevin Sutherland, a 31-year-old, from Edinburgh, who was diagnosed with borderline personality disorder (BPD) nine years ago, has launched a petition calling on Liam McArthur MSP to extend the criteria for assisted suicide in his proposed Bill to: “[…] include those suffering with incurable mental health issues”. Mr Sutherland says that he: “[…] would like Scotland to come in line with the progressive policies of other countries and the ECHR. He is referring here specifically to Belgium, where Mr Sutherland says, he plans to travel to end his life. Belgium formally legalised euthanasia in 2002 and allows patients to apply to be killed who are deemed to be in a “futile medical condition of constant and unbearable physical or mental suffering that cannot be alleviated”. Belgian cases have included instances where patients have been euthanised for psychiatric conditions, including depression. Mr Sutherland’s petition is currently receiving wide coverage, including from Scotland’s leading tabloid, the Daily Record (MacDonald, 2022).
Preparing the way?
Dr Gordon MacDonald, also notes that in 2019, campaigners for a Scottish assisted suicide law were “coached” by a prominent member of the Canadian euthanasia lobby. Dr Ellen Wiebe, a practitioner of Canada’s MAiD (Medical assistance in Dying), attended the Annual General Meeting at Holyrood of the Cross-Party Group (CPG) on End of Life Choices as the Group’s special guest. The point of Dr Wiebe’s visit to Scotland was to advise Scottish parliamentarians on how to frame euthanasia law “… so that Scotland and the UK can learn from them [Canadian practitioners] before the legislation changes”.
Minutes of the CPG’s AGM show the meeting was packed with supporters of Friends at the End (FATE) and Dignity in Dying (DiD)— groups committed to changing the law on assisting suicide. That same year (2019), Professor Jocelyn Downie, a legal expert on Canada’s MAiD and euthanasia law, was the guest speaker at a ‘Friends at the End’ Scotland event at the Scottish Parliament.
It would be not unreasonable to conclude that the drive for a change in the law is relentless and somewhat obsessive. It is increasingly clear that in Europe, the ‘slippery slope’ slide and the decline in adherence to the ‘safeguards’ for the vulnerable are a worrying reality, which now impact on access to true palliative care. The same depressing scenario is reported in Canada where defunding of Hospices which do not abide by the assisted suicide ‘option’ can occur.
MacDonald, G. (2022) Urgent: Assisted Suicide Bill Moves a Step Closer. Autumn Appeal. Our Duty of Care. 27 September.
Australia – Voluntary Euthanasia
New South Wales landmark moment for the state, means within 18 months people with a fatal diagnosis in NSW will be able to access voluntary assisted dying. This state is the last in Australia to legalise assisted suicide.
The bill was spearheaded by the independent MP Alex Greenwich with 28 co-sponsors last year after a series of failed past attempts.
He said the bill marked a moment in which NSW “finally passed a threshold of honesty and compassion”.
“Honesty that not all people die well, and compassion that people with advanced and cruel terminal illnesses will have the same end-of-care options as those in every other state,” he said.
This, has happened despite the clear evidence that most people who request such deaths are not enduring intractable pain but do feel a burden. People in need of Palliative care are not receiving it due this cheap and easy option. It is a failure of the caring ethos and a death knell for palliative care which has so much to offer. It is not progress in care for the dying, but a false compassion.
Assisted suicide: A betrayal of palliative care
Jersey has decided that assisted dying must be legalised there. If proposals are backed, then a draft law could be discussed and voted in 2023. Despite the best intentions for the dying, it is inevitable that they will suffer rather than benefit from legalised assisted suicide as evidenced elsewhere. Considering that palliative care cannot meet all needs does not mean patients should be deprived of the excellent expertise on offer.
Assisted suicide is legal in Oregon. Last year, the following complications were reported, which have inevitable psychological consequences for all involved and need acknowledgement:
• Over half of patients who underwent assisted suicide took more than three-quarters of an hour to die.
• In some cases, death took more than four days.
• The eight patients who reawakened after receiving their drugs did not repeat the experience .
Patients will be deprived of palliative care. Research from Canada reveals the negative impact that assisted suicide has had on palliative care treatment. In their 2020 qualitative study, Matthews et al., found that assisted dying had adversely affected palliative care . Both the patients and the palliative care providers found this distressing .
Baroness Finlay reminded the Lords in her speech that the Meacher Bill does not focus on the need for bridging gaps in palliative care.
As well as that, there is evidence of hospice de-funding in Canada of some hospices wishing to maintain ethical standards to prohibit legalised assisted suicide. Baroness Finlay also reported troubling statistics in Belgium, where assisted suicide is legal and two-thirds of all dying people do not access specialist palliative care .
There is much for the people of Jersey to fear as a result of all this.
1. Mac Donald. G. (2021) “This Bill WON’T solve suffering nor improve care. ‘Our Duty of Care’. 12 November.
2. Mathews, J .J.,Hausner, D., Avery J., Hannon, B., Zimmerman, C., al Awamer, A. (2020). Impact of Medical Assistance in Dying on palliative care: A qualitative study. Palliative Medicine. Sage Journals. 30 October.
UK October 2021
Baroness Meacher’s Assisted Dying (Suicide Bill) Bill was well debated in the House of Lords on 22 October .
The Bill will now to proceed to Committee Stage, but is unlikely to be given time in Parliament to be debated in the House of Commons and become law, given that it is not supported by the Government.
Similar to the Maris Bill of 2015, Peers were again inundated with communications from the public voicing their concerns about such a change in the law. One Peer commented that this issue surpassed the volume of correspondence in comparison with that on any other issue.
Lord Winston made the opening case for the opposition to the Bill and focused on the misleading title of the Bill, having laid an amendment to change references in the Bill from ‘assisted dying’ to ‘euthanasia’ instead.
All right thinking health professionals look to the situation in Europe which is now completely out of hand, despite supposed safeguards which have become meaningless.
Nurses and doctors are not trained to operate or even think this way.
Many, therefore, will refuse and be persecuted for a lack of ‘compassion’ in the parlance of today – which is actually false compassion.
Do we want nurses and doctors to be hounded out of their profession as their conscience will be compromised despite the so called ‘conscience’ provision in the bill ?
The palliative care movement is diminished by this relentless attempt for a law change
Baroness Meacher is not impartial as one of the Dignity in Dying devotees and her Bill nowhere mentions ‘suffering’
Lord Falconer whose 2014 Assisted Suicide Bill failed (and of a similar persuasion to Baroness Meacher) has admitted there is no failsafe way such a law can be implemented. Safeguards inevitably become mere barriers to be overcome..
No patient should be made to feel disposable and pressured by such a soulless move. We know now that an overwhelming number of people ‘asking’ for assisted suicide where it is legal, do so due to a sad feeling of being a potential ‘burden’ – not terrible pain or other symptoms
We need to remember why medical professionals entered their careers, it was certainly not to offer their patients a defeatist, dangerous ‘option’ but to protect, nurture and love them, not to consider some as a ‘problem’.
People should be aware of what a bad message this bill gives to young people, many of whom have mental health problems after the recent, destabilising months.
The fact that the huge numbers of young men who commit suicide (the highest cause of their deaths in the UK) is being totally disregarded by such a bad bill.
As a nurse, with much palliative care experience, knowing that Britain revolutionised this important specialty, which is continually being threatened in such a way, is heartbreaking.
Dutch nurses have told me that they came to Britain to learn about palliative care as it is a vanishing specialty in Holland due to the law on assisted suicide
Professor Theo Boer was previously a strong supporter of euthanasia and assisted suicide, serving on a Dutch Regional Review Committee on Euthanasia, reviewed cases of euthanasia and physician-assisted suicide to determine if they took place legally. This experience resulted in Professor Boer becoming one of the most vocal critics of the Dutch euthanasia law and cautions the UK: ‘thinking you can legalise one without the other is a fantasy’.
Writer, Christopher De Bellaigue, has warned after his investigations in the Netherlands and Belgium that: “Euthanasia won’t be an occasion for empathy, ethics or compassion but a bludgeon, swinging through people’s lives, whose handiwork can’t be undone” (De Bellaigue, 2019)1.
We need to counteract the prevailing attitude that it is better to be dead than disabled, and that people in need, are burdens to themselves and others.
Such a law change on the UK would be foisted on the majority by a few desperately determined individuals who appear avowed never to abandon their cause. This would result in irreparable harm to the majority, the vulnerable, palliative care itself and UK medicine and nursing.
1. De Bellaigue, C. (2019). Death on Demand; has euthanasia gone too far? The Guardian, 18 January.
IS IT A QUESTION OF WHEN, NOT IF, ASSISTED SUICIDE IS INTRODUCED INTO THE UK?
Proponents of physician assisted dying, (assisted suicide), including The British Medical Journal (BMJ) claim that access to the option gives dying people choice and control over their death and can prevent intolerable and intractable suffering. But opponents fear consequences for vulnerable people, for society, and for the medical profession when doctors are permitted actively to induce death. The BMJ thinks it likely to be more ‘a question of when, not if, assisted dying is legalised in the UK‘, and that all doctors should now engage with the debate (BMJ, 9 September 2021).
British Medical Association (BMA)
A recent survey of BMA members which revealed a very close balance of views has resulted in a ‘neutral stance’ on assisted suicide. This may give some encouragement to the Dignity in Dying proponents and MPs when their vote is required. Despite several other countries and states having legalised assisted suicide, this is no example to right thinking people who will acknowledge the erosion of so-called safeguards which inevitably occurs with the consequent dangers to the vulnerable. This recognition should disallow wilful ignorance for those determined for a change in UK law.
Much suffering arises without anyone seeking to inflict it or negligently allowing accidents to happen. We have a deep-seated need to understand the meaning of suffering, its causes and its purpose, but this does not entitle us to decide that those suffering are better off dead if we cannot come to terms with this aspect of the world. ‘Suffering’ can be caused not only by (uncontrolled) physical pain but by feelings of abandonment, or of being a burden. These feelings may impact on patients who may feel that society values only ‘quality’ or ‘productive’ life. Intractable suffering needs a proactive approach to dealing with this problem and not a defeatist and, what can appear as a lazy dismissal of our ability to manage it.
Patients who suffer in this way are to be cherished by those charged with looking after them. A professional’s prime vocation is to show goodwill and compassion in caring for their patients’ physical, emotional, psychological, and spiritual needs (holistic care) in liaison with the others who comprise the multi-disciplinary team. This cannot be impossible in the 21st century.
The independent review of the discredited Liverpool Care Pathway, (LCP) stated that assisted dying is not care of the dying (More Care less Pathway, 2013).
Effects on medical staff
We need to remember and learn from the past, whether in the UK or elsewhere. Evidence is emerging in the Netherlands of emotional devastation for doctors who have assisted their patient deaths. This role would be devolved to nurses, ultimately, who of course, like their medical colleagues (according to the current, Meacher Bill promoting assisted suicide), could, one hopes, refuse such a role. A consequence of which may be an accusation of a lack of ’empathy’.
A new alliance of faith leaders has formed to ensure the voice of religious proponents of legalised, assisted dying is heard. The former Archbishop of Canterbury George Carey and Rabbi Jonathan Romain, argue that nothing in the scriptures directly prohibits assisting a death to end suffering.
They claim to be leaders of a new religious alliance in support of doctor assisted dying (along with Archbishop Desmond Tutu and Reverend Canon Rosie Harper). They have launched this initiative because of concern about the impression being conveyed that all faith groups are implacably opposed to changes in the law to help people longing to die on their own terms, without discomfort, indignity, or extreme pain. They claim that this is not the case.
Religious leaders have a God given duty of spiritual safeguarding
A religious and lay perspective, however, can argue that Ministers of religion who are expressing their support for assisted suicide to be legalised, is scandalous. All religious leaders are, and have always been, charged with leading their flocks to heaven by following God’s law. The Ten commandments do not evolve, they are set in stone as God’s word, one of which commands us not to kill.
All Judeo -Christian and Islamic faiths abhor people killing themselves. The remit of their leaders (or good shepherds) is not to lead their followers to hell. Judgement follows death by whichever way it occurs.
This support from ‘compassionate ‘religious leaders is misguided at best and perverse at worst. They need reminding by ‘ordinary’ people that they are not God. They also need to be aware that the biggest cause of death in young men is suicide. What message are they sending to all people about the importance of suicide prevention, and the value and sanctity of life?
Pope Francis considers such ‘compassion’ as false.
They also claim that a massive change is going on in religious attitudes to assisted dying (by which a person is given a prescription for life ending drugs, which they themselves take). They also claim that most church-goers are in favour of assisted dying, according to the polls.
These are so often proved not to reflect public opinion. This was revealed by the overwhelming (and shock) defeat of the Assisted Dying (Maris) Bill in 2015. People have been appalled by the practices of the LCP (where euthanasia occurred without communication or consent, with use of dehydration, and over- sedation). Introducing assisted dying would encourage such terrible deaths.
Compassionate health professionals see such a development as dangerous to the vulnerable, elderly and disabled, who are against such a change in the law.
They understand too well that safeguards are notorious in being eventually considered as mere barriers to be overcome. The Abortion Act of 1967 is a case in point.
Latest UK moves for assisted suicide: England and Wales
“Good care of the dying is not assisted dying” (More Care Less Pathway, DH, 2013).
Baroness Meacher, an independent member of the House of Lords and Chair of the assisted suicide advocacy group ‘Dignity in Dying’, on May 26, 2021, proposed a private member’s bill to legalize assisted suicide in England and Wales, rephrased as “aid in dying” by its supporters. No doubt, with the best of intentions, the promoter of this proposed law wishes for choice to be enabled for mentally competent adults, in the final six months of a terminal illness, with each request to be assessed by two doctors and a judge.
But ‘suffering’ is nowhere mentioned in the wording of the Bill. In order to be eligible for suicide, it is not necessary for the person to give any reason as to why they wish to end their life. They simply have to demonstrate a ‘settled wish’. So, the proposed UK legislation is based on the presumption that the suicide of a person with limited life expectancy should be supported and facilitated whatever the motivation, provided that person has legal capacity and is ‘un-coerced’ (Wyatt, 2021).
Such conspicuous lack of focus in the Meacher Bill, makes the anticipated deluge of abuse of the vulnerable so much more likely. It is well-established that the general reason for asking for assisted suicide where it is legalised is people’s fear of being a burden.
Liam McArthur, a Scottish MP, launched similar legislation in June 2021. This would give people who have lived for twelve months in Scotland, access to life ending drugs to take themselves if two doctors are satisfied that they meet safeguards, including being mentally competent.
Economic consideration can be the sinister underbelly of the attempts to allow patients ‘compassion’ and ‘dignity’ by doctor assisted suicide. The nurses’ code of professional conduct (NMC, 2018), states that nurses must adhere to the laws of the country in which they practise. Hope remains that nurse managers, and nursing representatives will support and protect nurses who refuse to comply with any change in law that compromises their conscience and who wish to provide continuing, safe, humane care to their patients until their natural end.
Views of UK Bishops
Catholic English Bishop, Mark Davies of Shrewsbury, warns that Baroness Meacher’s 2021 Bill on assisted suicide, if successful, would cross a ‘moral line’. He added: “The language employed in seeking this seismic change in the law is one of compassion, knowing that no one is opposed to the relief of human suffering. However, the fact this legislation is being proposed in Parliament by the Chair of what was the Voluntary Euthanasia Society should leave us in no doubt as to “the goal of medical killing of the sick and aged” (Davies, 2021a).
The following words from Mark Davies and John Sherrington, Catholic Bishops of England, and Wales, summarise what many believe will happen, should there be a change in the law on assisted suicide:
“If Parliament were ever persuaded to legalise Assisted Suicide, we should be in no doubt as to the moral line that would be crossed. A line that has never been legally crossed in our care of the sick and elderly since the foundation of our society” (Davies, 2021b).
“Life is a gift to be valued and cherished until its last breath, through natural death, which opens into the promise of eternal life” (Sherrington, 2021).
Those who cannot bear to deal with the suffering and disability of those whom they love, all too easily may reduce vulnerable people, who may or may not be dying, to “objects” to be managed. Detachment is an understandable defence, but this withdrawal of contact, affection, and care is probably the greatest single cause of the de-humanization of dying.
The proposals for assisted suicide are at odds with the ethos of Christianity, which is to uphold the value of human life, at its end as at its beginning. What this bill would do, if enacted, is present vulnerable people with an intolerable choice. Those who feel they are a burden will opt to end their lives so as to spare their families and society of the expense and trouble of their care. Many people with disabilities or conditions such as dementia would, if presented with this terrible choice, opt for death for altruistic reasons. As Cardinal Hume once put it, “the right to die can become the duty to die”. No human being should be put in this position (Catholic Herald, 2021).
Assisted suicide is ‘Euthanasia by the back door’. If there can be any dignity in dying, it must be by the continuation of humane and practicable treatment and holistic care until the natural end of life.
The Palliative Care Bill 2020
Baroness, Ilora Finlay, an expert Professor in Palliative Care, introduced the ‘Access to Palliative Care and Treatment of Children Bill’ (2020) [HL].
The aim of the Bill is to: “Make provision for NHS service commissioners to ensure that persons for whom they have responsibility for commissioning physical and mental health services have access to specialist and generalist palliative care and support services; to enable hospices to access pharmaceutical services on the same basis as other services commissioned by a clinical commissioning group; and to make provision for treatment of children with a life-limiting illness”.
Definition of Palliative Care in the Palliative Care Bill (2020).
Within the Palliative Care Bill, Palliative Care has been defined in a holistic way as:
“care which is delivered to seek to improve the quality of life of persons with life-limiting illness or approaching the end of life, through the prevention and relief of suffering by means of early identification, assessment, treatment and management of pain and other problems whether physical, psychological, social, or spiritual”. (Finlay, 2020).
House of Lords (2020). Access to Palliative Care and Treatment of Children Bill’ (2020) [HL].
Catholic Herald (2021). No duty to die. 1 July. HC 343. London. CQC, P. 77.
Davies, M. (2021a). Legalising Assisted Suicide would cross a ‘moral line’ says English Bishop. Catholic Herald. 24 May.
Davies, M. (2021b). Don’t let ‘false compassion’ legalize assisted suicide, say bishops of England and Wales. Catholic News Agency. https://www.catholicnewsagency.com/news/247835/dont-let-false-compassion-legalize-assisted-suicide-say-bishops-of-england-and-wales
Finlay, I. (2020). Access to Palliative Care and Treatment of Children Bill [Hl ].
NMC (2018). The Code of Professional Conduct: Standards of practice and behaviour for Nurses and Midwives.
Nursing and Midwifery Council. NMC: London
Sherrington, J. (2021). Don’t let ‘false compassion’ legalize assisted suicide, say bishops of England and Wales. Catholic News Agency. https://www.catholicnewsagency.com/news/247835/dont-let-false-compassion-legalize-assisted-suicide-say-bishops
Wyatt, J. (2021). What’s wrong with the Assisted Dying Bill? End of life in depth series. Christian Action, Research and Education (CARE).
ETHICS OF CARING FOR THE DYING AND SERIOUSLY ILL
Cecily Saunders was the founder of the modern Hospice movement and progress in palliative care has improved ever since.
Care for the dying is a special privilege in the stewardship of creation because it is serving the life of the human person. Serving life in Palliative Care means assisting it to its natural completion. When the health of an individual deteriorates to an irreversible state, palliative care is appropriate for the person.
Patients need to believe in the skill and dedication of their health team, whether in hospital, hospice, or home. The maxim: ‘primum non nocere’ (first do no harm) of traditional medical ethics has guided medicine and nursing for centuries. Rather than lobbying for assisted suicide (yet again in the UK), with all its dangers: coercion, overcoming safeguards and inviting people not to feel ‘burdens’ , lobbying should concentrate on resourcing Palliative Care.
Palliative care should be introduced, based on the patient’s needs rather than relying on prognosis which is generally a subjective judgement.
Questions about prognosis are to be encouraged by the team members from the patient and the family members. It is, however, notoriously difficult to give a completely accurate prognosis. This particularly applies if the patient is not suffering from a terminal condition, due to cancer.
Aim of Palliative Care
One of the primary purposes of care for the dying patient is the relief of pain and suffering. Effective management of pain and other symptoms, in all forms is, therefore, critical in the appropriate treatment and care of the dying. This aim underlines the need for holistic approaches, aimed at restoring optimum mental and physical function.
Ethical Palliative Care
Ethical issues in palliative care often arise because of concerns about how much and what kind of care makes sense for someone with a limited life expectancy. There is often conflict between clinicians, nurses, other health care team members, patients, and family members about what constitutes appropriate care, particularly as patients approach death.
A lesson can be learned from the discriminatory and ageist practices of the intrinsically flawed Liverpool Care Pathway. Health professionals should seek to preserve life quality and not destroy it. We are not the arbiter of anyone’s death or life. Health professionals must not participate in any act directly aimed at shortening or suppressing life.
Euthanasia, in all its forms is morally unacceptable, even when requested by the patient. Requests for assisted suicide need exploration, and patients need underlying issues to be addressed which, undoubtedly are causing suffering whether physical or mental.
Health professionals may have to challenge the culture where optimum benefit for patients is at risk. This may be at the expense of the health professional’s personal comfort to fulfil their healing role and dictate of conscience.
Proportionate treatment and care
In good clinical practice an awareness of the condition and prognosis for the patient may occasion a change in the focus of treatment from cure to palliative care.
The health team has a moral obligation to use ordinary or proportionate means of preserving a patient’s life. Proportionate means are those that in the judgement of the health team and the patient offer a reasonable hope of benefit and do not entail excessive burden. The Catholic Church teaches that there is no moral obligation to use disproportionate means and that the patient has a right to refuse them.
One of the healthcare provider’s first duties to a client is to inspire hope through the development of a therapeutic relationship and the provision of appropriate and accurate health education and information. This may help patients to understand, that their rights to autonomy, must confer real benefit not harm.
Such issues as the complexities of cardiopulmonary resuscitation and advanced directives need sensitive discussion with patients by the doctors and nurses as part of effective communication with their patients.
Effective communication is fundamental to good clinical practice and in line with patients’ rights. Health professionals caring for a patient in danger of death from illness, accident, or complication of advanced age, should provide the patient with appropriate information to help with understanding of the condition. This gives patients the opportunity to discuss the situation with family members, as wished, unless the patient is lacking capacity.
Consent is a fundamental patient right and applies in all fields of treatment and care. It is particularly important to ascertain consent in palliative care before the patient may lose capacity, due to deterioration. Therefore, regular communication with dying patients is essential.
The nurses’ code of conduct, expects nurses to: “make sure that those receiving care, are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged” (NMC, 2018).
One of the recommendations made by the LCP independent review panel was the need for more evidence-based care and research into the care of the dying.
An Italian study of the LCP by Constantini et al, which reported in the Lancet, in 2014, showed that there was no overall benefit to patients placed on the LCP, in comparison with best practice at that time.
Professor Irene Higginson, co-author of the Constantini study and Director of the Cicely Saunders Institute at King’s College London, said: ‘Our findings demonstrate just how important it is for any initiative that replaces the LCP in England to be grounded in scientific evidence and tested in controlled trials before being rolled out across the board. She recommended that the challenge should be faced, head-on and ensure that scientific evidence forms the foundations for any new initiative if end-of-life care is to be genuinely improved for patients and their families in England.
This involves interacting and integrating care with the assistance of the chaplains, social workers, family members and friends to allow the patient to accept death and live out life until its natural end.
Florence Nightingale was the founder of modern, holistic nursing. Patient management and care should incorporate the physical, psychological, and spiritual needs.
Patients in the advanced stage of a serious and/or life-threatening illness typically experience multiple symptoms, the most common of which are pain, depression, anxiety, confusion, fatigue, breathlessness, insomnia, nausea, constipation, diarrhoea, and anorexia.
In all circumstances, health professionals must be knowledgeable (as with any other specialty) to provide basic, humane care and relieve pain and prevent other distress such as hunger and thirst.
Nutrition and hydration
Emotional and cultural factors influence decision-making about assisted nutrition and hydration. Lack of information and misperceptions of medically assisted nutrition and hydration can play a predominant role in the decision to begin or suspend nutritional or hydration support (Del Rio et al, 2021).
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
Hydration should never be withheld or withdrawn, with the sole purpose of causing the death of the patient. Such unlawful and unethical practice was condemned by the panel charged with the independent review of the LCP. This pathway was discredited and recommended for withdrawal in 2014.
The review panel recommended that caring for the dying must never again be practised as a tick box exercise and in relation to nutrition and hydration:
- All staff in contact with patients should be trained in the appropriate use of hydration and nutrition at the end of life and how to discuss this with patients, their relatives, and carers.
- Specialist services, professional associations and the Royal Colleges should run and evaluate programmes of education, training, and audit about how to discuss and decide with patients and relatives or carers how to manage hydration at the end of life (DH, 2013).
The LCP review panel also stated that doctors and nurses should be held to account by their regulatory bodies as deliberate denial of fluids is unacceptable and unethical. This happened for years without evidence of the impact on thirst sensation as questions tended not to be asked.
Such questions should include the following: What is known about brain functions required for thirst experience? How soundly is that knowledge based? How confidently can knowledge about thirst sensation derived from animal studies be transferred to the human situation? How likely are the brain lesions of patients considered for withdrawal of hydration to be compatible with retention of the capacity for thirst? How can this likelihood be assessed in individual patients? (McCullough, 1996). Assisted Hydration, when required, absorbable, practicable and carefully monitored, will not harm patients and should be included as part of fundamental and humane care. Subcutaneous fluids may be considered as convenient in the home but should be not used as a precursor to easing a patient into ‘end of life care’ status where this may not be morally sound.
The LCP review panel recommendation in relation to hydration needs, was that practitioners will monitor and review rate and volume (DH, 2013).
Various modes of providing clinically- assisted hydration may be explored and depending on the health care setting, should be appropriately used. Competent practitioners will monitor patients’ hydration needs whether in the dying phase or not and titrate accordingly.
Titration of drug dose is also well-established when ensuring effective pain and other symptom relief.
Many patients can experience a feeling of being a burden, either to their family or the carers. This is now established as the top reason for requests for assisted suicide, in countries and states where it is legal.
The most important assistance to dying patients is the “loving presence” at the bedside. This makes the patient feel comforted. The terminally- ill patient needs human accompaniment which a health professional must bring to bear in his/her relationship with the patient.
The dying person should not be dismissed as incurable and abandoned to his own family, but the patient and whole family unit should be assisted by the loving care of the members of the health team.
Depression in Advanced Illness
Up to half of patients with cancer suffer from symptoms of depression (Rosenstein 2011). The elderly, also suffer from high rates of depression and suicide (Brown & Rutherford et al, 2016).
Because depression often manifests somatically (Tylee & Gandhi, 2005), and if patients are not screened, clinicians miss half of all cases of clinical depression (Ansseau et al, 2004). The proponents of holistic care are vindicated by these findings.
Where depression and anxiety are suspected, or exhibited, the team members have a duty to seek appropriate help for the patient to allow thorough assessment and appropriate treatment and care.
Use of sedation and other drugs.
The LCP review found many examples of patient drug management which was not appropriate or exemplary. Common practice of the LCP was the use of terminal and ‘blanket’ sedation and often inappropriate use of opioids. This involved, as has been commonly reported by relatives, the sedating of patients who were not in obvious need. Families reported that patients, immediately before being placed on the LCP, often were eating, drinking, talking, and walking, before being sedated and suddenly becoming comatose (without staff communication with the patient or the family).
Sedation, as part of required treatment may be needed for patients who are: terminally agitated, delusional, or psychotic and becoming a danger to themselves or others. The “ethical and legal risks of sedation would be greatly reduced if palliative carers took a more active approach to hydration and quite simply provided hydration for a matter of days until life ends naturally (Craig, 2002). Palliative Care specialists have argued that ” with careful assessment of reversible factors and alternative management for problems like delirium, some of the need for sedation may be avoided” (Thorns & Sykes, 2000).
Escalation of analgesic opioid drugs is not always wise. The cause for pain needs to be investigated and relevant drugs employed, such as nerve pain agents where pain is nerve based. This can minimise the known complications of opioid drugs.
Opportunities for completion of ‘unfinished business’, are treasured by most patients whether or not they may be dying. Wherever possible, the onus of meeting the important need for addressing this important completing issue is on those health care professionals who are responsible for patient treatment and holistic care.
Sedation drug regimes, without hydration, give patients no chance of return from the point of oblivion. Such practice goes against health professionals’ mandate to provide ethical, individualised and humane holistic care.
Spirituality and the intra psychic strength of the ageing individual can provide a source of help when coping with stressful life events. This can take the form of intrinsic religiosity: prayer, a sense of meaning and purpose, and transcendence (Fehring et al, 1997).
Spiritual awareness involves care to alert the patient and family to the spiritual dimensions of human life. Health professionals should help patients to prepare for death according to their religious beliefs and strive to put at their disposal the comforting rituals and sacraments of their individual religion.
Hope is a vital element in healing and can be considered as an important, invisible virtue. even though the possibility of a cure may be remote. Human beings need encouragement in practising this virtue as it is a positive orientation to life rather than despair. Patients need faith and hope in their carers’ skill and readiness to always meet any challenge regarding symptom prevention and control.
This should be a regular part of best practice in palliative care. It should involve examining medical treatment, nursing care, spiritual support and any concerns of relatives and carers.
There is no dispute that the NHS is under strain particularly with the advent of Covid -19. However, rather than defeatist staff attitudes to the challenges of palliative care or a ‘tick box’ mentality, patients warrant optimum management and care by committed professionals.
The duty of health professionals is to lobby for appropriate funding for both training of staff in palliative care and for staffing to be improved.
Those responsible for medical and nursing curricula need to consider the time allocated for education on this important specialty.
Care assistants and volunteers, with appropriate training and safe monitoring, can be invaluable members of the care team.
The overall responsibility for palliative care should not be devolved to unsupervised, junior doctors. The responsibility for patient care generally is within the province of the Consultant or General practitioner.
Brown, PJ, Rutherford, BR, Yaffe, K, et al (2016). The depressed frail phenotype: the clinical manifestation of increased biological aging. Am J Geriatr Psychiatry. 2016;24(11):1084–94. [PMC free article] [PubMed] [Google Scholar]
Constantini, M. et al. (2014). Liverpool Care Pathway for patients with cancer in hospital: a cluster randomised trial. The Lancet. 383(9913):226-37. 18 January.
Craig, G. (2002). Terminal Sedation. Catholic Medical Quarterly, February.
Del Rio, M. I., Shand, B., Bonati, P., Palma. P. (2011). Hydration and nutrition at the end of life: A systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff. Psycho-Oncology 21(9):913-21. December.
Department of Health (2013). More care, less pathway: a review of the Liverpool Care Pathway. UK: Department of Health.
McCullagh, P. (1996). thirst in relation to withdrawal of hydration. Catholic Medical Quarterly. February.
Nursing and Midwifery Council (2018). The Code of Professional Conduct. Professional standards of practice and behaviour for nurses, midwives and nursing associates. NMC. London.
Thorns, A, Sykes, N. (2000). Opioid use in last week of life and implications for end-of-life decision making. The Lancet; 356:398-9.
UK : June, 2020
Stoma bag patient should be allowed to die, rules judge.
It is incomprehensible how Mr Justice Heyden can state that the case of the man facing a stoma and wanting to die “is not about choosing to die, it is about an adult’s capacity to shape and control the end of his life”. A predicted 60- 70% chance of survival, albeit with a stoma, does not, by any means equate with the man being at the end of his life.
Advanced directives offer a false promise. It is important to understand a patient’s desires but be able to ensure their understanding of what they sign up to and to judge the occasions for their preferences without compromise of long-accepted moral principles.
Stoma specialist nurses have helped many patients facing similar prospects to this man, to face the challenge and triumph over perceived adversity and to go on to live a happy and meaningful life. Counselling and positive, non-defeatist attitudes are needed in such difficult cases, not the hopeless ethos of such people being considered better off dead. Heathcare professionals, however, working in opposition to such apparent beliefs may be considered as lacking in compassion.
Holistic care, as promoted by Florence Nightingale, does not means dehydrating and starving to death a man with every need to be helped to see that love and dignity is not contingent on physical condition alone.
It is well known where it is legalised, that requests for assisted suicide are due to a fear of being a burden. Repeated lobbying for a change in the law on assisted suicide in the UK, would inevitably lead to euthanasia.
Belgium: May 2020
Stripping the hospitals of their “Catholic” label will lead to a dispute over the “Brothers of Charity” as a business name as well as ownership of the assets. The president of the Belgian group, Raf De Rycke, has told the media that he wants to continue to work with the same name, mission and vision.
See more: https://www.bioedge.org/bioethics/vatican-strips-belgian-group-of-catholic-label-over-euthanasia/13434
UK – Presumed Consent to Organ Donation Act, May 2020
The government need to put on hold the above Act’s implementation planned for May this year.
The corona virus has interrupted UK life beyond life as we know it. People without internet access are unable to download the required online ‘opt out ‘ forms. The access to GPs is considerably limited and is likely to be the case for some months. Therefore, this avenue to access the ‘opt out’ forms is not possible. It is not only elderly people who are without internet access. People need their right to informed consent to be exercised.
Many people recall the promise of Alan Milburn, that never again would the scandal of Alder Hey hospital be repeated. There are clear dangers implicated in this Act: a rush to organ retrieval via inadequate death confirmation, possibility of live donor processes becoming the norm for obtaining organs and even experimentation on people who have opted in ostensibly for organ donation only.
It is an ill judged change in the law. People will not have time to realise the dangers of this law which is a classic example of the slippery slope and the right to informed consent is being denied.
This reasonable request to halt the Act has been put to the government on behalf of vulnerable people who are worried about the current health climate but also that their personal liberty to choose for their future will not be respected.
See the website to access the opt out forms: https://eur04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.organdonation.nhs.uk%2Fhelping-you-to-decide%2Fabout-organ-donation%2Ffaq%2Fconsent%2F%3Fgclid%3DCjwKCAjwssD0BRBIEiwA-JP5rIs4hwMGGaGpa1oUn8SfYOnMLg0kzCg7TEan4KcQIxbguQ4D9TgGLBoCD5cQAvD_
Europe, April 2020
An Italian report alleges that elderly people are being asked if they want to be ventilated long-term or would rather let nature take its course — even if they haven’t been diagnosed with COVID-19.See the link:
Germany, February 2020
GERMANY’S highest court has repealed a ban on commercial assisted dying clinics, introduced in 2015, This repeal paves the way for doctors and Dignitas-style organisations to supply lethal drugs to seriously ill patients. Relatives or doctors who helped a single patient to die were already exempt from punishment.
The German ruling was welcomed by ‘palliative care doctor’ Matthias Thöns, who said: ‘This is a good judgement for people in desperate situations, who we can now treat according to our conscience.’
It is astonishing that a ‘palliative care doctor’ can see killing a patient as ‘treatment’. And surely it is his job to ensure that patients are not ‘in desperate situations’?
See the related feature by Anne Farmer which appeared in Conservative Woman (28 February 2020):
See the response from Pro -Life Nurses UK (29 February 2020):
UK October 2019 – Parents v Clinicians
Tafida Raqeeb suffered a traumatic brain injury in February as a result of a rare condition. She has arteriovenous malformation, where a tangle of blood vessels with abnormal connections between the arteries and veins risks causing a ruptured vessel.
Tafida’s mother, Shelina Begum, and her father, Mohammed Raqeeb, wanted to seek treatment in Italy. But the Royal London Hospital, which is caring for their daughter, said releasing her was not in her best interests.
A spokesperson for Barts Health NHS Trust, which runs the hospital, said that its clinicians and independent medical experts had found “further medical treatment would not improve her condition”.
It said it was in Tafida’s best interests to withdraw treatment.
- Tafida Raqeeb: Brain-damaged girl can go abroad for treatment
Can hospitals overrule parents?
BBC NEWS October 2019
In England and Wales the concept of parental responsibility is set out in law, in the Children Act 1989. This gives parents the responsibility broadly to decide what happens to their child, including the right to consent to medical treatment.
But this right is not absolute.
If a public body considers that a parent’s choices are not in the best interests of their child, and an agreement cannot be reached, it can challenge these choices by going to court.
A judge makes the final decision, based on the evidence available.
The law does not consider either doctors or parents to be automatically right – instead, it says that the best interests of the child are the deciding factor.
A judge will have heard evidence about Tafida’s clinical condition, the impact of moving her and the possibility of further treatment having any success, in order to decide the best course of action.
At the High Court, Mr Justice MacDonald said “life-sustaining treatment” for Tafida must continue. He dismissed Barts NHS Trust’s application to withdraw life support. The hospital did not appeal this ruling. See more:
The Liverpool Care Pathway: Dead or buried?
David 1961- 2019
By Catherine Ashenfelter
David was like a brother to me. He went to school with my own brother but due to family problems he eventually moved in with my own family. He came for 3 months but stayed for 15 years, still living with my parents when I left home to get married. His fate with my own mother would be disturbingly similar, made even more poignant by their birthdays both being in May, under the sign of Gemini the twins.
Eventually his time came to leave my family’s home when he got married and had two daughters. Sadly, whilst only in his 40s he was diagnosed with a benign brain tumour and it was shortly after this that his marriage crumbled, whereupon he lived with my mother for a second time even though by then she was a widow. Ultimately my brother became his main carer. David was initially given a few years to live after the brain tumour diagnosis, then only six months. He was meant to definitely die by 2011. In 2019 he was still eating hamburgers, chatting coherently to his children and watching Rolling Stones DVDs.
Like my Mum, he seemed immortal, the patient who would never die until also like my Mum the same hospital decided when his time was up. One difference between David and my mother’s ending was their age: Mum was 86 whilst David was merely 57. Shortly before he died, David had some falls so was told to bed rest with a hoist at home: this led to breathing problems (he was asthmatic) and two admittances to A&E at the William Harvey Hospital in Ashford, Kent in early 2019. It was during the second admittance that his discharge note curiously had pneumonia as his diagnosis, when the family had been told it was a chest infection and not pneumonia. Although David made an excellent recovery he was probably let out too soon, with even ambulance men expressing surprise at his early release from hospital.
There was no follow-up in place even though I requested a respiratory therapist to monitor him. But more worryingly a staff member at the William Harvey said ominously that the team had decided to make David ‘comfortable’ for the future and to not have intensive care if he wasn’t reacting to treatment. This coded information was given when I wasn’t present but ‘comfortable’ can mean being pumped with morphine; it therefore appears that David’s End of Life was planned by the hospital even before his next and final admission. The day before his third and final admission to A&E he was eating without swallowing problems at his home.
Then on Monday March 18th, just a few days after his previous hospital stay, David started gasping for breath and an ambulance was called once again. My brother who called the ambulance wanted active care for him; David’s own brother also fought for active care but they were both ignored, whilst his other family members appeared brainwashed by a hospital team who pushed for End of Life (EOL): the hospital used their belief that David had a poor quality of life to convince his family to place him on EOL
There was family division but within a few hours of his third admission to A&E in 7 weeks, David was hooked up to a syringe driver pumping morphine, without receiving hydration or nutrition. His brother said he wouldn’t have wanted this and that his time wasn’t up; also that he didn’t need morphine because he never took more than the occasional paracetamol at home. My husband John and I heard of David’s terrible fate much later in the day, whereupon we drove straight to the hospital to see what we could do even though it was around 11pm at night. What we experienced there has been a life-altering event for us both. We found David in a side room close to A&E – the door was open and many bottles of water were on a trolley by his bed. Their presence suggested that he was being offered a drink but in reality this was not the case. David’s breathing was very rapid indeed and the only ‘treatment’ visible was the morphine syringe driver making him excessively drowsy.
John, my husband, commented on no charts being in the room or information. I requested to see a nurse who arrived swiftly, informing us the plan was to make David ‘comfortable’. I brought up the lack of an IV drip and asked what the plans were for his hydration. The nurse responded with ‘He doesn’t need hydration because he is End of Life’. On hearing this I expressed that he would become dehydrated whereby the nurse raised her voice at me, concluding that as I wasn’t family she wouldn’t discuss his hydration needs. Then she left the room.
If he was to have no hydration, why were there several bottles of water by his bed? Was this a deception, making people who walked past his door think that he was being allowed a drink, as recommended by the Neuberger Report? 1
Without hydration I knew that David would die an agonising death, so wet my index finger with fresh water I’d brought and spoke to him, explaining who I was. Because he was drugged, waking him was difficult, so whilst holding up his head I slowly pushed the wet finger into his mouth and placed the drop of water on his dry, rough tongue. He swallowed it and immediately woke up, his eyes alert. ‘Would you like more drops of water?’ I inquired, to which he replied yes.
He ended up swallowing 4 sips of water before falling back into his drug-induced coma, whereafter, his breathing became easier. John will always remember how he was on the look out to protect me from David’s nurse, whilst I’ll never forget David chewing on my wet finger as he was sucking the water from it. We wanted to pull out the syringe driver but it was likely that some members of his family had approved it.
The following day David was taken to the local hospice where his brother said ‘things were worse’. He was made Nil By Mouth and had the most astonishing things said by medical staff which sadly most family members believed, e.g: he was so ill because of his brain tumour; his oedema was because of the brain tumour; he couldn’t have hydration because it would seep through his skin; he couldn’t eat or drink as he might aspirate. Yet David didn’t present with oedema at A & E (which can be a sign of dehydration and starvation) neither with deteriorating neurological symptoms; he was admitted due to a repeated respiratory condition, probably the same one as before which needed further treatment. His brother said the hospice doctor had ‘an answer for everything’ when he tried in vain to get his brother fed and hydrated.
The doctor did agree to reduce the morphine whereupon David was more alert, recognising people and following them around with his eyes. Yet still he was denied a drink, only allowed the oral mouth care gel which of course isn’t a drink at all; then also like my mother, his lips and tongue became caked with sticky, thick gunge. Most of his family were in praise of the hospice: how kind the nurses were; the lovely daffodils with birds singing outside; the impressive equipment they had. This may all be well but once these distractions are taken away the picture left is nothing more than a repeat of the shameful Gosport situation, where the Independent Inquiry judged similar situations as unlawful killing.2
David’s relatives were pleased that a nurse rolled him on his side to help his chest, as she said he was too ill to cough. But how can he cough if he’s drugged and weak from starvation and dehydration? Three days after his hospital admittance David died. I have a copy of his death certificate which states cause of death as Oligodendroglioma, which means brain tumour. There is no mention of the respiratory condition he was admitted for. In a letter he wrote to me years before, he mentioned ‘how minutes are like diamonds and we must not let them go to waste’.
As minutes tick by, I’m getting tired of writing tributes to those killed on death pathways, planting forget-me-nots in the garden to remember how they died; of viewing their bodies in chapels of rest, their faces etched with a fighting expression from what was being done to them; of hearing at funerals how the medical teams did everything they could to help them. David, like my mother, welcomed a sign of the cross on his forehead from oil blessed at St. Jude’s shrine, patron for desperate causes. May the despair of those killed on End of Life join in with our own voices as we demand establishment to stop the killing.
1 The panel for the Liverpool Care Pathway Review (2013) states ‘There should be a duty on all staff to ensure that patients who are able to eat and drink should be supported to do so, unless they choose not to’. ‘Failure to support oral hydration and nutrition when still possible and desired should be regarded as professional misconduct.’ 1.64
2. Professor Livesley determined that Mrs. Gladys Richards death (1998) was respiratory depression caused by large doses of drugs she continuously received by syringe driver and or the effects of dehydration. Page 115 chapter 5 The Report of the Gosport Independent Panel 2018.
Conscientious Objection in Medicine
Pressure mounts from Bioethicists around the world for Catholic healthcare providers to drop their bans on controversial medical procedures. Conservative Bioethicist, Wesley Smith, recently published a stinging opinion piece in the National Review, denouncing a concerted campaign among Bioethicists to take away the liberties of Catholic healthcare institutions and Catholic medical professionals.
“Most bioethicists, it is fair to say, seek to destroy Catholic institutions’ and professionals’ medical conscience rights and force them (and other religious or conscience dissenters) to adhere to the advancing utilitarian bioethical imperative”. (Acknowledgement to Xavier Symons, deputy editor of BioEdge, 22 September, 2019).
See the related report from BioEdge on the Catholic- founded hospital in Nova Scotia heavily criticised by euthanasia advocacy groups and pro-euthanasia academics:
Is death by organ donation around the corner?
Arthur Goldberg writes (Co-Director of the American based Jewish Institute for Global Awareness):
The idea of killing someone for the sake of obtaining their organs and transplanting them is gaining adherents. Advocates point out critical benefits to the receiving patient such as avoiding damage to the organs during the “ischemia time”, that is, the time during which there is an absence of blood flow that can occur during the actual dying process. See the link to a frightening article by Dr E Wesley Ely of Vanderbilt University’s Medical Center, which appeared in USA Today in May 2019 in which he asked, “what if we euthanized patients by harvesting their organs?” Or, to make the issue crystal clear, another way to ask the question is: “Can we end a person’s life with their (or their family’s) informed consent by taking them to the operating room and, under general anesthesia, opening their chest and abdomen surgically while they are still alive to remove vital organs for transplantation into other people”?
The issue of euthanasia and its proposed extension to death by donation is an important challenge we as a society must face in order to maintain a political moral centre within our culture. One essential ingredient of this process is to overcome the emerging support for sanctioned killing and to re-anchor contemporary culture in the protection of life rather than its disposal. See the link :
An international group of distinguished medical doctors and scholars refuted “brain death” as a legitimate criterion for determining actual death at a two-day conference in Rome in May 2019. Dr Paul Byrne, a neonatologist and president of the Life Guardian Foundation, addressing the 2019 John Paul II Academy for Human Life and the Family conference. showed a video of him interviewing Zack Dunlap, a man diagnosed as “brain dead” who was minutes away from having his organs harvested. But thanks to Zack’s cousin who feverishly showed obstinate nurses that Zack’s condition was improving, Zack was spared from being killed. He eventually made a full recovery and is now married.
UK: BMA Guidance on Clinically-Assisted Nutrition and Hydration (CANH) for non-imminently dying patients OCTOBER 2018
The BMA’s new 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.
(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.
WHERE DOES PALLIATIVE SEDATION BECOME EUTHANASIA?
A special issue of the journal Theoretical Medicine and Bioethics is devoted to the controversial issue of palliative sedation. As the editor, bioethicist Daniel Sulmasy, points out, palliative sedation has special relevance for Christians. For them, the relief of unnecessary suffering is a duty, but euthanasia is wrong. Identifying the right response to suffering at the end of life is often perplexing, especially since some doctors use palliative sedation as terminal sedation – rendering patients unconscious and withdrawing hydration and nutrition until they die.
Sulmasy says that the articles in the June issue bring to the topic “an almost unprecedented degree of clarity, precision, honesty, and ethical reflection” which is valuable not only for Christians but for anyone interested in medical ethics.
Palliative sedation involves several seemingly uncomplicated issues which begin to unravel as soon as they are subjected to some gentle probing. When does palliative become terminal? Is continuing unconsciousness a human good? While the authors have different perspectives on subtle points, Sulmasy says that they are united in distinguishing three kinds of palliative sedation.
See more via the following link from BioEdge:
Supreme Court Ruling, July 2018 for patients in persistent, non- responsive states
The ‘slippery slope’ takes over when ideology trumps compassion, positive medicine and true patient advocacy. This judgement is an attack on innocent human lives whose need for nutrition and fluids is a fundamental right. The following principle should be morally binding: To make an attempt on the life of, or to kill an innocent person is an evil action. This sad development will place nurses in terrible situations, requiring courage and steadfast patient advocacy in line with their Code of Conduct. See more via this link:
USA : New guidelines seek to address misdiagnosis of disorders of consciousnes.
- 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, August, 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. Acknowledgements to BioEdge.org . More via this link:
- Gosport Memorial Hospital, July 2018
- A fourth investigation is intended on Dr Barton’s patients’ deaths.They had usually been transferred from an acute hospital where they had been admitted for major illness or surgery. They needed more support than could have been provided in a nursing home.In some cases the aim of transfer to Gosport was for long-term care, as in patients with terminal cancer.Others, however, were there for rehabilitation following a stroke or fractured hip.When people die from a fracture, the cause of death should be recorded as “accidental” and accidental death is reported to a coroner.Dr Barton, however, recorded fracture-related deaths as stemming from bronchopneumonia, meaning the coroner was not informed. Any unusually high post-fracture death rate would therefore have passed unnoticed.
- June 2018
- Dr Shipman, was a warning and now we have another. There will always be the problem of eugenicists, sad to say, in healthcare. The Liverpool Care Pathway certainly opened the door to them and others, for so long. Perhaps this case will make other, unknown, but like-minded types think again about continuing the use of such practices encouraged by the Liverpool Care Pathway, despite its recommended disposal to the waste bin by 2014, following the Neuberger Review (pushed for by grieving, shocked relatives).Were the RCN, GMC or the Trust CEO, ever approached by those opposed nurses, or doctors unhappy, but seemingly unable, to stop this murderous and bullying culture?Again, the poor relatives had to battle on for so long for an inquiry for some hoped-for justice. See the link:http://www.lifenews.com/2018/06/25/hospital-staff-caught-euthanizing-hundreds-of-patients-if-a-nurse-didnt-like-you-you-were-a-goner/
- See also Judith Woods (Daily Telegraph) excellent article about Whistleblowers’ chilling stories
- June 2018 – Noel Conway loses his appeal to be allowed Assisted Suicide. It appears this is not to be considered as a human right. Advocates for Assisted Suicide will no doubt see the Gosport tragedy as a rare occurrence and redouble efforts, as usual, for a change in the law.
May 2018 Assisted Suicide Guernsey defeat
- A back door to assisted suicide and euthanasia in the United Kingdom has been closed. After a three-day debate, the Parliament of Guernsey, a British Crown dependency in the English Channel, has voted 24-14 to reject an Oregon-style bill for assisted suicide.The proposal was a private member’s bill proposed by Guernsey’s chief minister, Gavin St Pier. He released a statement expressing his regret that the measure had not passed:
“We believe that a majority of the population do support a change in the law. However, we live in a representative democracy and our parliamentary assembly, the States of Deliberation, has by majority, made a democratic decision which settles the matter in Guernsey.”
“We, of course, accept that decision. We remain of the view that this is an inevitable change which in the fullness of time Guernsey will one day adopt. However, that is matter for our parliamentary successors, not us.”
The proposal was modelled on the law in the US state of Oregon, meaning that applicants for assisted suicide should have a diagnosis of terminal illness with less than six months to live and full mental capacity. People from other parts of the United Kingdom would not be able to travel to Guernsey for “suicide tourism”.
Scientist,Dr David Goodall, at the great age of 104, who suffered no serious illness, but was tired of living with ‘reduced abilities’, travelled to Switzerland to end his life as he desired.
Reasons for requests for assisted suicide
- Requests for assisted death usually arise from a person who is depressed, or whose symptoms are not controlled, and/or are fearful of what is before them, like abandonment or increasingly – a fear of being a burden. No one should overlook the findings of audits in countries and states where Assisted Suicide is legal that, ‘fear of being a burden’ underlies many people’s request for assisted suicide, rather than pain. Many of these patients have never been assessed by a psychiatrist for treatable, clinical depression.
- The Nursing and Midwifery Council (NMC), in their Care Booklet, stress that nurses must promote dignity and self-worth. This involves showing empathy and encouragement. For patients or their relatives to feel that the patient would be better off dead, does not promote self-worth and many will equate dignity with death and killing will become an option.The Nursing and Midwifery Council’s Code of professional Conduct (2015), states that nurses must make the care of the patient their first concern. If symptoms are present but are not being not relieved and fears not addressed, by referrals to the appropriate members of the Multidisciplinary team for their specific expertise, nurses are not meeting the holistic needs of the patient.
- Palliative and Holistic Care. The Hospice movement was created to provide palliative care for any patient. It is an active and total approach to care, from the point of diagnosis and prognosis, throughout the person’s life, death and beyond. It embraces physical, psychological, emotional, social and spiritual elements and focuses on the enhancement of quality of life for the person and support for the whole family. It includes the management of distressing symptoms, provision of short breaks, care at the end of life and bereavement support. This requires the involvement of all relevant members of the multidisciplinary team.Caring for any patient requires holistic assessment of their care needs and the planning, implementation and regular evaluation of that care. This is particularly important for elderly patients who are described as healthcare’s ‘core business’.There is growing interest in holism which emphasizes that all three aspects of the person: psyche, soma and spirit must be addressed. The Nurse’s Code of Conduct (NMC 2015), expects nurses to make sure that people’s physical, social and psychological needs are assessed and responded to in the following ways:
- pay special attention to promoting well- being, preventing ill health and meeting the changing health and care needs of people during all life stages
- recognise and respond compassionately to the needs of those who are in the last few days and hours of life
- act in partnership with those receiving care, helping them to access relevant health and social care, information and support when they need it.
In the practical circumstances, however, in which staff caring for patients feel under pressure, and experience themselves as having very little time, it is often difficult to provide one thing – time, for the patient, that makes him or her feel cared for.
Safeguards and ‘the slippery slope’
The evidence in countries where assisted suicide is legalised, is that there is erosion to the point of destruction of effective Palliative Care and terrible abuse of the law.
Moreover, existing extensions of the law in some countries for non- physical or psychological reasons for requesting death is a damning indictment of a society which views death as a commodity and consumer right and where ‘safeguards’ become merely obstacles to be overcome.
Thousands of elderly people in Belgium have been killed by their doctors under the country’s euthanasia law, despite them not giving permission, a new report claims.
The study published by the Journal of Medical Ethics said that many pensioners are being euthanized by their GPs in Belgium, even though they had never expressed a desire to die unnaturally. “The Belgian population should be aware of the present situation and know that if their lives may come to the point where physicians think they are not worth living, in the absence of specific living wills advising physicians what to do then, they might be put to death,” said report author Raphael Cohen-Almagor of Hull University. The report claimed that around one in sixty deaths that happened under GP care, involved someone who had never requested euthanasia. Research also showed more than half of the patients killed without giving their consent were over the age of eighty, while two thirds of them were in hospital but not suffering from terminal illness.
Christian charity CARE said the report was an example of why assisted dying (suicide) was a dangerous precedent. It said the findings were a “serious warning of the consequences of following the same path as countries like Belgium”. CEO Nola Leach said: “I hope MPs pay close attention to this stark and very serious report, the contents of which is frightening and disturbing – “It is clear a real culture of euthanasia has developed in Belgium in the thirteen years since assisted suicide was legalised”.
The doctor’s supposed role in this proposal for a change in the law, would inevitably be devolved to nurses as have so many other roles been delegated to nurses over time.
Nurses are trained to provide truly compassionate and dignified care. This means holistic, compassionate care delivered by nurses trained to promote life and its quality, rather than to become agents of the state by agreeing to participate in assisted suicide for their patients.
Parliament’s duty to protect the vulnerable
We must not be afraid to argue that there is nothing compassionate about putting the vulnerable at risk. This is a matter of public safety, and we must not allow it to be spun otherwise. As Baroness Campbell said in her excellent contribution to the Falconer Bill debate “This is a dangerous time to consider facilitating assistance with suicide for those who most need our help and support. It is not only dangerous for those who may see suicide as their only option, but can be tempting for those who would benefit from their absence.”
Parliamentarians themselves need to stick to the public safety angle. Some may agree in principle that we should permit others to help people to die, but there is no way around the argument that allowing the practice would put vulnerable people at risk as Belgium, Holland and Oregon have shown. Parliament and Government have a duty to protect the vulnerable, not put them in jeopardy.
We must be resolute in the face of insults and jeering from those want to see our society taken back to a genuinely retrograde civil society where a ‘winner takes all’ culture, defines the way we see the vulnerable.
Hard cases make bad laws. Any change in the current law would give free rein to eugenics, and economically-driven or defeatist health professionals and others who would act with impunity Even in a free, democratic society there are limits to human freedom and the law must not be changed to accommodate the wishes of a small number of sadly desperate and determined people, who wish to impose their goals on all.
Hard cases make for bad laws Any change in the current law would give free rein to eugenics and economically-driven or defeatist health professionals and others, who could act with impunity.
Opposition to liberalising the law on assisted suicide is due to the risk such changes would pose to public safety and especially the most vulnerable in society.
The following links are excellent sources of information:
- UK Association of Catholic Nurses: http://catholicnurses.org.uk//Dear%20Lord%20Falconer%20of%20Thoroton.pdf
Catholic teaching: http://bit.ly/1m36Scv
The think-tank: Living and Dying Well: www.livinganddyingwell.org.uk
USA use of opioids http://www.lifenews.com/2018/05/04/doctors-
Pope Francis speaks on end of life issues.
(Acknowledgement to BioEdge) “Care” vs “overzealous treatment”: Pope Francis has advised doctors to avoid “overzealous treatment” of patients at the end of life, saying that “burdensome” treatment may not be in the bests interests of the person.
- The term ‘treatment’ however, needs careful consideration and understanding of how it is defined under UK law. Within the UK Mental Capacity Act (2005) the term ‘treatment’ is defined as: ‘any diagnostic or other procedure’ This is an extraordinarily wide definition in relation to true care of patients.
- Addressing the World Medical Association European Regional Meeting on End of Life Questions — a conference jointly organised by the World Medical Association, the German Medical Association and the Pontifical Academy of Life — the Roman Pontiff said that the development of powerful medical technologies calls for prudent discretion on the part of clinicians.”Within democratic societies, these sensitive issues must be addressed calmly, seriously and thoughtfully, in a way open to finding, to the extent possible, agreed solutions, also on the legal level. See the link:
August 2017: What do we mean by ‘Dignity’. See Tiffany Dawson’s excellent ‘abundant life’ blog on this concept from CareNet website: https://www.care-net.org/abundant-life-blog/debunking-the-death-with-dignity-myth?
UK – October 2017. Former lecturer with Motor Neurone Disease, Noel Conway, fails in his bid to be helped to commit suicide but intends to appeal the ruling.
- His case was supported by Humanists UK and opposed by the secretary of state for justice, Care Not Killing and Not Dead Yet UK, also made submissions.The British Medical Association has previously expressed its opposition to physician-assisted dying, saying it risked putting “vulnerable people at risk of harm” and would be “contrary to the ethics of clinical practice”.
Please see an analysis of this case from the Care not Killing Alliance here:
Nikki Kenward of ‘Distant Voices’ demonstrated outside the High Court (17 July 2017) during Noel Conway’s legal bid for assisted suicide. See Nikki talking to the BBC that day:
September 2017: US Congress ponders assisted suicide (Acknowledgements to BioEdge)
- A resolution condemning Assisted Suicide has been introduced to the US House of Representatives. See the link: https://www.bioedge.org/bioethics/us-congress-ponders-assisted-suicide/12453
Europe – Germany: Nurse may have killed at least 90 in German Nursing Homes
A male nurse, Neils Hogel, above, may have killed scores of patients in nursing homes in northern Germany. Nurse Högel was given a life sentence in 2015 after he confessed to the murders of about 30 people at two clinics. Even at the time police suspected that he was responsible for more deaths.
Evidence for these has emerged now after they exhumed and examined 134 bodies. It appears that Högel had given a number of them a lethal injection. Although the total will never be known, as a number of patients were cremated, it appears that he killed at least 90. This makes him the worst serial killer in Germany’s criminal history.
More information via this link (Acknowledgement to BioEdge) :
ROYAL COLLEGE OF NURSING : ‘Raising Concerns’:
Nursing staff should feel comfortable raising concerns, but speaking out is not always easy and often takes courage. Now a new RCN publication: ‘Raising Concerns’ supports you wherever you work and whether you act as an individual or as part of a group. Alongside a step- by- step guide, the publication looks at your rights and responsibilities; the support and response you should expect: and the differences between sharing concerns and whistle blowing. See the following link: http://www.rcn.org.uk/publications
Care Quality Commission (CQC ): Whistleblowing: Guidance: See the following link:
Public Concern at Work Charity– See the link to this UK Charity: http://www.pcaw.co.uk/
USA – September 2017: Are ‘brain dead. patients really dead?
A provocative new journal article challenges conventional accounts of human death.
A new article in the Journal of Medical Ethics challenges conventional accounts of human death, and calls for a “new consensus” on the ethics of vital organ transplantation. (Acknowledgements to BioEdge)
Bioethicists Michael Nair-Collins, of Florida State University College, and Frank Miller, of Weill Cornell Medical College, assert that patients who are brain dead may nevertheless be said to have retained the integrated functioning characteristic of human life. This is the case even when the patient is supposedly “dependent” on a ventilator.
The authors observe that that mechanical interventions (such as a ventilator) do not in and of themselves allow for the functioning of the lungs and heart — other natural bodily operations play and equally important causal role:
- “The ventilator does not cause the heart to beat. The ventilator does not cause gas exchange. The ventilator does not trigger the actions of the other organs. And the ventilator certainly does not cause the coordination of activity between the different organs. It blows air in and out; the living organism does all the rest.”
- The corollary to this is that the ethical justification for organ procurement from brain dead patients is undercut. “The science underlying the claim that the ‘brain dead’ are biologically dead organisms is weak and fundamentally flawed. Since the accepted ethical rationale for vital organ procurement from ‘brain dead’ patients relies on the validity of the neurological standard for determining death, the accepted ethical rationale is undermined as well.”The authors suggest that “a new consensus” must be reached on the ethics of vital organ transplantation — “one which is not premised on demonstrably false claims about the vital status of biologically living patients”.The provocative paper echoes claims made elsewhere about the invalidity of current justifications of brain death. It will be interesting to see how the bioethics community reacts to the growing clamour against conventional accounts of organismal death.
UK: 29 July 2017, Baby Charlie Gard dies
- The press statement of the Anscombe Bioethics Centre (Oxford), entitled “Doing the right thing for the right reasons” presents a well-balanced ethical analysis, see the following link:
Letter to the Telegraph, 17 July 2017, from Ann Farmer:
Dear Sir,Astonishingly, the state-appointed lawyer defending little Charlie Gard’s best interests is chairman of Compassion in Dying, a sister organisation of Dignity in Dying whose aims it shares, denies a conflict of interests in representing a child whose right to be treated is being decided (Anger at choice of Charlie’s lawyer,Telegraph, July 17, 2017).Dignity in Dying used to be the Voluntary Euthanasia Society, formerly the Voluntary Euthanasia Legalisation Society, which in the 1930s saw euthanasia as a weapon against overpopulation and called for it to be applied to patients with diseases like tuberculosis; if they had succeeded, no cures would have been found.Dignity in Dying say they want to legalise the killing of people with severe problems, but by now it is abundantly clear that legalisation, even with a very narrow remit and hedged about with safeguards, establishes the precedent that for the sick and disabled and indeed anyone who is “tired of life” (as in Holland), death is in their best interests. No treatment is guaranteed to work, and if we insist on cast iron proof that it will, we may as well give up on medicine and just kill people. It’s certainly cheaper.Yours faithfully,Ann Farmer
CANADA : Euthanasia provision ‘medical fees’
Canadian euthanasia doctors are pressuring the provincial governments to pay them more money for euthanasia. Supposedly, some euthanasia doctors have stopped killing people based on money.
An article by Kelly Grant published in the Globe and Mail, appears to pressure governments to pay more for euthanasia. The article insinuates that access to euthanasia has been impeded by the money doctors make to do lethal injections:Dr. Pewarchuk, an internal medicine specialist in Victoria who has presided over 20 assisted deaths, took his name off the list of willing physicians last month after the body that sets doctors’ pay in British Columbia approved new fees that he and some of his fellow providers say are so low they could chase away even the most committed physician supporters of assisted dying.Maclean’s magazine published an article by Catherine McIntyre stating that physicians in the Netherlands are paid more money to kill:In the Netherlands, for example, where physician-assisted dying has been legal since 2002, providers are paid a flat rate of about 1,500 euros. That’s $2,200 Canadian dollars and at least five times more than what MAID providers can earn in Canada. On top of that, Dutch physicians are given a paid day off after assisting a death to take care of themselves emotionally. (Correction: Professor Theo Boer sent a message to the Euthanasia Prevention Coalition’s Executive Director, Alex Schadenberg, stating that Maclean’s magazine was wrong. According to Professor Boer, doctors in the Netherlands receive 227 euro per euthanasia).
More from Canada: ‘The Slippery slope in action’
(acknowledgement to Lifenews)
See the video link: http://alexschadenberg.blogspot.co.uk/2017/07/mother-upset-after-doctor-offers.html
(Acknowledgement to Euthanasia Prevention Coalition)
In other news: Scotland:
A Scottish Catholic bishop wrote a passionate letter to his fellow Catholics in May 2017, urging them to speak out against the growing threats to human life. Bishop Stephen Robson of Dunkeld, Scotland wrote the letter for Scotland’s Day for Life on May 31, the Scottish Catholic Observer reports. He said:
Vulnerable people such as the disabled, elderly and frail are increasingly in danger from pressures to introduce assisted suicide or euthanasia. Campaigners have been relentless in pursuing their aim of introducing such laws. Worryingly, there is a broad coalition and considerable political support for extending the threats to life including extending abortion to birth for any reason.”
The Bishop’s letter also coincides with the release of new data showing that unborn babies with disabilities are being aborted at higher rates than in the past in Scotland.
UK: Multidisciplinary Conference: 08/05/2017. 10.30 – 16.15 hrs
(Convened by the Pro-life Nurses Group).Venue: the Royal College of Nursing, 20 Cavendish Square, London.
Keynote speakers: Dr Peter Saunders, Christian Medical Fellowship, Steve Fouch Head of Nursing, CMF and Paul Diamond, Standing Counsel for Christian Concern.
This was a well-evaluated programme with top class speakers. The delegates were interested in knowing more about this fundamental aspect of nursing in line with the expectation of the Nursing and Midwifery Council.
The dangers to the vulnerable today were explored well from Â the historical, pharmacological, legal, nursing and conscience perspectives.
The role of the nurse as patient advocate, is recognised as vital for patient well-being and safety, Â particularly in a utilitarian age with cost- cutting preoccupying many care settings. Shift patterns, particularly 12 hour shifts, were discussed, and are known from research to be a source of nurse stress and can impact greatly on care continuity but can, and should, be re examined for their contribution to both nurse and patient best interests.
- The Mental Capacity Act and the former Liverpool Care Pathway were revisited. Concerns were raised that the former inappropriate LCP practices are continuing in some areas. Discussion was generated about the need for automatic use of syringe drivers in Palliative Care. Though a useful means of giving drugs, this route is not always to be considered inevitable where inappropriate/not required. The defence of ‘merely obeying orders’ was emphasised from an historical perspective – as there is no defence in law, for ‘merely following orders’ when patients are harmed (Germany, Nuremberg World War II trials).
- The toll, both physical and psychological, on the nurse, in attempting to maintain the role of patient advocate can be significant. Nurses need full support in managing this inherent responsibility with help from the profession, the managers and each other. The importance of Clinical Supervision cannot be underestimated.
- The Nurse’s Code of Conduct is a good means of ethical and legal protection for both the patient and the nurse. There was good interaction with personal experiences being shared which included those from the nurses, a former patient, a bereaved relative (LCP experience) and a hospital visitor.
- Simple comfort measures and extra time given by nurses, particularly at the end of life, were discussed. These do not always require expense and can relieve the possible feelings of isolation or distress, particularly when patients are placed in single rooms.
UK February 2017. Hospital launches a probe after a stroke patient who suffered a fit in his care home is ‘put on a death pathway’
Walter Prescott, 62, was admitted to hospital in Bury after suffering a fit
His family claim he was put on a ‘end-of-life’ regime when he was discharged
Police are probing the death of Mr Prescott’s mother in similar circumstances
- Professor Patrick Pullicino, the neurologist who helped expose the LCP in 2012, said there were still big concerns over NHS palliative care. He called for new, fully evidence-based guidelines. Read more: http://www.dailymail.co.uk/news/article-4216162/Hospital-launches-probe-stroke-victim.html#ixzz4Yf9mw12X
New England Journal of Medicine, April 6, 2017: University of Pennsylvania bioethicists, Ronit Y. Stahl and Ezekiel J. Emanuel, have written a controversial article exploring Conscientious Objection laws which give health care professionals the legal right to refuse, on the basis of personal beliefs, to perform certain procedures or care for particular patients. The authors argue that professional societies should declare conscientious objection unethical and remove conscience clauses from their codes of ethics. This opinion has caused strong reaction among conservative bioethicists. According to the authors, objection to providing patient interventions…that the profession deems to be effective, ethical, and standard treatments…is unjustifiable. Stahl and Emanuel argue that doctors, in entering the medical profession, agree to abide by the ethical and professional standards of the profession: By entering a health care profession, the person assumes a professional obligation to place the well-being and rights of patients at the center of professional practice.
These authors suggest that doctors who object to standard practice should choose between the following two options: select an area of medicine, such as radiology, that will not put conscientious health care objectors in situations that conflict with their personal morality or, if there is no such area, leave the profession
We hope doctors and nurses will resist with all their might, together, as a strong body, this insidious, creeping culture which is as worrying as it is chilling. Belief in the right to exercise conscientious objection reflects the belief in universal human rights, the importance of recognizing conscience as fundamental to civilisation and ultimately the rights of vulnerable people.
Assisted Suicide: read an American nurse’s opinion via the link: https://nancyvalko.com/2017/01/04/the-slippery-slope-tactics-in-the-assisted-suicide-movement/
Oregon Bill Would Allow Starving Mentally Ill Patients to Death: http://www.lifenews.com/2017/02/06/oregon-bill-would-allow-starving-mentally-ill-patients-to-death/
Euthanasia Debate- fears of ill patient : http://alexschadenberg.blogspot.co.uk/2017/01/im-terminally-ill-and-euthanasia-debate.html
Catholic hospitals in Belgium which provide a substantial portion of psychiatric beds will permit euthanasia for non-terminally-ill patients. It is an unprecedented reversal of their stand on end-of-life care. Supporters of euthanasia, see this development as individual self-determination, which trumps long held Judeo- Christian prohibition. Such a development can only worry those who oppose euthanasia. Fifteen years after Belgium legalised euthanasia, most hospitals now provide this form of ‘care’. The overthrow of barriers which are an irresistible goal for the proponents of the culture of death has been achieved at the cost of Â true medicine and patient abuse. Many patients for euthanasia will be non- consenting as seen in those countries/states where euthanasia has been legalised.
The religious founders of these care facilities are opposed to this decision, taken by lay people now involved in the day to day running of the hospitals.
Switzerland: February 2017 : Completely ‘locked in’ patients can communicate: http://www.bbc.co.uk/news/health-38761461
A Dutch doctor who held down a patient and euthanised her against her will did not break the law, a panel has ruled. A committee in the Netherlands concluded that the doctor had “acted in good faith”, even though the patient, who had dementia, struggled when the doctor tried to insert the intravenous drip. The committee decided the case should be brought to court to determine whether other doctors who euthanise dementia patients will be prosecuted. Andrea Williams, Chief Executive of Christian Concern, described the case as “a tragedy”.
“This story is an example of the risks that the Netherlands liberal euthanasia laws are placing on the elderly, the sick and the vulnerable.
“It should never be for a doctor to decide on a patient’s behalf whether that patient wishes to live or die.
“Despite this tragedy, this doctor has not been charged. This sends the wrong message to Dutch society and indicates that others may carry out similar actions in future without facing prosecution.
“The Netherlands is increasingly embracing a culture of death, when instead it should be promoting life and doing more to protect it. It is vital that we firmly resist any such policies being implemented in the UK.
evangelicals say it‘s okay near the end of life?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
End of Life and Palliative Care, Nursing Times On line Comment:
Comment on: How EastEnders injected realism into Peggy Mitchell’s death
TERESA LYNCH’S COMMENT 19 MAY, 2016 4:29 PM
When will the BBC show at least a degree of balance to its programming? Peggy’s demise in
EastEnders is just the latest in the BBC’s apparent dedication to showing suicide as the best option
at the end of life. Its recent pro assisted suicide programme about Dignitas revealed a clear need
for another view to be portrayed. Many patients, whose time at the end of life is considered
precious by themselves and their families, and love life, can be so well managed without the need
for assisted suicide. The BBC’s negative portrayals of end of life experience need to be balanced by
a more positive experience of which there are many. The BBC in portraying repeatedly this
creeping, defeatist ‘control’ of all aspects of life as entitlement, should ponder the staggering
statistics on suicide for men under 45 in the UK. As a nurse opposed to euthanasia, it is well known
that once assisted suicide is legalised, it heralds in euthanasia as the experiences in Holland and
Belgium testify. Time will tell whether the BBC will decide on a more balanced approach to this
serious subject .
Comment on: ‘Nursing has for too long been outside assisted dying debate’
TERESA LYNCH’S COMMENT 26 JULY, 2014 7:37 AM
Medicine and nursing in the 21st Century ever seeks to increase the percentage of patients achieving a pain-free existence in the terminal phase of illness. Patients with end stage disease are a constant challenge to the vocational skills of their carers. In my experience, patients look to their carers to affirm their lives, not offer them death as a defeatist, cheap and easy option.
No one of any age or degree of illness is granted a pain-free existence. To suffer is part of the human condition. We see practical love operating frequently in times of natural disaster, to make bearable the suffering of those having experienced loss, natural disasters, torture, persecution, injustice,or bereavement, in other words, in all forms of suffering, whether mental or physical. What makes suffering bearable is the constant, invaluable support by family and friends, and of course their carers in their loving concern,support, and practical care for pain, wounds and misery.