The "Liverpool Care Pathway," Hospice and Palliative Care Abuse

The "Liverpool Care Pathway" (LCP)  is a system of hospice/palliative care in the UK.  In the last few years, the system has come under fire as "stealth euthanasia" in which patients are put on the LCP "without consent" and without "being allowed, food, fluids and medication."  See the BBC article set forth below: “Liverpool Care Pathway: Your experiences.”

I periodically receive similar complaints from people in the US and Canada.  Consider, for example, this letter by an elder care facility owner in Washington State where assisted suicide is legal:

"Since the [assisted suicide] act passed, we have . . . noticed that some members of the medical profession are quick to bring out the morphine to begin comfort care without considering treatment.  Sometimes they do this on their own without telling the client and/or the family member in charge of the client's care." 

http://www.montanansagainstassistedsuicide.org/2012/07/dear-montana-board-of-medical-examiners.html

Consider also, this letter published in a Montana newspaper:

“If these terrible deaths happen when aid in dying (assisted suicide and euthanasia) is not legal, what will happen if these practices are made legal? Doctors will have even more power to take away patient choice."

http://www.montanansagainstassistedsuicide.org/2013/04/dont-give-doctors-more-power-to-abuse.html

Margaret Dore, Attorney at Law
President, Choice is an Illusion, a nonprofit corporation

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"Liverpool Care Pathway: Your Experiences"

http://www.bbc.co.uk/news/health-23301360

The LCP was developed to support dying patients

 

The Liverpool Care Pathway (LCP) should be phased out, an independent review is expected to say.

The system was designed to allow terminally-ill patients to die peacefully and with dignity.

However, the LCP has come under criticism with some believe it is being used to speed up the process of dying. There have been some reports of patients being put on it without consent and not being allowed, food, fluids and medication.

Here, [three] family members of those who have been on the Liverpool Care Pathway, share their experiences of the programme. [There are two unfavorable views and one favorable view of the LCP]

Kayleigh Hollobone

Two years ago, when I was 22, I lost my 56-year-old mother to cancer.

During the six months from her diagnosis in January 2012 until her death, she was unknowingly to us put on the LCP. She was deprived of fluids and any source of nutritional supplement without even the slightest consent or conversation with me or my family.

It was only after my absolute insistence and persistence that my mother received fluids and that was after over 36 hours without any.

It scares me that people who do not have bossy and demanding families, like me and mine, to fight for them will be left or even encouraged to die via the LCP.

My mother survived another three months. We got to hear her laugh and joke again and importantly my mother got to say her goodbyes. Had the enforced LCP been allowed to continue, those few important months of time with my mother would have without a doubt been taken away from me and my family.


I can't stress how important me and my family feel about the process of the LCP. It needs to be readdressed - the memories it could have deprived me of are invaluable. She wrote me a letter that I will have forever and it will always be the most treasured item I possess.

Helen Redshaw

"The Liverpool Care Pathway aided her in a gentle and thoughtful way”

My mother passed away from cancer just three months ago. The Liverpool Care Pathway was used and I have nothing but praise for it. We had help from night nurses through the NHS Beacon program, Marie Curie and Macmillan, all of which gave exemplary care. Leaflets on the LCP were given to us and time was taken by all to fully explain why and how it would work. 

Towards the end, my mother couldn't swallow and didn't want food - this was her body getting ready to die. It was slow and peaceful, and she was my mother until about the day before when we all knew she was leaving.

There was no prolonging of life. She was ready to go and the Liverpool Care Pathway aided her in a gentle and thoughtful way. It wasn't the refusal to give her food and drink; she no longer wanted it.

She had as natural an early death as can be and I am thankful as it helped me and my family cope as we saw her slip away. This is something that should be offered and explained to patients and family and I have nothing but support for it.

William Hughes

My father Professor Robert Hughes was subjected to this technique without my or his consent. When it became clear that his cancer of the prostrate became untreatable I was asked what I wanted to do and I told them clearly that I wanted him to die with dignity.

I was assured by the staff at the hospital that would happen, that he would have died a dignified death. He didn't. He was sedated, unconscious and died within three days looking like something from Belsen concentration camp.

He was not given water or food but instead put on a driver syringe containing diamorphine, midazolam and cyclizine. The first two of those drugs would down a horse. . .

Sadly there is no going back. I didn't know that once started, it's irreversible.

No one makes this clear. This is the main part, if not for some the final part, of the LCP.

In the new scheme when that comes out, if they allow these two drugs to be continued to be used, it is euthanasia, plain and simple.

Excuse the mess!

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Choice is an Illusion

Beware of Vultures

"[I]t seems odd that the top lobby spender in Montana this year was Compassion and Choices, a 'nonprofit' group that spent $160,356 advocating for legalization of assisted suicide."

By Senator Jennifer Fielder

As we wrangled through the budget this spring, the beautiful state capitol began to feel like a big, ripe carcass with a dark cloud of vultures circling about. 

Senator Jennifer Fielder

The magnitude of money in government attracts far more folks who want to be on the receiving end than it does those who just want fair and functional government. Until that ratio improves, it may be impossible to rein in unnecessary regulation and spending. 

Special interest groups spent over $6 million dollars on lobbyists to pressure Montana legislators during the 2013 session. Seems like a lot of money, until you compare it to the billions of taxpayer dollars at stake. Does the average taxpayer stand a chance against organized forces like that?

As your Senator one of my main duties is to sort out who wants your money, or a change in a law, and why. Getting to the bottom of it takes work. It would certainly help if well-intentioned citizens would do a little more research before clamoring onto any particular bandwagons as well.

We have to be careful not to be fooled by catchy slogans, shallow campaign propaganda, biased media reports, or plays on our emotions which, too often, conceal a multitude of hidden agendas. 

For example, it seems odd that the top lobby spender in Montana this year was Compassion and Choices, a “nonprofit” group that spent $160,356 advocating for legalization of assisted suicide. The second biggest spender was MEA-MFT, the teachers and public employees union who spent $120,319 pushing for state budget increases.

I earned a reputation for asking a lot of questions. I certainly didn’t take this job to rubber stamp anything. It's my duty to determine whether a proposal relates to an essential, necessary service of fair and functional government, or if it is motivated by piles of money to be gained from ill-advised government decisions.

You see, there is so much money in government that almost everything in government is about the money. The usual tactic is to disguise a ploy as “the humane thing to do”. . . .

Some groups work very hard to provide factual information about their issue. Others stoop to the lowest of lows to invoke heart wrenching emotions, twisted half-truths, or outright lies. You really have to look carefully for all the angles.

Assisted suicide is another issue that can be highly emotional. There are deep and valid concerns on both sides of this life and death debate. But I found myself wondering, “Where does all the lobby money come from?” If it really is about a few terminally ill people who might seek help ending their suffering, why was more money spent on promoting assisted suicide than any other issue in Montana?

Could it be that convincing an ill person to end their life early will help health insurance companies save a bundle on what would have been ongoing medical treatment? How much would the government gain if it stopped paying social security, Medicare, or Medicaid on thousands of people a few months early? How much financial relief would pension systems see? Why was the proposed law to legalize assisted suicide [SB 220] written so loosely? Would vulnerable old people be encouraged to end their life unnecessarily early by those seeking financial gain? 

When considering the financial aspects of assisted suicide, it is clear that millions, maybe billions of dollars, are intertwined with the issue being marketed as “Compassion and Choices”. Beware.

Public issues are not easy, and they are not always about money. But often times they are. If we want fair and functional government, we need to look deeper than most people are willing to look.. . .

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Published as Communication from Your State Senator, "Beware of Vultures," by Montana State Senator Jennifer Fielder, Sanders County Ledger, http://www.scledger.net, page 2, 6-4-13. Senator Fielder lives in Thompson Falls MT, representing Montana State Senate District 7.

Maine House Says No to Physician-Assisted Suicide (95-43)

http://bangordailynews.com/2013/05/31/politics/maine-house-says-no-to-physician-assisted-suicide-law/print/

 

By Matthew Stone, BDN Staff

 

Posted May 31, 2013, at 3 p.m.

 

AUGUSTA, Maine — The Maine House on Friday rejected a bill that would allow terminally ill patients to order lethal doses of medication from their doctors. The bill also would free doctors from legal liability for helping to end a consenting patient’s life.

House members voted 95-43 against the measure, which is sponsored by Rep. Joseph Brooks, an independent from Winterport. The bill next heads to the Senate.

Brooks’ bill, LD 1065, would allow a patient and his or her doctor to sign companion end-of-life care agreements. Those agreements would be signed after the two have discussed the patient’s medical condition and treatment options and the patient has rejected life-extending treatments and agreed to accept “care that is ordered or delivered by the physician that may hasten or bring about the patient’s death.”

The bill also would free doctors from criminal liability or the possibility of professional discipline for helping a consenting patient end his or her life.

The vote followed an emotional debate on the House floor in which lawmakers described their experiences caring for parents and friends as their lives ended.

Brooks said ill patients should be able to decide to end their lives when they can die in dignity.

“Dignity was important to this mill laborer,” he said of his father. “Had he been aware that he was lying in a hospital bed in the living room of his home not in control of anything, he would have probably said, ‘Please help me with this.’”

“How many of us have lost or seen others lose loved ones who linger painfully and unnecessarily for long periods?” asked Rep. Roberta Beavers, D-South Berwick. “We treat ill pets more humanely than we treat ill parents.”

But in letting doctors administer lethal doses of medication, the assisted-suicide bill would go too far, said Rep. Ann Dorney, D-Norridgewock. End-of-life care has changed for the better in recent years, said Dorney, a physician.

“We have very good end-of-life care. We have very good hospice care. We have very good palliative care,” she said. “I guess I’m not sure we need this bill.”

Dorney also worried about the prospect of a guardian who makes medical decisions for a patient making the decision to end that patient’s life.

Rep. Deborah Sanderson, R-Chelsea, said she wouldn’t want to rob a patient of a natural end to life.

“I sat with my mom the last five days of her life. I slept in a wheelchair by her bed,” Sanderson said. “The night before my mother passed, my mother said, ‘It’s not like what I thought it would be.’ She said, ‘It’s peaceful.’ And I was very glad to hear that.”

The Maine House’s rejection of the physician-assisted suicide legislation came more than a week after Vermont Gov. Peter Shumlin signed a similar measure into law in that state. Vermont’s law was the first in the nation to be approved through the legislative process.

Physician-assisted suicide measures on the books in Oregon and Washington passed through public votes.

In Maine, voters rejected a physician-assisted suicide ballot measure in 1990.

http://bangordailynews.com/2013/05/31/politics/maine-house-says-no-to-physician-assisted-suicide-law/ printed on June 2, 2013

Vermont: Jackowski: Assisted suicide is not the answer

http://vtdigger.org/2013/05/20/jackowski-assisted-suicide-is-not-the-answer/

Posted By Opinion On May 20, 2013 @ 11:00 pm

Editor’s note: This op-ed is by Rosemarie Jackowski, an advocacy journalist and peace activist who is the author of “Banned in Vermont.”

The “assisted suicide bill” does exactly what it is designed not to do. It will eliminate choice for the most vulnerable. Unintended consequences are sure to follow. We need more, not fewer rights. Government-approved suicide as an end-of-life option does not give more rights — in reality it takes them away.

Some legislators promise “safeguards.” There are no safeguards that can ensure that there will not be abuse. Some of the most vulnerable will be pressured to end it all for the convenience and sometimes for the financial benefit of others. Patients will be unduly influenced into giving in to family members. Many elderly/disabled have loving supportive families. It is those who do not who are at the highest risk. There is no way that abuse can be prevented. Imagine being isolated with caregivers — Stockholm syndrome.

The assisted suicide law will deprive many of choice. Recent history shows that more than 300 cases of reported abuse of the disabled/elderly have been ignored by the state. This is evidence that the state cannot protect the vulnerable. The assisted suicide law will add another layer of risk. It will make things worse.

Not what Vermont needs

http://www.timesargus.com/apps/pbcs.dll/article?AID=/20130517/OPINION02/705179982?template=printart

May 17, 2013

By Rep. Anne Donahue
 
Wake up, Dorothy. You’re not in Oregon anymore.

The final week of the political path to death with dignity in Vermont was a reminder of how a cadre of politicians can want something so desperately that they push it through even if abandoning key promises.

For months — no, for years — Vermonters have been told that Oregon’s experience of physician-assisted suicide has demonstrated that extending this compassionate option to persons who want it comes at no risk to the vulnerable.

The mantra has been Oregon. Oregon protections. Oregon data. Everything has worked flawlessly in Oregon, so if we follow the exact model as Oregon, we can ignore the fears of the naysayers.

When the Senate was short one vote in February to pass the Oregon model, it sent a narrow bill to the House that focused instead on independent actions of a patient rather than on prescriptions for intentionally lethal medication. It was roundly criticized for lacking the protections of the Oregon bill.

The House restored the Oregon, active-prescription version. Proponents were emphatic on the House floor that it was because every one of the Oregon protections were locked into place that members could be assured there could be no coercion, no errors in diagnosis, and no one making the choice lacking full informed consent.

When it pingponged back, the Senate still couldn’t muster the votes to pass it. So a few backers patched and pasted an assorted set of new and old language together directed exclusively at gaining the one extra vote needed.

Gone were both the Oregon model and any model that left the doctor out of the role of prescribing lethal drugs. Enter the land of political Oz.

Sen. Claire Ayer, who had been the most vigorous in attacking what the Senate had passed via a floor amendment in February, now pressed for the new hybrid, though acknowledging that it was drafted “on the fly.”

Eradicated by the Senate were fully 29 separate protective provisions that the House had required in its Oregon version, some of them small, some of them huge. Among the huge ones:

— There is no longer any written informed consent required.

— A guardian or an agent for an advance directive is no longer barred from taking the place of a direct patient request.

— There is no longer any requirement that the patient actually be able to “self-administer.”

— There is no longer a second opinion required to assess whether a patient has the rational judgment capacity to make an informed decision.

— There are no requirements for follow-up by the Department of Health. The required review of patient files is gone. The requirement to collect statistical data and publish annual reports is gone.

This last is particularly ironic, because it has been the patient information and report data from Oregon that has been the basis for assuring Vermonters that all is well in Oregon.

The new Vermont bill sunsets even the “Oregon-lite” approach in 2016, then eliminates all remaining structural protections. But there isn’t any data being required to assess how the process works in those first three years.

Despite all this, House members who wanted to see a bill pass stuck by what they had so strongly criticized before: a bill that no longer maintained many of the long-promised protections. Only a few looked twice and voted against accepting what the Senate had done. The winning vote margin dropped from 17 to 10.

Our radical new social policy that endorses having doctors write prescriptions that will kill their patients, cobbled together by just a few individuals from bits and pieces of language drafted on the fly, was passed by two votes in the Senate and 10 votes in the House.

But no, Dorothy. We’re no longer in Oregon.

Rep. Anne Donahue, a Republican from Northfield, is a member of the House Human Services Committee, which passed the Oregon-style bill on a 7-4 vote in April. She was an opponent.

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