I am sure that most of you will have been shocked and distressed by recent reports that, during lockdown, Many care homes were ordered to place “Do not resuscitate” orders on all their residents. In many cases, there was no discussion of this with either the residents themselves or their families. About half of these were care homes for the elderly. The other half were for younger adults with learning difficulties or other disabilities.
It is hard to find words for this violation of the most fundamental of human rights – the right to life. We thought we were going into lockdown to protect the most vulnerable, when in reality, there seems to have been a policy of leaving the most vulnerable to die. It seems to have been decided that the lives of elderly and disabled people somehow mattered less than those of the young, or of people free of disabilities.
Even if it could be argued that very frail elderly people often would not benefit from resuscitation, or from treatments like ventilation, this would not apply to the younger, healthy people, who happened to have a learning difficulty, who were also being condemned to die.
This horrifying situation was not confined to the care home sector. Some GP practices put pressure on elderly people, people with certain health conditions, disabled people, and in some cases autistic people, to sign “Do not resuscitate” forms for themselves, and agree that an ambulance should not be called if they were to become ill with Coronavirus. Imagine the feelings of these people, on being asked to agree that their lives were not worth saving. In many cases these were people living alone, unable to see friends and family due to lockdown, and now finding that the health service was apparently turning its back on them. They must have felt utterly abandoned. Many must have despaired. Meanwhile, their neighbours “clapped the carers” every Thursday.
How dare anyone suggest that the life of an elderly, disabled or autistic person is of less value than that of a young, able bodied, neurotypical person?
I hope every liberal believes that every life is of equal value. We must never forget that the most fundamental of human rights is the right to life itself.
We must always speak out against any policy which suggests that any life is somehow less precious than another, or makes judgments about someone else’s quality of life.
You may be thinking that of course liberals believe that every life is of value, and that to state this is to state the obvious. But we need to think carefully, and ask ourselves, honestly – have there been occasions when liberals been guilty of regarding some lives as of less value than others?
The party seems to be moving towards support for “assisted dying”. You may say that support for assisted dying does not conflict with the right to life, and that it is all abut individual choice. That there will be safeguards in place, to ensure that only terminally ill people can request an assisted death, and that no-one will be put under pressure to make such a choice.
But it is a fact that in many countries that have legalised assisted dying, people have died in this way who were not terminally ill, even though the original intention of the legislation may have been that it should apply only to terminal illness. Among those who have died have been disabled people, autistic people, and people suffering from severe depression. Doctors have agreed that these people’s condition meant that their life was not worth living. What message does that send about society’s attitude to the disabled, and to the value of their lives?
Sadly, it seems that few liberals in these countries have spoken out to oppose this.
You may believe that this would never happen in the UK. But in this country, very few liberals speak out against the fact that a disabled baby may be aborted at any point before birth, even at full term, while the limit for abortion for babies who are not disabled is twenty-four weeks. I am not trying to make an anti abortion point here. But it is undeniable that making disability grounds for late abortion, which would be illegal if the baby was able bodied, clearly sends a message that society does not believe disabled lives to be of equal value. Liberals need to consider the possibility that support for abortion is not always a progressive stance.
We need to affirm our belief in equal value of all lives, and in the most fundamental of all human rights – the right to life.
* Catherine Crosland is a member in Calderdale and joined the party in 2014
Follow @LibDemVoice on Twitter
Like us on Facebook
Subscribe to our feed
Sign-up for our daily email digest
The Joy of Six 1274
Gasping Local Government.
The Chagos Islands, Mauritius and the ICJ
Honouring the Real Thing and launching Black History Month in Liverpool
Starmer kills off Leveson two
Michael's weekly ward surgeries today! #dundeewestend
Leon Duveen
Helen Dudden
Roland
Suzanne Fletcher
Joseph Bourke
49 Comments
I must ask: who, legally, has the power to make a DNR order?
The author of this article seems to have relied on TV medical soaps for her information. In reality, CPR is rarely successful and often comes with serious side-effects as the first paragraph of this GMC advice makes clear:
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/treatment-and-care-towards-the-end-of-life/cardiopulmonary-resuscitation-cpr
Meanwhile, someone who has a cardiac arrest outside of a hospital setting has around a 10% chance of surviving to be discharged from hospital, as this review shows:
https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-2773-2
Those who advocate a ‘right-to-life’ in all circumstances need to consider that in many cases they are causing unnecessary suffering.
The law requires the following process – those close to the patient should be involved unless a patient has asked for them not to be.
If a patient is likely to stop breathing or their heart stop, they should be made aware that a DNR decision may be appropri- ate and that this will not affect other treatment decisions.
The patient should have access to clear information about what DNR decisions are and how the decisions are made. If a patient does not want to discuss the matter further but wants to leave the matter in the hands of their doctors, this can be confirmed at this early stage and it will be documented in your medical records.
The patient should then have a chance to have a full discussion with the doctor who shall make the DNR decision so they can express their views and listen to the expert medical opinion of their doctor.
The doctor should then make a decision and communicate this to the patient, explaining to them clearly the reasons for the decision. If the patient disagrees with the decision, the doctor should, as a matter of good practice, offer to arrange a second opinion.
Source: https://www.leighday.co.uk/Human-rights-abuse-claims-judicial-review/Health-social-care/Do-Not-Resuscitate-DNR-Decisions
this is possibly the most important subject and thus piece, we could have on here. Thank you to Catherine, who knows my views are the very same on these issues, my very many references to it usually getting little support other than from her, and apparently seventy to eighty per cent of women, according to polls! My wife, Lana, has read this and thinks as highly of the article as I do , in keeping with that poll, she worries about the discarding of life implicit in our culture both here, and especially in her country of origin, the US.
The scandal in care homes is complicated and the issues need more space than the limits of the word count here could allow, but Catherine starts what is an essential discussion. The statist approach to health care, despite what those on the left believe, often, encourages the attitude of do not resuscitate. It saves money, which in a non market system, is the normal everyday concern, lack of money. A purely commercial approach is wrong, but rarely leads to the horrors, these type in this piece. Money that is for treatment, or care, comes , per patient, the more expensive the care, is not the concern of the provider of care, if getting the money, per person. In fact, the worst even, of the private sector in the US, keep people alive, because the more expensive the care, provided in money, by insurance, the more the provider of care, make. This too, is wrong. A social market is the only ethical way to run health care, until a shift in practices, in state provision happens.
The odd thing here is, the care homes are often private, but the money is from the state usually, or private means. The norm in such homes would, as with most markets, to keep the client, alive, to get the payments as well as to provide a good service. Here I reckon the fact that it was known, that local NHS hospitals could not cope, meant, that state underfunded save money norm, happened to influence all decisions. The NHS is not all its considered to be. Remembering scandals is necessary.
This one needs more publicity. It is a disgraceful awful one. As is the discarding of life in our abortion laws. Not that we should outlaw abortion, no. But to allow abortion of a potential life, due to minor disability or gender being female, is a terrible and horrible thing.
I am surprised our party of individual rights and conscience cares little about these issues compared to once .
The DNR orders were horrifying and sickening – it was right that we spoke up against them and we should seek to ensure it never happens again. Nobody should ever have a DNR applied to them against their will.
Let’s not conflate this with the right to die, which is an important and Liberal principle – people should not be expected to suffer a life they do not wish to live where there is no serious prospect of that changing. It should not be up to the judgement of others whether someone should be forced to live – if we have exhausted all avenues available to us, they should have the right to die.
On the abortion point, it’s clear that a woman should be able to terminate a pregnancy at any point and for any reason. Support for abortion is always the Liberal stance, and no Liberal has any ground for forcing a woman to stay pregnant where she doesn’t want to.
(It could be argued that there should be a medical judgement on whether it’s more ethical to destroy the foetus or deliver it – to be put up for adoption – if it has a reasonable chance of surviving. But that’s a tangent and not really what the op was arguing)
Joe Otten, a doctor has the legal power to make a DNR order. The doctor is supposed to give careful consideration to the individual patient’s state of health, and to discuss the decision with the patient and / or their family. The orders to care homes to place blanket “Do not resuscitate” orders on all their patients, with no consideration of individual circumstances, or discussion with the patient or their family, was therefore arguably illegal.
Laurence Cox, I don’t watch medical soaps. I wasn’t suggesting that a DNR order is never appropriate. Obviously their are cases where there would be virtually no chance of resuscitation succeeding, and perhaps the patient is terminally ill, with no chance of surviving for long. But in the cases I was referring to , DNR orders were placed on all care home residents, just because they were care home residents, with no consideration of their individual circumstances.
Catherine Jane Crosland
In both the OP and your comment above you say that ‘care homes were ordered to place “Do not resuscitate” orders on all their residents’ – I think you should provide a source for this claim. If true, it is extraordinary.
Thank you, Lorenzo
James you make two very confusing points, because they do not go together.
First, you state, as if your view is based on a general truism, you say , it is clear , referencing what is in fact, merely your interpretation. It is no more clear to me that every woman in all circumstances should have no law or regulation of her right to do as she wants with no rights to the other growing life. It is clear to me that at the point of viability of that life, that the woman should have to balance the right to life of that potential life. It is clear to me that the right to end that life based on down syndrome or being female, is wrong and the law should say that. It is clear that seventy to eighty per cent of women agree with this view and want a reduction to twenty or less weeks, and no right to end the life based on down syndrome or being female.
You then say that there is a debate to be had on ethics, and to give space to consider adoption as better. So a Liberal could prefer that in these circumstances. So your earlier statement was your view as a Liberal and one you should express as that. My view is the latter and as Liberal, as concerned for human rights and human life. In Ireland and France, they set it at twelve weeks. Ours is double. If I am an Irish Liberal or french Liberal who favours a rather longer number, say eighteen or twenty, I am to the left of the spectrum there on this. Only here and Canada and America am I a little to the right according to left wingers, in actuality I am in the centre. But I favour these changes based on Liberal human rights of life, liberty of the potential child. Not conservative views based on religion or morality of a powerful church.
Malcolm Todd, this was reported in several newspapers in the last few days, The Queen’s Nursing Institute, the world’s oldest nursing charity, was mentioned as having discovered that one in ten care home staff survey had been ordered to place NDR orders on all their residents, with no consultation with families. The one in ten was just those surveyed, suggesting the real number is likely to have been higher
“How dare………”
Well on HMS Birkenhead it definitely was not women and pensioners first.
I am an old person and the lives of my children are much more important than mine. They have more to lose and I have had my life.
So I suppose I do dare, sorry.
Ok, it would still have been helpful to provide an actual link, rather than just treating it as an “everyone knows about this” sort of thing.
I’ve googled it a bit and I have to say the evidence isn’t that convincing. A survey of staff, somewhat self-selecting, with 163 responses, of which “16 were reported negatively. For example, blanket DNACPR instructions from the GP or the CCG or hospitals putting DNACPR in place without discussion with the resident, family or care home. Also, hospitals refusing to admit patients who had DNACPR or blanket ‘no admission’ policy.” (emphasis added)
It does not say that “one in ten care home staff survey[ed] had been ordered to place NDR orders on all their residents” – it says that one in ten reported “negative” effects on DNR policy, and gives a number of examples (including “hospitals refusing to admit patients who had DNACPR”), without numbers. It’s a real stretch, on such sparse and under-quantified evidence, to conclude that “Many care homes were ordered to place ‘Do not resuscitate’ orders on all their residents.”
It shouldn’t happen at all, of course. One of a number of bad decisions made in the early stages of this pandemic. But the media reporting is (surprise surprise) making it sound like a much bigger problem than it is; and that’s quite apart from the fact that “DNR” is nothing to do with denying a right to life.
James Belchamber, I agree with Lorenzo’s replies to you. Do you really believe that a woman has a right to abort her baby at ant stage of pregnancy and “for any reason”. Would you actually consider it acceptable if a woman requested, and was given, an abortion a few days before her due date because she had discovered the baby was a girl and she wanted a boy? Very few people, including liberals, would consider that to be acceptable.
Even if you do believe abortion should be legal at any stage of pregnancy and for any reason, would you not agree that the situation we actually have – in which babies can be aborted up to birth only if they are disabled – sends a terrible signal about how societies attitudes to disability.
My feeling is that parents who opt for an abortion on discovering that their child disabled often do so because medical professionals often give them an exaggeratedly bleak picture of what their child’s future may be, and sometimes perhaps even give parents the impression that an abortion is the choice that is expected of them.
On the subject of assisted dying, do you really believe that someone who is suicidal due to severe depression should have suicide offered to them by medical professionals?
Malcolm Todd
https://www.telegraph.co.uk/news/2020/08/23/care-homes-asked-place-blanket-do-not-resuscitate-orders-residents/
Malcolm, I hope you are able to view the article, and do not come up against a pay wall. Yes, perhaps it was just that one in ten were asked to place DNR on some residents without consulting family. But the article does make it clear that there is evidence that a number of care homes were ordered to place DNC orders on all their residents. I didn’t actually say one in ten in the article, but while making the comment I remembered the “one in ten” – I should perhaps have checked more carefully, but I think you’ll agree that what the article describes is horrifying
“.. In reality, CPR is rarely successful and often comes with serious side-effects…” [Laurence Cox]
Which would require a spell in a hospital’s high-dependency unit…
I suspect the DNR orders are just one of several ramifications of trying to keep people out of hospitals and specifically high-dependency units when the expectation was for these units to be flooded with CorVid19 patients. Sometimes hard decisions have to be taken – if the LibDems are serious about getting into Government then they need to learn this lesson.
Whatever the arguments for and against the abortion and right to die issues, there can be no argument about the dereliction of human care and abysmal handling of the care home debacle. The way this government treated its fellow citizens just shows their lack of empathy and should never be forgotten or swept under the carpet. I hope our new leader and the party keep the pressure on to have a proper enquiry into this matter.
@Catherine I was very careful to use the phrase “terminate a pregnancy” (that is, not necessarily destroying the foetus) – and yes, of course a woman should not be expected to carry a child she no longer wishes to carry. It is anyway insensible – forcing someone to parent a child they do not want is the start of too many stories we as Liberals want to consign to history.
(There are far better ways to resolve the problems you raise than to enforce your will on someone’s womb. And yes, I disagree with the status quo, pretty obviously)
And yes, again: it’s very obvious to me that someone who has severe depression, has exhausted all medical medical avenues, and has no serious prospect of reprieve, should have their will to die respected and enabled in a way that gives them control and relieves them of pain. I would argue that to deny them this is actually barbaric.
This article conflates a horrific attack on the rights of elderly and disabled people with what are essentially morality judgements, which no Liberal should have any business enforcing.
Innocent Bystander, you say that you consider your children’s lives to be more important than your own. But no-one else has the right to make a judgement about the value of your life, without consulting you. A DNR order is not meant to be based on the importance of someone’s life compared with someone else’s life. It is meant to be based solely on whether the individual might benefit from resuscitation.
This was not a case of a shipwreck with not enough places on the lifeboats. We are supposed to have a health service that is the envy of the world. Treatment should be offered to all who need it and would benefit from it. It should not need to be a case of either / or. (And anyway, what would we think if we heard of a shipwreck in which young and able-bodied people took all the places on the lifeboats, leaving the elderly and disabled to drown).
Thank you for raising this subject Catherine. I’m afraid that my experience between the beginning of 2014 and the beginning of 2019 is purely anecdotal and I am still too angry and traumatised to be able to formulate any policy response. My father was being treated for pneumonia and was discharged from hospital after three days, and then readmitted and died after a week of poor treatment and the deliberate use of drugs inappropriate to his condition. My mother died the day after the 2015 General Election of a brain haemorrage after a fall in her care home: the inquest agreed with us that it was a consequence of lack of care – accidental death – rather than the natural causes that the care home had insisted on. The GP assigned to the care home lied through his teeth at the inquest. My partner’s mother fell out of bed at her care home and broke her neck, and died in hospital on Christmas Day. She had been pressured into signing a DNR form on one of her trips to a day centre – none of the family knew about that but the doctors used it as a trump card to deny her treatment in hospital. The consultant in charge of her ward called my daughters a “comedy act” when they protested to him about how she was being treated. My partner’s father was given a drug by the GP assigned to his care home which should never be administered to someone with Parkinson’s and went into a coma from which he never emerged. You can dismiss my experience as being unbalanced or paranoid if you like, but there are a lot of people working in the NHS who are lazy, incompetent and uncaring, as well as there being many more (I hope) who are none of those things and do a wonderful job.
Tonyhill, I am so very sorry to hear about the appalling treatment received my members of your family. I am afraid the “care” sector is all too often the opposite of caring, and medical professionals are sometimes horrifyingly lacking in compassion.
Catherine,
I’m sorry, my misunderstanding, I thought you were referring to a temporary period when it was anticipated that the NHS would be overwhelmed and that HMS Birkenhead decisions would have to be made by someone in which case the amount of remaining life would be a parameter. This never came about and any mistakes were just that. I am with Tony Hill. My own family’s experience of the NHS left me unimpressed (my wife survived but only just) and if the rest of the world envies it then they have low standards. But any suggestion of ‘improvement’ is pure blasphemy.
Outside of my comment on morality based on religion not being my own motivation with my views on a more humane attitude to the rights of the unborn, especially based on disability or gender not being what some pregnant women or their men, want, a ;lack of morality of any type is getting me worried about this and all parties on these issues.
James you do not answer my points or those of Catherine in a way clear. If you do think a woman or her man putting a pressure on her, the case sometimes, should be permitted to do as they please the week before a due date of birth, my blood is hot with rage. thanks to catherine, truly one of the finest herein, for advocacy for decency in the face of immorality!
It is a pity that a powerful critique of how transmission of CoVId-19 was cynically mishandled gets side tracked onto the topic of some of the most distressing, but very rare cases of late abortions.
The scandal is that it was in effect a policy to export CoVid-19 into care homes and to deny care workers and NHS front line staff protection.
Catherine: I have to admit that I’m rather angry at your yolking the supposed application of Do Not Resuscicate orders without the consent of the people concerned, together with assisted dying.
That is fundamentally misguided.
Assisted Dying is about honouring a terminally ill person’s right to determine the time and manner of their own deaths.
Bulk Do Not Resuscitates are a denial of that right: it is forcing death on people who wish to live.
A person who is physically able to end their own life has the right to do so at any point, for any reason – including clinical depression – and without any safeguards whatsoever.
As a society, of course, we have a duty to try to help vulnerable people never to reach that point, and that includes making the remaining lives of people who are terminally ill as comfortable and fulfilling as possible.
But we also have a duty to recognise that ultimately it is their right to decide whether to soldier on or not even if they are physically incabable, because of their disease, of ending their own lives.
Toby Keynes, I included the issues of assisted dying and of abortion, because I thought it was important to ask ourselves whether there are times when liberals may be guilty of failing to affirm that all lives are of equal value.
I know that assisted dying might seem to be very very different issue, because it is supposed to be about the individual’s right to choose to die. But if we were to accept that disability or severe depression were valid reasons for someone to request assisted dying, then we would be sending a signal that we believed that the life of a disabled person, or of someone suffering from depression, was not worth living.
At the moment, it is usually taken for granted that someone who is suicidal should be prevented from acting on their suicidal feelings. Currently, a doctor with a suicidal patient will offer them medication and counselling to help them recover. Do we really want a situation where a doctor with a suicidal patient would be expected to arrange the suicide?
The only person who can remove your right to life is yourself so DNAR’s with no informed consent is a nonsense, barring powers of attorney that I think cover this. When staff attempt to resuscitate people they must take into account the chances of success. It is unlikely that resuscitating elderly people in nursing homes will succeed.
Peter Hirst, It may be that resuscitating elderly people in care homes often will not succeed, but it is still important that careful consideration must be given to every individual case, and there must be discussion with the patient and / or their families. This clearly did not happen, so blanket DNR’s placed on all residents of a care home, without consultation, were arguably illegal.
I am surprised that comments have not discussed the fact, mentioned in my article, that many of the care home residents given DNR orders were younger people with learning difficulties, and some of the patients asked to sign DNR orders for themselves by some GP practices were autistic. Having a learning difficulty or being autistic does not mean that resuscitation is less likely to succeed. It seems that a decision was made that the lives of people with learning difficulties, or autistic people, were less worth saving
Catherine deserves much credit for raising this issue…. for both the elderly and for those with learning difficulties and autism.
However, it is essential as a first step is to establish the facts in order to leave no doubt about the truth. Given his family circumstances this would seem a natural issue for Ed Davey to pursue……. the truth must come out. I sincerely hope it turns out to be unfounded, but if it isn’t then Ed should go really for it.
As the recipient of an organ transplant (and a previous operation when on the transplant waiting list when the surgeon told me survival stats were 1 in 3, I’d urge a wee bit of caution on Lorenzo Cherin. His statement, “The statist approach to health care, despite what those on the left believe, often, encourages the attitude of do not resuscitate. It saves money, which in a non market system, is the normal everyday concern, lack of money”. This is very far from accurate in my experience, Mr Cherin.
I thank NHS (Scotland) for my life and the subsequent chance to walk four daughters down the aisle, to see seven wonderful grandchildren I would not have otherwise seen, and the opportunity to give a little bit bit back by chairing a foodbank.
Lorenzo, the “statist approach to healthcare” saved my life….. a life I continue to enjoy despite the inadequacies of the political establishment…… especially in Westminster.
PS. Before Liberal Historians get ‘holier than thou’, they should recall the Liberal Home Secretary Winston Churchill (and both Keynes and Beveridge were supporters of eugenics) ….. Churchill urged Asquith to pursue it with a ‘the feeble minded breeding’policy. Asquith wisely ignored him.
Keynes and Beveridge were on the Council of the British Eugenics Society, something often overlooked in the Liberal Chapter of Saints. Whilst we’re at it Lloyd George
believed in phrenology… the pseudo science claiming the larger the head the bigger the brain. Needless to say LLG had a large head.
tonyhill thank you for sharing this despite the appalling trauma for you and your family. It helps remind us that Liberals must look at disparities of power within and without institutions every time and all the time.
@Catherine Crosland: “I know that assisted dying might seem to be very very different issue, because it is supposed to be about the individual’s right to choose to die. But if we were to accept that disability or severe depression were valid reasons for someone to request assisted dying, then we would be sending a signal that we believed that the life of a disabled person, or of someone suffering from depression, was not worth living.”
No, this absolutely IS about the individual’s right to choose to die – or to live.
And the signal we are sending, if we legalise assisted dying, is that we recognise this right and that such a choice is just as valid, whether it is made by someone who can physically bring this about or by someone who cannot.
When a mentally competent person is terminally ill, knows that they only have a short time to live and is probably in considerable unpreventable and long-term pain, but is physically incapable of ending their own life, NOONE but themselves has the right to decide whether their choice of whether to extend their life or to end it on their own terms is for “valid reasons”.
Any other terminally ill person has the right to make that decision; it should not be taken away from someone purely because they are not physically capable of enacting their choice.
Of course, it is essential that there are strong safeguards in place, to ensure that this is genuinely their choice and that they are not being pressured into it, that this is their settled decision – one that they have made and stuck to over a period – and that they are mentally competent to make that decision.
Toby Keynes, in the comment that you quote, I was not thinking of people who request assisted dying because they are terminally ill. As I mentioned in the article, it has been the case that when a country legalises assisted dying for people who are terminally ill, it is often not long before people request, and are granted, assisted dying who are not terminally ill, but who wish to die because they are disabled or severely depressed. This has been the case in Belgium and the Netherlands. Sometimes people have requested assisted dying because they are autistic, and this has been accepted as a reason.
But people suffering from depression can recover. Disabled and autistic people can live full lives. Many people who have made unsuccessful suicide attempts have later looked back and been grateful that the attempt was unsuccessful – perhaps because of the efforts of medical professionals to save them. Do you really believe that it would have been better for medical professionals to have enabled the suicide?
https://ukhumanrightsblog.com/incorporated-rights/articles-index/article-2-right-to-life/
There must be a case against the DHSC under Art.2 of the HR Convention and the Human Rights Act.
@Roland
Let me spell it out to you :
GMC Advice: Generally, however, CPR has a very low success rate and the burdens and risks of CPR include harmful side effects such as rib fracture and damage to internal organs; adverse clinical outcomes such as hypoxic brain damage; and other consequences for the patient such as increased physical disability. If the use of CPR is not successful in restarting the heart or breathing, and in restoring circulation, it may mean that the patient dies in an undignified and traumatic manner.
Review paper: the rate of survival to hospital admission was 22.0% (95% CI 20.7–23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2–9.4%)
So, for everyone (and that includes young people involved in traffic accidents or stabbings as well as old people in care homes) if your heart stops there are more than three chances in four, even with CPR, that you will be declared dead at the scene or when you reach hospital and less than one chance in 11 that you will survive to leave hospital. The odds if you are elderly are much worse. We are not talking about a few days in an ITU following a cardiac arrest, probably more like a month or more.
Just because there is a DNACPR notice doesn’t mean that an elderly patient won’t be taken into hospital; it just means that if their heart or breathing stops the ambulance crew or the doctors will not attempt CPR. I know this because my wife (who is terminally ill and has a DNACPR) was taken into hospital earlier this month with an infection and was in an ITU for the first day before being transferred to a geriatric ward. She recovered and is back home now.
Obviously, if a hospital’s ITU is already full with covid victims, patients will be taken to other hospitals that still have capacity. This is already common practice when major disasters occur. We never had a situation where all hospital ITUs were full.
Laurence, I did not include this in my article, but apparently some care homes were told that their residents must not be taken to hospital, for any reason
@ Catherine I n tonight’s edition of the Guardian :
“Covid-19 death tolls at individual care homes are being kept secret by regulators in part to protect providers’ commercial interests before a possible second coronavirus surge, the Guardian can reveal.
England’s Care Quality Commission (CQC) and the Care Inspectorate in Scotland are refusing to make public which homes or providers recorded the most fatalities amid fears it could undermine the UK’s care system, which relies on private operators”.
I suggest you get on to Ed Davey PDQ to challenge this.
We need a National Care Service.
David Raw
David, yes in your situation, a better funded system, a statist approach, worked. There cannot be a free market in heart transplants. But in many people going on lists, an under fund of health care rather than an over fund, in other words, too much demand, to little supply, the system we have does not work. Money needs to follow each patient, every treatment. yes of course funded by the state, you refer to funds, me to systems as well. A social market, as in Germany, Italy, france, where supply is often separate, often non profit, often non state, and funds do follow patients, means, if well funded, which they are more than not, the patient gets the better of both, public and private. I know you think somehow because you have experienced something great, the whole is great. It is not. y experience with my wife, is of a lousy system. my experience over years has led me to research, coupled with having a wife born and bred in the Us, a father, from italy, an awareness of other systems outcomes far more successful. I detest the Us systems, dislike ours though, I would keep the NHS, though redesign the whole system, incorporating the whole or most of the private, and loosening the public..
@Catherine Crosland: “As I mentioned in the article, it has been the case that when a country legalises assisted dying for people who are terminally illd, it is often not long before people request, and are granted, assisted dying who are not terminally ill, but who wish to die because they are disabled or severely depressed.”
Catherine, our party’s existing policy is to support a right to choose an assisted death for those who are terminally ill, and only for those who are terminally ill.
As Chair of Humanist & Secularist Liberal Democrats, I was involved in the drafting of this policy, I submitted it to Conference and I spoke in support of it and it was carried by a substantial majority (which also reflected the support of a strong majority in this country for such a policy).
If there is ever a proposal for the party to change its position so that assisted dying would be available to people who are not terminally ill, that would require a further policy debate, and would be the time for you to argue your case.
David Raw, thank you for your responses.
It is completely unacceptable that information about the death rates from Covid at individual care homes is not being made public.
I hope Ed Davey will hold the government to account on these issues. I watched the Liberal Democrat Disability Association hustings, and Ed seemed genuinely committed to standing up for the rights of disabled people, although the questions at the hustings focused on issues like employment rights, and ensuring that disabled people could play a full role in the party (vitally important issues, of course), rather than the right to life issues I raise in this article. During the leadership campaign as a whole, Ed said a good deal about the need for more support for carers, and spoke about his own experience as a carer. It is important that there should be more support for carers, but at times I did worry that Ed seemed to be focusing on the rights of carers, rather than on the rights of the people they are caring for.
@Catherine Jane Crosland
I did not include this in my article, but apparently some care homes were told that their residents must not be taken to hospital, for any reason
You should really be attacking this failing, which is wrong to my mind also, rather than concentrating on all DNACPRs. Equally the dumping of covid-positive patients from hospitals into care homes has to be an issue where hospital managements need to be held accountable.
It is always important when attacking failings in public services to direct your fire at specific targets rather than spraying the whole field with shot.
@ Catherine J.C. “at times I did worry that Ed seemed to be focusing on the rights of carers, rather than on the rights of the people they are caring for”.
I don’t think that’s the case, Catherine, given that his own son is disabled :
‘No one will write off my disabled son’: Ed Davey speaks …posabilitymagazine.co.uk › no-one-will-write-off-my-d…
25 Sep 2012 – The Lib Dem minister takes his son John, who cannot walk or talk, to Hungary for treatment at the Peto Institute which specialises in teaching …
Sir Ed Davey opens up about disabled son as he formally …www.standard.co.uk › News › Politics
4 Jun 2020 – Sir Ed Davey opened up about caring for his disabled son as he formally announced his bid for leader of the Liberal Democrats.
As a liberal, I feel very strongly that it is my right as an individual to decide the matter and timing of my death. That in no way equates to making a value judgement on anyone else’s life. In fact it asserts the opposite: that I should not be categorised by the state or anyone else, and should be supported in my own choices.
Of course, assisted dying is only truly a choice if there are safeguards in place to prevent abuse and if the state is adequately providing healthcare, social care and assisted living. Our party continually makes the case for a properly funded, fully integrated health and social care system. It is vital that everyone gets the support they need to live life to the fullest.
For avoidance of doubt, I will post in my next comment the party’s assisted dying policy as adopted in 2012. This should be the starting point for any discussion on Lib Dem support for / opposition to assisted dying.
“Conference notes that:
a) A significant minority of people who suffer unendurably from medical conditions that offer no hope of recovery are physically unable to end their lives at a time of their own choosing without assistance.
b) It is over 50 years since the passage of the 1961 Suicide Act established the current legislative framework, but that scores of British citizens now travel to Switzerland each year to seek medical assistance to die.
c) Legislation making provision for medically assisted dying, and incorporating many safeguards to prevent misuse, was enacted in Belgium and the Netherlands a decade ago and continues to enjoy very strong public support in those countries.
d) There is continuing debate on the subject in the United Kingdom, and the evidence of successive opinion polls demonstrates very strong public support for similar legislation here.
Conference reaffirms the policy it adopted in the conference motion Medically Assisted Dying in 2004 in support of legislation providing for medical assistance to die to be available to patients in particular circumstances, subject to rigorous safeguards to prevent abuse. Conference also recognises the importance of high quality palliative care being available to all who may need it, and of greater support for carers.
Conference calls for Liberal Democrat ministers:
1. To press for the introduction of a government bill on the subject, allowing Parliament the opportunity to consider, as a minimum, the legalisation of those who are terminally ill to have assistance to die with dignity, subject to safeguards.
2. In the event of a Bill being introduced through Private Members’ procedures, to press for time to be made available in the House of Commons to enable it to be fully considered.
Conference believes that any such legislative proposal should be determined by way of a free vote in order to respect the freedom of conscience of Parliamentarians.”
As Toby says, “this absolutely IS about the individual’s right to choose”, and not to determine someone else’s life, death, or worthiness of living for them. The safeguards for proposed changes in UK law have always included the sign-off of two doctors to confirm the individual is suffering from an irreversible terminal illness, plus an independent psychiatric assessment to make sure the person requesting a medically assisted death is of sound mind and has not been coerced. I find the fact that the state would force me to go through every stage of an incurable terminal illness against my will highly illiberal, and frankly quite terrifying.
Please therefore do not conflate this issue with the government’s catastrophic mishandling of COVID and recurring assaults on human rights. They really couldn’t be more different!
David Raw, I’m sure you are right in saying that Ed does care about the rights of disabled people, especially in view of his experience as the parent of a disabled child. It is clear that he and Emily are devoted parents, who are doing all they can to ensure that their son fulfills his potential.
I suppose I just felt that it would have been better, when Ed made support for carers one of the main policies of his campaign, if he could have also made the rights of disabled people an equally central campaign issue. As I mentioned, he spoke well at the Liberal Democrat Disability Association hustings, and made it clear that he does believe passionately in the rights of disabled people, but apart from this hustings, the issue was not mentioned very often in the leadership contest, by either campaign.
Carrie, thank you for your replies, and I am sorry I have taken a while to respond.
I have a lot of sympathy with the argument that someone who is terminally ill, with no chance of recovery, should have the right to ask to be helped to die. But I have thought a good deal about these issues, and I feel it is just too dangerous to give doctors the power to kill their patients, even in the circumstances set out by the motion passed by Conference in 2012.
The main reason I feel this way is the fact that, based on what has happened in countries that have already legalised assisted dying, it is often not long before the criteria is extended to include people who are not terminally ill at all.
It is ironic that the 2012 motion mentioned Belgium and the Netherlands as evidence that assisted dying can be safely implemented. In 2012, it be not yet have been clear what direction these nations were moving towards in the implementation of their assisted dying legislation. But it is clear now that both nations have moved far beyond what the 2012 Conference motion called for.
In both Belgium and the Netherlands, many of the people who have been “helped to die” have not been terminally ill at all. People have requested, and been given, assisted dying because they are disabled, or suffering from depression and other mental illness, or in some cases because they are autistic.
In the Netherlands, the criteria now seems to be that someone considers that they are enduring “unbearable suffering”, and that suffering can include psychological suffering.
The following is a link to the tragic story of a young woman of twenty-nine, suffering from mental health issues, who was “helped to die” in the Netherlands.
https://www.bbc.co.uk/news/stories-45117163
This was a young woman with her life ahead of her. Even if she had never fully recovered from mental illness, it may be that her condition would have improved sufficiently for her to have a good quality of life. She may have thought she was sure she wanted to die. But suicidal thoughts were surely a symptom of her illness. Medical professionals should have offered her treatment and counselling to help her overcome her suicidal feelings, instead of enabling the suicide.
Some people in the Netherlands have even been given “assisted dying” without their consent.
The following is a link to an account of the disturbing case of an elderly woman with dementia, who was killed although there is evidence that she did not want to die. When she had first been diagnosed as being in the early stages of dementia she had written what is referred to in the Netherlands as an “Advance Euthanasia Directive”. In this she stated that she would want Euthanasia if her condition deteriorated to the extent that she had to go into a care home. She later revised this, to make it clear that she would want Euthanasia only when she decided the time was right.
Eventually she did need to go into a care home. There, a doctor asked her whether she wanted to die, and she said “not yet. It’s not so bad yet”. But doctors nevertheless decided that her earlier directive must be followed, and euthanasia must be carried out, even without her consent. Her family were told to hold her down, while a doctor administered a lethal injection.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120810/
Thanks Catherine for your response. It is imperative we learn from cases where doctors have administered without consent and make patient autonomy an absolute red line in legislation. Out of interest, would you feel any differently if it was up to the patient themselves to administer the dose rather than it being administered by doctors?