N.I.C.E. Death Panels

C. S. Lewis might say, "Told you!" This Telegraph article describes the concern some Brits have expressed about, well, British "death panels," pushing people over the edge too hastily.

What’s up with this?

In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.

The Netherlands?! Maybe it has something to do with bad medical care, or worse—death panels.

In a letter to the Telegraph, palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others warn:

“Forecasting death is an inexact science,” they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong.”

Hmm. So someone is forecasting death for patients.

The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.

Public, government-run health care? No way, not in merry ol' England!

The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours.

It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004.

So, Nice Pathway?

Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor.

A team, forecasting death. Sounds like a “death panel” to me, but maybe that's a bit harsh. Final Exit Committee?

They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication.

However, doctors warn that these signs can point to other medical problems. Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance.

Or even after a "diabetic episode" or even after a very bad dream. Take someone, sell the house they've lived in for the last several decades, take most of their possessions, put them in a hospital or nursing home, they might wake up in the middle of the night a bit confused. I would.

When a decision has been made to place a patient on the pathway doctors are then recommended to consider removing medication or invasive procedures, such as intravenous drips, which are no longer of benefit.

If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention.

Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition.

He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.

He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in.

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”

He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.

“If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said.

Really?! Maybe we don't want to know that!

Comments

[Kamilla]

Jim,

Thanks for posting this. I've thought about that comparison for some time, since I first heard about the contemporary N.I.C.E.

Kamilla

[Christopher Hathaway]

Are you kidding me? THEY named it "Nice"? Illiterate and immoral is a sad epitaph for England.

I'm hoping to go back there to finally finish my doctoral studies (resurrect it from the dead, actually). It will be interesting to see how different Britain feels after nine years. Maybe I should bring some marshmallows to toast while Britania burns to the ground.

[Thomas]

Sounds like patients should go through some sort of "end-of-life" counseling, and set out in clear terms what their desired treatment should be in something like a living will.

That idea sounds familiar...