The Daily Telegraph describes how patients in Britain’s National Health Service deemed close to death are shunted off into a kind of “death row”, in which people who are misdiagnosed and capable of recovery are left to die.
- Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors have warned.
- 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 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across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.
- “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 creation of a “death pathway” according to a patient’s group has been caused by the adoption of guidelines promulgated by a British Government body called NICE.
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. … 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.
Dr. Hargreaves says “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. ‘It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.’”
While the problem of misdiagnosis or medical mismanagement is certainly not confined to Britain, the standardization of “end of life care” procedures does two things: it increases risk by reducing diversification and it creates a “positive feedback loop” in which imminent death, once suspected, is treated in such a way as to guarantee its eventuation. As an increasing number of physicians apply the NICE guidelines there eventually is no escape from its defects. If the benefits of “universal health care” are universal, so are its fatal defects. But it is the positive feedback loop that is really lethal in this case. Wikipedia defines it as “‘cumulative causation’, is a feedback loop system in which the system responds to perturbation in the same direction as the perturbation. That is, ‘A produces more of B which in turn produces more of A’”. Once the doctors believed you would die, the guidelines militated against recovery. One commenter on the Telegraph article wrote:
Whilst sitting through the night in Scarborough by my dying sister’s hospital bed six years ago I witnessed a dying, desparately fragile old lady lying prone in a cot, begging for water repeatedly in a faint anguished little cry. This continued for hours. The night staff were a few yards from her bed reading newspapers, playing cards or chatting about trivia. Not one went to this poor soul’s bed to touch her hand or speak a word of comfort to her. My sister slept throughout the night as I sat there listening. The memory of such inhuman indifference is etched on one’s mind.
Resources at the NHS are likely to be stretched even further. “The NHS could be forced to sack tens of thousands of doctors and nurses and cancel hundreds of operations after the next election, a leaked report suggests,” according to the Daily Mail. It was more glamorous in the movies. Edward G. Robinson at least looked to be having a good time.
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The NHS’s hundreds of thousands of employees include nice people, indifferent incompetents and murderous psychopaths (several well documented cases, and they certainly have not all been found).
When you’re in a helpless state in the UK “you get what you’re given”. It is important to be aware that under such a system, as an individual you have no enforceable right to anything at all. If the system fails you there is no appeal and no redress, and in the overwhelming majority of cases no consequence at all for anyone who works there.
It’s interesting that in the UK people wouldn’t dream for instance of having their cars serviced by a system run on these lines, and yet they consign their old people to it, and themselves in due course at a later date, without a second thought.
It’s important to remember that while there are myriad problems with state-run health care, the biggest one is that if legislators want to spend tax money on something besides health care in order to bribe some group or another into voting for them, they will do so without hesitation.
Private health care takes this possibility off the table entirely.
My question for the Telegraph commenter is: Why didn’t YOU get that helpless woman some water?
Once you get people believing that only the government can provide health care, they really, Really, REALLY believe it, don’t they?
Of the six threads that Wretchard has graced us with in the last two days this is the most important. Indeed this may be the key information that can yet save us from a looming disaster. Every effort will be made to suppress this knowledge.
“[End of life care]… creates a ‘positive feedback loop’ in which imminent death, once suspected, is treated in such a way as the guarantee its eventuation.” -Wretchard
I think 0bama is well aware of Death Path and the resulting Positive feedback loop. This particular End of Life care appeals to politicians who are in chalking up huge debt while in a financial crunch.
They realize it is much cheaper to dehydrate and sedate the elderly population until death rather than to properly care for them in the traditional manner.
The economics are clear. Give them a cheap End of Life counseling and pull the plug. Problem solved for Medicare and 0bama.
Unfortunately, this is slippery slope which can lead to other patients getting the very same End of Life care. Why stop a cancer victims and heart victims?
Take Alzheimer’s victims and Parkinson’s victims – they are on the same path. One could argue that retarded children are in the very same Death Path with not hope of a meaningful life.
Next, children with Cystic fibrosis are on the Death Path and are a just a burden to society…on and on.
I would hope the American people would realize the dangerous path 0bama is leading them down and stop him before it is too late.
Further, doctor should not violate their Hippocratic Oath – first do no harm – let alone become practitioners of lethal injections, euthanasia and out right killing.
Medical decisions are probably the most sensitive and private decisions Americans make. It is unethical for the US government social workers to decide who should live and who should die. It’s the individual right (or the right of their family) to make those decisions.
“[End of life care]… creates a ‘positive feedback loop’ in which imminent death, once suspected, is treated in such a way as the guarantee its eventuation.” -Wretchard
I think 0bama is well aware of Death Path and the resulting Positive feedback loop. This particular End of Life care appeals to politicians who are chalking up huge debt while in a financial crunch.
They realize it is much cheaper to dehydrate and sedate the elderly population until death rather than to properly care for them in the traditional manner. The economics are clear. Give them a cheap End of Life counseling and pull the plug. Problem solved for Medicare and 0bama.
Unfortunately, this is slippery slope which can lead to other sick people getting the very same End of Life care. Why stop a cancer victims and heat victims?
Take Alzheimer’s victim and Parkinson’s victims – they are on the same path. One could argue that retarded children are in the very same Death Path with not hope of a meaningful life. Next, children with Cystic fibrosis are on the Death Path and are a just a burden to society…on and on.
I would hope the American people would realize the dangerous path 0bama is leading them down and stop him before it is too late.
Further, doctors should not violate their Hippocratic Oath – first do no harm – let alone become practitioners of lethal injections, euthanasia and out-right killing.
Medical decisions are probably the most sensitive and private decisions Americans make.
It is unethical for the US government social workers to decide who should live and who should die. It’s the individual right to make those decisions (or the right of their family).
[Please remove #5. it is a duplicate post. There is a glitch in the system]
I forwarded the Telegraph article to my mother in Florida with the following description.
Please read and share without sending my email addy to strangers. The thing to remember is that once anything is controlled by the government then there is no way to prevent abuse, incompetence or corruption from taking over. We must prevent the efforts of the SEIU hospital workers union and Obama to push through socialized medicine in America. This has nothing to do with improving health care and it has nothing to do with saving money. In fact it will reduce the quality of health care and it will cost the tax payers Trillions of dollars that we can not afford. This is a naked grab for power and effort to reward his supporters. Just as he used a manufactured crisis to seize control of GM and Chrysler and give them to his supporters in the UAW he now is attempting to foment a crisis and use it to take control of another industry so that he can give it to his supporters.
It’s really sad when the death scene in Soylent Green provides more dignity than what is provided now.
The people that voted this system into existence have mostly shuffled off this mortal coil, ignorant, perhaps, of what they left for their descendants.
We, in the USA, on the other hand, are totally aware of the results of such a decision. We leave our children to inherit whatever system we today install.
Change things very very carefully.
tom
This is the kind of story that keeps me up nights. One year ago my 82-year-old father was diagnosed with an extremely rare form of cancer: ph+cml. He immediately received treatment with Gleevec, a new “miracle” drug. In just two weeks he entered full remission. He is now as mentally sharp and physically active as the average 65-year-old, according to his doctor. The two pills he takes every day let him live a happy, normal life. (There are side effects, but they are mild) Here’s why I just said all this: he gets his medicine via private insurance *only.* Medicare will not cover it, and there is no other real treatment unless you count palliative care.
I think about this a lot. I hope he dies of just plain old age- and the doctor thinks he might live out a normal lifespan- before some fancy new “national” healthplan puts his treatment at risk.
I witnessed a dying, desparately fragile old lady lying prone in a cot, begging for water repeatedly in a faint anguished little cry. This continued for hours. The night staff were a few yards from her bed reading newspapers,
Basically, private services work for the benefit of the customer/patient – whereas public services always work for the benefit of the employee.
Red, Dead, brought back by Barack
- ht Deuce
…while there are myriad problems with state-run health care, the biggest one is that if legislators want to spend tax money on something besides health care in order to bribe some group or another into voting for them, they will do so without hesitation.
Exactly.
The Corporation for Public Broadcasting alone gets $500 mil/year. Etc, etc.
Government gravy in all 50 states supports “Black Cultural Centers,” “Women’s Resource Centers,” and “Multicultural Centers,” (not to mention faculty teaching these agendas).
Likewise, most land-grant institutions, pressured by industry groups, devote millions to golf course turf research and gay-appropriate species of wheat (ok, I made that last one up — but you weren’t sure, were you?).
Dying people? They probably won’t vote in the next election cycle.
“Dying people? They probably won’t vote in the next election cycle.”
Unless they wind up on a list of voters registered by ACORN….
Further to Lynne’s comment about Gleevec: It was developed to treat a chromosome defect (Philadelphia Chromosome, or ph) which is the hallmark of chronic myeloid leukemia (CML). That it is not covered by Medicare is not surprising in view of its cost of $32,000 per year for a 400 mg/day dose.
As Megan McArdle has pointed out, under the European model, drugs such as Gleevec would not become cheaper and more accessible as some imagine, they would not have been developed in the first place. People would die for lack of these drugs and no one would be the wiser.
I cannot comprehend how so many otherwise intelligent people can be so blind towards the dire consequences of handing more and more power and money and decision-making over our lives to our government. I live in the Hollywood Hills. Most of my friends and acquaintances are liberal to radical. Most of my family too. None of them are in the least fearful of the growing fascist government under Obama. They seem complacent with the notion that our government already treats us as cattle or sheep. Cattle whose job it is to graze in the pastures of government created legal landscapes only to be harvested for the steady stream of meat and wool we provide for government subsistence in the form of taxation. They cannot see how we are simply and inevitably commoditized for the sake of efficiency and profits. After 9/11, Bush’s best advice to his herd was to go shopping — that was bad enough. My “liberal” friends didn’t seem to appreciate it any more than I did.
Now we have the greatest and gravest and most cynical expansion of the US government in history, those same friends and relatives are all in love with the prospect. This also seems like some kind of feedback loop. When the despised Bush treats the population like mere cattle = BAD. When the Messiah proves himself much more invasive = GOOD. These true “liberal” cattle and sheep moooo and baaaah in adoring approval. Their feedback loop includes the notion that if Obama thinks of the world much like they do, then any enormities he commits, any overreach he’s guilty of in obtaining his greedy power-mongering goals is no overreach at all.
I
If NICE doesn’t look like a death panel, I don’t know what does. As this administration moves from creating one disaster to the next, I am reminded more and more of the words attributed to Thomas Jefferson: “A government which can give you everything you want is powerful enough to take away everything you have.”
Re:Ernie G.’s comment-
Yes, Gleevec is prohibitively expensive. When we first heard about the prescription, I just groaned. The Dr. quoted 5k per month! My parents are working-class folk with pretty good but not top-of-the-line private insurance. They crossed their fingers and took the script to the insurer.
In only one week, the insurance company agreed to cover the Gleevec, charging my Dad only $100 per month. We were stunned. They even have a special delivery program that ensures Dad never has to wait for more than a day for a new month’s supply. He just recently had to reapply for continued coverage of the Gleevec, and we all held our breath- but the company came through again, with the same price and service.
Medicare could never do this.
I’m worried for people who suffer from “orphan diseases” like rare cancers and so on. Who will develop the breaththrough drugs to save them? How will they get them?
PH+CML is so rare- only 21,000 cases in the US- that it is unlikely Gleevec will ever come down in price, unless it finds broader application.
This is truly a case of the private sector outdoing the government.
Side note: nobody knows what causes PH+CML. There’s a growing understanding of how it works in the body but no real idea how one acquires it. My father led a healthy, active, teetotalling life and had no cancer in his family tree. Everyone is mystified as to how this happened.
Ernie G- are you a doctor? Do you have any idea how ones acquires this disease?
It’s not supposed to be passed from generation to generation, so what on earth triggers it?
The problem here is the bureaucratization of medicine.
The goal of improving care of the dying is certainly laudable. I wouldnt read anything more sinister into the intent of LCP than that. The problem is in the replacement of a decentralized and individualized process, to a standardized product which can result in unintended consequences.
NHS and much of British Medicine has become little more than medicine by guidline, and hence, by commitee. Pathways, such as this one, are meant to be adhered to. To deviate from the path is discouraged and difficult to justify in what is a subjective judgement. Evidence based medicine is a good thing, but there are problems when relying on it too much.
So let us say, for example, that evidence suggests that pill A works better than pill B and the guidlines say “for the diagnosis of hairy earwax sydrome pill A should be prescribed for a six month trial’. The doc knows however, from past experience, that this patient doesnt take big white pills when prescribed, only little blue or pink ones. Pill B is little and pink and A looks like a golfball.
Of course the pharmacy no longer carries pill B. To find it would be a big hassle, requiring paperwork and explainations, and one only has to check off A on the form and be done with it. He does so, knowing that he has adhered to guidlines and cannot be faulted if the patient didnt cooperate by taking their medicine.
These docs are rightly concerned that the process here is too simple and easy. It is designed to allow these folks to be cared for at home. That is not in itself a bad thing but it is a double bonus for medical workers who save work, and it is not easy to take care of the dying, as well as the government who saves money.
Which leads to what everyone is worried about, overuse and manipulation by those with vested interests. These are inescapable because as human beings we cannot escape self interest and there is nobody in this process who gets anything by keeping the patient alive for a few more months. Except the patient and they do not seem to have much to say here.
Medicine is a health care system now staffed by care providers servicing customers. These are increasingly run like Disney with matching uniforms color coded for different areas (pink for mammography – sorry women’s imaging), patients wait in ‘comfort areas’, can recive massages, aromatherapy, and room service delivered by workers wearing a faux waiters uniform. In fact the book “If Disney Ran Your Hospital” by Fred Lee has been awarded #1 status by the American College of Healthcare Executives.
Liberals love systems.
Spindok
One of the saddest articles I’ve read recently, in last Sunday’s New York Times, about allegations of euthanasia of ‘inconvenient’ patients in New Orleans during hurricane Katrina:
http://www.nytimes.com/2009/08/30/magazine/30doctors.html?scp=1&sq=katrina%20euthanasia&st=cse
From wretchard’s text:
They are NOT “Death Panels”, they are NICE Panels!
Feel better now? [/snark]
I navigated through the Medicare system with my Mom for 13 years until her death in 1998 at the age of 88. Just prior to her 75th birthday she had a massive stroke. This left her handicapped. At no time did Medicare + Federal Supplemental Insurance provide proper rehab services nor much of anything else. It was a constant battle to get them to provide on-going rehab as needed. The rub is that stroke, once it happens, is degenerative. Bottom line = Death panels operate and have for some time. Saying otherwise is just a lie.
Lynne – My F-I-L got this and was dead in 10 days. The Gleevac did nothing for him so you are truly blessed. The doc, who is a friend of mine, said that it is environmentally caused, they think. Something triggers it.
2. no mo uro:
“”"” It’s important to remember that while there are myriad problems with state-run health care, the biggest one is that if legislators want to spend tax money on something besides health care in order to bribe some group or another into voting for them, they will do so without hesitation. “”"”"”
Which describes the dynamics of Tobacco Settlements made by various states perfectly. While the supposed intent was to provide funds for treating tobacco-related illnesses, the first consideration was to enrich lawyers to a degree never before imaginable, and the second was to fatten state coffers in a way that took the pressure off of the need to increase taxes. Treating tobacco-related illnesses isn’t even third in line, but fourth, after general healthcare funding. By the time you get to step four, there is no money left.
Lynne:
I’m not a doctor, just a retired engineer with a background in research and a flair for using Google.
Normally we think of inherited defects when we think of chromosomal abnormalities , but this is not always the case.
Prompted by your question, I did some more digging and found that the villain of the piece is something called an oncogene:
The Oncogenes may be activated to produce tumours in a variety of ways eg as a result of viral infection, chromosomal translocations, deletions and gene mutation.
The ph’ oncogene, which leads to chronic myeloid leukaemia, is believed to be caused by a chromosomal translocation, according to Leong Yuet Yow, a Consultant Pediatrician at Singapore General Hospital.
In his paper, he described in detail the geometry of the translocation, didn’t say what causes it in the first place, so I suppose more research is indicated.
Someone should do a poll of utilitarians, progressives, and avid supporters of Obamacare, and ask them the following questions:
1) Are you for or against the death penalty (i.e., capital punishment)?
2) Do you think that killing some wild animals to cull the herd and make it more sustainable is cruel?
I’m convinced that a commanding majority of these people will answer “against” for (1), and “cruel” for (2). Keep in mind that when park services have to periodically shoot some deer or wolves, lefty activists get their panties in a bunch and demand “animal birth control” instead. I’ll bet you serious money they have no problem with starving someone else’s grandma if it serves the state to do so. The attitude towards the notion of killing a few of the criminally depraved after exhaustive legal appeals is self-evident among our highly-evolved progressive elites.
I think such a survey would be very, very useful in further exposing what metrosexual monsters many of these people are.
Jeff, I don’t know Anna Pou but I do know members of her family. And my family supported her Legal Defense fund. So I am admittedly biased.
I agree that the story is very sad.
What is also very sad that wasn’t mentioned in the NYT article is that most of these patients were completely abandoned by their families. While there is a mention of some intervening, most simply left them alone? I don’t know about you, but I wouldn’t leave a loved one of mine alone in any hospital with a Cat 4 hurricane bearing down on the city. Many of these who did so were the same ones yelling for financial reparations after the fact.
What is also not mentioned is how CNN ran a virtual jihad against Dr. Pou and the nurses that assisted her. It was totally portrayed as black victims vs. white perpetrators. Google CNN and Anna Pou; you get 14,000+ hits, but the NYT makes it sound like an afternoon talk show host on WWL swung the debate. The way CNN treated her has forever varnished my view of that organization.
It’s very easy for someone who did not experience this horrid event under horrid conditions try to second guess the heros and heroines like her who didn’t leave their posts, even under great duress and at danger to themselves.
Dr. Pou spent millions of dollars defending herself, and will forever be haunted by being a good samaritan. I wonder if her life would be better today had she just simply walked away, like many of the families of the patients? But knowing what I know of her, she would have never done that and her actions speak loudly to that.
Spindok No. 19: “The problem here is the bureaucratization of medicine.”
Indeed. As that great writer, Ernest K. Gann, put it one of the more minor but frequent tragedies of war is that those who would most thrill to the call of battle are left home to guard the whorehouse while others who only want to get by quietly are dragged kicking and screaming into combat. Bureaucracy does that, and that same spirit of earnest carelessness will be infused into the medical profession.
Gee, I wonder why we have not heard from Fletcher and his less-than-Christian remarks on this subject.
Thank you, Ernie G. It was kind of you to go to such trouble.
If they could only figure out what causes the translocation in the first place, many people could be helped.
The translocation, btw, is what Gleevec stops- as I undertand it.
Thanks for your help
Robohobo:
I’m so sorry to hear about your F-I-L. Yes, you’re right; we are truly blessed.
The information packet we were given says they are now experimenting with a new drug for patients that don’t respond to Gleevec. Sadly, this comes along too late for your family.
Please accept my condolences. Life can be so unfair.
Monty Python: Not Dead Yet
Obama lies, Grandma dies.
It’s a good chant.