Pathway for the elderly that leads to legal execution

Being "made comfortable" is no longer the reassuring euphemism it once was, says Liz Hunt.

At around 4am on Monday, a friend of mine was woken by a call from the private care home in south-west London where her 98-year-old grandmother is resident.

"Mrs ------- has breathing difficulties," the night manager told her. "She needs oxygen. Shall we call an ambulance?"

  "What do you mean?" my friend responded. "What's the matter with her?"

"She needs to go to hospital. Do you want that? Or would you prefer that we make her comfortable?"

Befuddled by sleep, she didn't immediately grasp what was being asked of her. Her grandmother is immobilised by a calcified knee joint, which is why she is in the home. She's a little deaf and frail, but otherwise perky. She reads a newspaper every day (without glasses), and is a fan of the darling of daytime television, David Dickinson. Why wouldn't she get medical treatment if she needed it?

Then, the chilling implication of the phone call filtered through – she was being asked whether her grandmother should be allowed to die.

"Call an ambulance now," my friend demanded.

The person at the other end persisted. "Are you sure that's what you want? For her to go to hospital."

"Yes, absolutely. Get her to hospital."

Three hours later, her grandmother was sitting up in A&E, smiling. She had a mild chest infection, was extremely dehydrated, but was responding to oxygen treatment.

It was a happy ending – of sorts. My friend is reeling from the care home manager's questioning. Had she really been asked to pronounce a possible death sentence on her grandmother, a woman with no underlying ailment other than old age? The issue of a "Do Not Resuscitate" order had never been raised with the family – if it had been, they would have dismissed the idea. And why was her grandmother found to be so dehydrated on her arrival at hospital that she remains on a drip: is this down to negligence, or something more sinister?

Withdrawal of fluids (and drugs) is one of the steps on the controversial palliative care programme known as the Liverpool Care Pathway, which has been adopted by 900 hospitals, hospices and care homes in England. The intention is admirable: to prevent unnecessary invasive treatment and help cancer patients to die comfortably.

But there is growing evidence that patients who don't fit the criteria are being railroaded on to the Pathway, and into premature death.

The Daily Telegraph reported two cases this week. Hazel Fenton, an 80-year-old from Sussex, was admitted to hospital in January with pneumonia and put on the Pathway regimen. Her daughter, Christine Ball, fought to stop her mother from being left to "starve and dehydrate to death". Nine months on, Hazel is doing well and is "happy", Christine says. Jack Jones, a cancer patient from Merseyside, wasn't so lucky. Doctors did not treat the 76-year-old's pneumonia because they claimed his cancer was spreading aggressively. A post-mortem examination found otherwise. His wife has never managed to confirm that Jack was on the Pathway, but she has no doubt he was denied precious time with his family. Readers, I am sure, will have their own, similar experiences. I'd like to hear them.

We've long accepted the practice of easing terminally ill patients towards death, by upping the dose of morphine so that pain and consciousness are blunted until respiration is suppressed completely. Sensible people view it as the most compassionate of acts. But being "made comfortable" is no longer the reassuring euphemism it once was. While we've been preoccupied with the moral pluses and minuses of living wills, assisted suicide and euthanasia, legalised execution of some of society's most vulnerable has become available, most probably at a hospital near you. How did we let this happen?

http://www.telegraph.co.uk/comment/columnists/lizhunt/6322738/Pathway-for-the...