Hilary White

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

Hilary White
Hilary White
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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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Indiana Gov. Mike Pence signs the state's Religious Freedom Restoration Act.
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Indiana faces backlash as it becomes 20th state to protect religious liberty

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By Ben Johnson

INDIANAPOLIS, IN, March 27, 2015 (LifeSiteNews.com) – On Thursday, Indiana became the 20th state to prevent the government from forcing people of faith to violate their religious beliefs in business or the public square.

Gov. Mike Pence signed the Religious Freedom Restoration Act (SB 101) into law, saying the freedom of religion is a preeminent American value.

“The Constitution of the United States and the Indiana Constitution both provide strong recognition of the freedom of religion, but today, many people of faith feel their religious liberty is under attack by government action,” Pence said.

Gov. Pence, a possible dark horse candidate for president in 2016, cited court cases brought by religious organizations and employers, including Catholic universities, against the HHS mandate. “One need look no further than the recent litigation concerning the Affordable Care Act. A private business and our own University of Notre Dame had to file lawsuits challenging provisions that required them to offer insurance coverage in violation of their religious views.”

The new law could also prevent Christian business owners from being compelled to bake a cake or take photographs of a same-sex "marriage" ceremony, if doing so violates their faith. In recent years, business owners have seen an increased level of prosecution for denying such services, despite their religious and moral beliefs.

The state's pro-life organization applauded Pence for his stance. "Indiana's pro-life community is grateful to Gov. Mike Pence for signing the Religious Freedom Restoration Act into law,” said Indiana Right to Life's president and CEO Mike Fichter. “This bill will give pro-lifers a necessary legal recourse if they are pressured to support abortion against their deeply-held religious beliefs.”

“RFRA is an important bill to protect the religious freedom of Hoosiers who believe the right to life comes from God, not government,” he said.

The state RFRA is based on the federal bill introduced by Sen. Chuck Schumer, D-NY, and signed into law by President Bill Clinton in 1993. The Supreme Court cited the federal law when it ruled that Hobby Lobby had the right to refuse to fund abortion-inducing drugs, if doing so violated its owners' sincerely held religious beliefs.

In signing the measure – similar to the one Arizona Gov. Jan Brewer vetoed – Pence and the state of Indiana have faced a torrent of venom from opponents of the bill, who claim it grants a “right to discriminate” and raises the spectre of segregation.

"They've basically said, as long as your religion tells you to, it's OK to discriminate against people," said Sarah Warbelow, legal director of the Human Rights Campaign, a national homosexual pressure group.

The Disciples of Christ, a liberal Protestant denomination based in the state capital, has said it will move its 2017 annual convention if the RFRA became state law. The NCAA warned the bill's adoption “might affect future events” in the Hoosier state.

Pence denied such concerns, saying, "This bill is not about discrimination, and if I thought it legalized discrimination in any way I would've vetoed it."

The bill's supporters say that, under the Obama administration, it is Christians who are most likely to suffer discrimination.

"Originally RFRA laws were intended to protect small religious groups from undue burdens on practicing their faith in public life,” said Mark Tooley, president of the Institute on Religion and Democracy. “It was not imagined there would come a day when laws might seek to jail or financially destroy nuns, rabbis or Christian camp counselors who prefer to abstain from the next wave of sexual and gender experimentation. And there's always a next wave.”

The bill's supporters note that it does not end the government's right to coerce people of faith into violating their conscience in every situation. However, it requires that doing so has to serve a compelling government interest and the government must use the least restrictive means possible. “There will be times when a state or federal government can show it has a compelling reason for burdening religious expression – to ensure public safety, for instance,” said Sarah Torre, an expert at the Heritage Foundation. “But Religious Freedom Restoration Acts set a high bar for the government to meet in order to restrict religious freedom.”

Restricting the ability of government to interfere in people's private decisions, especially their religious decisions, is the very purpose of the Constitution, its supporters say.

"Religious freedom is the cornerstone of all liberty for all people,” Tooley said. “Deny or reduce it, and there are no ultimate limits on the state's power to coerce."

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Fight pornography. Beat pornography. And join the ranks of those who support their fellow men and women still fighting.
Jonathon van Maren Jonathon van Maren Follow Jonathon

Porn is transforming our men from protectors into predators. Fight back.

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By Jonathon van Maren

Since I’ve gotten involved in anti-pornography work, I’ve met countless men who struggle, fight, or have beaten pornography. Each person seems to deal with the guilt and shame that accompanies porn use in a different way—some deny that it’s “all that bad,” others pretend that they could “stop whenever they want,” many insist that “everyone is doing it,” and most, when pressed, admit to a deep sense of self-loathing.

One worry surfaces often in conversation: What do my past or current struggles with pornography say about me as a man? Can I ever move past this and have a meaningful and fulfilling relationship?

I want to address this question just briefly, since I’ve encountered it so many times.

First, however, I’ve written before how I at times dislike the language of “struggling” with pornography or pornography “addiction,” not because they aren’t accurate but because too often they are used as an excuse rather than an explanation. It is true, many do in fact “struggle” with what can legitimately be considered an addiction, but when this language is used to describe an interminable battle with no end (and I’ve met dozens of men for whom this is the case), then I prefer we use terminology like “fighting my porn habit.” A semantic debate, certainly, but one I think is important. We need to stop struggling with porn and start fighting it.

Secondly, pornography does do devastating things to one’s sense of masculinity. We know this. Pornography enslaves men by the millions, perverting their role as protector and defender of the more vulnerable and turning them into sexual cannibals, consuming those they see on-screen to satisfy their sexual appetites.

What often starts as mere curiosity or an accidental encounter can turn into something that invades the mind and twists even the most basic attractions. I’ve met porn users who can’t believe the types of things they want to watch. They haven’t simply been using porn. Porn has actively reshaped them into something they don’t recognize and don’t like. 

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Porn is this generation’s great assault on masculinity and the role of men in society. It is essential that we win this battle for the sake of society’s survival. Contrary to what the gender-bending and family-morphing progressive elites claim, good husbands and good fathers and good church leaders are necessary for a healthy society. But pornography is destroying marriages, creating distant and disconnected fathers, and, metaphoricaclly castrating men, hindering their ability and desire to make a positive difference in the society around us.

So, with this sobering set of facts in mind let’s return to the question: what do pornography struggles, past and present, say about a man?

The proper way to respond is with everything that is good about masculinity. We have to fight pornography as men have fought countless evils throughout the ages. We need to fight pornography to protect women, and wives, and children, and our society at large. This is how pornography threatens society, by castrating men, and turning them from protectors into predators. Rooting out the evil in our own lives allows us to better fulfill the role we are called to perform in the lives of others. Battling our own demons enables us to battle the wider cultural demons. Every day without porn is another bit of virtue built. Virtue is not something you’re born with. Virtues are habits that you build. And one day without porn is the first step towards the virtue of being porn-free.

Many men ask me if men who have had past porn addictions are cut out for being in a relationship or working in the pro-life movement or in other areas where we are called to protect and defend the weak and vulnerable. And the answer to that is an unequivocal yes. Our society needs men who know what it means to fight battles and win. Our society needs men who can say that they fought porn and they beat porn, because their families and their friends were too important to risk. Our society needs men who rose to the challenge that the evils of their generation threw at them, and became better men as the result. And our society needs men who can help their friends and their sons and those around them fight the plague of pornography and free themselves from it, too—and who can understand better and offer encouragement more relevant than someone who has fought and been freed themselves?

So the answer to men is yes. Fight pornography. Beat pornography. And join the ranks of those who support their fellow men and women still fighting. Lend them support and encouragement. We cannot change the fact that porn has left an enormous path of destruction in its wake. But we can change the fact that too many people aren’t fighting it. We can change our own involvement. And we can rise to the challenge and face this threat to masculinity with all that is good about masculinity.

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Red Alert!

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By John-Henry Westen

I don’t like having to do this, but we have always found it best to be totally upfront with our readers: our Spring fundraising campaign is now worrying us! 

You see, with just 6 days remaining, we have only raised 30% of our goal, with $125,000 still left to raise. That is a long ways to go yet.

We have no choice but to reach our minimum goal of $175,000 if we are going to be able to continue serving the 5+ million readers who rely on us every month for investigative and groundbreaking news reports on life, faith and family issues.

Every year, LifeSite readership continues to grow by leaps and bounds. This year, we are again experiencing record-breaking interest, with over 6 million people visiting our website last month alone!

This unprecedented growth in turn creates its own demand for increased staff and resources, as we struggle to serve these millions of new readers.

And especially keep this in mind. As many more people read LifeSite, our mission of bringing about cultural change gets boosted. Our ultimate goal has always been to educate and activate the public to take well-informed, needed actions.

Another upside to our huge growth in readers is that it should be that much easier to reach our goal. To put it simply: if each person who read this one email donated whatever they could (even just $10) we would easily surpass our goal! 

Today, I hope you will join the many heroes who keep this ship afloat, and enable us to proclaim the truth through our reporting to tens of millions of people every year!

Your donations to LifeSite cause major things to happen! We see that every day and it is very exciting. Please join with us in making a cultural impact with a donation of ANY AMOUNT right now. 

You can also donate by phone or mail. We would love to hear from you!

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