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Posted By: ProVox

What’s with this Liverpool Pathway? :-k
The UK NHS seems to be turning geriatric wards into extermination wards! How long before they put down the mentally ill, the disabled, the blind, diabetics etc.? The NHS hierarchy would be better engaged putting down people like Abu Qatada and his associates or some of those living in comparative luxury in the UK’s overcrowded prison system! But, of course, that would be a breach of their human rights. #-o
Just what is happening in the UK?????

Why is it deemed immoral and made illegal to end your own life with dignity in clinics like Dignitas in a humane way and at a time and place of your own choosing and yet the NHS can literally starve you and deny you fluids over a period of time, without your consent, and it would appear without consultation with relatives or even the victims, to meet bl**dy targets. The doctors and administrators concerned should stand trial for manslaughter.

How did it get the name THE LIVERPOOL PATHWAY ....... anybody know? Surely Belsen/Auchwitz/Sobibor Pathway ( for those that can remeber the significance ?) would be more appropriate? :x



Posted By: FatMob

The LCP was developed during the late 1990s at the Royal Liverpool University Hospital, in conjunction with the Marie Curie Palliative Care Institute. It was intended to provide the best quality of care possible for dying patients in the last hours and days of life, whether they were in hospital, at home, in a care home or in a hospice. It was widely seen as a way of transferring the model of “excellence” in the care provided in hospices to other healthcare settings such as hospitals and care homes. The goal of the LCP is to ensure a death is as dignified and as peaceful as possible. I speak from many years' NHS experience in an Intensive care setting. I believe that the latest review does not necessarily paint this method in its best light... I have witnessed or been involved in the care of many people whose potential for a viable existence is nil...yet clinicians have been afraid to withdraw active intervention because they are afraid of litigation ...in our lovely culture of blame and compensation...I have also witnessed relatives who are hurting so much or are so shocked that they are unable to 'see' or absorb the gravity of the conditions in which their loved ones have suffered, in many instances it is cruel to continue the punishing and aggressive physical and chemical treatments that can be unleashed on 'the patient'... ( I liken this to the many people I have met who have chosen not to continue chemotherapy, because of the horrific side effects they have to endure...) The Liverpool Care Pathway (LCP) is by no means perfect, but it does permit some leeway to allow someone to die with some dignity, though I will agree there is always room for improvement/development. It is also not a one-way ticket...such as death row.. just because the LCP is commenced, does not mean that it cannot be ceased and active treatment recommenced. Believe me... I have seen many an horrific death....and as I say...the modern culture doesn't seem to make allowances for anyone to simply expire or old age...they have to be resuscitated and agressively treated with actions and therapies to treat multi system or multi-organ failure until they have little but shreds of dignity left Also, where I worked, there was active participation of the patient (where possible), and as many of their loved ones as wished to...in the decision-making ...Having seen more people die in some weeks or months of my career than many people see in their entire lifetime...I have now come to live a little in Cyprus ...

Posted By: mikelen

Big money available for NHS Trusts once they kill you off. http://www.dailymail.co.uk/news/article-2223286/Hospitals-bribed-patients-pathway-death-Cash-incentive-NHS-trusts-meet-targets-Liverpool-Care-Pathway.html Mike

Posted By: ProVox

Fatcatz123,
That was a very well put explanation and taking the source of my information, the Daily Mail, far more plausible. You were obviously ‘in the profession’ so to speak. But what gives these professionals the right to make my decisions for me, surely if you believe in a God that is his/her prerogative?
What I cannot get my head round is the fact that these medical ‘ experts ’ can make the decision for me when I am beyond a reasonable chance of recovery and really not in any state to make such a decision on my own behalf and yet the same people who OK this practice will not allow me to make that decision to terminate my life with equal dignity, earlier when I realise what the outcome of my illness will eventually be and the effect it will have on others.
As far as I am aware I am not in that position and look forward to a few more years yet but, if I were diagnosed with something that would eventually come to the point where I was too sick to make my own decisions, I would far rather be able to decide myself and say goodbye coherently to those I loved and let them remember me as a human being, not a sick person waiting to die.

Posted By: FatMob

well, although there are people who believe that money and/or menaces are at the root of NHS problems...from first hand experience,in relation to patient care, that NEVER presented itself in the place in which I worked, and believe me, the daily cost of care of critically ill patients is quite scarey!....though I could imagine that where private medicine only is practiced...or absence/limitations of insurances..maybe this does come into decision making. Your view seems to be taking the view that clinicians are able to take a decision to kill people......this is not the realm of the LCP...it is not a way of actively ending someone's life..it is a framework within which a life which is not able to survive may be permitted not to be punished and ravaged by continued aggressive, active treatments. I'm not judging you..but will pose a little devil's advocacy.. If you feel unwell with chest pains, for example, you would call for an ambulance, or attend casualty, or visit a G.P...when you use these services..you basically opt in to a contract.. you are requesting urgent assessment and treatment of your symptoms....this would indicate that you are willing to accept their medical knowledge/expertise/judgement..and hopefully you would comply with their advice.....you also have the option to ask a second opinion all medical practictioners pledge to abide by the THE HIPPOCRATIC OATH ...in summary: - Respect your teachers - Pledge your life to the service of others - Place your patients interests before your own - Protect your patients from harm & injustice - Treat all patients equally - Respect patient’s right to make decisions - Continue to improve the care you give - Do not become intimate with patients - Try to prevent as well as cure disease - Protect your patients’ confidentiality - Impart your medical knowledge to others so with this in mind, using the chest pain as an example..when we become unwell, we opt to put ourselves into the care/management of those whose knowledge exceeds our own...we have to trust them to make the right call for us...similarly, if you consented to have your appendix removed and once the surgeon 'opened you up' he found a tumour, and not an inflamed appendix..would you expect them to remove the tumour? or to close your abdomen and wake you up to wait for a new and specific consent form? simply because one's life reaches the point of no realistic recovery..it is no different than presenting with a curable condition in terms of the clinician's role, and way their decisions are based. you see what I mean...by entering hospital/medical care you request their knowledge and care...they have the hope that the patient will comply.. but I have had the privilege of many non-compliant aggressive and abusive patients :-( Getting back to the points you raised. I often voiced my thoughts/opinions to act as my patients' advocate if there was no-one to shout their corner, and they were not personally capable, particularly if I felt strongly about any medical decisions...though in reality, there are usually many family members or close friends who can offer opinions in relation to their loved one's care. I am not going to get into science...but the decisions made by clinicians are not based on the number of available beds, or whether they got out of bed the wrong side that day, but upon interpretation of medical/clinical evidence... blood results in relation to blood composition, infection markers within the blood results, breathing efficiency reflected by blood gases (whether the brain is receiving sufficiently oxygenated blood), kidney and liver function, toxicity, X-rays, MRI's & CT scan results compared to 'normal' values or observations... they are clinical evidence-based decisions, not merely someone trying to play God.. and the distinction is to allow someone to die who has no reasonable possibility of survival rather than to actively euthanase someone. Hope this helps with perception of LCP from a hands-on person.....incidentally, a close friend of mine complained to me (last year) that the LCP didn't go far enough when she watched her father die...she felt it didn't go far enough, because it had no way of advancing his death when she felt he was simply lingering...:-(

Posted By: fettler

Unfortunately, your assertion regarding the Hippocratic oath is wrong. There is no legal requirement involved, and many do not make this pledge. Sorry. Alex

Posted By: ProVox

Fatcatz: Thank you for taking the time and trouble to reply in detail.
I really don’t believe..... ‘that clinicians are able to take a decision to kill people .’ Although I often wish they had that freedom of action as in general I believe they could do so ethically, with knowledge and compassion and in the best interests of the patient but in our ‘ compensation ’ driven society I can understand why they would be reluctant to do so.
As ‘ fettlers ’ comment shows we clearly have a clash of professions. :-k
On one hand we have the medical profession that works within a framework of ethics and compassion, which puts the patient’s welfare first however, some doctors also have religious principals that can cloud their judgement as a medical professional so they are not infallible.
On the other hand we have the lawyers who have no principals, no ethics and no compassion. They are there merely to argue ‘ The Law’ , laws which their profession drew up in the first place and for every legal argument there is a legal counter argument as that is the way the law works. Even the Lawyers do not have the power to make a decision, that has to be made by a Judge who will make his decision based on the best of two arguments, presented by the opposing lawyers.
But, even the Judge could have his judgement clouded by his religious beliefs and is therefore no more capable of making a pragmatic decision than the medical professionals. So in practical terms we don’t need the Judges or the Lawyers!
The only one that seems to get no say at all in what is happening ..... is the Patient . The most important person in the equation and yet they have no say in events which directly affect them and nobody else. The patient seems to have been relegated to a mere silent observer status!
I am an Atheist but do believe in some form of after life. I do not believe in a God character and regard all religious teachings as simply brain washing for the control of the many and for the benefit of the few. But that is merely my opinion and I accept that others will feel differently.
I am in favour of euthanasia in a controlled way and in absolute favour of the patient being allowed to make a decision when they are still able to do so, of the manner and time of their death. If I were in no position to be able to make that decision when the time came, say due to an accident or an instantaneous medical event, then I would want the doctors to make the decision for me .... not lawyers or a Judge!
Off the thread but related: I am interested in the following explanations of life and ‘ The Soul ’ and consider it for more credible than the purely religious view of the subject:
A more simplistic non-technical explanation:
http://www.sott.net/article/252984-Scientists-offer-quantum-theory-of-souls-existence
A more detailed explanation more for the scientists and mathematicians:
http://www.huffingtonpost.com/deepak-chopra/can-science-explain-the-s_b_675107.html

Posted By: geoffreys

  • ProVox wrote:
    Fatcatz: Thank you for taking the time and trouble to reply in detail.
    I really don’t believe..... ‘that clinicians are able to take a decision to kill people .’ Although I often wish they had that freedom of action as in general I believe they could do so ethically, with knowledge and compassion and in the best interests of the patient but in our ‘ compensation ’ driven society I can understand why they would be reluctant to do so.
    As ‘ fettlers ’ comment shows we clearly have a clash of professions. :-k
    On one hand we have the medical profession that works within a framework of ethics and compassion, which puts the patient’s welfare first however, some doctors also have religious principals that can cloud their judgement as a medical professional so they are not infallible.
    On the other hand we have the lawyers who have no principals, no ethics and no compassion. They are there merely to argue ‘ The Law’ , laws which their profession drew up in the first place and for every legal argument there is a legal counter argument as that is the way the law works. Even the Lawyers do not have the power to make a decision, that has to be made by a Judge who will make his decision based on the best of two arguments, presented by the opposing lawyers.
    But, even the Judge could have his judgement clouded by his religious beliefs and is therefore no more capable of making a pragmatic decision than the medical professionals. So in practical terms we don’t need the Judges or the Lawyers!
    The only one that seems to get no say at all in what is happening ..... is the Patient . The most important person in the equation and yet they have no say in events which directly affect them and nobody else. The patient seems to have been relegated to a mere silent observer status!
    I am an Atheist but do believe in some form of after life. I do not believe in a God character and regard all religious teachings as simply brain washing for the control of the many and for the benefit of the few. But that is merely my opinion and I accept that others will feel differently.
    I am in favour of euthanasia in a controlled way and in absolute favour of the patient being allowed to make a decision when they are still able to do so, of the manner and time of their death. If I were in no position to be able to make that decision when the time came, say due to an accident or an instantaneous medical event, then I would want the doctors to make the decision for me .... not lawyers or a Judge!
    Off the thread but related: I am interested in the following explanations of life and ‘ The Soul ’ and consider it for more credible than the purely religious view of the subject:
    A more simplistic non-technical explanation:
    http://www.sott.net/article/252984-Scientists-offer-quantum-theory-of-souls-existence
    A more detailed explanation more for the scientists and mathematicians:
    http://www.huffingtonpost.com/deepak-chopra/can-science-explain-the-s_b_675107.html

Surely you are an agnostic?
Geoff





Posted By: ProVox

Geoffrey:
    Quote:
  • Surely you are an agnostic?

According to Wikipedia: Agnostic atheism , also called atheistic agnosticism, is a philosophical position that encompasses both atheism and agnosticism. Agnostic atheists are atheistic because they do not hold a belief in the existence of any deity and agnostic because they claim that the existence of a deity is either unknowable in principle or currently unknown in fact.
No, I would more correctly claim to be atheistic in my belief in the non-existance of a religious deity. :wink:

Posted By: FatMob

ProVox ....my pleasure! I also wish that living wills and the like would actually be adhered to, and some form of voluntary euthanasia be permissible....however...clinician are often afraid of complying with these patient directives (again based on fear of litigation, post mortem, by relatives) that maybe the circumstances in which they presented were not those wholly addressed by the patient when drawing up their wishes. Re: euthanasia... I don't believe that the British legislative system will make provision for this in my lifetime due to fears of it being abused. Regarding the Hippocratic oath....if that is the case, then I stand corrected. BEST wishes to all for a Happy and healthy 2013. XX

Posted By: geoffreys

  • ProVox wrote:
    Geoffrey:
      Quote:
    • Surely you are an agnostic?

    According to Wikipedia: Agnostic atheism , also called atheistic agnosticism, is a philosophical position that encompasses both atheism and agnosticism. Agnostic atheists are atheistic because they do not hold a belief in the existence of any deity and agnostic because they claim that the existence of a deity is either unknowable in principle or currently unknown in fact.
    No, I would more correctly claim to be atheistic in my belief in the non-existance of a religious deity. :wink:

What you said in your earlier post was that you DID beieve in some form of after life. To me that is being an agnostic, same as me.
NOW you bring in the concept of a religious deity.
We need now to start a new thread on this topic, as we will be accused of hi-jacking this one!
Geoff

Posted By: ProVox

    Quote:
  • We need now to start a new thread on this topic, as we will be accused of hi-jacking this one!

I believe in no Deity but do believe there is ' something ' after death that we do not understand. An analagy would be a computer that needs an operating system. The body as I see it is the organic equivalent that also has an 'operating system '. But I do not have the faintest idea what that is or how it operates but I am willing to listen!
You start the thread and I will happily explain my views to you if you are interested in discussion. :roll:

Posted By: geoffreys

  • ProVox wrote:
      Quote:
    • We need now to start a new thread on this topic, as we will be accused of hi-jacking this one!

    I believe in no Deity but do believe there is ' something ' after death that we do not understand. An analagy would be a computer that needs an operating system. The body as I see it is the organic equivalent that also has an 'operating system '. But I do not have the faintest idea what that is or how it operates but I am willing to listen!
    You start the thread and I will happily explain my views to you if you are interested in discussion. :roll:

I thought we might be about to find out last week - but the World did not come to an end after all.
Geoff

Posted By: FatMob

Anytime you're ready... PLEEEASE start your new thread LOL xx

Posted By: geoffreys

  • fatcatz123 wrote:
    Anytime you're ready... PLEEEASE start your new thread LOL xx

Done, it is in the Debate section.
Geoff



Posted By: ProVox

Kwacka: NHS news - What is the Liverpool Care Pathway I think the comments said more than the article itself. So, who is right? :-k

Posted By: Kwacka

NHS news - What is the Liverpool Care Pathway

Posted By: Kwacka

Perhaps the recently set up Government independent review body will be able to tell us.

Posted By: journo

LCP provides an excellent solution for those who want to die (immediately) with dignity. But an appalling situation for those who actually wish to live.

Posted By: ProVox

The more I read and understand about the LCP it seems to have all the hallmarks of something the UK Government, in particular, excels at!
A group of medical professional has obviously realised that there is a way they can introduce some dignity into the process of dying. It may not be perfect but for the majority I am sure it is what they would wish for given the opportunity to voice an opinion, maybe at an earlier stage.
Like any scheme in a state controlled environment it obviously requires approval and some financing. So, along come the ‘ experts ’ with degrees in ‘ Hospital Management ’ who know little or nothing first hand of the situation, take over and start writing a rule book. Then the financial experts climb on board to see how they can quantify and put a value on everything. Combine those two and you now have bureaucrats imposing unnecessary regulation and accountants trying to do it on the cheap.
Then the controllers and regulators turn up and start imposing targets increasing the cost with administrators and men in white coats with clip boards and ball-points! This diverts already scarce resources away from benefiting the system, pours them into highly paid ‘ management ’ and ‘ administration ’, the writing of reports and the production of endless statistics. The ‘ experts ’ then destroy the original principals because they are trying to make the system cope with something it was never intended to and/or skimp on the finances and the whole process then gets bad publicity. Unfortunately very few people actually go to the trouble of looking for more detailed information on such a subject as this and are quite content for the Daily Mail to do their thinking for them.
Look at the UK's record through history and it the same story every time! From the NHS, the welfare system, the benefits system, human rights, health and safety, Corgi gas fitters, etc. and even through the EU bureaucracy to Democracy itself. Brilliant ideas in principal ruined by over regulation and control and by exploitation in a way that was never envisaged in the original concept. The system is then so complex it is open to abuse and becomes a liability out of which it is impossible to retreat without flouting the law and the patients human/civil rights, compensation for which the lawyers are only too pleased to initiate.
The LCP seems to be little different in principal to that of The Hospice’s for cancer patients but with a broader base and a degree of assistance by denial of the necessities for life. The only thing that would concern me, and that is why I believe the patient should be the primary focus for approval where possible, is the fact that there are documented cases where patients on LCP have recovered when the relatives have taken over, reinstituted food and fluids and the one-on-one care the system cannot afford to provde.

Posted By: fettler

  • ProVox wrote:

    As ‘ fettlers ’ comment shows we clearly have a clash of professions. :-k
    On one hand we have the medical profession that works within a framework of ethics and compassion, which puts the patient’s welfare first however, some doctors also have religious principals that can cloud their judgement as a medical professional so they are not infallible.


What an utterly amazing set of conclusions to draw from a simple statement that not all doctors take the Oath!
All those who take the Oath adhere to it rigorously, those who don't are out to kill you.
Wonderful. The same applies to marriage vows, by logical extension. All couples who took a vow at their wedding are faithful, all couples who haven't done so are unfaithful.
RIP logic.
Alex

Posted By: Kwacka

One big problem hospitals face is the TV/film dramas where, in just about every hospital setting, the alarm goes off sending the 'crash team' to Ward X where the patient inevitably recovers.
In reality as few as 1 in 12 survive within the hospital setting, many of those who do not survive have the indignity of being dragged to the floor (if the bed is too soft) and a total stranger breaking their ribs when they pound on their chest.
There is a vast difference between killing someone and not keeping them alive. Should a 96-year-old man suffering fom septicaemia, but fully compus mentis , with gangrene in both feet and bones revealed be kept alive or should the old 'Brompton Cocktail' (a mixture of heroin & cocaine dissolved in rum or gin) be prescribed and administered?
Likewise on a hospital Special Care Baby Unit, should a baby born at (say) 23-week gestation be deliberately kept alive? At the time all the parents are concerned about is their child living; but little (if any) thought is given to the condition of the child should it live, possibly never being able to walk, see, hear, feed itself, control its bowels.
What about a child whose parents belong to a religious sect that proscibes surgery? Should their views be allowed to determine the treatment for the child, or should (as often happens) the case automatically referred to the courts for judgment on whether the child should be made ward of court or not?



Posted By: Tangutica

you are posing quite a lot of different questions for debate concerning vastly different circumstances Kwacka. Perhaps you should start three new threads! Treatment of geriatric patients Treatment of very premature babies Respect for religious views


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