On page 2 (there are only 2) of the LCP Relative Carer Information leaflet reads
“Loss of interest in and a reduced need for food and drink is part of the normal dying process. When a person stops eating & drinking it can be hard to accept even when we know they are dying. Your relative or friend will be supported to eat and drink for as long as possible. If they cannot take fluids by mouth, fluids given by drip may be considered. Fluids given by a drip will only be used where it is helpful and not harmful. This decision will be explained to your relative or friend if possible and to you.”
The bottom line is.
“If you take water away from people or for that matter animals THEY ARE GUARANTEED TO DIE.”
The average time of survival without water is approximately 29 HOURS. Some people have survived longer, in the much publicised life and death of TERRI SCHIAVO, Terri lived for 13 days without water, this is not such an unusual case others have also survived longer.
Dying through lack of fluids is a very painful, terrifying death that can only be covered up by the use of other drugs; these drugs may mask the effects of dehydration and render patients too helpless to call out for fluids. However it’s not difficult to discover several instances (WHAT THE PEOPLE SAY) whereby patients cried out for fluids despite being heavily sedated. It is important to point out that dehydration, especially in the elderly, can mimic the signs that someone is dying.
Let’s just consider what the proponents of the LCP have said (quote above) about people not needing fluids. The creators of the LCP seem to be totally at odds with the opinions of other professionals regarding the withdrawal of fluids from patients deemed to be dying.
DR Anthony Cole, Chairman of the Medical Ethics Alliance said in a meeting (arranged by Baroness Knight) at the House of Lords 23rd January 2013.
“In fact no one can survive without hydration and nourishment. They are basic human needs. The human body has a built in control system to ensure that fluid intake continues.”
He continues, and please note:
“Thirst is a primitive sensation which eventually comes to dominate all others and the thirst centre lies in the hypothalamus one of the deepest levels of the brain. There can be no certainty that drugs working on the higher centre will abolish thirst.”
Dr Cole had asked the opinion of the Chief Executive of NICE (National Institute of Clinical Excellence) and the Association of Palliative Care Medicine, before he made this statement, POSING the question,
“How long should a person be without fluids?
“No answer was forthcoming.”
Dr Cole quoted from Dr. Peter McCullough a senior researcher at John Curtin School of Medicine. Dr. McCullough has written extensively on this subject in an article entitled Thirst in Relation to Withdrawal of Hydration (read article) can be found on line. It is some 14 pages long and leaves the reader in no doubt as to the evidence that the dying still have a desire for water.
… “moistening the mouth failed to relieve thirst in dogs and horses with oesophageal fistula… and it is evident that, whereas dryness of the mouth can aggravate a sensation of thirst resulting from body water depletion, its alleviation will not remedy thirst in the absence of correction of water depletion.”
The writer would like to support these findings. As someone who was a sufferer of ‘locked in syndrome’ for some four months I can testify without doubt that ‘moistening the mouth’ only makes the need for a proper drink more urgent and does in fact make the problem much worse by tantalising, but not fulfilling the need stimulated by the rather horrid sponges.
In his summary on the issue of Withdrawal Of Hydration Dr. McCullagh states,
… “sensation of thirst can be demonstrated to persist despite very severe damage to other parts of the brain, for example decortication” (removal of the outside layer).”
Of course we must remember that in the majority of patients placed on the LCP brain damage per se is not the issue. Dr. McCullough is using the instance of brain damage to question and conclude that if the onset of death could be seen to bring about the same problems in the brain as an incident of damage caused by other means, then the evidence that the patient does not then feel thirst is absent and erroneous. The LCP offers no evidence that the two are akin or even vaguely alike.
Dr. Gillian Craig a retired Consultant Geriatrician has, since 1990, when she came across the practice of ‘sedation without hydration’ written and taught extensively on this subject. Her books, under the title of Challenging Medical Ethics 1 and 2, (No Water No Life Hydration and the Dying & Patients in Danger – The Dark Side of Medical Ethics) are both full of comprehensive, reasoned, considered and vital information that the proponents of removal of fluids from the dying would do well to read. She states that,
“If naturally or artificially administered hydration and nutrition is withheld, the responsible medical staff must face the fact that prolonged sedation without hydration or nutrition will end in death, whatever the underlying pathology.”
It appears that decisions are made based on quality not quantity of life. As such they are bound to be subjective, made by someone who is not old or ill, or disabled and coloured by deeply held biased beliefs in what constitutes a worthy life.
Dr. Patrick Pullicino in letters sent from him and Dr Philip Howard, chairman of the Joint Medical Ethics Committee of the Catholic Medical Association, has this to say about these decisions.
“The danger of putting patients into the ‘poor outcome’ category is that it leads to self-fulfilling prophesies.”
He goes on,
“In a recent staff meeting I attended, two medical consultants expressed the view that pressure to find empty beds and difficulties nurses face trying to manage and treat agitated and confused elderly patients both influenced who was put on the LCP.”
So for relatives and patients we must ask,
- Is our relative really dying?
- Why are they not receiving food and water, especially water?
- Is the hospital just waiting for the bed?
Regarding the giving of water it can be given in 4 ways:
- Orally (by mouth).
- Subcutaneously (through a drip)
- Anally with a rectal tube (via the anus)
- Via a gastric tube (in the mouth)
Traditional end of life, palliative care, as Richard Lamerton points out in his letter, included fluids. (WHAT DOCTORS SAY)
“If someone could not swallow but still showed signs of consciousness, we could rehydrate them”
It is also worth noting that patients at home who according to the LCP will only be assessed as and when the Health Visitor or doctor calls – so no 4 hourly check on the LCP there?