Submitted by Jacqueline Laing on Fri, 2014-01-31 14:55
The Leadership Alliance for the Care of Dying People (LACDP) professes to be involved in public engagement on a proposed substitute for the UK’s Liverpool Care Pathway. Families of victims who died on the pathway and many who made submissions to the Neuberger Review have been omitted from its trumpeted ‘public engagement exercise’. This is, perhaps, unsurprising. The LACDP is led by longtime admirer of the Liverpool Care Pathway, Dr Bee Wee. Families of victims of the infamous Death Pathway (with its self fulfilling sedation-dehydration regimes) have outlined their concerns about Bee Wee and have already announced no confidence in both her and her public consultation exercise. This notwithstanding, the guiding principles outlined in the recently publicised document apparently dated 25th October 2013 nonetheless introduce new dangers for patients in hospitals, hospices, care and individual homes nationally.
In view of the FOI Act revelations of 2012 demonstrating a staggering increase in numbers of people dying on the Pathway after the 2008 financial incentivisation strategy, the LACDP Guidelines exacerbate existing dangers identified by the Neuberger Review. They do so by undermining transparency and accountability, shifting legal responsibility and triggering altogether new human rights incompatibilities.
To summarise, the Guidance:
- Invites and involves state and medical complicity in suicide or homicide of an often costly patient at a time when a patient is vulnerable, sick, suggestible, young or elderly.
- Invites and institutionalises medical complicity in suicide or homicide by allowing medical professionals to leave syringe drivers and lethal doses of drugs with patients and their carers while professing immunity for the resultant death.
- Undermines autonomy by allowing unaccountable third parties to make these decisions on behalf of a patient
- Creates undue influence medical protocols, ie ‘care plans’ which are in fact quasi advance directives unlike up-to-date refusals of treatment. These in turn invite and institutionalise medical complicity in homicide by seeking a person’s consent to be killed by sedation-dehydration and other lethal regimes while shifting responsibility for that death to the patient and his family.
- Sets up quasi-advance directives while failing to explain to a person that in law (Airedale NHS Trust v. Bland (1993) AC 789 HL) treatment includes food and fluids delivered both by tube and in the ordinary way). By signing a care plan refusing treatment, the patient allows authorities power to trigger sedation-dehydration regimes without legal responsibility, redress or transparency.
- Potentially deprives the patient and his family of legal redress whether by way of criminal law, tortious liability or disciplinary proceedings.
- Creates conflicting and contradictory obligations for health professionals who may know that simple measures like fluids, insulin or antibiotics would save the patient but for the existence of a care plan cannot get involved. Prudential reasons of employment dictate that a medical professional avoid contradicting his superiors and fellows.
- Endangers the incapacitated and disabled, undermining the disabled, depressed, vulnerable, demented, suggestible, elderly and young who may not be in a position to comprehend the gravity of what is being suggested and done to them.
- Allows cost, research, organs, politics and simple discrimination (e.g. race, disability, for example) to act as reasons to trigger the use of lethal regimes.
- Undermines the caring duties, functions and purposes of the medical profession.
- Sets up the conceptual apparatus for institutionalised medical homicide. Demonstrates a disregard for the rights of the vulnerable and a profound failure to learn from both recent and past experience.
Dr. Jaqueline Laing is Director of Juris, a forum for jurisprudential discussion at London Metropolitan University where she teaches Jurisprudence and Criminal Law. She took her doctorate in Jurisprudence at the University of Oxford, after studying philosophy and law at the Australian National University. She has taught at Oxford, briefly at the Open University, and at Melbourne. She practised law as a Crown Prosecutor and as Associate to Justice of the Supreme Court of the Australian Capital Territory and Federal Court of Australia.