Having blogged about the lack of a Christian context to Danny Boyle’s extravaganza that opened the London Olympics, I was interested to note that his idiosyncratic scene of NHS nurses in starched caps and uniforms dancing around hospital beds also received some guarded criticism. As one reviewer noted, in the NHS today, sick people try to avoid hospital because of the danger of superbugs they might pick up there, and frail elderly people fear hospital in case they might die of neglect.
I blogged recently about the Liverpool Care Pathway (LCP). Subsequently there has been a report in the Daily Telegraph headed “Cards help patients opt out of “death pathway”. We learn that Alert, an anti-euthanasia charity, is handing out cards to terminally ill patients, to ensure that they have the choice to opt out of being put on the LCP if they wish. These cards operate like an organ donor card, giving seriously ill people some control of their future circumstances in advance of a crisis.
It is estimated that almost a third of hospital deaths are now associated with the LCP and its critics say it is becoming the routine NHS way of ensuring that the dying process is discreetly speeded up. Patients placed on it are put under heavy sedation; food and fluids are withdrawn. Members of the public have often cited its abuse in the case of sick relatives. It is widely perceived as being employed for economic reasons –to free up hospital beds occupied by elderly “bed blockers” –rather than for reasons of good medical practice. The wording on the cards produced by Alert states: “Please do not give me the Liverpool Care Pathway treatment without my informed consent or that of a relative.” Like advance directives, which give patients the right to refuse treatment under the Mental Capacity Act of 2005, the cards give those using them the right to question the LCP “treatment”.
Among those who have requested a card is Leslie Burke, aged 52, who suffers from cerebellar ataxia, a degenerative disease. He says, “All I want is to live my life from end to end and not have it ended prematurely under any circumstances.” We hear so much of well-publicised cases requesting the opposite, the right to die, that it is important to be reminded that many very sick people do not regard their lives as burdensome and dread the thought that men in white coats (or nurses in starched uniforms) might decide otherwise.
The practice of “palliative sedation” as it is sometimes called, is also being queried in Holland, where 12 per cent of deaths are accounted for in this way. The Royal Dutch Medical Association issued guidelines in 2005, insisting that “palliative sedation” was not a form of “slow euthanasia”, but simply normal medical practice, put in place in the last two weeks of life, combined with withdrawal of nutrition and hydration, to induce deep unconsciousness. But three Dutch authors of an article in the Journal of Medical Ethics have raised serious issues: how can doctors be sure that life expectancy is merely two weeks? They point out that “normal medical practice” should mean alleviating suffering, not deliberately ending life. Further, because palliative sedation is not considered a form of euthanasia, a doctor deciding to employ it does not need to consult with a colleague.
We might want to cling fondly to Danny Boyle’s romantic image of the NHS and forget that the reality, especially for those in hospital who are very sick or very old, is rather different.