Betting on red

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across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.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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