NCPA - National Center for Policy Analysis

SENTENCED TO DEATH ON THE NATIONAL HEALTH SERVICE

September 10, 2009

In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.  Under Great Britain's government-run health system - the National Health Service --NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.  But this approach can also mask the signs that their condition is improving, the experts warn.  As a result the scheme is causing a "national crisis" in patient care, the letter states.  It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr. Peter Hargreaves, a consultant 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 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 warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS:

  • The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours.
  • Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes 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.
  • It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system.

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.
  • 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.
  • If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention.

Source: Kate Devlin, "Sentenced to death on the NHS," Daily Telegraph, September 2, 2009.

For text: http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html

 

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