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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The first pro-abortion Republican enters the 2016 presidential race

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By Ben Johnson

EXETER, NH, May 28, 2015 (LifeSiteNews.com) – The large and expanding field of would-be Republican presidential candidates grew by one today, as George Pataki became the first GOP presidential hopeful this election season to openly support abortion-on-demand.

The 69-year-old long-shot candidate also has a history of supporting homosexual legislative causes.

In the weeks leading up to his formal announcement, George Pataki took out TV ads asking Republicans to refrain from talking about abortion and gay “marriage,” branding them “distractions.”

“In 12 years [as governor], I don’t think I talked about that issue twice,” he once said of abortion.

On same-sex “marriage,” he says, “I think, leave it to the states. I don’t think it’s a role in Washington.”

However, Pataki has a long history of enacting the homosexual political agenda as governor of New York from 1994-2006. He signed a “hate crimes” law that added the words “gay” and “lesbian” to New York state law for the first time.

He signed the Sexual Orientation Nondiscrimination Act (SONDA), which prohibits business owners from “discriminating” against homosexuals in housing or hiring, with an exemption only for religious institutions.

He also added sexual orientation to state civil rights laws, alongside such immutable characteristics as race and sex, in an apparent quid pro quo for a gay activist group's endorsement in his last run for governor. The New York Times reported that, under pressure from Pataki, the then-Senate Majority Leader “shifted his position on the bill as part of what is tacitly acknowledged, even by Senator [Joseph] Bruno's senior aides, to have been a deal to win an endorsement for Governor Pataki from the state's largest gay rights group, the Empire State Pride Agenda.”

After the LGBT activist group endorsed Pataki in 2002, citing a long list of his service to the homosexual political cause, Pataki personally lobbied senators for the bill's passage, then signed it into law that December.

Coupled with his stance on gun control, environmentalism, and other issues, he stands well to the left of the Republican mainstream.

The three-term governor of New York, who belongs to the Roman Catholic Church, took his own advice by largely avoiding social issues today. The closest he came was his vow, “I'd repeal oppressive laws like ObamaCare and end Common Core.”

He added that he would “fire every current IRS employee abusing government power to discriminate on the basis of politics or religion. That is not America!”

Otherwise, Pataki's announcement speech hewed to stand pat Republican issues like reducing taxes, shrinking the number of federal employees, increasing military spending, and supporting entrepreneurship.

He began by thanking his supporters, in English and Spanish.

Smiling, his head pivoting between twin teleprompters, he said, “Let me tell you some of the things I'd do right away to get oppressive government off the backs of Americans.”

He would institute a lifetime ban on congressmen acting as lobbyists after they leave office. “If you ever served one day in Congress, you will never be a lobbyist,” he said. He favors forcing Congress to live under the laws it passes, so there will be “no special rules for the powerful.”

He cited his history of cutting taxes, reducing welfare rolls, and leaving his state with billions of dollars in surplus. “That's what our policies can do,” he said. “I know we can do the same thing for the United States.”

In recent weeks, he has called for a more interventionist foreign policy in the Middle East. Today, he reminded his audience that he was governor of New York in 9/11. “I will not fear the lesson of September 11,” he said. “To protect us, first we must protect the border,” he said – an unexpected phrase, as Pataki supports amnesty for the at least 11 million illegal immigrants already in the United States.

“We will stand with our ally, Israel, a democracy on the front lines of terror and barbarism,” he said.

Like former Sen. Rick Santorum, who announced he is running for president yesterday, Pataki agreed that “if necessary, American forces will be used to actually defeat and destroy ISIS on the ground” – although he promised not to become “the world's policeman.”

Some of his campaign promises drew skepticism, such as seeking to develop self-driving cars and to cure Alzheimer's disease and cancer within the next decade.

The speech's venue was chosen deliberately by Pataki, who considered entering the presidential race in 2000, 2008, and 2012. The town of Exeter, New Hampshire, claims to be the founding place of the Republican Party. (Ripon, Wisconsin, makes a similar claim.)

More importantly, the first-in-the-nation primary skews more libertarian on social issues than evangelical-dominated Iowa and South Carolina, so Pataki has essentially staked his candidacy on doing well in New Hampshire. Fellow pro-abortion Republican Rudy Giuliani made a similar bet in 2008, banking on a good showing among transplanted New Yorkers in the Florida primary. He left the race after finishing a distant third.

Short of a stunning upset in the Granite State, Pataki has little chance of breaking through the pack this year. A Fox News poll ranks him dead last among 16 announced and potential candidates. Holly Bailey of Yahoo! News said, “George Pataki would never say this, but you do have to wonder if he's sort of, maybe, gaming for vice president.”

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Pataki is not the first “pro-choice” Republican to run for president.  Giuliani (who supported partial birth abortion) and Virginia Gov. Jim Gilmore (another potential 2016 candidate, who supports abortion during the first trimester) ran in 2008. Twelve years earlier, both California Gov. Pete Wilson and Pennsylvania Sen. Arlen Specter supported abortion-on-demand. Arlen Specter later left the party and became a Democrat.

In 1988, General Alexander Haig opposed a human life amendment to the U.S. Constitution. So did Texas Gov. John Connally in 1980.

George H.W. Bush supported abortion and voted for Planned Parenthood funding early in his career but changed his position by the time he ran for president the second time, in 1988.

President Gerald Ford was the last Republican nominee to proclaim himself “pro-choice.” 

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Ireland ‘defied God’ by voting for gay ‘marriage’: Cardinal Burke

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By Pete Baklinski

OXFORD, May 28, 2015 (LifeSiteNews.com) -- Cardinal Raymond Burke lamented how formerly Catholic Ireland has gone further than the pagans in the pre-Christian days of old and “defied God” by calling homosexual behavior “marriage” in the referendum last week.

“I mean, this is a defiance of God. It’s just incredible. Pagans may have tolerated homosexual behaviours, they never dared to say this was marriage,” he told the Newman Society, Oxford University’s Catholic organization, in an address Wednesday about the intellectual heritage of Pope Benedict XVI. The Tablet, Britain’s liberal Catholic newspaper, reported his remarks.

On Friday, 1.2 million Irish people voted to amend the country’s constitution to say: “Marriage may be contracted in accordance with law by two persons without distinction as to their sex.” A little over 734,000 people voted against the proposal. 

Burke said that he could not understand “any nation redefining marriage.”

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The cardinal also emphasized the important role that parents play in protecting their children in a culture increasingly hostile to God’s laws. “The culture is thoroughly corrupted, if I may say so, and the children are being exposed to this, especially through the internet,” he said. One practical piece of advice that he offered families was to put computers in public areas to prevent children from “imbib[ing] this poison that’s out there.”

During the same Oxford visit, but during a homily at a Mass the day before, Burke called marriage between a man and woman a “fundamental truth” that has been “ignored, defied, and violated.”

Burke warned during the homily of the dangers of “various ideological currents” and of “human deception and trickery which strives to lead us into error.”

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Why young Christians can’t grasp our arguments against gay ‘marriage’

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By John Stonestreet

May 28, 2015 (BreakPoint.org) -- For five years, Dr. Abigail Rine has been teaching a course on gender theory at George Fox University, an evangelical school in the Quaker tradition.

At the beginning of the semester, she tells her students that “they are guaranteed to read something they will find disagreeable, probably even offensive.”

Writing at FirstThings.com recently, she related how five years ago it was easy to find readings that challenged and even offended the evangelical college students “considering the secular bent of contemporary gender studies.”

But today, things are different. “Students now,” she says, “arrive in my class thoroughly versed in the language and categories of identity politics; they are reticent to disagree with anything for fear of seeming intolerant—except, of course, what they perceive to be intolerant.”

And what do they find “intolerant”? Well, in her class, an essay entitled “What is Marriage?” by Sherif Girgis, Robert George, and Ryan Anderson, which was the beginning of the book “What Is Marriage?: Man and Woman: A Defense.”

In their article, Girgis, George, and Anderson defend what they call the conjugal view of marriage. “Marriage,” they write, “is the union of a man and a woman who make a permanent and exclusive commitment to each other … that is naturally fulfilled by bearing and rearing children together.” They defend this view against what they call the “revisionist view” of marriage, which redefines marriage to include, among other things, same-sex couples.

“My students hate it,” Dr. Rine wrote. They “lambast the article.” “They also,” she adds, “seem unable to fully understand the argument.” And again, these are evangelical students at an evangelical school.

The only argument for conjugal marriage they’ve ever encountered has been the wooden proof-texting from the Bible. And besides, wrote Rine, “What the article names as a ‘revisionist’ idea of marriage—marriage as an emotional, romantic, sexual bond between two people—does not seem ‘new’ to my students at all, because this is the view of marriage they were raised with, albeit with a scriptural, heterosexual gloss.”

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As Rine points out “the redefinition of marriage began decades ago” when “the link between sexuality and procreation was severed in our cultural imagination.”

And if marriage “has only an arbitrary relationship to reproduction,” then it seems mean-spirited to Rine’s students to argue that marriage by its very nature excludes same-sex couples.

And where do students get the idea that marriage “has only an arbitrary relationship to reproduction”? Well, everywhere—television, church, school, their homes, in youth groups.

Rine writes, “As I consider my own upbringing and the various ‘sex talks’ I encountered in evangelical church settings over the past twenty years, I realize that the view of marital sex presented there was primarily revisionist.”

In other words, once you say, “I do,” you get “the gift” of sex which is presented as “a ‘gift’ largely due to its [erotic], unitive properties, rather than its intrinsic capacity to create life.” Even in the Church, children have become an optional add-on to married life rather than its primary purpose.

What can we do to win back our children, our churches, and the culture? In our recent book “Same Sex Marriage,” Sean McDowell and I lay out a game plan. We offer strategies for the short-term and the long-term, with the ultimate goal: re-shaping the cultural imagination towards what God intended marriage to be, starting with the church. Come to BreakPoint.org to pick up your copy.

As Chuck Colson once said in a BreakPoint commentary about marriage, “We Christians are very good at saying ‘No.’ But we’ve got to get better at saying ‘Yes’: showing how God’s plan for humanity is a blessing. That His ways, including faithful, life-giving marriage between one man and one woman, lead to human flourishing physically, emotionally, and spiritually.”

I couldn’t agree more.

Reprinted with permission from Break Point.

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