The Pathway to Death Pathways

Speaking of Obamacare in one of the 2012 presidential debates, Mitt Romney asserted that Obamacare “puts in place an unelected board that’s going to tell people, ultimately, what kind of treatments they can have.” [ref]

Obama’s reply danced around Romney’s accusation: “this … unelected board that we’ve created — what this is, is a group of health care experts, doctors, et cetera, to figure out how we can reduce the cost of care in the system overall.” [ref]

How do you reduce the cost of care? You ration it. You “tell people, ultimately, what kind of treatments they can have.”

You start by limiting health care services to the elderly and to terminally ill adults. You even refuse intravenous food and fluids, to hasten their demise. When that doesn’t save enough money, you start denying care to babies born too premature or with severe complications or disabilities. You withdraw food and fluids, and watch them shrivel and die over the course of a week or two or three. Still too much cost? Then you extend the same “treatment” to terminally ill young adults.

Does this sound far-fetched to you, like the premise of some conspiracy theorist’s Sci-Fi flick?

Well, it’s not. That’s how they do it in the United Kingdom, that great bastion of socialized medicine.

The UK has what is known as the “Liverpool Care Pathway”. (Once again, a nice-sounding name for something that ain’t nice at all. Liberals love to do that.)  What is the Liverpool Care Pathway? It is a withdrawal-of-care protocol that hastens the death of elderly and terminally-ill adult patients — as many as 130,000 of them a year. This same Death Pathway (let’s call it what it really is) is now being used to euthanize babies and young adults as well. [ref]

Here is the excerpted testimony of a British doctor, published in the British Medical Journal:

The voice on the other end of the phone describes a newborn baby and a lengthy list of unexpected congenital anomalies. I have a growing sense of dread as I listen.

The parents want ‘nothing done’ because they feel that these anomalies are not consistent with a basic human experience. I know that once decisions are made, life support will be withdrawn.

Assuming this baby survives, we will be unable to give feed, and the parents will not want us to use artificial means to do so.

Regrettably, my predictions are correct. I realise as I go to meet the parents that this will be the tenth child for whom I have cared after a decision has been made to forgo medically provided feeding.

The mother fidgets in her chair, unable to make eye contact. She dabs at angry tears, stricken. In a soft voice the father begins to tell me about their life, their other children, and their dashed hopes for this child.

He speculates that the list of proposed surgeries and treatments are unfair and will leave his baby facing a future too full of uncertainty.

Like other parents in this predicament, they are now plagued with a terrible type of wishful thinking that they could never have imagined. They wish for their child to die quickly once the feeding and fluids are stopped.

They wish for pneumonia. They wish for no suffering. They wish for no visible changes to their precious baby.

Their wishes, however, are not consistent with my experience. Survival is often much longer than most physicians think; reflecting on my previous patients, the median time from withdrawal of hydration to death was ten days.

Parents and care teams are unprepared for the sometimes severe changes that they will witness in the child’s physical appearance as severe dehydration ensues.

I try to make these matters clear from the outset so that these parents do not make a decision that they will come to regret. I try to prepare them for the coming collective agony that we will undoubtedly share, regardless of their certainty about their decision.

I know, as they cannot, the unique horror of witnessing a child become smaller and shrunken, as the only route out of a life that has become excruciating to the patient or to the parents who love their baby.

I reflect on how sanitised this experience seems within the literature about making this decision.

As a doctor, I struggle with the emotional burden of accompanying the patient and his or her family through this experience, as much as with the philosophical details of it.

Survival is often much longer than most physicians think; reflecting on my previous patients, the median time from withdrawal of hydration to death was ten days

Debate at the front lines of healthcare about the morality of taking this decision has remained heated, regardless of what ethical and legal guidelines have to offer.

The parents come to feel that the disaster of their situation is intolerable; they can no longer bear witness to the slow demise of their child.

This increases the burden on the care-givers, without parents at the bedside to direct their child’s care.

Despite involvement from the clinical ethics and spiritual care services, the vacuum of direction leads to divisions within the care team.

It is draining to be the most responsible physician. Everyone is looking to me to preside over and support this process.

I am honest with the nurse when I say it is getting more and more difficult to make my legs walk me on to this unit as the days elapse, that examining the baby is an indescribable mixture of compassion, revulsion, and pain.

This physician is among many medical personnel blowing the whistle on this practice. According to the UK’s Daily Mail newspaper, Bernadette Lloyd, a hospice pediatric nurse, wrote to the Cabinet Office and the Department of Health to protest using death pathways for children:
The parents feel coerced, at a very traumatic time, into agreeing that this is correct for their child whom they are told by doctors has only has a few days to live. It is very difficult to predict death. I have seen a reasonable number of children recover after being taken off the pathway.

I have also seen children die in terrible thirst because fluids are withdrawn from them until they die.

I witnessed a 14 year-old boy with cancer die with his tongue stuck to the roof of his mouth when doctors refused to give him liquids by tube. His death was agonising for him, and for us nurses to watch. This is euthanasia by the backdoor.

I have a son who was two years old when he was diagnosed with Kidney cancer. His cancer had advanced to stage four, meaning it had spread into the bone, specifically into areas of his skull and spine. The tumor itself had consumed his right kidney, and filled his abdomen. It was wrapped around some major arteries. We were told it was inoperable.

In the UK, with socialized medicine, perhaps he would have been sent home to die. Fortunately we were in the US, and we had wonderful doctors and nurses providing advanced care at a modern children’s cancer center. Through their efforts, and the Grace of God, my son’s cancer was successfully treated, and continues to be in remission. We were fortunate to have insurance, through my employer, that paid for almost everything. This was before Obamacare was signed into law.

What if we didn’t have insurance? I believe my son’s outcome would have been the same. During his 10 month ordeal I saw many children receive similar care who couldn’t possibly have had the same level of insurance coverage as my son, some who probably had no insurance. I saw terminally ill patients who continued to receive care, including intravenous feeding and pain medication.

Is anyone reading this aware of any child in the USA who was permitted to die, without every effort to preserve their life, because they didn’t have private insurance? What about adults or the elderly? I am aware of none. Our healthcare system, in spite of its expense (blame the government for that), provides for the poor. My insurance is consequently more expensive than it would otherwise be. The cost of treatment for those who can pay is more than it would otherwise be. But the system works. Could it work better? Absolutely! (That’s a topic for another post).

Socialized medicine is not the path to a better health care system. Rather, it is a guarantee of rationed services — a Pathway to Death Pathways. Don’t just take my word for it. Former Obama adviser Steven Rattner had this to say in a New York Times Op-ed:

WE need death panels. Well, maybe not death panels, exactly, but unless we start allocating healthcare resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget. [ref]
Does anyone believe for a second that Obamacare, without significant rationing, won’t face the same miserable future as Medicare’s present, specifically, “exploding cost[s]” that will “swamp the federal budget”?

Obama and the architects of Obamacare certainly feared a future of exploding costs. That’s why, in Obama’s own words, Obamacare creates an “unelected board …  to figure out how we can reduce the cost of care in the system overall.”

What will this unelected board ultimately conclude is a necessary means to reduce costs? “Life Care Pathways” or something pleasant sounding like that. What it will really be is a death panel mandating death pathways.