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Brooks Wilson's Economics Blog: British Death Panels?

Friday, September 4, 2009

British Death Panels?

Monty Python-Bring Out Your Dead

(HT to Drudge for running the article, and Russ Roberts at Cafe Hayek who beat me to the punch with the Monty Python video)  The economic point in the following article is that all goods and services must be rationed.  If not by price, then by some other mechanism.  In a tragic story that is growing in depth, six British doctors signed an open letter claiming that some terminally ill patients are incorrectly judged as close to death and then given treatment that induces an untimely death.  Those with gallows humor might enjoy the Monty Python clip that foreshadows the British health care system's misdiagnosis of death alarmingly well.  In "Dying patients," published by the Telegraph, the six doctors write
SIR – The Patients Association has done well to expose the poor treatment of elderly patients in some parts of the NHS [National Health Service] (report, August 27). We would like to draw attention to the new “gold standard” treatment of those categorised as “dying”. Forecasting death is an inexact science.

Just as, in the financial world, so-called algorithmic banking has caused problems by blindly following a computer model, so a similar tick-box approach to the management of death is causing a national crisis in care.

The Government is rolling out a new treatment pattern of palliative care into hospitals, nursing and residential homes. It is based on experience in a Liverpool hospice. If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death.

As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients. Syringe drivers are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong.

It is disturbing that in the year 2007-2008, 16.5 per cent of deaths came about after terminal sedation. Experienced doctors know that sometimes, when all but essential drugs are stopped, “dying” patients get better.
Kate Devlin, a medical correspondent for the Telegraph in "Sentenced to death on the NHS," describes how the system of treatment of the terminally ill evolved.  Those who are following the American health care debate will recognize parallels in language use and goals with the British system: an attempt to limit unnecessary procedures for the benefit of the ill and the use of evidence-based medicine. 
Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

But this approach can also mask the signs that their condition is improving, the experts warn...

The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.

The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours...

It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004...

Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor...

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...

A spokesman for the Department of Health said: “People coming to the end of their lives should have a right to high quality, compassionate and dignified care.

"The Liverpool Care Pathway (LCP) is an established and recommended tool that provides clinicians with an evidence-based framework to help delivery of high quality care for people at the end of their lives.
In a superb example of Orwellian doublespeak, the death panels were established by a government agency with the acronym NICE.  Niiiice!  Any system of medical care will have errors that end in death, and the article does not provide the percentage of those placed under deep sedation who died unnecessarily, but, based on the articles, the number is probably uncomfortably large. 

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