Thursday, September 03, 2009

End of Life Guidelines in England Result in Doubled Death Rate

The Daily Telegraph reports that England’s National Health Service dying patients guidelines result in 16.5% deaths after continuous deep sedation. This is twice the rate of death as in Belgium and the Netherlands.

Terminally ill care experts in England warn that guidelines for removal of fluids and drugs from patients are a self-fulfilling death prophecy for patients wrongly diagnosed as dying but who are in fact suffering from conditions that can be reversed such as dehydration or side effects of pain killing drugs.
“Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

“But this approach can also mask the signs that their condition is improving, the experts warn.

“As a result the scheme is causing a ‘national crisis’ in patient care, the letter states. It has been signed 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.

“‘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.’

“‘As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to 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.”
. . .

“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.

“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.’

“‘It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.’

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

“Prof Millard said that it was ‘worrying’ that patients were being ‘terminally’ sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours.

“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.

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

As Mark Steyn comments:
Sarah Palin got it right on the "death panel" business, and finnicky conservative critics missed the point: Governmentalization of health care leads to rationing, and rationing leads to death panels - very literally.

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