I have a piece up on To The Source discussing the serious charge that the Liverpool Care Pathway, intended to ensure that no patient dies in unalleviated pain, has mutated into back door euthanasia. I explain why palliative sedation is not killing, and then show how what should be a very rare form of palliation became almost standard practice. From, “When Doctors Give Warning:”
The point of the Pathway was to ensure that patients who need palliative sedation receive it, not to make it standardized practice. But that has not been how the protocol has been applied. Indeed, almost from the beginning, there were bitter complaints that the LCP was being used in cases that did not require sedation, and indeed, was used to sedate and dehydrate non terminally ill patients—a form of euthanasia known as “terminal sedation,” which, isn’t a medical treatment at all.
I give examples, and opine on how such a thing could happen:
So, why are too many patients in the UK apparently on the Pathway? I think it is a direct consequence of bureaucratizing of healthcare. The purpose of the LCP was to assure that the few patients with unrelievable pain do not die in agony. But centralized control leads to follow-the-dots medicine in which patients are often treated as members of a category rather than as individuals. At that point, nuance can easily go out the door.
Deprofessionalization, in other words. I conclude:
We can’t solve the UK controversy from here, but we can learn some important lessons. For example, if Obamacare or some other centralized system rules American healthcare, medical practice here could become as sclerotic as it appears to be in the United Kingdom. Indeed, the law already calls for the creation of many cost/benefit/best-practices boards of the kind that led to adoption of the Liverpool Care Pathway. Making matters more alarming, these boards would not only govern treatment provided under Medicare and Medicaid, but also are empowered to set the standards of care paid for treatments paid for by private insurance. If we allow centralized control over medical care—whether under Obamacare or a successor law—don’t be surprised when one dark day, an American version of the Liverpool Care Pathway comes soon to a hospital or nursing home near you.
The danger is real. But it isn’t too late to avert the calamity.