Sunday, September 20, 2009

'Palliative care in UK' = death by dehydration

.....Thanks, Father Finigan for the following! K.C. is posting this story because of its similarity to case featured in Father Ron Rolheiser's glowing endorsement of 'palliative care' in his South Texas Catholic article of one month ago.....

Vera’s story must be a warning to us allAs doctors fear 'euthanasia by the back door' Felicity Smart describes her chilling experience when a elderly neighbour entered hospital
18 September 2009....

My friend Vera (not her real name) is 98 and she desperately wants to live to be 100. I have known her for 20 years. She is frail, with poor eyesight and limited mobility, but she is definitely "all there". Strongly independent and unmarried, she lives alone. She can wash and dress herself unaided, and still cooks. She goes shopping in a wheelchair. A cleaner comes once a week, but Vera finds it hard to accept help.On Sunday afternoons I invariably phone her before visiting. There's no answer at first, as it takes her several minutes to reach the phone her poor eyesight prevents her from using a mobile. I try again a bit later. She usually answers then, but not this time. After two more tries, I am puzzled and anxious. Then I remember that her niece, Jo (not her real name, either) could have taken her out. She is her nearest relative. Her visits are infrequent, but maybe she has turned up. I leave a message.


......On Monday the phone rings. It's Jo, and what she tells me comes as a shock. Vera was found on Saturday evening by a neighbour, collapsed and in pain. She was rushed to hospital suffering from an acute abdominal inflammation. I ask if I can visit her. Yes, although she is unconscious. She says how sad it is that she won't be coming out. [this is the same certainty voiced by the palliative care nurse in Father Rollheiser's article prior to 'giving Granny her shot...']

Can she really be dying?I go with my husband. We find her in a ward with curtains drawn round the bed. Another shock: she looks bloated and almost unrecognisable; her breathing is laboured. She is being given oxygen, but there is no drip to hydrate her. By the bed is a small sponge on a stick, stained by pink gel, and some water in a glass. These are used to moisten her mouth so that dehydration does not cause her tongue to stick to it. A tube is inserted in her arm, which must be for pain relief - not only for the inflammation, but probably to allay the pain of dehydration. Pain relief is also a sedative. Dehydration, and the additional painkillers for it, could shorten her life.Knowing nothing about her condition, I feel at a disadvantage. ....

But as a supporter of the pro-life cause, I am concerned by what I see. I am a Catholic; Vera and her niece are not, but I am in no doubt about her will to live. We go to the desk where there is a senior nurse. I ask her about treatment and say how much Vera wanted to live. She says there is no treatment for the condition, which can be fatal even in younger people. Vera is receiving only palliative care because she is dying. Her niece has agreed to this after discussion with the consultant. My impression is that the nurse is talking fast and seems on the defensive.We return home not feeling reassured. I look up her condition on the internet. It does not say it is untreatable, although it can be very serious. Briefly, treatment is by intravenous infusion of fluids (nil by mouth) and pain relief. Surgery and antibiotics may be needed. I phone a pro-life helpline, Patients First Network, for advice. This support service promotes good medical care for people at risk near the end of life - at risk, that is, under the Mental Capacity Act of euthanasia by the omission or withdrawal of nutrition and hydration, and through medical and nursing care being stopped.Having explained the situation, I am advised to ask more questions at the hospital. ....

But have I the right to do this, given that what is happening to Vera has been agreed with her niece? Yes, because the Mental Capacity Act contains a clause stating that the person who determines what is in someone's "best interests" must take into account the views of anyone interested in his or her welfare. We decide that the best way forward would be to talk to Jo first. This might clarify the situation and possibly avoid causing her offence by our going directly to the hospital for information. I phone her. When she realises I have rung to do more than commiserate, her voice changes. Like the nurse, she talks fast and sounds on the defensive, but she remains friendly. I ask if Vera was unconscious when taken to hospital. No, but she had made a "living will" saying that she did not wish to be resuscitated, so when she became unconscious, she agreed with the consultant that she should be allowed to die.....

I am very concerned about what this means, and whether Vera really understood what would happen.I print out the Mental Capacity Act and we take it with us to the hospital the next day. The change in Vera is marked. She now looks emaciated, the oxygen has been removed and her breathing is rapid and shallow. Only pain relief and the pink sponge are being used. We ask if we can speak to someone directly responsible for her care. Another nurse appears. I want to know why Vera is not being hydrated. I am told that she is that's what the pink sponge is for. I am astounded. I reply that it can only moisten her mouth.I ask about intravenous hydration and almost hope to be told that there would be no benefit, because then withholding it would be justified and I could stop asking questions. But the nurse says that in a case such as this, hydration is only given if the relatives request it because it just prolongs a life that would otherwise end sooner rather than later. So Vera could benefit from it.....

The Mental Capacity Act says that in considering whether life-sustaining treatment is in a patient's best interests the person making the determination must not be motivated by a desire to bring about the patient's death. I say that I think Vera should be allowed a natural end and that it is wrong to hasten her death.The nurse asks me to wait. She returns with a form headed Liverpool Care Pathway. She explains that this is the gold standard of care for the dying, and is being rolled out across the NHS. Vera's care conforms to it. I am aware that there are serious pro-life concerns about it because it encourages the use of pain-relieving sedative drugs to ease the passage from life to death, opening the way for managed death or involuntary euthanasia. There is nothing in the ongoing care plan about food and fluids.I press the question of hydration. She says that sticking a needle into someone to hydrate them is hardly natural. I come back with it being unacceptable to inflict the pain of dehydration on someone, which then has to be relieved with additional life-shortening painkillers. What is the point of a medical advance, such as intravenous hydration, if it isn't used when needed? The nurse has had enough of me, but she is careful. She asks if I would like to talk to a doctor. I say yes.....


A doctor duly appears. She invites us into a private room. A palliative care specialist will be joining us, she says. By this time I'm feeling the strain, so my husband asks for more information. She tells us that Vera was fully conscious when admitted to hospital. Treatment of her condition with fluids was tried, but failed. A "very difficult" discussion then took place with her, during which it was explained that no further treatment was possible, surgery being too risky for someone so frail.She had accepted that palliative care was the only option, and was consistent with her living will. We are stunned. What are we to believe?I pull myself together and say that this is not our understanding of what had happened. We are simply told it is true and that her niece agrees with the decision. I ask if Vera knew that "treatment" now includes nutrition and hydration. Did she really want to be dehydrated to death? No answer. The palliative care specialist arrives to hear my question. She tries to tell me that very ill people don't want fluids anyway, so withholding them is not unkind. But did Vera know that dehydration is painful? Ah, but pain relief can make her "comfortable" (a word used several times as a euphemism for this kind of death). And her life will be shortened, I say. The doctor then says that hydration couldn't prolong it. Not what the nurse said earlier, I reply. We are going round in circles. I ask if this is the death they would want for themselves. Again, no answer.My husband sums up our views. He says we haven't been given a clear picture of what has happened and remain unconvinced that hydration has been justifiably withheld. He expresses our concern about the decreasing respect for life, which the law supports.....

They make no comment and it is we who end the meeting. But afterwards my husband and I agree that their aim was to head us off. We are left with the impression that the collective view is that this very old lady should be hastened to her end as speedily and painlessly as possible, her life having become of little or no value.We say our goodbyes to Vera. That evening, Jo phones. Vera has died. It took three days.Did we achieve anything? At the very least, we were listened to. I hope we also made the point that not everyone thinks the Mental Capacity Act protects patients or that the Liverpool Care Pathway is being used appropriately things which need saying repeatedly. Anti-life legislation is eroding trust in the medical profession.

http://www.catholicherald.co.uk/features/f0000471.shtml

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