Selecting for death

Elspeth Chowdharay-Best on the next stage in the battle for life involving new hospital procedures for ensuring a speedy death

When utilitarian values take over from Judeo-Christian tradition, the weakest go to the wall. The Human Fertilisation and Embryology Bill demonstrates the official contempt for human beings too young to defend themselves.

Another danger to helpless people in hospitals, nursing homes and care homes is the governments new End of Life Care Programme. It is linked to the 'Liverpool Care Pathway', which bears some resemblance to the method of euthanasia which is becoming popular in the Netherlands: deep sedation without hydration, so that the patient dies for lack of water. Controversy in the British Medical Journal centres round the Pathways usefulness to patients. It is undoubtedly useful to the Department of Healths budget.

Serious design weakness

Dr Adrian Treloar, a psycho-geriatrician, wrote on 26 April 2008: The Liverpool Care Pathway (LCP) is the UK's main clinical pathway of continuous deep sedation and is promoted for roll out across the NHS. Rietjens et al.'s study highlights some serious weakness in its design.

The eligibility criteria do not ensure that only people who are about to die are allowed on to the pathway. They allow people who are thought to be dying, are bed-bound, and are unable to take tablets onto the pathway. In chronic diseases such as dementia, dying can take years, but such patients maybe eligible.

Death-by-dehydration has been occurring for some years in Britain without the new official blessing, and sometimes challenged by relatives. An inquest has been ordered into ten suspicious deaths at an old peoples convalescent unit in Hampshire, between 1996 and 1999 [Sunday Times, 16 May 2008]: 'Many of the other families are dismayed that their cases have not been selected for the inquest. Mike Wilson from Gosport says his 91-year-old mother, Edna Purnell, was out of bed and using a walking frame after a hip replacement operation, before she was transferred from Portsmouth's Haslar hospital for a brief period of rehabilitation at Gosport.'

'We have all her notes - we can prove what happened,' he said. 'She was put to bed when she arrived there and given oral morphine, then transferred to a morphine pump. They threatened me with arrest when they caught me feeding her. They told me she was demented, which was not the case before they started giving her morphine. We are in no doubt that is what killed her.'

Losing the right to food

In 2005 the Court of Appeal reversed the High Court judgement in favour of Leslie Burkes claim to a right to assisted feeding and hydration when he should come to need it. It was influenced by a submission from the Department of Health: 'The Secretary of State would wish to put before the Court evidence of the actual cost of the ANH (artificial nutrition and hydration) in individual cases...'

In reality the cost of ANH is small, but the continued survival of people who need it, such as victims of a stroke, is expensive to the NHS. Leslie Burke, who has cerebellar ataxia, lost the right to food and fluid. If he had not, as the Secretary of State went on to say, the forthcoming Mental Capacity Bill would have been impeded. The new United Nations Convention on the Rights of Persons with Disabilities lays down that no one should be denied food and fluid by reason of their disability, but the British government has reservations.

A conference entitled 'Making it Happen: Using the Mental Capacity Act to Improve End of Life Care' was held in London in March 2008. The government's End of Life Care National Programme Director showed immense enthusiasm. The Liverpool Care Pathway is one recommendation. Dr Treloar, in his BMJ letter, notes that the Pathway involves setting up a syringe driver within four hours of a doctor's order. 'This is laudable, if it is needed. But the Pathway encourages the use of syringe drivers even where symptoms can be managed without them.' He concludes, T hope the LCP can be reviewed and modified.' If not, there will be many grieving families like those whose relatives in the Gosport Memorial Hospital lost their lives. |

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