Matthew Cullinan Hoffman

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Alfie Evans not alone: Hundreds of patients starved to death in UK every year

Matthew Cullinan Hoffman Matthew Cullinan Hoffman Follow Matthew

May 17, 2018 (LifeSiteNews) – Britain’s National Health Service (NHS) tells the public that euthanasia, or the deliberate killing of patients, is “illegal” in Britain and that the “maximum penalty is life imprisonment.”

However, the NHS’s handling of the Alfie Evans case has provided another reminder to the world that the country’s prohibition of euthanasia has become little more than a dead letter.

It has been a well-documented fact for years that hundreds of patients die every year of starvation and thirst in NHS hospitals, a phenomenon that is facilitated by ambiguous end-of-life treatment guidelines that allow doctors and nurses to arbitrarily classify a person as “dying” and to withhold nutrition, hydration, and other basic forms of life support with no danger of punishment.

The practice of starving and dehydrating patients who have been written off as “dying” has made the NHS’s “palliative care” policy into nothing less than a euthanasia program, in which the diagnosis of a “fatal” condition becomes self-fulfilling.  The result is a system for eliminating patients for whom death is said to be “in their best interests,” using reasoning and methods chillingly reminiscent of Third Reich hospitals in the 1940s.

Alfie Evans’ mistreatment by Alder Hey Hospital is an example of a systematic approach to end-of-life treatment that is widespread in the NHS and which was reportedly originated at Alder Hey itself. Originally called the “Liverpool Care Pathway,” and nicknamed “the road to death,” it now functions under the rubric of “palliative care” for the dying, when in reality it facilitates the murder of patients by one of the cruelest methods possible: starvation and thirst. The "Liverpool Pathway for the Dying Child” was issued by the Royal Liverpool Children’s NHS Trust together with the participation of Alder Hey.

Although it is unclear what ultimately provoked Alfie Evans’ death, what seems uncontested is that the Alder Hey made a decision not merely to cease extraordinary treatments for the child, but to cut off his ventilator abruptly, a medically irresponsible act that can easily provoke a patient’s death. Treatments that could have enabled Alfie to breathe on his own were withheld, such as a tracheostomy. Furthermore, the palliative care “treatment” plan included the administration of drugs such as Fentanyl that would tend to suppress the child’s breathing.

When Alfie managed to breathe on his own despite the abrupt withdrawal of the ventilator and lack of tracheostomy, Alder Hey hospital refused requests to give him supplemental oxygen until Alfie’s attorney reportedly managed to outwit security to bring an oxygen mask to the boy – and then the hospital repeatedly sought to remove it.  

In the meantime, Alder Hey was literally starving Alfie, denying him nutrition for almost 28 hours until hospital staff finally relented and agreed to feed him, although the nutrition he received was reportedly minimal.

Finally, after Alfie had survived for four days deprived of ventilation and without a tracheostomy, a nurse reportedly administered four injections of unknown drugs to the child late at night, and within two hours he was dead. Now he has been buried without a coroner’s investigation or toxicology report after a request for such was denied by UK courts.

The fullest account of Alder Hey’s shameful treatment of Alfie Evans was published in Italian and English by the Italian newspaper La Nuova Bussola Quotidiana, in an article entitled, “How Alfie Died: All the Facts.” The account has never been contested by Alfie Evans’ parents nor the National Health Service.

Tens of thousands starved and dehydrated to death since 2000

Alfie Evans’ shocking mistreatment might appear to the casual reader to be nothing more than a strange and disturbing exception to the National Health Service’s repudiation of euthanasia, but it isn’t. The terrible truth is that repeated and very credible reports based on the government’s own death certificates for NHS patients have shown that literally tens of thousands of patients have died of starvation and thirst in UK hospitals since 2000. Even worse, the NHS’s own policies expressly support the practice of withholding nutrition and hydration from patients written off as “dying.”

In January of 2017, Britain’s Sun newspaper reported the latest data fully available to the public on starvation and dehydration in the country’s public hospitals, based on a study of the death certificates of all of those who died in NHS hospitals and care homes in 2015. Shockingly, according to the NHS’s own records, dehydration contributed to the deaths of 505 patients that year, and in 351 cases starvation was a contributing factor. In a total of 113 cases, dehydration or starvation was the main cause of death. Partial statistics published in 2018 regarding 2016 deaths indicate that a similar number of people died from the same causes that year as well.

The UK government’s British Broadcasting Corporation (BBC) responded to the 2015 figures with an article that sought to minimize the gravity of the situation, quoting doctors who claimed that some cases were due to stomach cancer, a questionable claim given that stomach cancer victims can easily be fed intravenously or by a feeding tube. Even Britain’s Prime Minister Theresa May has denied that the NHS is in a “humanitarian crisis,” a phrase used by the British Red Cross to describe the massive failures in care brought on by the NHS’s grave level of understaffing and insufficient budget.

How could Britain’s prime minister get away with denying that a health care system that allows hundreds of people to be dehydrated or starved to death every year is in a “humanitarian crisis”? Perhaps it’s because the British public has become desensitized to the problem. As incredible as it may seem, starvation and dehydration deaths in the hundreds each year have been reported on a regular basis since at least the year 2000, when 862 patients were killed principally or in part by starvation or dehydration in NHS hospitals and care centers. By 2010, the horrific figure had climbed even higher, to 1,316 patients annually.

Although many of the deaths are due to systematic omissions of care on the part of an understaffed NHS, critics have also observed that the health system’s own guidelines, in place for decades, have encouraged medical staff to place people into the category of the “dying,” which then permits caretakers to withhold hydration and nutrition if they deem it in the “best interests” of the patient, and to give them heavy doses of pain medication that can contribute to their deaths.

Britain’s original “road to death”: the infamous Liverpool Care Pathway

An earlier version of Britain’s deadly “palliative care” policy, known as the Liverpool Care Pathway for the Dying Patient (LCP), was originated at Alder Hey Hospital. It expressly allowed doctors to determine that a patient was “dying” according to vague and superficial criteria, and then to withhold nutrition and hydration from them if it was deemed to be “in the patient’s best interest.” It also allowed doctors to give nurses large amounts of extra pain medication and to allow them to vary the dose in ways that critics said caused or hastened death.

Even worse, hospitals were given financial incentives to place people on the LCP, which made the diagnosis of “terminal” a self-fulfilling death sentence. One doctor, Professor Patrick Pullicino, told the British media that he had personally saved the lives of patients placed on the LCP by insisting on their removal.  

The result, according to doctors and families of patients whose stories were reported in the British media, was patients begging for water being refused by medical personnel, and even desperately sucking on sponges as they died of thirst. The LCP became known as “the road to death.”

One hospice pediatric nurse, Bernadette Lloyd, was horrified to witness children being starved and dehydrated to death as they were ravaged by cancer and other diseases in NHS facilities.

“The parents feel coerced, at a very traumatic time, into agreeing that this is correct for their child whom they are told by doctors has only has a few days to live. It is very difficult to predict death,” she told Britain’s Daily Mail in 2012. “I have seen a ‘reasonable’ number of children recover after being taken off the pathway.”

“I have also seen children die in terrible thirst because fluids are withdrawn from them until they die,” said Lloyd. “I witnessed a 14 year-old boy with cancer die with his tongue stuck to the roof of his mouth when doctors refused to give him liquids by tube. His death was agonizing for him, and for us nurses to watch. This is euthanasia by the backdoor.”

An elderly woman, 90-year-old Kathleen Vine, was admitted to an NHS hospital with a dislocated shoulder, and then developed pneumonia. It was then that hospital staff decided to place her on the LCP. They placed a sign above her bed that said “nil by mouth” and refused to feed her or give her water despite her desperate requests.

“All I remember is they weren't feeding me. Up above my bed they put 'nil by mouth' and I was begging for food,” she told the BBC in 2013. Doctors and nurses ignored her requests.

When Vine’s grandchildren asked for an explanation, medical staff insisted she was dying, but could give no explanation for the claim. They also said their hands were tied and they weren’t permitted to feed her. After her family continued to insist on an explanation, they relented and began to feed Vine and give her water. She survived.

“I was being left to die. If it hadn't have been for my family I would be dead now. I would just have been another statistic on the books,” Vine said. She added that she felt sorry for other elderly patients on the ward who had no family to defend them against the LCP.

New guidelines continue to facilitate euthanasia by starvation

During the period of the Liverpool Care Pathway, annual deaths attributed to starvation and dehydration rose 50% to their incredible 2010 peak, leading to a massive outcry against the policy, which was finally withdrawn in 2014. A new set of guidelines were established December of 2015, which decreed that patients would no longer be placed on a standardized death plan, and instead would be given individualized care plans. However, critics decried the guidelines as a mere “rebranding” of the LCP, warning that patients would continue to be vulnerable to mistreatment.

The new December 2015 guidelines enacted by the NHS, “Care of dying adults in the last days of life,” allow medical personnel to use an “individualised approach” when “considering clinically assisted hydration for a dying person,” which should take into account things like “their level of consciousness,” “their level of thirst,” and “whether even temporary recovery is possible.”

The implication seems clear: the unconscious patient, or the patient who is unable to indicate his thirst, or the patient written off as incapable of temporarily recovering, can be refused hydration by medical staff.

In addition, the guidelines dictate that patients should be told that “it is uncertain if not giving clinically assisted hydration will hasten death.”

In more detailed protocols established to implement the guidelines, there appears a repetition of the claim from the Liverpool Care Pathway that withholding hydration might be in the “best interests” of the patient: “If a child or young person is given enteral or intravenous fluids, review this decision regularly to make sure it continues to be in their best interests.”

However, even more alarming is the fact that the current guidelines for adults do not mention nutrition for dying patients at all. No guidelines are provided for ensuring that dying patients such as Alfie Evans will be fed in any way. Withholding nutrition from patients such as Alfie for almost 28 hours was completely within the new guidelines.

Other life support measures are also left unmentioned in the new guidelines, apparently leaving the withdrawal of basic life support, such as a ventilator, as well as other treatments, to the discretion of doctors.

Doctors are able to diagnose the person as “dying” based on vague criteria, such as “increasing fatigue and loss of appetite,” or “changes in communication, deteriorating mobility or performance status, or social withdrawal,” all of which can be associated with normal disease symptoms and even with clinical depression.

The NHS “End of life care for infants, children and young people with life-limiting conditions” guidelines, published in 2016, also speak of the possibility that hydrating the “dying” patient may not be “in their best interests.” The same possibility is mentioned for nutrition.

Professor Patrick Pullicino, a Professor of Clinical Neuroscience at the University of Kent who was one of the first to publicly sound the alarm about the devastating effects of the Liverpool Care Pathway, wrote an article in 2015 for Britain’s Daily Telegraph newspaper warning that the same deadly practices were still occurring under new names, and that the new guidelines then being proposed constituted a “disaster of misinformation, distortion and ambiguity” that would continue to result in the deaths of NHS patients.

“Dehydration was a central mechanism of the deaths on the LCP. Despite the removal of the LCP, I still frequently witness severely dehydrated elderly patients on hospital wards,” wrote Pullicino. “Unless it becomes standard, and monitored by the Care Quality Commission, that hospitals are obliged to give nutrition and hydration adequate for patients’ physiological needs at all times and regardless of prognosis, end-of-life care is going to remain lethal,” he added.

Pullicino also disputed the new guidelines’ claim that “it is uncertain if not giving clinically assisted hydration will hasten death.”

The claim is “completely untrue,” he told the Catholic Herald. “Not giving hydration is certain to kill someone if they can’t take hydration by mouth.”

The Catholic Medical Association, which includes over 500 UK doctors, concurred with Pullicino’s judgment, as did Britain’s Medical Ethics Alliance, a coalition of medical groups that upholds Hippocratic medicine, according to the Catholic Herald.

“We simply do not accept the view that the dying do not experience thirst. Nor do we accept that mouth hygiene relieves thirst,” wrote the chairman of the Medical Ethics Alliance in a letter to the National Institute for Health and Care Excellence, which authored the guidelines for the NHS.

“The draft guidelines say nothing about nutrition. Why is this? We have learnt of deaths that are caused by both dehydration and patients who have been starved over weeks,” he added.

If the Alfie Evans case is any indication, the deliberate starvation of patients and withholding of very basic forms of care appear to continue to be a standard practice in NHS hospitals. The fact that Alder Hey Hospital was able to withdraw nutrition from Alfie Evans for almost 28 hours, even while the child’s case was being followed intensely in the media, is a chilling indication of how deeply rooted the starvation of the sick and dying is in the practices of the NHS.

British judge in Alfie case chafes at comparison to Nazi euthanasia practices

During the judicial proceedings that led to the withdrawal of Alfie Evans’ life support, a German doctor and professor of medicine drew the ire of British judge Anthony Paul Hayden, when he pointed out the danger of imitating Nazi euthanasia practices in the Evans case. However, the doctor’s concerns appear to have been well-placed.

Professor Nikolaus Haas, Medical Director of the Department of Paediatric Cardiology and Intensive Care of the University Hospital Ludwig-Maximilians university (LMU) Munich, told Judge Hayden that Alfie’s illness was almost certainly terminal, but noted, “Withdrawing of treatment will immediately lead to his death and this can certainly not be in his interest. It is clear that in his best interest there should be a possibility for Alfie to live the possibly short rest of his life in dignity together with his family if this is the wish of his parents at home, which I believe is the best for him, outside a hospital or in a hospice or other form of caring institution.”

Haas then added, “Because of our history in Germany, we've learned that there are some things you just don't do with severely handicapped children. A society must be prepared to look after these severely handicapped children and not decide that life support has to be withdrawn against the will of the parents if there is uncertainty of the feelings of the child, as in this case”.

Justice Hayden called Haas’ remarks “inflammatory and inappropriate,” and claimed “the views expressed bear no relationship to and do not engage with the facts of this case.”

Haas’ remarks seem to have struck a nerve. The doctor’s statements did indeed bear a relationship to the Alfie Evans case. Alfie was being condemned to die by the brutal sudden removal of ventilation to which his body has become accustomed, as well as the withholding of nutrition, and the chemical suppression of his breathing, all of which are perfectly within the regulations of the NHS for patients diagnosed as “dying.” Moreover, he was justifying the measure on the grounds that it was in the “best interests” of Alfie.

German hospitals in the early to mid 1940s had a similar policy for those with serious handicaps and degenerative diseases, and the main target was children.

The Nazi euthanasia policy was initiated in 1939 with the now-infamous “T4” program, which executed handicapped children in gas chambers. However, following protests by parents, the program was replaced by a general policy of killing the children by starving and overmedicating them, or giving them lethal injections in the hospital and care settings in which they lived. The new approach allowed doctors to disguise the euthanasia of patients much more easily. Children could be be portrayed as “sick” and “dying,” and the fact of their murder was more difficult to prove.

In toto, Nazi euthanasia policies are estimated to have killed 200,000 patients from 1939 to 1945, most of them children, and the majority, approximately 130,000, were killed by overmedication malnutrition, and lethal injection.

Justice Hayden, in defense of his decision to assign Alfie Evans to the NHS’s palliative care “road to death,” quoted a guidance published by Britain’s Royal College of Paediatrics and Child Health, called “Making Decisions to Limit Treatment in Life-limiting and Life- threatening Conditions in Children: A Framework for Practice.”

The guide expressly allows “Life Sustaining Treatments” (LST) to be withheld from children if their “quality of life” is deemed insufficient for justifying their continued existence. Among such “life sustaining treatments” are listed “Clinically Assisted Nutrition and Hydration.”

Britain’s government and health practitioners have become so accustomed to this cruel and barbaric form of patient mistreatment that they appear to have become unable to recognize Nazi-esque euthanasia when it is before their very eyes. It seems that at the level of medical ethics, the “Battle of Britain” is currently being won by the long-dead Third Reich.

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Matthew Cullinan Hoffman

Matthew Cullinan Hoffman is an essayist, journalist, and author whose articles have appeared in numerous publications worldwide, both secular and Catholic, including the Wall Street Journal, London Sunday Times, Detroit News, New York Daily News, LifeSiteNews, Catholic World Report, Crisis Magazine, and the National Catholic Register. He is the translator and author of The Book of Gomorrah and St. Peter Damian's Struggle Against Ecclesiastical Corruption (2015). He holds an M.A. in Philosophy from Holy Apostles College and Seminary, where he is certified for academic competency in five foreign languages. He currently resides in Mexico, and does specialized coverage of Latin America for LifeSite and other publications.