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Human dignity
24 October 2012

How we die – the most important issue we never talk about

We’re all going to die, so why do we so rarely talk about it? There is, of course, the ongoing public debate about euthanasia – specifically, the assisted-suicide of terminally ill patients – where the focus tends to be on particular, and often rare, medical conditions.

But as well as the fact that we’re all going to die, it is also the case that we will all become terminally ill at the end of our lives – in that, at some point, our bodily functions will be so compromised as to make our imminent demise inevitable. This may all take place very quickly, for instance in the case of a massive heart attack or a fatal injury, but for most of us, the process of dying will take place over hours or days.

So the question is this: how would you like to be cared for when the time comes? Would you prefer a barrage of aggressive medical interventions to extend what little life remains to you? Or would you have nature take its course, with medical attention focused on the alleviation of pain and discomfort?

Most people would surely choose the latter – and the purpose of the Liverpool Care Pathway, as widely practiced within the NHS, is designed to give the dying that choice. It is explained here by Dr Peter Saunders on his Christian Medical Comment blog:

  • “The Liverpool Care Pathway for the dying patient (LCP) is a treatment pathway used in the final days and hours of life which aims to help doctors and nurses provide effective end of life care…
  • “Before a patient can be placed on the pathway the multi professional team caring for them have to agree that all reversible causes for their condition have been considered and that they are in fact imminently dying.
  • “The assessment then makes suggestions for palliative care options to consider and whether non- essential treatments and medications should be discontinued.”

Last week there were a number of reports alleging that the NHS was using the Liverpool Care Pathway as a covert form of euthanasia. Some headlines even gave the impression that 130,000 elderly patients were being killed off every year.

Dr Saunders leads the Christian Medical Fellowship, which opposes euthanasia. If the NHS really was euthanising the elderly en masse, he would surely raise the alarm:

  • “What we are seeing this week is a classic application of the ‘post hoc propter hoc’ fallacy, the mistaken notion that simply because one thing happens after another the first event was a cause of the second event.
  • “It is certainly true that 130,000 British patients per year are dying whilst on the LCP. But it does not therefore follow from this that the LCP is the cause of their deaths.
  • “If a patient is judged to be imminently dying and is placed on the LCP and dies within hours or days one can be virtually certain that the death was caused by the underlying condition.”

Though Saunders believes that we need to be vigilant against individual abuses, he is also concerned that the false notion of systematic abuse will only make the legalisation of euthanasia more likely:

  • “…such claims run the risk of playing into the hands of the pro-euthanasia lobby who like to claim that doctors are killing thousands of British people with sedation, morphine and dehydration already and that legalising injection euthanasia will therefore change nothing.”


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