September 3rd, 2009

Not quite “death panels”—but the slippery slope of palliative care policy

Several British doctors, experts on palliative care (which means the compassionate treatment of the dying in order to make them more comfortable), have registered alarm at a trend in British medical practice:

Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong.

“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients.”

The current model for care of the dying in Britain was based on recommendations for cancer patients and was adopted by NICE (National Institute for Health and Clinical Excellence), the British government panel that oversees health policy. It’s been slowly expanded to cover patients who are supposedly dying of other illnesses.

Dr. Hargreaves, one of the doctors who has a problem with the program as currently implemented, says that its success:

…depend[s], however, on constant assessment of a patient’s condition.

He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.

He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in…

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”

He added: “What they are trying to do is stop people being overtreated as they are dying.

“It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.”

He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.

The difficulty, as the article goes on to state, is that there can be no “one size fits all” approach to medicine. That is one of the main problems with government getting increasingly into the picture—it tends to promulgate these sorts of rules, and the rules tend to spread to larger and larger populations, as in the program under discussion. The slippery slope is very real, and government intervention has a propensity to grease the skids.

15 Responses to “Not quite “death panels”—but the slippery slope of palliative care policy”

  1. Tournefort Says:

    In 1998 my dad had a mild stroke. However, he was able to sit in a chair and feed himself. He had some swallowing problems that might have led to food escaping into his windpipe.

    The doctor’s solution? With no word to my dad, he issued a “nothing by mouth” order to let my dad fade away a la Schiavo.

    In 2001, while recovering from hip surgery, my mom became dehydrated and was hospitalized.
    She had “flash pulmonary edema” which filled her lungs with fluid, a lethal situation.

    The doc’s solution? Apparently “looking ahead”, he had issued an unauthorized DNR which meant that my mother was simply made “comfortable” instead of actions being take to reverse the edema.

    In both cases, my sister and I were able to quickly intervene and reverse the doctor’s orders.

    Patients without family or other advocates won’t be so fortunate.

  2. dane Says:

    The whole problem with state run health care is that it looks upon the elderly as a liability instead of an asset. Just like with so many other things (including global warming – oh I forgot they are calling climate change these days) when they take the concept of a higher power out of the equation so many things are missed. Like how much we gain and learn from incredible amounts of experience embodied in older people. And how much we grow in a spiritual sense from the act of taking care of those who took care of us – in our own families and in the general sense that they fought and sacrificed to keep us free and protect our liberty (most of which has eroded). I am ashamed to be a member of the same human race as people who expound these views.

  3. SteveH Says:

    Who was it that said “If you want to know the character of a person, just notice how they treat someone who can’t possibly do anything for them”.

  4. Louise Franke Says:

    I think what bothers people the most, is that they expect someone to care about them as they leave this earth. I think it’s the caring that makes the difference. Nobody wants to die for a bureaucratic abstraction, we want some kind of transcendence, some kind of deep feeling and care. We want to believe that that our whole lives can’t be reduced to some simple accounting formula.
    I guess I’m trying to say that we want our lives to have meaning. I wish I could say it better,

  5. Vieux Charles Says:

    When Palin brilliantly coined the term “death panels” she was ridiculed not just by the left by the intellectuals of the right. Few ever went to her facebook page.

    Granted, this UK nightmare doesn’t rise to Ezekiel Emanuel’s soylent green “level of productivity in society” litmus. Nevertheless, it does throw some veracity on the claim that Obama’s enormous government apparatus actually “will basically pull the plug on grandma”.

  6. rickl Says:

    dane:

    Like how much we gain and learn from incredible amounts of experience embodied in older people.

    Maybe I’m just being paranoid, but I can’t shake the thought that those who wish to transform our society into something utterly alien are anxious to hustle off the stage those who have not undergone the indoctrination of our modern educational system.

  7. Andrew_M_Garland Says:

    Denial of care is an issue for all emergency services.

    Right now in the US, emergency rooms are being financially squeezed by federal law that requires giving services to all comers, regardless of medical judgment, and without federal reimbursement. That is why an ER aspirin costs $10.

    It is a federal law (EMTALA) that forces emergency rooms to give full workups to everyone, including drug seekers who repeatedly make up symptoms. This drives costs way up. If government can’t deal with the costs of this current policy, then how will it change this policy?


    Begging for Medical Care

    The well-known actress Natasha Richardson was very unlucky. She hit her head in a minor ski fall. Montreal, Canada, does not have fast transportation to a full-service hospital, even near a ski area. Why not? Patients are a cost to the system.

    The bureaucracy sees you as a cost, especially if you have already paid. All people and organizations seek income and avoid costs. Socialized or centralized healthcare is paid up-front and delivers services after the fact.

    How hard will a system work to earn the money that they have already been paid? This is something that everyone can understand in his gut. A customer is lost without competition for his dollar.

  8. Oblio Says:

    The economics of health care are unworkable unless patients have incentives to limit their own consumption. You will never fix the free-rider problem otherwise. The problems with health care cost are 1) that insurance is too generous and 2) government puts too much money into it. Giving more people more insurance and having the government spend even more money is to prescribe whiskey as a cure for alcoholism.

  9. stumbley Says:

    I like Dennis Prager’s line:

    “The bigger the government, the smaller the citizen.”

  10. camojack Says:

    As Willie Shakespeare said: “a rose by any other name” and so forth… 🙁

  11. Stphnd Says:

    N.I.C.E. begins to look as though it might more appropriately be known as N.A.S.T.Y. (National Agency to Stifle Terminal Yestermen).

  12. Chris Says:

    It surprised me that so many people took after the “Death Panel” issue to mean end-of-life counseling.

    A “death panel” suggests a board of people who denies care at some point when a patient is close to dying.

    That’s rationing.

    Who will do this? Not the doctor – the government will approval/disapprove of treatments based on certain thresholds.

    You’ll find this in any current ObamaCare bill.
    (You’ll also find it in insurance companies, but I’ve more freedom to control an insurance company than a gov’t.)

  13. Thomass Says:

    Chris Says:

    “It surprised me that so many people took after the “Death Panel” issue to mean end-of-life counseling.”

    It was mostly a dishonest trick… strawman to avoid Palin’s argument. Many knew better and others chose to only read the partisan talking points that Palin was an idiot talking about the end of life chat stuff that really was not a big deal.

  14. Cappy Says:

    Of course, there are ways they can improve their predictive record. Paging Dale Gribble…

  15. jon baker Says:

    Neo, you must stop doing this. Can’t we all get along? You will drive the moderates out of the party and they will all vote Democrat in the next election. Plus its racist. (sarc)

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