Here’s how that single-payer paradise, Great Britain, deals with patients deemed terminally ill s under its National Health Service: It gives them a morphine-assisted push over the edge.
A Drudge-linked story in the U.K. Telegraph titled “Setenced to Death on the NHS,” reports on a letter to the Telegraph by six physicians and other experts in care for the terminally ill. The letter complains that NHS guidelines for dealing with dying patients have resulted in many of those patients being deliberately denied food and fluids and then put on continuous sedation until they expire. In other words, according to the letter, the patients are hurried along to death. And some of them may not actually be dying but getting a little better!
The authors of the letter include Peter Millard, emeritus professor of geriatrics at the University of London and Dr. Peter Hargreaves, a consultant in palliative medicine at St. Luke’s cancer center in Guildford. From the Telegraph:
“Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong.
“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients.”
The process the experts are complaining about is called the Liverpool Care Pathway. It’s the brainchild of the National Institute Health and Clinical Excellence (NICE). This supposedly advisory body created in 1999 is the equivalent of the Independent Medicare Advisory Council (IMAC), the answerable-to-no-one panel that was pushed by President Obama into the House health care bill as a cost-cutting measure. that would decide what medical treatments would be approved for senior citizens and how much the government would pay for them.
In Britain NICE is the agency that regularly decides to withhold expensive life-extending drugs to cancer patients. Its bureaucrats assign “quality-adjusted life-years” to the patients and then decide whether a particular course of treatment is “cost-effective”–and they often decide it isn’t. NICE guidelines are supposed to be merely advisory but they are typically adopted by the NHS and given binding force. IMAC would extend the NICE model a step further with regulatory powers of its own that could not be changed except by an act of Congress.
The Liverpool Care Pathway is a NICE idea dating from 2004 that has been adopted by more than 300 hospitals, 130 hospices, and 560 nursing homes in Britain. Here is how it works, according to the Telegraph:
Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor.
They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication.
However, doctors warn that these signs can point to other medical problems.
Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance.
Prof Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours.
In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.
“If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said.
Katherine Murphy, director of the Patients Association, said: “Even the tiniest things that happen towards the end of a patient’s life can have a huge and lasting affect on patients and their families feelings about their care.
“Guidelines like the LCP can be very helpful but healthcare professionals always need to keep in mind the individual needs of patients.
Visit the Liverpool Care Pathway’s creepy website, and you’ll read this:
The Liverpool Care Pathway for the Dying Patient (LCP) provides an evidence based framework for the delivery of appropriate care for dying patients and their relatives in a variety of care settings. It encourages a multi-professional approach to the delivery of care that focuses on the physical, psychological and spiritual comfort of patients and their relatives that has also been shown to empower generic staff in the delivery of care.
“Evidence based.” That’s code for one size fits all treatment, a key cost-cutting notion that also underlies IMAC. “Multi-professional” and “generic staff” mean that dying patients–or at least patients thought to be dying by an empowered generic staffer–don’t have much, if any, interaction with a real doctor who might second-guess the “team” diagnosis. Furthermore, the Pathway is very keen on “advance directives” (voluntary, of course!) in which it’s gently suggested to old folks that they might want to “refuse care.”
And just to give you a hint that you’re on your way out, the medical “team” at the facility photographed by the Telegraph wears black “Dr. Death” scrubs. NICE touch!