By Kate Devlin
Sentenced to death on the NHS
Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors have warned.
In a letter to The Daily Telegraph , a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.
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across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.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.
The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours.
Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions.
It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004.
It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system.
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.
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.
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.
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.
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.
The letter has also been signed by Dr Anthony Cole, the chairman of the Medical Ethics Alliance, Dr David Hill, an anaesthetist, Dowager Lady Salisbury, chairman of the Choose Life campaign and Dr Elizabeth Negus a lecturer in English at Barking University.
A spokesman for the Department of Health said: “People coming to the end of their lives should have a right to high quality, compassionate and dignified care.
“Many people receive excellent care at the end of their lives. We are investing £286 million over the two years to 2011 to support implementation of the End of Life Care Strategy to help improve end of life care for all adults, regardless of where they live.”
By Richard Savill
Terminally ill grandmother ‘left to starve’ by doctors
Hazel Fenton, an 80-year-old grandmother who was placed under a controversial care plan and left to “starve to death” after doctors identified her as being terminally ill, only recovered after the intervention of her daughter.
Mrs Fenton, from East Sussex, is still alive and “happy” nine months after doctors declared she would only survive for days, withdrew her antibiotics and denied her artificial feeding, her daughter, Christine Ball, said.
“Without my persistence and pressure I know my mother would be dead now,” she added.
Mrs Fenton, a former private school house mother, had been placed on the Liverpool Care Pathway (LCP) scheme, which was originally developed as a way to care for cancer patients towards the end of their lives.
However, there has been recent criticism that not only cancer patients but others with terminal illnesses are being made to die prematurely under the NHS scheme.
Miss Ball, who had been looking after her mother before she was admitted to the Conquest hospital, Hastings, East Sussex, on Jan 11, said she had to fight hospital staff for weeks before her mother was taken off the plan and given artificial feeding.
Miss Ball, 42, a carer, from Robertsbridge, East Sussex, said: “My mother was going to be left to starve and dehydrate to death. It really is a subterfuge for legalised euthanasia of the elderly on the NHS. ”
Mrs Fenton was admitted to hospital suffering from pneumonia. Although Mrs Ball acknowledged that her mother was very ill she was “astonished” when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days.
On Jan 19, Mrs Fenton’s 80th birthday, Mrs Ball said her mother had lost “an awful lot of weight” but was feeling better, and told her she “didn’t want to die”.
But it took another four days to persuade doctors to give her artificial feeding, Miss Ball said.
Mrs Ball said the fight to save her mother had been made harder by the Mental Capacity Act. “I was told that we had no rights, and food and hydration were classed as treatment, which meant they had the right to withhold feeding. It gave a doctor the power to play god with my mother’s life,” she said.
By James Tozer
Pensioner ‘left to die in hospice after doctors wrongly diagnosed him with cancer’
A grandfather who beat cancer was wrongly told the disease had returned and left to die at a hospice which pioneered a controversial ‘death pathway’.
Doctors said there was nothing more they could do for 76-year-old Jack Jones, and his family claim he was denied food, water and medication except painkillers. He died within two weeks.
But tests after his death found that his cancer had not come back, and he was in fact suffering from pneumonia brought on by a chest infection.
To his family’s horror, they were told he could have recovered if he’d been given the correct treatment.
Today, after being given an £18,000 pay-out over her ordeal, his widow Pat branded his treatment ‘barbaric’ and accused the doctors of manslaughter.
Mr Jones was being cared at a hospice which was central to the contentious Liverpool Care Pathway under which dying patients have their life support taken away, although the hospice claims it wasn’t officially applied in his case.
The scheme is now used by hundreds of hospitals and care homes, and is followed in as many as 20,000 deaths a year.
He was told he was in remission from cancer, but the grandfather-of-two continued to suffer pain following the operation as well as difficulties in eating, and on January 3, 2006, he went to the city’s Marie Curie hospice for respite care.
While there, however, his shocked family were told the cancer had returned by Dr Alison Coackley, a palliative medicine consultant who played a key role in drawing up the Liverpool Care Pathway.
Despite the fact that no tests were carried out to confirm the diagnosis, his family say doctors instructed nurses to stop giving him food and fluids.
The only medication he was permitted were painkillers, and he slipped into semi-consciousness without the chest infection being diagnosed and died on January 14.
But a post mortem found he was free of cancer and had in fact died of pneumonia.
Reports commissioned by Mrs Jones’s solicitor concluded that with antibiotics and a rehydrating drip he could have made a full recovery and survived for at least another two years.
The hospice and the doctors who treated Mr Jones continue to deny liability, but his widow has now accepted an £18,000 out-of-court settlement after being told she would otherwise lose her legal aid.
Yesterday she said: ‘If they’d only treated his chest infection, my husband could well still be alive today.
‘We fought in the hospice to get Jack the right treatment and they blocked us, making us feel we were a nuisance.
‘I was worried it was pneumonia, I wanted them to check his chest, but they wouldn’t.’
Nevertheless the family want to know whether it – wrongly – placed him on a pathway to death anyway.
‘As far as I’m concerned, his death was manslaughter,’ said Mrs Jones.
‘It’s barbaric and I don’t want any other family to go through what we’ve had to.’
The 75-year-old, of Childwall, plans to report Dr Coackley and another doctor to the General Medical Council.
‘If they had examined his chest, they would have diagnosed the infection, and he could have been treated.’
The hospice’s lawyer, Dorothy Flower, said it had settled the case to enable Mrs Jones to grieve for her husband, but did not accept liability.
‘Some things are done for economic reasons, and a case like this costs a huge amount of money, which would do nobody any good,’ she said.