I have written before about the UK’s National Health Service protocol known as the Liverpool Care Pathway. After many families complained that their loved ones were allowed to die in agony by NHS doctors, the Pathway was developed to ensure that patients who needed to be sedated received the necessary relief.
But the plan’s intended nuances got quickly lost in the connect-the-dots approach that plagues centralized health care systems. As I wrote about at NRO, too many people were being sedated — patients not imminently dying and/or not in the kind of unrelievable agony for which sedation is supposed to be reserved. There was even one case in which a man was sedated and dehydrated to death, whose autopsy showed, wasn’t dying at all.
Now, a new corrective has been put in place requiring two doctors to sign off on sedating a patient. From the Daily Mail story:
The call for at least two medical staff to assess patients – one of whom should be the most senior on duty – was issued in a ‘consensus statement’ by 20 bodies including the Royal College of General Practitioners, the Royal College of Physicians, the National Council for Palliative Care, pressure groups including Age UK and the Alzheimer’s Society, and the Royal College of Nursing . . . The statement added: ‘It is not always easy to tell whether someone is very close to death – a decision to consider using the pathway should always be made by the most senior doctor available, with help from all the other staff involved in a person’s care. It should be countersigned as soon as possible by the doctor responsible for the person’s care.
And here’s another important point:
The statement also said that the withdrawal of fluids and food by tube was not always necessary.The pathway, it said, ‘does not preclude the use of clinically assisted nutrition or hydration – it prompts clinicians to consider whether it is needed and is in the person’s best interest.
Palliative sedation is an appropriate remedy in extreme cases: It is not intended to cause death. Indeed, it can be titrated and levels of sedation varied depending on circumstances. In other words, it isn’t the same thing as “terminal sedation,” often used in the Netherlands by doctors who sedate patients whose conditions do not require it, after which sustenance is withdrawn as a way of causing death — which can take up to two weeks. Disturbing recent reports have shown that about 10% of Dutch deaths are caused by this kind of backdoor euthanasia, and indeed, that doctors are using it in place of lethal injection.
The motives of the Pathway creators were beneficent and not intended to create a situation like in the Netherlands. I hope these changes of protocol refocus care to the individual patient in the bed. But given the intense centralization of the NHS, I worry when the deemed solution to mistakes caused by bureaucratic medicine — appears to be more bureaucratic medicine.