Govt Medicine vs. the Elderly: In Britain in 2007-08, 16.5% of deaths came after 'terminal sedation

the patient will be able to do anything about it as they will no doubt be heavily sedated from the outset. There will be no debate...the patient will be given a mix of morphine and sedation so they are barely conscious and dehydrated to death. As a relative you will sit for days watching them die and hearing the death rattle as their respiration is deliberately suppressed until they die.

You seem to be assuming I haven't already been in that position, I have, more than once, and I tell you now I would have preferred that the family members in question had been allowed to die swiftly and painlessly LONG before they got to the final drawn out turning off of various treatments, both of the elder family members in question wanted to go.

I also know through personal experience that there are things we shouldn't have to live through for the sake of random joe public thinking everything is fine and dandy and made of roses.

And tough if the imbecilic doctors have misdiagnosed and your relative would have survived for a few more years. This will be done as a matter of financial saving, not on any other criteria.

Sure there is a danger of this happening, but you better believe IT ALREADY HAPPENS, let alone all the BS that comes along with Big Medicine Corps funded via the private sector.

For those that support gleefully the idea of euthanasia or this form of murder, you have never sat at the bedside of someone who is being killed off or you would not be speaking like this.
I would personally like to euthanise the men who order this crap, the governing body of NICE, and anyone else involved...preferably with no sedation and in a painful way. The world is run by those unable to feel...deeply sick people.

Your wrong. As I have already said I have been in that position, and furthermore Ive been in the position where I wanted to die because of the extent of my illness, almost miraculously my last chance drug actually worked well beyond anyone's expectation.

What makes me sick is the plain faced cheek of those who have NEVER been in that position trying to tell other people that you MUST live, why so you can not be sad for another 6 months, what about the years of mental and physical pain people have actually experience to be in this state in the first place, what about having to watch your body waste away on you, feel another part of your body stop working every day.

Whether someone lives or dies should be their choice, that is something we can all agree on. Part of that choice is making sure you have the money to ensure you can survive as long as possible when you reach old age, thats part of the current global capitalist system (should this be changed yes again another debate), it does not make sense for communal health care to pay to prolong someone's life ad infinitum until the body finally just cannot go anymore, because someone whose 90 years old and can barely even feed themselves anymore is too scared to die.

[edit on 15-9-2009 by gYvMessanger]

reply to post by gYvMessanger

Fear of death is not a good enough reason to prolong everyone's life beyond what their body would cope with, if not for modern medical interference

Great. Next time you're hurt, or when you get H1N1, stay home, do not go to the clinic, and save the cost of "medical interference" for someone else who wants it.

At some point your life will be worth less than that of the person behind you in line and you will be passed over. Why don't you just stay out of the line in the first place?

"Next."

I do not favor the U.S. system. You know that if you've read.

But I don't want yours, either.

jw

reply to post by gYvMessanger

Whether someone lives or dies should be their choice, that is something we can all agree in. Part of that choice is making sure you have the money to ensure you can survive as long as possible when you reach old age, thats part of the current global capitalist system, it does not make sense for communal health care to pay to prolong someone's life ad infinitum until the body finally just cannot go anymore, because someone whose 90 years old and can barely even feed themselves anymore is too scared to die.

You know, it won't be those who are terminal or those 'too scared to die' as you sadly put it. It will be just because you are over 65. It is OUR choice when and if we die, not some protected, corrupt and normally insane authority figure basing it on money. The choice to have enough money in old age is something that has been stripped from a lot of people now in this corrupt and sick system. So really you are advocating survival of the fittest, in not only physical but monetary terms. So the scum like the Rothschilds and the Rockefellers and the Bush family, not to mention Obama and his ilk will all survive very nicely thank you, whilst in fact they and scum like them should be the first to go.
If under a socialised system it is deemed that one will pay into that system all one's life, only to have medical care denied one when one actually needs it...how sick is that? Or to be told that all your lifetime's contributions will go to someone younger. It does make absolute sense that if you have paid into a damn system and promise of treatment, that said treatment is not ever denied to you because you are old, whilst having contributed the most to the system...more than anyone else in fact. So maybe the young should be denied first if it is purely a financial judgement...otherwise really nobody should have to pay if they are paying to be killed off at the whim of some fool in a suit who has the compassion of a gnat. Then maybe they could afford some private care when they actually need it.

Originally posted by gYvMessanger
You seem to be assuming I haven't already been in that position, I have, more than once, and I tell you now I would have preferred that the family members in question had been allowed to die swiftly and painlessly LONG before they got to the final drawn out turning off of various treatments, both of the elder family members in question wanted to go.

I also know through personal experience that there are things we shouldn't have to live through for the sake of random joe public thinking everything is fine and dandy and made of roses.

Aye, interesting to hear people who have more experience beyond reading slash & burn texts on this issue. My mum made the decision well before the LCP was put in place and we took control once she lost consciousness and were kept fully informed.

Again, the same process (Terminal sedation) is used in the US under a system that is also government run, like the NHS. The same issues apply in both. But we still live longer - stick that in ya pipe and shove it where the sun don't shine.

It's just a total scaremongering strawman - the public option isn't like the NHS, and your grannies will be under the same system as they are now, lol. Face it dudes, 77% of the US want a 'public option'. A similar number of doctors want the same or more.

Empty vessels yadda yadda.

[edit on 15-9-2009 by melatonin]

Originally posted by jdub297
At some point your life will be worth less than that of the person behind you in line and you will be passed over. Why don't you just stay out of the line in the first place?

I would need to be in the line to get treatment and information as necessary.

There was a cancer patient on NPR a month or so ago, who knew his condition was terminal and that the very expensive treatment he received would only buy him a few months. He was very doubtful that the right thing was done by administering all these procedures to him.

reply to post by buddhasystem


I heard the same NPR story, and others like it as part of the "Story Corps" series.

My parents both faced the same situation. Doctors and other providers offered life-prolonging care, because insurance (or the government) would pay for it.

They did not want to die in a hospital. We brought mom home in 1991 despite the doctors' protestations ("What about my Ferrari payment?").
We hired a nurse to help.

My dad made the same decision in 2007.

If we'd left the decision to others, neither would've ever seen their home again.

WE can retain the right to choose if we keep government out of the decision-making process.

jw

[edit on 15-9-2009 by jdub297]

reply to post by oneclickaway


To be fair it depends on the system, I'm not suggesting anyone should copy the NHS, but I'm sure there is a better medium between what we have in the NHS and what you have in forced Private Health care.

IF your system requires contribution for life whenever your employed AND then blanket refuses any kind of treatment to people over 65, that system is clearly boinked, and a better one should be developed and introduced. I'm not convinced that is the system being proposed for the US.

And Jdub there is a difference in my opinion between using medical tech to cure illness which will then allow the patient to go on and lead an active life, and using medical tech to extend the life of someone who may as well be a vegetable, sorry if that sounds crude and uncaring, but we live on a planet of finite resources, and whilst it would be nice to develop a system whereby we can sustain people indefinitely with infinitely available resources at our disposal that is not the reality we find ourselves in.

I find this statement by the OPer to be intentionally provocative:

Is this is the UK version of the "end of life" care and counseling contemplated in HR 3200?

I don't see anything inherently wrong with counseling. It's in my best interest to know what options I have. If pain control is necessary, I better hear about it and use it as I see fit.

I believe that UK has far better cost control. Which means if they were spending the same amount of money as we do, they'd be doing fantastically better! They got something right.

reply to post by gYvMessanger

but we live on a planet of finite resources, and whilst it would be nice to develop a system whereby we can sustain people indefinitely with infinitely available resources at our disposal that is not the reality we find ourselves in.

But we do not live in a world of finite resources at all. Everyone could be sustained indefinitely in every which way (not that I am suggesting they should be in every case). The only reason that there is any shortage of anything at all is that some rich pig somewhere is manipulating a corrupt system which is designed for the rich, to get even more. More money, humanity and resources is wasted on killing people the world over in the name of war, in order for the few to gain even more. These people are the ones that should be euthanised..lol

reply to post by St Vaast


So am I to understand it right, that you want to FORCE me to euthanize? I'm sorry, but under my observation, that is paramount to murder. Why do you hate all these people, what motivates you to want to murder them?

reply to post by Gregarious


Proper Euthanasia would indicate having a CHOICE.

At the moment you don't have a choice, you have to live regardless of your condition, in my book that's torture, see it goes both ways.

reply to post by gYvMessanger

At the moment you don't have a choice, you have to live regardless of your condition, in my book that's torture, see it goes both ways.

In Texas you have a choice. Both my parents chose not to accept life-prolonging treatment.

That is not the same as euthanasia, though. Your NHS takes affirmative steps to terminate the infirm.

I don't like our system, but if you stand up for your rights you can exercise control over your care and expenses.

It's a matter of accepting the "nanny state" or taking responsibility for yourself.

jw

Our NHS takes steps to kill off the inferm ?

Wow I wish they had taken those steps for my grandfather when he spent a year and a half in hospital unable to get himself out of bed, or even grasp a cup in his hand after his second stroke before dying alone in a strange place one night.

We could have bought him home to die off the machines (that wasnt my choice to make obviously my grandmother and mother couldnt handle it), but what would have been better is if they had actually helped him to pass gracefully (with as much as can be managed) when he knew he was ready to die a good year before he was finally released, or at least if we had that choice, if we lived in a society where helping someone in pain who cant be helped any other way wasnt illegal.

BTW one of the inferm your talking about (As has been pointed out earlier) is Dr Stephen Hawkings who the NHS very much keep alive and in a functioning state, another not so famous one is myself, believe me it would have been A LOT cheaper for the government to leave me to rot and die, the amount its going to cost them to keep me alive for the next 30-40 years, just for my genetic problems, its not gonna be cheap, but my government chose to help me with an ailment I suffer through no fault of my own, and they will continue to support me through the rest of my life to ensure I have a decent standard of life, not nanny state, not in my face controlling me all the time (well no more than normal thats another topic), if I was an American, I would be frakked thats just the god honest truth.

Hand on my heart even despite all of that and the help I got, I hate the NHS, I hate the sytem, it needs a lot fixing, but to say their is a systamatic plot amongst the british health system to kill of the inferm and the aged is utter utter lies.

[edit on 15-9-2009 by gYvMessanger]

reply to post by gYvMessanger

Our NHS takes steps to kill off the inferm ?

What, precisely, do you think "terminal sedation" means?

That's a term and practice you and your system have created and accepted.

I hate the NHS, I hate the sytem, it needs a lot fixing, but to say their is a systamatic plot amongst the british health system to kill of the inferm and the aged is utter utter lies.

Then why "attack the messenger?"

Perhaps you should address that opinion to the Patients Association, the authors of the report, the doctors who wrote the letter, and the various British media reporting these facts.

The OP merely relays what your countrymen are already saying among themselves.

Given your hatred of the NHS, why must you criticize Yankees' opposition to state-run health care?

Why must you criticize those of us who ENDORSE giving PATIENTS the greater voice in choice of provider, payment for services, and source of payment?

Given what I've read from YOUR press reports, you WILL be cut off from the level of care you've come to expect.

Read them yourself. These are YOUR spokespeople.

Deny ignorance.

jw

[edit on 16-9-2009 by jdub297]

Originally posted by gYvMessanger
Our NHS takes steps to kill off the inferm ?

You can't reason with the unreasonable. You'll learn with experience.

Terminal sedation is used across the world, including the US. It is just one potential component of the Liverpool Care Pathway. People are trying to suggest that it is essentially forced euthanasia or involves 'death panels' (lol, eejits). It isn't and doesn't. In fact, the main supporters of the LCP are against euthanasia, and the developer of the pathway at Liverpool is also an opponent of euthanasia (Ellershaw).

Apparently introducing integrated care for the dying is a bad thing. The LCP is accepted as a high standard of care for the dying, and has been implemented across the world.

The audit does not support criticisms of the LCP that have appeared recently in the media – namely, that patients who are managed in accordance with the Pathway's guidelines are being heavily sedated until they die or that the LCP is promoting a 'tick box' approach in which doctors sometimes fail to spot where patients show signs of recovery. The audit reveals that two thirds of the 3,893 patients whose deaths were assessed needed no continuous infusion of medication in the last 24 hours of life to control distress caused by restless or agitation and that, of those who did require such infusions, all but 4% needed only low doses. Unlike practices in other countries, such as the Netherlands where deep continuous sedation until death is administered according to a protocol, palliative care physicians in Britain have the skills to ensure that the overwhelming majority of terminally ill patients are able to die peacefully and without any significant sedation.

Commenting on the Audit, Dr Peter Saunders, Director of Care Not Killing, said: “This audit of LCP practice in some three quarters of hospitals in England is reassuring. It confirms that deep sedation of terminally ill patients is rare in Britain and that recent suggestions of its widespread use under the LCP are unfounded. It also underlines that any trusts prescribing relatively high doses of sedatives regularly to dying patients 'need to review their practice'”. Professor John Ellershaw, Director of the Marie Curie Palliative Care Institute, confirmed this. “The Liverpool Care Pathway”, he said, “does not endorse continuous deep sedation nor, as has been misreported in some places, the removal from dying patients of beneficial medication”.

Only used in 4% of cases in a recent audit. The 66% die naturally without medication or sedation. 4% required deep sedation under LCP.

How many receive terminal sedation in the US? We know it's done. There's just no reliable numbers, and until they show these numbers they are pissing in the wind.

Internists' attitudes towards terminal sedation in end of life care.

Kaldjian LC, Jekel JF, Bernene JL, Rosenthal GE, Vaughan-Sarrazin M, Duffy TP.
Department of Internal Medicine, Yale University, New Haven, CT, USA. [email protected]

OBJECTIVE: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide (PAS), and explore characteristics of internists who support terminal sedation but not assisted suicide. DESIGN: A statewide, anonymous postal survey. SETTING: Connecticut, USA. PARTICIPANTS: 677 Connecticut members of the American College of Physicians. MEASUREMENTS: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics. RESULTS: 78% of respondents believed that if a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation (diminish consciousness to halt the experience of pain). Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents (47%) were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients (p = 0.02) and attending religious services more frequently (p

Instead of giving big cheques to families who turn out kids like there's no tomorrow or immigrants who contribute sod all to society, why doesn't the country pump some serious money into the NHS...

Oh right yeah, that would involve common sense - an aspect of human nature that is apparently not present in any elected officials

I was pretty intrigued about how there were two wildly varying measures of terminal/deep sedation in the UK. One is based on an audit of medical establishments where end-life decision making is made (hospitals/hospices). The other was just a report in a newspaper, but apparently based on a study from Barts by Clive Seale.

So, like a good lab-rat, I dug. Clive Seale is a medical sociologist and has done this type of study before. However, I couldn't readily access the most recent article.

Seale, 2006

Essentially, the study is questionnaire-based. In this study he sends the questions to 1000 GPs and 1000 'Hospital specialists' with a response rate of 53%. He asks stuff like:

Did you or a colleague withhold or withdraw treatment

. taking into account the probability or certainty that this action would hasten the end of the patient’s life or

. with the explicit intention of not prolonging life or hastening the end of life?

He then standardises (weights data) to make it representative for age and gender. He also asks questions about how many deaths they might attend a week and using cluster sampling methods (lol), produces estimations of decisions and outcomes.

I would be very sure the same approach was used for the newer study, with just added questions. From such methods, he makes assessment of terminal sedation across the UK. From the abstract of the 2009 article, there was only a 42% reponse rate (pretty poor) but a bigger sample (3733 medical practictioners) , and only ~75% of those had attending at least a single death in the last 12 months (lol).

That's a joke. Good for assessing opinions, not for collecting objective data.

Compare an audit of medical establishments and data for end of life treatment from those using standard care pathways vs. asking a random sample of GPs and 'specialists' questions for estimations of past events and end-life decisions (i.e. memory-based, highly-biased, and poorly targetted, with added cluster-f...).

lol

Think I'll stick to the actual audit data.

[edit on 16-9-2009 by melatonin]

reply to post by jdub297


I'm not shooting the messenger, your not the messenger, your an ill informed dupe spouting spoon fed propaganda, which I and others have tried to show you is patently false, you don't live in this country and have never experienced our health system.

I am willing to meet you half way and say our system (as it stands) is not the system that should be adopted, but I personally can't think of a more horrifying thought than adopting your current health system which clearly lets down the citizens of your nation (unless they happen to have the $$$), how can free health care be bad, when there are people going now without, if their is something specifically wrong with the proposition being put forward then by all means you should work to have it appropriately handled, but to me it feels like you actually have a problem with the concept of free health care full stop which I just cannot rap my head around.

[edit on 16-9-2009 by gYvMessanger]

reply to post by ItsallCrazy

why doesn't the country pump some serious money into the NHS...

I'm not as aware of your political climate, but it appears that there's a vigorous debate between Brit politicos whether to increase or decrease NHS funding.

Sorry situation. Unfortunately, we're looking at the same over here.

jw

What I find interesting given your OP, is the FACT that the UK has a higher life expectancy than the US does....

2007: UK- 5 deaths per 1000 births. Life expectancy 78.7 years

US- 6.4 deaths per 1000 births. Life expectancy, 78 years

So, even with the HORRORS of the UK health system, you have a better chance of surviviing your birth and you live longer than people in the US.

-wow