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
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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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Planned Parenthood closes Iowa abortion facility because of low business

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DUBUQUE, Iowa, May 3, 2016 (LifeSiteNews) – Planned Parenthood closed an Iowa abortion facility on Friday, noting low business that left the facility unsustainable from a financial standpoint.

Although Planned Parenthood of the Heartland announced in January that it planned to close the Dubuque, Iowa, office, pro-life sidewalk counselors were overjoyed on Friday to read the sign in the window that read: “Our office is closed, effective April 28, 2016.”

The office did not perform surgical abortions but did provide medication abortions to the community of about 58,000.

“Rejoice with us for the lives of unborn children saved!” Iowa Right to Life said in a statement after the closure.

As with numerous other closures, Planned Parenthood, which styles itself a provider of “care no matter what,” emphasized it was closing its doors to preserve its bottom line.

“After assessing the shifting health care landscape, changing demographics, and the challenges of operating in areas with low patient volumes, we made the tough decision to close the Dubuque Health Center,” the group said in an announcement. “This change allows us to expand hours and see more patients in Cedar Rapids, where there is unmet demand due to lack of clinician hours.”
“While we regret making this change, we know it is a necessary step in order to continue our mission to provide, promote and protect reproductive and sexual health through health services, education and advocacy. Patients have been notified, and if they wish, they can receive a broader array of services at our health center in Cedar Rapids, where we have expanded hours to accommodate more patient,” Planned Parenthood said.

American Life League’s vice president, Jim Sedlak, remembers speaking to the county right to life group nine years ago.

“I told them at the time that they needed to protest outside Planned Parenthood at least once a week,” he said. “They told me they would do better than that. Over the last eight years, these dedicated pro-lifers were outside Planned Parenthood every hour it was open. And now...it’s closed for good.”

That aligns with advice that David Bereit, the founder of 40 Days for Life, once told young people who wanted to know how to end abortion.

Be loving and compassionate, he said.

Your peaceful, loving presence out there flies in the face of all the stereotypes they want to throw onto us,” he added. “When you show them love instead of condemnation, when you show them peace and joy instead of anger and judgment, that will begin to break down the walls.”

Iowa Right to Life credited just such tactics with closing an office in Red Oak that performed webcam abortions. “Planned Parenthood shut down in Red Oak in large part because of the constant, prayerful presence outside their clinic,” the group said.

Upon hearing of the latest abortion facility shuttering, the Dubuque County Right to Life said that Planned Parenthood isn't the only group that will move its base of operations. “We will probably put our efforts in Cedar Rapids and will continue to spread the pro-life message,” said Executive Director Marian Bourek.



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Ted Cruz confronted by mom who supports aborting disabled babies…just like hers

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MARION, Indiana, May 3, 2016 (LifeSiteNews) – Senator Ted Cruz was met on the campaign trail by a mother who strongly opposed a state pro-life law that would have protected children with birth conditions – like her own.

Andrea DeBruler, a 41-year-old nurse, confronted the presidential hopeful in the city of Marion as Cruz campaigned with Gov. Mike Pence.

DeBruler first asked Cruz, then Pence, about House Bill 1337, which bans abortions performed due to the child's race, sex, or disability, such as Down syndome.

DeBruler held up a picture of her daughter, Jania, who was born with cerebral palsy. “This was a choice,” she said.

She asked Sen. Cruz if he supported the bill, which made Indiana the second state in the nation to ban abortion for Down syndrome, after North Dakota.

“I'm not Governor Pence,” he replied. “But I'll tell you this: I believe in protecting human life.”

Pence, who endorsed Cruz in today's make-or-break Indiana primary, listened to her objections.

“I'm not here as a Republican, I'm not here as a Democrat. I'm here as a woman, a woman with choices, choices that you guys should not make,” DeBruler said.

After hearing that she felt many families lacked sufficient resources to care for children, especially in an area like Marion, Gov. Pence offered to connect her with social services.

“God bless her,” he said, looking at Jania's picture, “and God bless you.”

Though it may be unusual to encounter a woman arguing for the right to abort her own child, the governor handled it calmly. Pence had specifically reflected on “precious moments” he spent with “families of children with disabilities, especially those raising children with Down syndrome” when he signed the bill into law in March.

"We are truly thankful for the passage of this historic legislation by the Indiana House and applaud the new civil rights protections this bill creates for unborn children, as well as the new provisions this bill establishes for the humane final disposition of aborted babies," Indiana Right to Life President Mike Fichter said at the time.

DeBruler told the UK media outlet The Independent that H.B. 1337 “means you can no longer have an abortion based on deformity. I’m against this law, because I think it should be a woman’s choice” to abort for any reason.

Congressional Democrats made similar statements during hearings last month for Rep. Trent Franks' federal Prenatal Nondiscrimination Act (PRENDA), with Congressman John Conyers saying the bill is “patently unconstitutional,” because a woman has the right to abort a child before viability for any reason.

Both leading contenders for the Democratic nomination expressed their displeasure with the law, which protects unborn children from racial or sexual discrimination, as well as discrimination on the basis of an inborn trait like mental capacity.

When Gov. Pence signed the law, Sen. Bernie Sanders tweeted:

Hillary Clinton later said, “I commend the women of this state, young and old, for standing up against this governor and this legislature.”

DeBruler told The Independent, despite her comment about not being a Democrat or a Republican, she is in fact a Democrat and will vote for Hillary Clinton in today's primary. 



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This year, as Notre Dame prepares to confer an honor on Vice President Joe Biden, the silence from the Catholic hierarchy is deafening. Drop of Light / Shutterstock.com
Phil Lawler

Opinion,

The moral challenge to Cardinal Wuerl in pending Notre Dame outrage

Phil Lawler

Ask Notre Dame not to honor pro-abortion Vice President Joe Biden. Sign the petition!

May 3, 2016 (CatholicCulture) -- In 2009, when the University of Notre Dame invited President Barack Obama to deliver a commencement address, dozens of American bishops lodged loud public protests. Yet this year, as Notre Dame prepares to confer an even greater honor on Vice President Joe Biden (together with former House Speaker John Boehner), the silence from the hierarchy is deafening.

Back in 2009, Cardinal Daniel DiNardo of Houston said that Notre Dame’s invitation to President Obama was “very disappointing,”, while then-Archbishop Timothy Dolan termed it a “big mistake.” The late Bishop John D’Arcy, then leader of the Indiana diocese in which the university is located, spoke of “the terrible breach which has taken place between Notre Dame and the Church.” For the first time in his 25 years of service to the Fort Wayne-South Bend diocese, Bishop D’Arcy declined to attend the Notre Dame commencement exercises; instead he addressed a protest rally organized by pro-life students, faculty, alumni, and staff.

These prelates and others explained their dismay by referring to the statement “Catholics in Political Life,” released in 2004 by the US Conference of Catholic Bishops. In that document, the bishops reflected on the need to maintain a consistent public witness in defense of human life, and therefore to distance themselves from public officials who support legal abortion. The statement set forth a clear policy that Catholic institutions should not give public honors to “pro-choice” politicians:

The Catholic community and Catholic institutions should not honor those who act in defiance of our fundamental moral principles. They should not be given awards, honors or platforms which would suggest support for their actions.

By giving President Obama an honorary degree and offering him an opportunity to speak at graduation, Notre Dame clearly violated that policy. University officials could offer only garbled partial defenses, claiming that they were honoring Obama not because he supports unrestricted abortion, but because he is President of the United States.

This year the university cannot offer even that lame defense of the decision to award the Laetare Medal to Vice President Biden. Unlike Obama, Biden is a Catholic, and by granting him this award the university is explicitly saying that the Vice President has “illustrated the ideals of the Church and enriched the heritage of humanity.” In other words, Notre Dame is honoring Vice President Biden as a Catholic political leader despite his unwavering support for abortion and same-sex marriage.

Give credit to Bishop Kevin Rhoades, the current leader of the Fort Wayne-South Bend diocese, for raising a lonely voice of protest. “I believe it is wrong for Notre Dame to honor any ‘pro-choice’ public official with the Laetare Medal, even if he/she has other positive accomplishments in public service,” Bishop Rhoades said. But if any other bishops have joined him in that rebuke to Notre Dame, I must have missed their public announcements.

Some observers, of liberal political sympathies, have argued that it is wrong to honor John Boehner, too, because the former Speaker disagreed with the US bishops’ stand on immigration. This is a tired old argument, conflating disagreement with the bishops on a prudential political decision with defiance of Church teaching on a fundamental moral principle. But it is noteworthy that Notre Dame officials saw fit to make a joint award, no doubt in a cynical effort to dodge political criticism by choosing one honoree from each side of the political spectrum.

“We live in a toxic political environment where poisonous invective and partisan gamesmanship pass for political leadership,” said Father John Jenkins, the president of Notre Dame, in announcing the Laetare Award recipients. (Notice the pre-emptive suggestion that those who criticize the school’s choices may be engaged in “poisonous invective.”) He went on to make a tortured argument that although Notre Dame is honoring two politicians, it is not honoring them for what they have done in their political careers:

In recognizing both men, Notre Dame is not endorsing the policy positions of either, but celebrating two lives dedicated to keeping our democratic institutions working for the common good through dialogue focused on the issues and responsible compromise.

By now we all know the familiar dodges. The politician claims to oppose abortion personally, but to feel a delicate reticence about imposing his views on others. He says that we must be willing to compromise (even on life-and-death decisions). He insists that he is not “pro-abortion” but “pro-choice.”

That last bubble of rhetoric was unceremoniously burst by Cardinal Donald Wuerl of Washington, DC, when he celebrated Mass at Georgetown after Planned Parenthood president Cecile Richard had delivered a lecture there. “The word ‘choice’ is a smokescreen,” he said, “behind which those killing unborn children take refuge. Every chance you get, blow that smoke away!”

Now Cardinal Wuerl himself has a chance to “blow that smoke away.” As things stand, he is scheduled to celebrate Mass at the Notre Dame commencement, and to receive an honorary degree. He could pull out; he could absent himself from the ceremonies, to ensure that he does not become part of an event that pays homage to a “pro-choice” Catholic politician.

And there is a precedent. Back in 2009, the Harvard legal scholar (and former US ambassador to the Holy See) Mary Ann Glendon was chosen to receive the Laetare Award. But when she learned that President Obama would be speaking, she announced her decision to decline the award. Clearly annoyed that her presence might be used to quiet the critics of the honor for Obama, Ambassador Glendon wrote that she did not want to be used as a counterweight, nor did she see the Notre Dame commencement as an appropriate venue for a genteel debate about legal abortion:

A commencement, however, is supposed to be a joyous day for the graduates and their families. It is not the right place, nor is a brief acceptance speech the right vehicle, for engagement with the very serious problems raised by Notre Dame’s decision—in disregard of the settled position of the U.S. bishops—to honor a prominent and uncompromising opponent of the Church’s position on issues involving fundamental principles of justice.

Could Cardinal Wuerl do this year what Ambassador Glendon did in 2009? Even at this late date, his withdrawal would send a powerful message of support for the right to life: an unmistakable rebuke to politicians who hide behind the smokescreen that the cardinal himself identified. To be sure, if he did withdraw, the cardinal would be caught in an avalanche of public criticism; he would suffer for his public witness. But there is a reason why cardinals wear red.

Phil Lawler has been a Catholic journalist for more than 30 years. He has edited several Catholic magazines and written eight books. Founder of Catholic World News, he is the news director and lead analyst at CatholicCulture.org. Reprinted with permission from Catholic Culture.



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