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Tighten controls on UK’s end-of-life protocol over abuse concerns, says group of 20 medical bodies

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LONDON, October 10, 2012 (LifeSiteNews.com) – A group of 20 medical bodies has said that the UK Department of Health needs to tighten controls on the controversial Liverpool Care Pathway, a medical protocol that pro-life campaigners have said is often used as a method of passive euthanasia.

After a consultant neurologist said in June that the LCP is being used to “clear” elderly patients out of scarce hospital beds, a ‘consensus statement’ by 20 UK medical bodies said that from now on, two doctors, one of whom is to be the most senior on staff, must sign off on the use of the protocol. The statement also said that the protocol does not require the removal of food and/or hydration from every patient placed on it.

The LCP was developed by a group of British bioethicists in the 1990s, and under the current rules it allows a single doctor to decide when a patient is in “the final days or hours of life” and to remove “medical treatment,” including food and hydration, while the patient is heavily sedated.

The statement comes from an array of interested groups, including the Royal College of General Practitioners, the Royal College of Physicians, the National Council for Palliative Care, pressure groups including Age UK and the Alzheimer’s Society, and the Royal College of Nursing.

“It is not always easy to tell whether someone is very close to death,” says the statement. “[A] decision to consider using the pathway should always be made by the most senior doctor available, with help from all the other staff involved in a person’s care. It should be countersigned as soon as possible by the doctor responsible for the person’s care.”

“The pathway,” the statement said, “does not preclude the use of clinically assisted nutrition or hydration – it prompts clinicians to consider whether it is needed and is in the person’s best interest.” The Pathway, they said, is “not in any way about ending life, but rather about supporting the delivery of excellent end-of-life care”.

Dr. Patrick Pullicino told a meeting of the Royal Society of Medicine in London that as many as 130,000 people had died under the LCP and that there is often a “lack of clear evidence” that a patient is dying when he is put on it. Far from being a last resort in the last possible extreme of terminal illness, the Pathway is often invoked as an “assisted death pathway rather than a care pathway,” he said.

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Steve Doughty of the Daily Mail quoted him saying that “pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients” are frequently-used criteria. He said that in one case in his own practice, a 71-year-old patient was admitted to hospital suffering from pneumonia and epilepsy, was put on the LCP, without his family’s consent, by a doctor on a weekend shift. Pullicino, Professor of Clinical Neurosciences at the University of Kent, said that he took the patient off the Pathway and when treatment was resumed the patient recovered fully and lived more than a year.

“Very likely many elderly patients who could live substantially longer are being killed by the LCP,” he said. “Patients are frequently put on the pathway without a proper analysis of their condition.

“Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically.”

Dr. Peter Saunders of the Care Not Killing Alliance, which supports the LCP in theory, warned that Pullicino’s statements could lead to misunderstandings. He said that an audit of 4000 LCP patients’ records in 2009 found that they are “receiving high quality clinical care for the last hours and days of life”.

Saunders wrote, “If a patient is judged to be imminently dying and is placed on the LCP and dies within hours or days one can be virtually certain that the death was caused by the underlying condition.” 

In cases where the patient is placed on the Pathway and dies ten to fifteen days later, Saunders added, “there must be a very real question about whether the withdrawal of hydration actually contributed to the death. But to put a patient on the LCP for this length of time is quite inappropriate.”

The LCP requires that patients only be judged eligible if they are within hours, or at most days, of death. They must be monitored and checked every four hours and if any improvement is seen, the protocol requires that treatment be resumed.

Other voices have been raised more strongly in warning against the LCP. In a July letter to the Daily Telegraph, seven doctors, including the heads of the Medical Ethics Alliance and the group First, Do No Harm that champions traditional medical ethics, warned that the LCP can be misused through several means.

“Other considerations” than those purely medical issues laid out in the Pathway protocol could easily be influencing doctors’ decisions, “not excluding the availability of hospital resources,” they warned.

“The onus of proof that the pathway is safe and effective, or even required, is upon its authors, who should furnish their evidence.”

They said, “The combination of morphine and dehydration is known to be lethal, and four-hourly reassessment is pointless if the patient is in a drug-induced coma. No one should be deprived of consciousness except for the gravest reason, and drug regimes should follow the accepted norms as laid down in national formularies.”

The physicians added that “informed consent is another major consideration” and that it is “not surprising” that patients are including a written refusal of the Pathway in legally binding “advance directives,” or “carrying cards refusing this form of treatment, as a measure of self-protection”.

Saunders said that his group regards the LCP itself to be “a great clinical tool” but warned, “we also do need to be alert to doctors and other health care professionals, either through negligence, ignorance or perhaps even malicious intention, misusing a perfectly good care tool to speed the deaths of patients who are not imminently dying.”

“Any misuse of the LCP must be exposed and dealt with,” he said.

The slide towards the routine use of withdrawal of food and hydration has been going on a long time. It started with the 1993 case of Tony Bland, a man who had suffered brain injuries and was in a coma. The hospital, with the support of his family, applied successfully to the courts to remove his hydration, an act that was uniformly described in the press as “allowing him to die with dignity.”

A physician with the Royal Hospital for Neurodisability later wrote that this decision was a major turning point in the history of medicine, in that “instead of considering the futility of the treatment, the burden of the treatment ... the decision for the first time considered the worthwhileness of the patient, and the burdensomeness of the patient himself.”

The Mental Capacity Act 2005 codified the definition of food and hydration as “medical treatment” that could be removed if a doctor decided a patient’s future expectations did not warrant him being kept alive. Since the Bland case, doctors who have petitioned the courts to remove food and hydration have never been refused.

A 2004 letter from the Bill Policy Officer in the Mental Capacity Bill legislative Division, to the Association of Lawyers for the Defence of the Unborn said the government has no intention of overturning Bland. Since the Bland decision, courts have sanctioned “around 36 cases” of deliberate killing by withdrawing assisted food and fluids, “and the Government does not disagree with it,” the letter said. 

This legal history is the atmosphere in which the Liverpool Care Pathway was developed and in which it was decided that patients who are judged to be nearing the end of their lives could be refused food and hydration. In a 2008 article in the British Medical Journal, Dr. Adrian Treloar a geriatrician, said that the eligibility criteria “do not ensure that only people who are about to die are allowed on to the pathway”.

“For instance,” he warned, “patients with dementia, in whom dying can take years, and those who are bed-bound and unable to swallow may be eligible.”


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UK quietly opens the door to genetic engineering, ‘3-parent’ embryos

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By Hilary White

Last month the UK’s Department of Health quietly redefined the term “genetic modification” to open the door to allow certain kinds of modification of human embryos – thus potentially making it the first country in the world to allow genetic engineering.

Scottish journalist Lori Anderson recently raised the alarm over the change in a column in the Scotsman, in which she alleged that the change is designed to “dupe” the British public into accepting “full-scale germline genetic engineering,” using human embryos as test subjects.

Anderson said that in July, the Department of Health “effectively re-wrote the definition of ‘genetic modification’ to specifically exclude the alteration of human mitochondrial genes or any other genetic material that exists outside the chromosomes in the nucleus of the cell.”

“The reason for doing this is that it believes it will be easier to sell such an advancement to the public if it can insist that the end result will not be a ‘GM baby’.”

This change follows a statement from the Human Fertilisation and Embryology Authority (HFEA), the government body that regulates experimental research on human embryos, approving the procedure to create an embryo from one couple’s gametes but with genetic material added from a third party donor, a procedure called in the press “three-parent embryos”.

Anderson quoted a statement from the Department of Health comparing this procedure to donating blood. The statement read, “There is no universally agreed definition of ‘genetic modification’ in humans – people who have organ transplants, blood donations, or even gene therapy are not generally regarded as being ‘genetically modified’. The Government has decided to adopt a working definition for the purpose of taking forward these regulations.”

This assertion was challenged by one of the UK’s leading fertility researchers, Lord Robert Winston, who told the Independent, “Of course mitochondrial transfer is genetic modification and this modification is handed down the generations. It is totally wrong to compare it with a blood transfusion.”

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The HFEA, which throughout its history has been known as one of the world’s most permissive regulatory bodies, has been working steadily towards allowing genetically modified embryos to be implanted in women undergoing artificial procreation treatments. In a document issued to the government last year, they called the insertion of mitochondrial DNA (mDNA) into embryos “mitochondrial donation” or “mitochondrial replacement”. mDNA is the genetic material found in the cytoplasm outside a cell’s nucleus, problems with which can cause a host of currently incurable genetic illnesses.

In the statement issued in June, the HFEA said the technique of inserting “donated” mDNA into already existing in vitro embryos, “should be considered ‘not unsafe’ for the use on a ‘specific and defined group of patients.’”

“Mitochondria replacement (or mitochondrial donation) describes two medical techniques, currently being worked on by UK researchers, which could allow women to avoid passing on genetically inherited mitochondrial diseases to their children,” the statement said.

The HFEA admitted that the techniques are “at the cutting edge of both science and ethics” and said that the results of a “public consultation” in 2012/13 were being examined by the government, which is considering “draft regulations”.

In June, the Society for the Protection of Unborn Children echoed Lori Anderson’s concern, commenting that the HFEA is attempting to deceive the public. Paul Tully, SPUC’s general secretary, said, “Human gene manipulation is being sold to a gullible public on a promise of reducing suffering, the same old con-trick that the test-tube baby lobby has been using for decades.” 

Any manipulation of human genetics, always breaks “several important moral rules,” entailing the creation of “human guinea-pigs,” Tully said. “Human germ-line manipulation and cloning – changing the genetic inheritance of future generations - goes against internationally-agreed norms for ethical science.”

He quoted Professor Andy Greenfield, the chairman of the scientific review panel that approved the techniques, who said that there is no way of knowing what effect this would have on the children created until it is actually done.

“We have to subject children who have not consented and cannot consent to being test subjects,” Tully said.

Altering the mDNA of an embryo is what cloning scientists refer to as “germline” alteration, meaning that the changes will be carried on through the altered embryo’s own offspring, a longstanding goal of eugenicists.

In their 1999 book, “Human Molecular Genetics” Tom Strachan and Andrew Read warned that the use of mitochondrial alteration of embryos would cross serious ethical boundaries.

Having argued that germline therapy would be “pointless” from a therapeutic standpoint, the authors said, “There are serious concerns, therefore, that a hidden motive for germline gene therapy is to enable research to be done on germline manipulation with the ultimate aim of germline-based genetic enhancement.”

“The latter could result in positive eugenics programs, whereby planned genetic modification of the germline could involve artificial selection for genes that are thought to confer advantageous traits.”


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Cable series portrays nun as back-alley abortionist

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'To depict a nun who performs an abortion is a new low,' said Bill Donohue, president of the Catholic League for Religious and Civil Rights.

The Cinemax TV series The Knick portrayed a Roman Catholic nun as a back alley abortionist who tells a Catholic woman God will forgive her for going through with the procedure.

In its latest episode, which aired Friday night, the series showed Sister Harriet (an Irish nun played by Cara Seymour) telling a Catholic woman named Nora, “Your husband will know nothing of it. I promise.”

“Will God forgive me?” Nora asked, adding, “I don't want to go to Hell for killing a baby.”

“He knows that you suffered,” the sister replied, before performing the illegal abortion off-screen. “I believe the Lord's compassion will be yours.” 

The period medical drama is set at the Knickerbocker Hospital (“The Knick”) in New York City around the turn of the 20th century, when abortion was against both civil and ecclesiastical law.

“It is no secret that Hollywood is a big pro-abortion town, but to depict a nun who performs an abortion is a new low,” Bill Donohue, president of the Catholic League for Religious and Civil Rights, said. “The only saving grace in this episode is the real-life recognition of the woman who is about to have the abortion: she admits that her baby is going to be killed.”

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The series is directed by Steven Soderbergh, known for such films as Erin Brockovich, the Oceans Eleven franchise, and Sex, Lies, and Videotape. More recently he directed The Girlfriend Experience, a film about prostitution starring pornographic actress Sasha Grey.

Critics have hailed his decision to include a black surgeon in circa 1900 America. But after last week's episode, the New York Times stated that The Knick has chosen to “demonstrate concern for other kinds of progress,” citing the depiction of the abortion. 


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Balcony of the Grandmaster Palace in Valletta, which houses the Maltese Parliament. Shutterstock
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Catholic Malta enacts ‘transgender’ employment discrimination law

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By Hilary White

An amendment to Malta’s Employment and Industrial Relations Act means that employment “discrimination” against “transsexuals” is now officially prohibited in the Catholic country. The provision, which was quietly passed in May, came into effect on August 12th.

The law allows those who believe they have a complaint to make a case with the National Commission for the Promotion of Equality, with an industrial tribunal or the courts. A government spokesman told local  media, “Employees do not need to prove that their employer has discriminated against them.”

“They only need to provide enough evidence pointing to a likely case of discrimination. The employer will then need to prove that discrimination has not taken place.”

The amendment defines illegal discrimination against “transgendered” people as, “in so far as the ground of sex is concerned, any less favourable treatment of a person who underwent or is undergoing gender reassignment, which, for the purpose of those regulations shall mean, where a person is considering or intends to undergo, or is undergoing, a process, or part of a process, for the purposes of reassigning the person’s sex by changing physiological or other attributes of sex.” 

Silvan Agius, Human Rights policy coordinator with the Ministry for Social Dialogue, Consumer Affairs and Civil Liberties, told Malta Today newspaper that the new amendment brings Maltese law into harmony with EU law.

“This amendment is continuing the government’s equality mainstreaming exercise. The inclusion of gender reassignment in the Act also brings it in line with the anti-discrimination articles found in both Malta’s Constitution and the Equality for Men and Woman Act,” Agius said.

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Agius is a key member of the homosexual activist apparatus in Malta’s government working to entrench the ideology of gender in law in Malta and elsewhere. In June, he was a featured speaker, with the notorious British anti-Catholic campaigner Peter Tatchell, at a Glasgow conference organised by the Edinburgh-based Equality Network, a group that helps organise and train homosexualist campaign groups.

The amendment to the law follows promises made recently by the country’s equalities minister, Helena Dalli, to a “transgender” congress in Hungary in May. Dalli, who brought forward Malta’s recently passed same-sex civil unions bill, told a meeting of gender activists in Budapest that while her government’s focus had been mainly on homosexuals, that she would shortly be turning her attention to “trans” people.

“The next step now is a Bill towards the enactment of a Gender Identity law. A draft bill has been prepared and it has now been passed to the LGBTI Consultative Council for its vetting and amendment as necessary,” Dalli said.

“Some of you may be thinking that we are moving forward quickly. I have a different perspective though. We are doing what is right, what should have been done a long time ago,” she added.

Since the legalisation of divorce in 2011, Malta has been remarkable for its rapid adoption of the gender ideology’s agenda. In 2013, Malta was named the “fastest climber” on the Rainbow Europe Index, a survey organised annually by ILGA Europe, the leading homosexualist lobby group funded directly by the European Union.

The ILGA Europe report notes (p. 114) that Helena Dalli Helena “was one of 11 EU Member States’ equality ministers to co-sign a call for the European Commission to work on a comprehensive EU policy for LGBT equality.” The report also noted that although the new Labour government has proved cooperative, the Christian Democrat Nationalist Party has “progressively proved more receptive to LGBTI issues, including same-sex unions.”


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