Care programme for dying 'is not euthanasia' (From Bicester Advertiser)

The trust’s assistant medical director, Dr Ian Reckless.


Unfortunate name for the Dr quoted in this story.

Sandy Wimpole-Smythe wrote:
The trust’s assistant medical director, Dr Ian Reckless.


Unfortunate name for the Dr quoted in this story.

I don't know why; I use the LCP in my work and believe it to be a humane, gentle and necessary guideline. There is nothing reckless about it; reckless would be to continue treating someone when it is futile, leaving them to die in pain and prolonging suffering through unnecessary intervention.

The Pathway is flawed and dangerous. The Pathway is giving clinicians a tremendous power which is often wielded precariously. I unreservedly make this statement, not as an "uninformed" and "stupid" person (these are some remarks made on a "Pro-LCP" webpage) but as someone who values the life of all beings, and as a Grandaughter to the most beautiful, strong and amazing woman ever to have walked this Earth. To have experienced first-hand people playing God, deciding she had reached the end of her days and terminating her life with no discussion surrounding this with Nan (who was fully compos mentis before they terminally sedated her) or the family, but instead deceiving us in order to have Nan admitted to a hospital (for physio, which she never received, as they pumped her with morphine instead) where they could carry out their evil plan, is but one example of the depraved and corrupt practice that is operating right now within the medical industry.

It's hard to defend a protocol like the LCP when it is clear that death is hard to predict. I signed a DNR for my mother over 4 years ago. When I saw I may have been in error - I'd be urged to sign by her surgeon -- I reversed it and had great difficulty getting the hospital to respect that reversal. She is still alive today, almost 4 1/2 years later. I have no doubt the LCP is being abused. They can claim success because who is left alive to say otherwise? Here is a link to an article I wrote: http://ireneogrizek.
ca/2012/12/28/5762-t
he-right-to-choose-l
ife-or-death/

Firstly, the LCP is NOT USED until a person is obviously dying and there is nothing left which can be done. Before it came into practise people were dying in pain, being force-fed by naso-gastric tubes and covertly euthanised by large doses of morphine. It is NOT hard to defend the LCP as it is completely different from a DNACPR order. If, as you say, you signed an order for your mother irene then you were complicit in its use. It has been reversed, and the hospital HAS to abide by that, even if they believe your mother would suffer a humiliating and painful resuscitation should the need arise. People live for many years after a DNACPR order has been signed, so I really cannot see what your point is. Having said that, I'm very glad she has gone on to recover from being so ill and hope that continues for many years.

Enlightened, what you describe is not the LCP. If your nan was compos mentis when she was sedated then that is murder, and if you witnessed it you should inform the police. Seriously, you're accusing doctors of murdering your Nan, and if you truly believe it you need to challenge it. Do you truly believe that a plot was hatched to get your Nan into hospital in order to kill her? I'm sorry, but your comment seems a little conspiracy-theorist to me.

Of course all human life is sacred, but we are so scared of talking openly about death in this country that we tend to believe our loved ones will never die. People die, and they die well or they die badly. The hospice movement, which spear-headed the LCP, does all it can to help people have a good death, and demonising pathways such as the LCP is putting all their hard work at risk. In a country where people are taking doctors to the high court in order to win the right to die with dignity we are moving closer to regaining some element of control over our own deaths; please don't let the hysteria surrounding a minority of abuses of the LCP put this good work back.

Feelingsmatter wrote:
Firstly, the LCP is NOT USED until a person is obviously dying and there is nothing left which can be done. Before it came into practise people were dying in pain, being force-fed by naso-gastric tubes and covertly euthanised by large doses of morphine. It is NOT hard to defend the LCP as it is completely different from a DNACPR order. If, as you say, you signed an order for your mother irene then you were complicit in its use. It has been reversed, and the hospital HAS to abide by that, even if they believe your mother would suffer a humiliating and painful resuscitation should the need arise. People live for many years after a DNACPR order has been signed, so I really cannot see what your point is. Having said that, I'm very glad she has gone on to recover from being so ill and hope that continues for many years.

Enlightened, what you describe is not the LCP. If your nan was compos mentis when she was sedated then that is murder, and if you witnessed it you should inform the police. Seriously, you're accusing doctors of murdering your Nan, and if you truly believe it you need to challenge it. Do you truly believe that a plot was hatched to get your Nan into hospital in order to kill her? I'm sorry, but your comment seems a little conspiracy-theorist to me.

Of course all human life is sacred, but we are so scared of talking openly about death in this country that we tend to believe our loved ones will never die. People die, and they die well or they die badly. The hospice movement, which spear-headed the LCP, does all it can to help people have a good death, and demonising pathways such as the LCP is putting all their hard work at risk. In a country where people are taking doctors to the high court in order to win the right to die with dignity we are moving closer to regaining some element of control over our own deaths; please don't let the hysteria surrounding a minority of abuses of the LCP put this good work back.

All I need to die with dignity, is to wheeled outside the door of the ward, and given a bottle of Sauvignon Blanc and a packet of ciggies. Now that is real patient care for the terminally ill coming to the end of their days, and I would die a happy man. All this BS above is just that, Doctors do not know, it is THE PERSON THAT IS DYING that knows what they want, and they should be given it.

I signed the DNR because it was strongly suggested to me. Yes, that makes me responsible, and I am not trying to evade responsibility. But how do you explain the difficulty I had getting the reversal respected? The hospital was withdrawing care without my or my mother's permission and this was AFTER my mother had clearly uttered words to the effect that she wanted to stay alive. It was only when I started phoning other hospitals that her care was restored.

I have no issue with people who WANT to use the LCP at the end of their lives. I say so in the article I wrote, here is the link again, just in case you missed it.

http://ireneogrizek.
ca/2012/12/28/5762-t
he-right-to-choose-l
ife-or-death/

I am not against the LCP, I am against its abuse and apparently there is a lot of abuse going on both in the UK and in Canada, which is where I am writing from.

I respect your position, but you may want to read my article before you answer me again.

I have read your article, and I see where you are coming from to an extent, but I am saying that abuse of the LCP is something which has taken on the feel of a witch-hunt, and to continually attack it in the press is undermining the many years of hard work which have gone into its design.

DNACPR and the LCP should not be confused, and I believe that your comment here, and your article, are in danger of doing just that. I understand your frustration at the seeming disregard of staff towards the care you wanted for your mother but I have to disagree with your final paragraph where you say;" The LCP protocol entails the withdrawal of food, water and medication. Patients are sedated so that they don’t feel these deprivations and their suffering is minimized." It does NOT give doctors the right to withdraw food and water and it does NOT specify that people are sedated. If someone refuses food & water we will respect that, but often they are too ill to swallow and in so much pain they need to have adequate analgesia so the LCP is just a nationally recognised tool for a pain free death.
Misdiagnosis doesn't only happen in the elderly; I almost lost my son when he was aged 5, 6 and 7 due to a terrible misdiagnosis. The issue with the elderly and the LCP is more to do with effective explanation, honesty from doctors when having the hard conversations and acceptance from relatives when their loved one is too ill to carry on. Yes, mistakes will be made, but I don't believe these happen from malice.

By the way, Grunden Skip, that is exactly what palliative care is all about; you've described it perfectly. The hospice movement strives to fulfill the wishes of the dying person in every way, and this is slowly filtering through to the NHS. A recent audit by the RCN shows that people are still not dying where they want to in 51% of cases, but that care and nursing homes are doing well in the area of palliative care. Now the NHS needs to catch up.

feelingsmatter: I have 9 years of post-secondary education so I don't think I am confused about anything. I understand the difference between the LCP and a DNR,.

However, it's interesting how often hospital staff did their best to convince me that I was confused.

Good grief.

irene, you have written about an emotive subject from a personal stand point and I have written my opinion. I am sorry if that has angered you. I did not say that YOU are confused, you misunderstand me; I am saying that your article and your comments here are confusing the LCP and a DNACPR order. Someone can live for many years with a DNACPR order, but the LCP is for the terminally ill. That distinction needs to be made or the waters are muddied. Your mother wasn't on the LCP, yet you condemn it.

As I said, I am glad that you mother is recovering from her ordeal, and sad that she had to suffer as she did. I'm also sad that hospital staff did not support you, and I hope that as fours years have passed the use of the LCP has improved.

Please don't throw your education at me; it doesn't take a doctorate to understand the LCP or to deliver high quality nursing care. You are clearly a very eloquent woman, so I hope that you can see that I am trying to defend a pathway which I firmly believe works well when applied correctly and is very necessary if we want to demystify death and allow people to die in peace.

Feelingsmatter wrote:
Firstly, the LCP is NOT USED until a person is obviously dying and there is nothing left which can be done. Before it came into practise people were dying in pain, being force-fed by naso-gastric tubes and covertly euthanised by large doses of morphine. It is NOT hard to defend the LCP as it is completely different from a DNACPR order. If, as you say, you signed an order for your mother irene then you were complicit in its use. It has been reversed, and the hospital HAS to abide by that, even if they believe your mother would suffer a humiliating and painful resuscitation should the need arise. People live for many years after a DNACPR order has been signed, so I really cannot see what your point is. Having said that, I'm very glad she has gone on to recover from being so ill and hope that continues for many years.

Enlightened, what you describe is not the LCP. If your nan was compos mentis when she was sedated then that is murder, and if you witnessed it you should inform the police. Seriously, you're accusing doctors of murdering your Nan, and if you truly believe it you need to challenge it. Do you truly believe that a plot was hatched to get your Nan into hospital in order to kill her? I'm sorry, but your comment seems a little conspiracy-theorist to me.

Of course all human life is sacred, but we are so scared of talking openly about death in this country that we tend to believe our loved ones will never die. People die, and they die well or they die badly. The hospice movement, which spear-headed the LCP, does all it can to help people have a good death, and demonising pathways such as the LCP is putting all their hard work at risk. In a country where people are taking doctors to the high court in order to win the right to die with dignity we are moving closer to regaining some element of control over our own deaths; please don't let the hysteria surrounding a minority of abuses of the LCP put this good work back.

I have to respond as you really know nothing about my Nan's case, so please don't insult me by calling it "conspiracy theorist".

All my little Nan had was a skin condition (caused by a topical cream that the GP admitted was wrongly prescribed in the first place) - it was like a domino effect from there on - Nan's skin was blistered and needed dressings which the GP recommended District Nurses for. They came to her home and befriended her, Nan loved talking to them, never imagining that they were in talks with her GP (who wanted her removed from his list) to eventually admit her into a community hospital with no A&E, "just for 2 weeks of physio" for her legs which had been a little weaker and to "cheer her up" (she'd be on a ward with other people to talk to). This didn't happen. They put her in a side room, took her off her water tablets and heart medication which she'd taken for years with no ill effect, nurses left any food or drink out of reach when they did bring it in her room, and started dosing her with morphine, rendering her semi-comatose - my Dad objected and even pointed out she wasn't in pain but they dismissed him totally. They ignored her low blood pressure and let her turn blue (cyanose) due to dangerously low oxygen levels, and when she finally suffered heart failure on the morning of her death, they took a whole hour to obtain a Doctor (being a Sunday) and it was too little, too late. She died in an ambulance being rushed to the nearest A&E. Yet, they get away with it! How? I will never trust them again - why didn't they leave my Nan at home, somewhere she was happy and where my Dad took pleasure in helping her in any way he could after all she had done for him, for the family, for others and for her country during the war - how dare they!

Enlightened, what you describe is appalling, and you're right, it should never have happened. I just have trouble believing that all these health care professionals colluded to get your Nan into hospital so they could kill her, which is what you said in your first comment (their evil plan).

That aside, what happened is the very worse side of our health service, and something which angers me greatly. As you so rightly said, how dare they take her away from you in such a way. No doctor should have stopped tablets which were well tolerated and had kept her well for so long, and the "care" she was given has me in tears. I completely agree with you that what happened to her was unjust, cruel and negligent. I would hope that the ward where I work would never allow that to happen, and that recent publicity surrounding awful care will lead to improvements.

But this wasn't the LCP being abused, or even applied, it was simply completely and utterly appalling care. For nurses to leave food and drink out of reach makes my blood boil. I am sorry you have this memory of your Nan as the last one; I don't blame you for feeling so angry and distrustful of the NHS. I wish that all wards were like the one I worked on, as my children have been at the receiving end of appalling care too, and almost lost their lives to it.

I know that nothing will bring your Nan back, and I can only hope that in time precious, happy memories will replace those of her final days. Palliative care should only ever be applied if someone is nearing the end of their life, and never used to hasten death. It certainly isn't indicated for someone like your Nan. Your experience is a lesson for all of us working in elderly care, but sadly one which some are slow to learn from. Take care.