The medics said my gran would not recover from her stroke. My mum who had worked in a hospital in rehabilitation of the elderly knew my gran would not recover from the stroke.
We know it was a case of waiting for God. Everyone knew she was going to die. She was 93 and ill. Why could they not give her something to allow her to pass away peacefully.
It was just preventing the inevitable and causing pain all around. two weeks of gurgling, writhing and distress for the family. What is the point?
If euthanasia was accepted practice then the example I gave of the 18 year old whose LCP was reversed and who went on to survive - he would now be dead rather than recovering from his condition.
As I have stated, patients on the LCP should still be reassessed if they continue to live for longer than expected. No one should be on the LCP for 2 weeks and showing any signs of discomfort and suffering. I would want an investigation about the care your gran received.
As an ITU nurse I would never want to work anywhere where euthanasia was acceptable. On New Years Day, I stopped all the life support my patient was receiving when it was agreed by all, including the family, that continuing treatment was futile, he died after about 90 minutes, of natural causes as his body gave up the fight but I would never have given him an injection that would have killed him immediately.
I do not believe in euthanasia and I would never be part of actively killing anybody.
For background, I work in medical psychology research and specialise in communication surrounding palliative and end of life care for non-cancerous illnesses.
The LCP is not the problem here. The LCP is a well researched, evidence based tool which improves care and comfort in the last few days of life when in the hands of well trained medical professionals.
The problem is the NHS refusing to fund advanced communication courses for many clinicians (particularly those who do not work in cancer care), which in turn makes it very difficult for the clinician to communicate, in the most appropriate way, to the relatives exactly what is happening to the dying person, what the LCP is for, and why their relative has been placed on it.
I strongly believe you should have choice in your final days.
My mum (63) died of CJD which was a very unplesent way to lose your dignity and life. She lost speach, then all communication and ended up being starved and dyhydrated as she pulled the tubes out. she could not write or talk to express her wishes but should have been saved the final stages. She was hot & agrivated.
My dad (59) was ill for 7 years with cancer. he was braking bones turning over in bed. He wanted to die. he was not allowed to.
There has to be a better more dignified way to die.
On another side. If I have the money and will to fight the illness and possibly blow that money to suvive for longer then no hospital should make that decision to allow me to die without telling me of other options.
Euthanasia in whose say so though
Relatives could have ulterior motives and not hold the interests of the person to heart
I would be reluctant and in fact refuse as a nurse to be involved
This topic is confusing euthanasia and care of the dying- sometimes medicine cannot cure, the person is dying- the LCP gives the choice between carrying on with sometimes painful Undignified treatment and not doing so.
A nursing. League if mine died tragically young on Christmas Day- she was on the LCP- because nothing could cure her.
Euthanasia in whose say so though
Relatives could have ulterior motives and not hold the interests of the person to heart
I would be reluctant and in fact refuse as a nurse to be involved
This topic is confusing euthanasia and care of the dying- sometimes medicine cannot cure, the person is dying- the LCP gives the choice between carrying on with sometimes painful Undignified treatment and not doing so.
A nursing. League if mine died tragically young on Christmas Day- she was on the LCP- because nothing could cure her.
But surely if the medics know an elderly person is dying, why would the relatives have ulterior motives?
The medics said my gran would not recover from her stroke. My mum who had worked in a hospital in rehabilitation of the elderly knew my gran would not recover from the stroke.
We know it was a case of waiting for God. Everyone knew she was going to die. She was 93 and ill. Why could they not give her something to allow her to pass away peacefully.
It was just preventing the inevitable and causing pain all around. two weeks of gurgling, writhing and distress for the family. What is the point?
I agree. Your family knew the situation, they knew what your gran would have wanted. In these circumstances I see nothing wrong with bringing the death forward, but if it is to be done it needs something much kinder than LCP.
If euthanasia was accepted practice then the example I gave of the 18 year old whose LCP was reversed and who went on to survive - he would now be dead rather than recovering from his condition.
As I have stated, patients on the LCP should still be reassessed if they continue to live for longer than expected. No one should be on the LCP for 2 weeks and showing any signs of discomfort and suffering. I would want an investigation about the care your gran received.
As an ITU nurse I would never want to work anywhere where euthanasia was acceptable. On New Years Day, I stopped all the life support my patient was receiving when it was agreed by all, including the family, that continuing treatment was futile, he died after about 90 minutes, of natural causes as his body gave up the fight but I would never have given him an injection that would have killed him immediately.
I do not believe in euthanasia and I would never be part of actively killing anybody.
LCP is euthanasia, simply a slow form of it so you can claim it is natural.
If euthanasia was accepted practice then the example I gave of the 18 year old whose LCP was reversed and who went on to survive - he would now be dead rather than recovering from his condition.
Undoubtedly this would happen. However I would take the risk, I have relatives that would assess the situation if I was not able to.
..and some people who are on the LCP may have lived for a significant period of time.
Well not really
People expect modern medicine to cure all and the LCP just stops interventions when they won't cure
Food and water is not medicine.
Its the equivalent of putting someone in sealed room with a fire that "removes" the oxygen. (a practice that used to be carried out in some countries -and a lot more caring than LCP)
Its the equivalent of putting someone in sealed room with a fire that "removes" the oxygen. (a practice that used to be carried out in some countries -and a lot more caring than LCP)
The LCP doesn't always stop hydration
Nutrition is more difficult in the unconscious
The common practice is that it does in order to increase the speed of death. There are of course many forms, but it all has the same aim, kill the patients as quick as possible without administering (doing?) something to them. It would be fine if it wasn't so barbaric.It would be kinder to administer a drug instead.
The common practice is that it does in order to increase the speed of death. There are of course many forms, but it all has the same aim, kill the patients as quick as possible without administering (doing?) something to them,
Clearly you will not budge in your view of the LCP
You though should remember that nurses and doctors actually don't want to kill people- but care for them, part of that is not prolonging life when there is no quality of life
If suddenly my job required me to euthanise patients, I would quit
Clearly you will not budge in your view of the LCP
You though should remember that nurses and doctors actually don't want to kill people- but care for them, part of that is not prolonging life when there is no quality of life
If suddenly my job required me to euthanise patients, I would quit
I think the bit in bold is the crux of the matter. You have fooled yourself into thinking that LCP is not euthanasia in order to satisfy your own moral standards. It's not to hard to understand why, seeing the suffering caused by keeping people alive. However killing them is what it is.
I think the bit in bold is the crux of the matter. You have fooled yourself into thinking that LCP is not euthanasia in order to satisfy your own moral standards. It's not to hard to understand why, seeing the suffering caused by keeping people alive. However killing them is what it is.
That post about what I have 'fooled myself' into is incorrect
Don't think you know what i think
my grandmother got admitted to hospital. While she was in there a few days my mother had a phone call from a rather irate after care specialist inquiring what was going to happen to my grandmother once she'd left hospital. My other explained that she would probably require more home care but that was something she would look into nearer the time of my grandmothers release from hospital.
I visited my grandmother daily whilst she was there and was reassured by a doctor that there was absolutely nothing to worry about. My grandmother had a blockage, probably Gaul stones and this was a relatively simple procedure.
I continued visiting my grandmother and noticed one day that there was a nil by mouth sign above her bed. I assumed they were prepping her for theater and thought nothing of it at the time.
A few days later and she was still nil by mouth and obviously getting worse. We felt frustrated and angry and couldn't get anything out of the staff there. The doctor I spoke to wished me well and said that he was going on holiday and I never saw him again.
After about a week my grandmother was seriously ill. Every time I visited her she begged me for water and I did try to give her some but was told off by a nurse, again I never questioned it but was incredibly upset and frustrated how a dying woman couldn't even have a drink of water.
We were told that she in the last stages and they would need permission to administer palliative care.
It was a few months later that stories of LCP began to hit the headlines. At the time we never had even heard of it but all the stories sounded frighteningly familiar.
The fact that my grandmother could, according to a doctor, have possibly been treated successfully but they instead chose to end her life was distressful, even more distressful was the fact we had that aggressive phone call from the after care specialist prior to her being nil by mouth. The two are probably not connected but you can't help but wonder whether the financial burden of after care support played some decision in this process.
Whilst I understand that the LCP and euthanasia are different things, I hope you see why people like me jump to the conclusion that LCP is being implemented as a form of euthanasia.
I am a district nursing sister and it is part of my role to commence dying individuals on the end of life pathway. It is simply a structured care plan which allows nurses to attend to every aspect of need. Pain levels, mouthcare, pressure area care, incontinence etc.,
As district nurses we have usually known the person and their families for some time - as they are usually referred to our service when first diagnosed with a terminal illness - which may not always be cancer. The decision to commence the pathway is taken by the GP, myself (or another senior nurse if I am not on duty), the patient and their family.
This decision is only taken when their overall condition as deteriorated to such an extent death is expected within days. As an experienced nurse we use our skills to inform the family about these signs of deterioration and keep them informed at all times and consider all views. Once on the pathway we visit several times a day to moniter the patients condition and support the family. A syringe driver with medication is only necessary if pain or other symptoms become problematic. I have known patients be on the pathway without need of any medications whatsoever.
Food and drink is NEVER withheld if the patient is able to swallow without the risk of choking. We advise the family to give their loved ones sips of fluid and easy to swallow food such as ice cream, yoghurts etc., if the patient wishes it. However, many people nearing the end of their lives are semiconscious or are too weak to swallow and giving fluids can cause them to inhale liquid which can lead to aspirational pneumonia which can cause breathlessness and other symptoms which can be distressing.
Drugs which are commonly used in syringe drivers are medications for pain, nausea & vomiting, excessive respiratory secretions and agitation. The drugs are only used if needed and they are all prescribed within a range. The mininum dose is always given initially and we increase the dose as needed. We never under any circumstances given more medication than is necessary - for that would be illegal. The aim is to control symptoms. However, the medication can hasten death but the intent is to control symptoms only. It is the intent which is the important point.
Articles such as this can only cause fear and make it harder for medical professionals to ensure the dying have a peaceful and dignified death.
Please do your own research as regards the Liverpool Care Pathway. We have been using it for years.... I would want it for myself and my loved ones at the end of my life.
Please do not allow the ignorant wailings of hack journalists to undo all the good work palliative care health professionals and hospices have developed over the years.
It's understandable that the recently bereaved find this a particularly difficult topic, but critics of the Liverpool Care Pathway should read the above post again, and if necessary a third time.
Implemented correctly, the LCP is the "gold standard" of care for the dying and ensures that pain and discomfort is minimised for patients who are approaching the end of their lives. It was essentially developed from the best practices of the hospice movement, and I would hope that no-one (even on this forum) would accuse hospices of lacking compassion or favouring euthanasia.
Undeniably there are instances of poor implementation but this isn't a reason to criticise the LCP, still less abandon it entirely. Such instances certainly need to be fully investigated, but we shouldn't abandon a hugely valuable part of end-of-life care simply because of some isolated failures.
Dying can be a complex business, and doctors and nurses are not perfect.
It's understandable that the recently bereaved find this a particularly difficult topic, but critics of the Liverpool Care Pathway should read the above post again, and if necessary a third time.
Implemented correctly, the LCP is the "gold standard" of care for the dying and ensures that pain and discomfort is minimised for patients who are approaching the end of their lives. It was essentially developed from the best practices of the hospice movement, and I would hope that no-one (even on this forum) would accuse hospices of lacking compassion or favouring euthanasia.
Undeniably there are instances of poor implementation but this isn't a reason to criticise the LCP, still less abandon it entirely. Such instances certainly need to be fully investigated, but we shouldn't abandon a hugely valuable part of end-of-life care simply because of some isolated failures.
Dying can be a complex business, and doctors and nurses are not perfect.
It is only the "gold standard" by those against euthanasia by drugs but in favour of killing patients by withdraw of food and water.
I'm not buying the "trust the doctors and nurses", The reason it is all coming out is because people trusted them, yet the actual nature of the "care" was kept secret from patients and family.
The reason it was kept secret was because "it's for the best, that they don't know".Keeping the illusion up of "managing the pain", while the reality is "kill them before the pain becomes too much".
Evidence it's euthanasia (although it plainly is), is to be found in the medical profession hiding the true nature of the LCP for so long.
What is the difference with killing someone by overdose, and killing them by withdrawing food and water?
(apart from one is quick and painless and the other is long and painful?)
I haven't worked on a ward for almost 3 years but in my experience LCP was always started later than ideal for patients. What was more common was medics continuing to treat and investigate patients that were clearly dying.
With regards to fluids, our normal practice was to continue until the cannula came out if it wasn't causing any distress to the patient. If swallowing was deemed safe then food would not be withdrawn. If it was deemed unsafe, then if awake enough then palliative feeding would be considered. What that meant was that food/drink could be given, with the accepted risks.
I
What is the difference with killing someone by overdose, and killing them by withdrawing food and water?
(apart from one is quick and painless and the other is long and painful?)
Because the patients need to be in such a state that they cannot take food or water. No patient of mine has ever been put on the LCP who was still completely conscious and able to take food and water, that would be absolutely barbaric and cruel and an inappropriate use of the LCP. We may withdraw medication such as antibiotics for these patients but this would be with their full consent. Patients on the LCP are normally semi-conscious or unconscious and are already dying and expected to die within a few hours or, at most, a couple of days - we are not committing euthanasia by not giving these patients food and water, it is certainly a medical intervention to give food and water to an unconscious patient because we would need to administer it through feeding tubes or drips, the patients die naturally as their organs continue to fail from whatever condition they are suffering from. Giving food and water by invasive methods only slows down the process of dying, the patients will still inevitably die (with some exceptions that I described earlier in the thread when the LCP needs to be reversed).
I don't know any doctor or nurse who would be willing to perform euthanasia on any patient and I would quit my job also if I was ever asked to participate in any form of euthanasia. The LCP is certainly not euthanasia and I strongly disagree with your uninformed view and insistence that it is.
I am a district nursing sister and it is part of my role to commence dying individuals on the end of life pathway. It is simply a structured care plan which allows nurses to attend to every aspect of need. Pain levels, mouthcare, pressure area care, incontinence etc.,
As district nurses we have usually known the person and their families for some time - as they are usually referred to our service when first diagnosed with a terminal illness - which may not always be cancer. The decision to commence the pathway is taken by the GP, myself (or another senior nurse if I am not on duty), the patient and their family.
This decision is only taken when their overall condition as deteriorated to such an extent death is expected within days. As an experienced nurse we use our skills to inform the family about these signs of deterioration and keep them informed at all times and consider all views. Once on the pathway we visit several times a day to moniter the patients condition and support the family. A syringe driver with medication is only necessary if pain or other symptoms become problematic. I have known patients be on the pathway without need of any medications whatsoever.
Food and drink is NEVER withheld if the patient is able to swallow without the risk of choking. We advise the family to give their loved ones sips of fluid and easy to swallow food such as ice cream, yoghurts etc., if the patient wishes it. However, many people nearing the end of their lives are semiconscious or are too weak to swallow and giving fluids can cause them to inhale liquid which can lead to aspirational pneumonia which can cause breathlessness and other symptoms which can be distressing.
Drugs which are commonly used in syringe drivers are medications for pain, nausea & vomiting, excessive respiratory secretions and agitation. The drugs are only used if needed and they are all prescribed within a range. The mininum dose is always given initially and we increase the dose as needed. We never under any circumstances given more medication than is necessary - for that would be illegal. The aim is to control symptoms. However, the medication can hasten death but the intent is to control symptoms only. It is the intent which is the important point.
Articles such as this can only cause fear and make it harder for medical professionals to ensure the dying have a peaceful and dignified death.
Please do your own research as regards the Liverpool Care Pathway. We have been using it for years.... I would want it for myself and my loved ones at the end of my life.
Please do not allow the ignorant wailings of hack journalists to undo all the good work palliative care health professionals and hospices have developed over the years.
Well put WinterLily
I would just like to say that a very dear friend of mine died at home recently of cancer. She was cared for exactly in the manner you describe, in co-operation with her wishes and with the help of her amazing husband.
The nursing care was second to none and I would just like to put in this little vote of thanks to the nurses concerned.
relatives often ask doctors and nurses to do just that. (the too much morphine thing)
My dad was literally bleeding to death (bowel) and in great distress. We all had been indformed it was the end. The Doctor came in and told us that wasn't him making those noises but his body shutting down and he could give him something to make him more comfortable. We said yes immediately............I don't know what he gave him nor do i care as it was what was needed at the time. My dad had a right to a dignified death
My daughter is married to a dutch man and they have a much more practical approach to end of life care which i wish we would adopt but far too many right wing christians here for it ever to get off the ground.............The same right wing christians who are happy to take medication to prolong life but that doesn't seem to dawn on them that that is also interfering in God's hand
Comments
If euthanasia was accepted practice then the example I gave of the 18 year old whose LCP was reversed and who went on to survive - he would now be dead rather than recovering from his condition.
As I have stated, patients on the LCP should still be reassessed if they continue to live for longer than expected. No one should be on the LCP for 2 weeks and showing any signs of discomfort and suffering. I would want an investigation about the care your gran received.
As an ITU nurse I would never want to work anywhere where euthanasia was acceptable. On New Years Day, I stopped all the life support my patient was receiving when it was agreed by all, including the family, that continuing treatment was futile, he died after about 90 minutes, of natural causes as his body gave up the fight but I would never have given him an injection that would have killed him immediately.
I do not believe in euthanasia and I would never be part of actively killing anybody.
The LCP is not the problem here. The LCP is a well researched, evidence based tool which improves care and comfort in the last few days of life when in the hands of well trained medical professionals.
The problem is the NHS refusing to fund advanced communication courses for many clinicians (particularly those who do not work in cancer care), which in turn makes it very difficult for the clinician to communicate, in the most appropriate way, to the relatives exactly what is happening to the dying person, what the LCP is for, and why their relative has been placed on it.
My mum (63) died of CJD which was a very unplesent way to lose your dignity and life. She lost speach, then all communication and ended up being starved and dyhydrated as she pulled the tubes out. she could not write or talk to express her wishes but should have been saved the final stages. She was hot & agrivated.
My dad (59) was ill for 7 years with cancer. he was braking bones turning over in bed. He wanted to die. he was not allowed to.
There has to be a better more dignified way to die.
On another side. If I have the money and will to fight the illness and possibly blow that money to suvive for longer then no hospital should make that decision to allow me to die without telling me of other options.
Relatives could have ulterior motives and not hold the interests of the person to heart
I would be reluctant and in fact refuse as a nurse to be involved
This topic is confusing euthanasia and care of the dying- sometimes medicine cannot cure, the person is dying- the LCP gives the choice between carrying on with sometimes painful Undignified treatment and not doing so.
A nursing. League if mine died tragically young on Christmas Day- she was on the LCP- because nothing could cure her.
But surely if the medics know an elderly person is dying, why would the relatives have ulterior motives?
Sorry I meant if people had ulterior motives and push for euthanasia BEFORE someone is actually dying
Oh right yes I agree with you there.
I fully believe people should be able to discuss and agree to end of life care whilst still in a position to do so, including euthanasia.
Well not really
People expect modern medicine to cure all and the LCP just stops interventions when they won't cure
..and some people who are on the LCP may have lived for a significant period of time.
Its the equivalent of putting someone in sealed room with a fire that "removes" the oxygen. (a practice that used to be carried out in some countries -and a lot more caring than LCP)
The LCP doesn't always stop hydration
Nutrition is more difficult in the unconscious
Clearly you will not budge in your view of the LCP
You though should remember that nurses and doctors actually don't want to kill people- but care for them, part of that is not prolonging life when there is no quality of life
If suddenly my job required me to euthanise patients, I would quit
That post about what I have 'fooled myself' into is incorrect
Don't think you know what i think
Kills people with thirst - lovely.
I visited my grandmother daily whilst she was there and was reassured by a doctor that there was absolutely nothing to worry about. My grandmother had a blockage, probably Gaul stones and this was a relatively simple procedure.
I continued visiting my grandmother and noticed one day that there was a nil by mouth sign above her bed. I assumed they were prepping her for theater and thought nothing of it at the time.
A few days later and she was still nil by mouth and obviously getting worse. We felt frustrated and angry and couldn't get anything out of the staff there. The doctor I spoke to wished me well and said that he was going on holiday and I never saw him again.
After about a week my grandmother was seriously ill. Every time I visited her she begged me for water and I did try to give her some but was told off by a nurse, again I never questioned it but was incredibly upset and frustrated how a dying woman couldn't even have a drink of water.
We were told that she in the last stages and they would need permission to administer palliative care.
It was a few months later that stories of LCP began to hit the headlines. At the time we never had even heard of it but all the stories sounded frighteningly familiar.
The fact that my grandmother could, according to a doctor, have possibly been treated successfully but they instead chose to end her life was distressful, even more distressful was the fact we had that aggressive phone call from the after care specialist prior to her being nil by mouth. The two are probably not connected but you can't help but wonder whether the financial burden of after care support played some decision in this process.
Whilst I understand that the LCP and euthanasia are different things, I hope you see why people like me jump to the conclusion that LCP is being implemented as a form of euthanasia.
It's understandable that the recently bereaved find this a particularly difficult topic, but critics of the Liverpool Care Pathway should read the above post again, and if necessary a third time.
Implemented correctly, the LCP is the "gold standard" of care for the dying and ensures that pain and discomfort is minimised for patients who are approaching the end of their lives. It was essentially developed from the best practices of the hospice movement, and I would hope that no-one (even on this forum) would accuse hospices of lacking compassion or favouring euthanasia.
Undeniably there are instances of poor implementation but this isn't a reason to criticise the LCP, still less abandon it entirely. Such instances certainly need to be fully investigated, but we shouldn't abandon a hugely valuable part of end-of-life care simply because of some isolated failures.
Dying can be a complex business, and doctors and nurses are not perfect.
I'm not buying the "trust the doctors and nurses", The reason it is all coming out is because people trusted them, yet the actual nature of the "care" was kept secret from patients and family.
The reason it was kept secret was because "it's for the best, that they don't know".Keeping the illusion up of "managing the pain", while the reality is "kill them before the pain becomes too much".
Evidence it's euthanasia (although it plainly is), is to be found in the medical profession hiding the true nature of the LCP for so long.
What is the difference with killing someone by overdose, and killing them by withdrawing food and water?
(apart from one is quick and painless and the other is long and painful?)
With regards to fluids, our normal practice was to continue until the cannula came out if it wasn't causing any distress to the patient. If swallowing was deemed safe then food would not be withdrawn. If it was deemed unsafe, then if awake enough then palliative feeding would be considered. What that meant was that food/drink could be given, with the accepted risks.
Because the patients need to be in such a state that they cannot take food or water. No patient of mine has ever been put on the LCP who was still completely conscious and able to take food and water, that would be absolutely barbaric and cruel and an inappropriate use of the LCP. We may withdraw medication such as antibiotics for these patients but this would be with their full consent. Patients on the LCP are normally semi-conscious or unconscious and are already dying and expected to die within a few hours or, at most, a couple of days - we are not committing euthanasia by not giving these patients food and water, it is certainly a medical intervention to give food and water to an unconscious patient because we would need to administer it through feeding tubes or drips, the patients die naturally as their organs continue to fail from whatever condition they are suffering from. Giving food and water by invasive methods only slows down the process of dying, the patients will still inevitably die (with some exceptions that I described earlier in the thread when the LCP needs to be reversed).
I don't know any doctor or nurse who would be willing to perform euthanasia on any patient and I would quit my job also if I was ever asked to participate in any form of euthanasia. The LCP is certainly not euthanasia and I strongly disagree with your uninformed view and insistence that it is.
Well put WinterLily
I would just like to say that a very dear friend of mine died at home recently of cancer. She was cared for exactly in the manner you describe, in co-operation with her wishes and with the help of her amazing husband.
The nursing care was second to none and I would just like to put in this little vote of thanks to the nurses concerned.
My dad was literally bleeding to death (bowel) and in great distress. We all had been indformed it was the end. The Doctor came in and told us that wasn't him making those noises but his body shutting down and he could give him something to make him more comfortable. We said yes immediately............I don't know what he gave him nor do i care as it was what was needed at the time. My dad had a right to a dignified death
My daughter is married to a dutch man and they have a much more practical approach to end of life care which i wish we would adopt but far too many right wing christians here for it ever to get off the ground.............The same right wing christians who are happy to take medication to prolong life but that doesn't seem to dawn on them that that is also interfering in God's hand