Monday, 9 July 2012

Letting people die or 'nudging them along'


A young hand touches and holds an old wrinkled hand in a hospitalA recent article in the London Telegraph has re-ignited the discussion about the Liverpool Care Pathway and the claim that this planned intervention at the end-of-life often results in premature death or, at the least, unnecessary sedation.
As Alex Schadenberg pointed out on his Australian visit, medical interventions such as sedation and the use of nutrition and hydration can be abused. But that does not mean that this is routinely the case, nor does it mean, in this instance, that the Liverpool Care Pathway is somehow a sinister system designed solely to limit costs.
Withholding nutrition and hydration, once a patient has clearly entered the dying phase, is often about comfort; a person's body that is beginning to shut down its functions such as digestion and excretion may only suffer more discomfort from receiving food and fluids. Pain management may be indicated, but as the article points out: natural deaths are often freer of pain and distress. 
The article, quoting from a letter from some eminent doctors, also warns that there is no “scientific way of diagnosing imminent death.” They write: “It is essentially a prediction, and it is possible that other considerations may come into reaching such a decision, not excluding the availability of resources.”  So, what are we to make of these observations? Simply the fact that it is as very clear error in medical care to move to treat all, or even a significant number of patients in precisely the same way. Further, a move to create a regimen where medical staff will routinely turn to a particular protocol for all cases to the point where the individual's needs and care plan is ignored in inhuman.


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