New York Times former editor and current columnist, Bill Keller, recently extolled the NHS’ Livermore Care Pathway in a column entitled, “How to Die.” He complimented the method of his father-in-law’s death in the UK, where doctors did not give him all options, and put him on a regimen of palliative care. Keller wondered why we don’t do something similar here.
Has Keller never heard of hospice care? Hospice allows patients to refuse life-extending treatment–based on informed consent, not doctor’s choice–and die naturally at home. Hospice nurses make house calls. Home care workers help with cleanliness. Volunteers provide what is needed. Social workers and chaplains are on the call. Too bad we are so behind the UK!
Not only that, but apparently unknown to Keller, the Pathway has sparked intense controversy on the other side of the Pond, some believing that it has become a means of forced shuffling of the elderly and no longer wanted off this mortal coil. The remarkable Melanie Phillips explains in her Daily Mail column:
One of its [the Pathway's] ten ‘key messages’ is that it ‘neither hastens nor postpones death’. But, on the contrary, many examples have emerged where it has, indeed, been used to hasten death. Terminally ill patients have been heavily sedated and deprived of essential nutrients and fluids in order to make them die more quickly. And there are claims that it is increasingly being applied without the knowledge of patients’ families, and when such patients still have a chance of recovering for a few more precious weeks, months or even years of life.
One report last year found that as many as 2,500 families were not even told that their relatives had been put on the LCP. In other cases, relatives have suddenly discovered that a ‘do not resuscitate’ notice has been issued against the wishes of patient and family. Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly One cancer patient who had suffered a heart attack and been put on the LCP had all his tubes and drips removed, including hydrating fluids, on the false grounds that he was dying.
This isn’t paranoia or alarmism. My contacts in the UK echo Phillips’ concern. As I noted here two weeks ago, new protocols require two doctors to now sign off on putting a patient on the Pathway.
Phillips correctly points out that the Pathway was not developed to be a form of backdoor euthanasia, but rather, because too many families complained about their loves ones dying in pain. So, NHS bureaucrats reacted, issuing their bulletins promoting the Pathway, and that resulted in some doctors going too far in the other direction, and hence, the current mess.
That is what happens when bureaucracies are in control of health care: Clipboard checklist medicine. With Obamacare, we are in pronounced danger of following the NHS leader.
Keller would do well to read Phillips. He might learn something about the dangers of centralized control of healthcare and not be so dismissive of care for the dying in the USA.