Liverpool Care Pathway, Obamacare, and Death Panels

The Affordable Care Act (ACA), or Obamacare as some call it, is in the process of being implemented in the United States. As the ACA moves forward concerns over death panels have increased. Some dispute whether or not death panels truly exist in the ACA. Yet, even some Democrats are concerned: ObamaCare ‘death panel’ faces growing opposition from Democrats. The issue is that someone outside the family – bureaucrats – would have the power to make life and death decisions.

Will the ACA be similar to The Liverpool Care Pathway (LCP) healthcare program in the United Kingdom?  The LCP gives power to health workers to make life and death decisions. For example, read about 90-year-old Kathleen Vine in Liverpool Care Pathway: ‘They told my family I was dying’. The LCP was used to sedate Mrs. Vine and deny her food and water. She has since been home for four months and is doing well.

In 2009, I wrote the following piece (slightly modified). The concern is whether or not Americans will face this type of treatment in the new ACA healthcare system where their elderly loved ones are sent to an early grave.

Dying patients in England are being put to death before their time according to Kate Devlin, Medical Correspondent writing for the Telegraph. In her article Sentenced to death on the NHS, she reports on a letter received from a “group of experts who care for the terminally ill” alleging that patients are being wrongly diagnosed as being near death. The allegations are that while patients are being treated they are heavily sedated until they die. This approach could “mask the signs that their condition is improving.”

The most alarming statistic in the article is the percentage of deaths in Britain tied to such heavy sedation.

In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands.

This approach to caring for the dying comes from the Liverpool Care Pathway (LCP) which was originally implemented to help dying cancer patients. When is the LCP used? The question is answered in the Pocket guide to the LCP.

The LCP is used when the multidisciplinary team (all the different doctors, nurses and allied health professionals treating a patient) has agreed that the patient is dying and all reversible causes for the current situation have been considered. The focus of care now changes to care of the dying, this includes discussion with the relative / carer and when possible the patient. The current plans of care need to be reviewed and inappropriate treatment or care stopped when the burden of this outweighs the benefits.

The LCP includes a regular assessment process and communication with the relative / carer and patient when possible and if the patient improves and is reviewed by the multidisciplinary team then the LCP can be stopped.

The curious reader might wonder who determines when the “burden outweighs the benefits?” In the United States Jack Kevorkian got into legal trouble for administering physician-assisted suicide. In Kevorkian’s situation the patient was allegedly the one deciding the burdens and benefits. These decisions ultimately concluded with the awful answer of suicide.  Some may argue that as bad as the suicides were it was still the individuals’ decision.

As the United States moves further into socialized medicine with the ACA, the report of premature death under the United Kingdom’s socialized medical system gives pause for concern. What Kevorkian did was illegal and wrong. However, it is worth asking if a U.S. Government controlled healthcare system would put similar life and death decisions in the hands of physicians and/or bureaucrats?

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