One of my sisters, Penelope Anne — or Penny for short — has just died at the relatively young age of 61. She had been battling a very aggressive cancer for three and a half years. After two lots of chemotherapy, both of which almost killed her, she decided not to have any more. The doctors didn’t expect her to reach her 60th birthday. When she did, the whole extended family joined her to celebrate. Then she reached her 61st birthday (we celebrated again) and then on for another seven months before she died on the 22nd August 2009, which happens to be my youngest son’s birthday, so we won’t be forgetting that date in a hurry.
Throughout those three and a half years, a palliative care team in Brisbane was quietly caring for Penny. They did an outstanding job. They kept Penny pain-free throughout the experience. They adjusted medicines as the cancer progressed. They gave Penny’s husband as much help as he needed. They even told me when I needed to fly up from Melbourne to talk with her before she went into a coma. Penny’s extended family are very grateful for the extra time and the surprising quality of life that she was able to enjoy in the circumstances — thanks to the palliative care team.
So when I read articles like the one below from Touchstone magazine about the situation in the UK and I remember the Victorian Government’s recent attempt to legalise euthanasia, I am not confident that we will all have such a good ending as Penny did.
We should all encourage the government and the medical profession to support palliative care as “the way to go”.
N.I.C.E. Death Panels
C. S. Lewis might say, “Told you!” This Telegraph article describes the concern some Brits have expressed about, well, British “death panels,” pushing people over the edge too hastily. What’s up with this?
In 2007-2008 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.
The Netherlands?! Maybe it has something to do with bad medical care, or worse — death panels.
In a letter to the Telegraph, 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 warn: “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.”
Hmm. So someone is forecasting death for 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. Public, government-run health care? No way, not in merry ol’ England!
The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours. It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004. So, Nice Pathway?
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. A team, forecasting death. Sounds like a “death panel” to me, but maybe that’s a bit harsh. Final Exit Committee?
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.
Or even after a “diabetic episode” or even after a very bad dream. Take someone, sell the house they’ve lived in for the last several decades, take most of their possessions, put them in a hospital or nursing home, they might wake up in the middle of the night a bit confused. I would.
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. Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition.
He added that 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 said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.
“If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said.
But maybe they don’t want us to know that.