AIBU to ask your opinion on whether babies & children are being denied life saving treatment by the NHS?

[MiniTheMinx]

I expect lots of people have heard recently in the press about something called the Liverpool care pathway. If you haven't, it basically entails the withdrawal of drugs, fluid and life supportive measures to people who are at the end of life but controversially also includes people who have had strokes who would survive but need huge levels of care.

Now sick babies go on death pathway: Doctor's haunting testimony reveals how children are put on end-of-life plan.

Until now, end of life regime the Liverpool Care Pathway was thought to have involved only elderly and terminally-ill adults.But the Mail can reveal the practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies. One doctor has admitted starving and dehydrating ten babies to death in the neonatal unit of one hospital alone

Writing in a leading medical journal, the physician revealed the process can take an average of ten days during which a baby becomes ?smaller and shrunken

Are babies being denied life saving treatment? Or are they only being denied life prolonging treatment? Do fluids constitute life prolonging treatment? or are fluids as with oxygen a natural and necessary requirement of life and should never be denied?

Sorry it's the mail but I picked it up this morning because this is on the front page. [NOTE ADDED BY MNHQ: some posters, particularly bereaved parents, may find the contents of this article distressing]www.dailymail.co.uk/news/article-2240075/Now-sick-babies-death-pathway-Doctors-haunting-testimony-reveals-children-end-life-plan.html

I have had a quick read through the ACT document. It stops short of advice on end of life care. So it does not replace the LCP but is in addition to the LCP.

Honestly? I think they should be able to go about euthanasia in a more humane way. The fact that withdrawal of fluids is the only way that they can end the lives of some people who really are not living is horrific.

I'm not saying all patients should be treated as such, but in some situations it is the kindest thing to do.

Children are different though. But then, I can't imagine any parent doing that to their child.

thing is SirBoob, there is always someone that thinks it is ok.....for someone elses baby

Agree with Mercibucket and SirBoob. Surely withdrawing fluid and bringing about a long drawn out death over ten days is a horrific, cruel act akin to torture. Even America's Death Row prisoners aren't murdered in such a protracted way. Awful and no way would anyone be torturing any child of mine to death in such a fashion.

From the article "The investigation, which will include child patients, will look at whether cash payments to hospitals to hit death pathway targets have influenced doctors? decisions"

It goes on to say that removing fluids can be likened to euthanasia by the back door and that on average it can take 10 days and the withdrawal of fluid becomes a self full-filling prophecy. People can not live without fluids so they will die and they will die in extreme discomfort. It also says that babies are placed on the LCP and that Liverpool's Alderhey hospital have confirmed this. So I am left really miffed why FutTheShuckUp would suggest that this isn't happening to babies and children.

If this is euthanasia and I believe it is a compromised form of it, why not just make euthanasia legal, quick and pain free.

I agree with SirBoobAlot - I'm not opposed to euthanasia in such circumstances if the carers deem it the least terrible option, but I do feel very strongly that we need a far more humane euthanasia procedure. We wouldn't consider it humane to starve/parch an animal to death (with or without sedatives), so why on earth is it considered to only medically acceptable way to end human life in adverse circumstances? I think it is likely to cause undue suffering to the patient, and will definitely cause undue suffering to the family.

I'm not suggesting that euthanasia should be the only option when an infant is severely disabled or an adult has a terminal/degenerative condition, but I do believe that it should be an option. Consent is a difficult issue - I suppose that under 18 it should be a matter for the person with parental responsibility, and over 18 living wills (complete with a very stringent process and regular updating) should be a matter of course.

The removal of fluids often occurs when a patient is on the LCP. The pathway is designed to ensure comfort and minimal intervention.

If a patient has for example heart failure it can cause pooling of fluid in the lungs causing distress and difficulty in breathing. If iv/sc fluids continue at this point it exacerbates this.Therefor fluids are often withdrawn. As long as adequate mouthcare continues there is no reason that the patient should be in any discomfort due to fluid withdrawal.

It is not a back door to euthanasia.

If a patient has for example heart failure it can cause pooling of fluid in the lungs causing distress and difficulty in breathing well that is a senseless argument IMO because administering Morphine mitigates against distress (or at least any outward sign of it) lowers heart rate and depressing breathing anyway. Again, giving morphine will hasten death, so why not give a larger dose, is that not what has happened for years but none dare say it!

The blog explained it well. I feel uncomfortable suggesting anyone's decision is wrong.

Yes, I would prefer to see morphine increased rather than fluids withdrawn. It would make for a more comfortable less barbaric death (as pointed out above even animals are afforded a comfortable death by vets).

but surely babies should not be allowed to die.
the oft used reason is severe disability, but a doctor cannot tell
at birth how this will play out.
I can't get my head round the fact that anyone would consider this in anyway right.

And I am not commenting on the rights or the wrongs of euthanasia, rather I am objecting to the infliction of a protracted, cruel death on babies and children.

X post, three socks.

Dr Kate Grainger is ver informed and I go with her view point. The DM just likes to scare people to sell papers, it's incredibly irresponsible IMHO.

Morphine will not remove the fluid from the lungs, and would only mask the signs of it. The patient is key, not disguising outward signs of the process.

The LCP is not about hastening death. It's about ensuring a peaceful comfortable dignified death.

The idea that giving morphine to hasten death is unfair, it's given in quantities to ensure comfort.

Has anyone on this thread actually got to the point where your having needles stuck in anywhere that there might possibly be a viable vein? Because I have and it's not pleasant. That was only trying to get blood. In order to get a canula into someone who hashad them everywhere possible already must be awful.

I have just read the blog, interesting but I still think the withdrawal of fluids is a step too far and basically is euthanasia.

I thought the hippocratic oath was undertaken and it states that life should be prolonged. It is this, that doctors point to when debating euthanasia

"I swear by Apollo the physician and by Asclepius and Hygieia and Panacea... to bring the following oath to fulfilment.And I will use treatments for the benefit of the ill in accordance with my ability and my judgment, but from what is to their harm and injustice I will keep them"

And I will not give a drug that is deadly to anyone if asked, nor will I suggest the way to such a counsel this section is because at the time, some 2500 years ago it was not uncommon for doctors to poison their patients, either my mistake or quite on purpose.

Now, doctors had to be paid for so it was possible that doctors might undertake anything they were directed to do, as long as they got paid

So doctors site this oath as guiding their principles and practice and this was written some 2500 years ago.......says it all really!

It occurs to me, that by offering cash incentives to hospitals and trusts to fulfill the quota of people placed on the LCP, doctors are actually in breach of their own oath.

Morphine will not remove the fluid from the lungs, and would only mask the signs of it that is correct and is what I said! Not so long ago, one of the only ways of hastening end of life was to give increasing doses of morphine. This was reviewed wasn't it, several years ago because people who argued for euthanasia said that doctors hastened death but did not allow carers/patients to be active in decision making. Doctors jumped up an down citing the oath as proof that this practice HAD NEVER occurred

In most nursing homes drips arnt used. The important thing is the patient is kept pain free, usually high doses of morphine and sometimes sedation so they arnt uncomfortable at any time.

As others have said fluids can cause problems themselves. Especially if the kidneys are failing.

So it's not a case of people being starved and dehydrated and in pain and discomfort as with morphine and sedation the patient wouldn't know it was happening.

do babies go to nursing homes??
I do think there is a lot of diference in helping to give an adult a pain free death.
with allowing a baby to die.

But why drag the death out over 10 distressing days when it could be achieved in a quicker, guaranteed pain free way (a larger dose of morphine). If euthanasia is allowed in quietly through the back door then why not welcome it properly through the front lobby?

Mini, my point is that withdrawal of fluids is for the patients comfort and morphine is not a substitute in many cases.

For the last time, the LCP is not euthanasia. It is allowing a patients imminent death to be comfortable, peaceful and dignified.

There has been no evidence that any dr has implemented the LCP for financial gain.

I agree with threesocksmorgan somehow the idea of allowing a child to die over several days because medical care ceases is not quite the same as it is with adults.

Who is to say that the pain of feeding, cannulars or even surgery is more than the pain of starving and dehydration, how can we know. If a child has a surgical intervention and dies under sedation in theatre, is that worse or better? does anyone know?

PropertyNightmare good question, IMO it has everything to do with doctors (experts) protecting their position to make decisions and actually preventing patient and carer input.

Of course not but it works in the same way

When my waters broke at 18 weeks last year and we decided to carry on with the pregnancy we were told if I got to term and his lungs were not developed enough to allow him to live then sedation and pain relief would be used to keep him comfortable. They would only withdraw equiptment and meds that are used to sustain life.

All they would have been doing was hastening death rather than drawing it out. Bring on a respirator for a long period of time would probably cause fluid on the lungs and pneumonia which would result in organ failure and prolonged death.

Continuing treatment is not always the best thing to do and should be decided on a case to case bases