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Canwest News Service
Patients with terminal illnesses are being made to die prematurely under a scheme by Britain’s equivalent of medicare to help end their lives, leading doctors claim.
In a letter to the Daily Telegraph, a group of experts who care for the terminally ill claim some patients are being wrongly judged as close to death.
Under National Health Service guidelines introduced in England, medical staff can withdraw fluid and drugs from dying patients and many are put on continuous sedation until they die. But this approach can also mask signs of improvement, the experts say.
As a result, the scheme is causing a “national crisis” in patient care, the letter states.
It has been signed by palliative care specialists including Peter Millard, emeritus professor of geriatrics at the University of London, Dr. Peter Hargreaves, an expert in palliative medicine at St. Luke’s cancer centre in Guildford, and four others.
“Forecasting death is an inexact science,” they say. Patients are being assessed as 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 warning comes a week after a report by Britain’s Patients Association estimated that up to one million people had received poor or cruel care from the NHS.
The scheme at the centre of the new warning, called the Liverpool Care Pathway (LCP), was designed to reduce the suffering of patients in their final hours.
Developed for cancer patients in a Liverpool hospice by Marie Curie, the cancer charity, it has been extended to other life-threatening conditions. It was recommended as a model by the National Institute for Health and Clinical Excellence (NICE), the government’s health scrutiny body, in 2004, and is in use in more than 300 hospitals, 130 hospices and 560 care homes.
Under the guidelines, the assessment that a patient is close to death is made by the entire medical team, including a senior doctor.
They look for signs that can include losing consciousness or whether the patient is having difficulty swallowing medication.
However, doctors say that these signs can point to other medical problems.
Patients can become semi-conscious and confused as a side effect of painkilling drugs such as morphine if they are also
dehydrated, for instance.
When a decision has been made to place a patient on the pathway, doctors are then recommended to consider removing medication or invasive procedures (such as intravenous drips) which are no longer of benefit.
The patient could still be offered food and water if able to eat and drink, as this is considered simple nursing care. Hargreaves said that the system depended, however, on constant assessment of a patient’s condition.
He said some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.
He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in.
“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”
He added: “What they are trying to do is stop people being overtreated as they are dying. It is a very laudable idea. But the concern is that it is tick-box medicine that stops people thinking.”
He said that he had taken patients off the pathway who went on to live for a “significant” period and warned that many doctors were not checking the progress of patients sufficiently well to notice improvement in their condition.
Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers which continually and automatically empty their contents into a patient over the course of 24 hours.
In 2007-08, 16.5 per cent of deaths in Britain followed continuous deep sedation, according to researchers from Barts and the London School of Medicine and Dentistry. The number was 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,” Millard said.
Katherine Murphy, director of the Patients Association, added: “Even the tiniest things that happen towards the end of a patient’s life can have a huge and lasting effect on patients and their families’ feelings about their care.
“Guidelines like the LCP can be very helpful but health care professionals always need to keep in mind the individual needs of patients.”
A spokesman for Marie Curie said: “The LCP is not the answer to all the complex elements of this area of health care but we believe it is a step in the right direction.”
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This document was never meant to be a tick box exercise.It is to encourage discussion and draw on medical expertise to alliviate symptoms of patients that are dying. Experience and research shows that medics are relutant to engage in the pathway due to ignorance and thus leave patients and reltives to suffer. I would be intrigued to see figures that show patients whom are wronged by this pathway and would be interested to know what the objectors would suggest to improve patients suffering in the dying phase, particularly in the community.
Please continue discussion on the forum: link