Wednesday, September 2, 2009

Government "Care"

A headline up on the UK's Daily Telegraph newspaper marks yet another reason not to trust government health care. "Sentenced to death on the National Health Service" is a line that doesn't mince any words. Seems those programs put in place by state run health care systems, which commence with such concern for patients, health, and care, come soon to be seen as cost centers by administrators desperate to cut costs regardless of patients, health, or care. This is yet more evidence, if any were needed, that the end of life provisions the Democrats were attempting to include in their bills are indeed dangerous, no matter how neutral or anodyne the language. The trajectory is dark but predictable. The power over people's literal lives seems to be of a more intoxicating kind than just the power to make us recycle or pay huge portions of our earnings to the Treasury. The Dutch and the Swedes have also found that sending the old, the weak, and the terminal into that goodnight is a power doctors get a taste for, and one they soon begin using early and often, sometimes without even notifying the families. Especially when beds are scarce, budgets are strained, and the overwhelming directive from above is to cut costs.

"In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.

"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across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.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 scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours. Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions.

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

"It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system

Notice, to begin with, the Orwellian language tricks--euthanasia is the "pathway;" the government board--or death panel, in Palin's parlance--is NICE. Nice. These soft despots and coercive Utopians always set out with the thought that they are doing good, and doing for us what we cannot do for ourselves. Of course, a big part of the plan is to steadily increase that which we cannot do for ourselves, leaving more and more for the government experts to shoulder in their valiant lives of selfless public service.

The surface appearance of a tender hearted and sensitive government panel concerned to improve the public weal is soon belied by the reality under that appearance. People are not equal; there are less desirables among us, and it is government's duty to be hard nosed enough to recognize the fact, and act upon it in a way that maximizes utility for the rest of us. We are all "the rest of us" until we are the one on the gurney--but you know, everyone's number comes up eventually, and who better at discerning it than the government's expert numerologists?

The doctors blowing the whistle on this understand that palliative care is perhaps the portion that most needs to be individualized; that patients near the end or in desperate straits need closer attention from attending physicians, not another set of bureaucratic guidelines that allow thoughtless box checking by doctors who then agglomerate patients under preset parameters based on general symptoms or indicators.

[Dr Hargreaves] 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. “It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.

“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.

Prof Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours.

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.

“If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said.

But hey--aren't we all better off with that bed freed up for the next--probably more deserving--patient?

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