A group representing hundreds of Catholic doctors and nurses has warned the NHS that new guidance on end-of-life care “unquestionably replicates” a major failing of the discredited Liverpool Care Pathway.
The Catholic Medical Association UK, which has nearly 500 members, said that proposals from the National Institute of Health and Care Excellence (Nice) would be just as deadly as the abolished end-of-life care protocol.
“One of our greatest worries is that the guideline still focuses upon the belief that the diagnosis of dying can be accurately and safely made,” said a submission by the CMA to Nice this week.
“It is very clear that this is difficult with evidence that the diagnosis of dying is especially difficult in dementia, heart failure and respiratory failure,” the submission said.
“The guideline therefore unquestioningly replicates one of the key failings of the Liverpool Care Pathway and suggests to clinicians that they can accurately and reliably make a diagnosis that someone is dying.”
The submission, authored by Dr Philip Howard, a consultant in a London hospital, said that the Nice Guideline Development Group (GDG) needed to re-write the entire section to state that “medical treatment and personal care should be based on a careful clinical assessment and tailored to the individual needs of the patient”.
This would be in keeping with the recommendations of the report issued by the Neugberger Committee which in 2013 recommended the abolition of the LCP after finding evidence of the “shocking” abuse of patients, including the common use of a “chemical cosh” to sedate them before they were starved and dehydrated to death.
“The guidance in this section should flow from the overarching principle that treatment should be based upon need and not prognosis,” the CMA submission said.
“Palliative care should be based upon the relief of symptoms and the needs of the individual patient and not merely on the premise that the clinician thinks someone is dying.
“We advise that the GDG should state clearly that the diagnosis of dying is inaccurate. The safest course in terms of patient outcome and the available evidence is that palliative care should be based upon need and not prognosis.”
The concerns of the CMA echo those made by Prof Patrick Pullicino, a consultant neurologist with East Kent Universities NHS Foundation Trust, who has described the Nice proposals as a “disaster of misinformation, distortion and ambiguity”.
He said that the new guidance “if anything was probably worse than the LCP” and that many of its assumptions totally lacked any evidence base.
The guideline states that “death is unlikely to be hastened by not having clinically assisted hydration”, for instance.
But Prof Pullicino said the claim is “completely untrue”, adding: “Not giving hydration is certain to kill someone if they can’t take hydration by mouth.”
The Medical Ethics Alliance, a group of six secular and faith-based medical groups which uphold Hippocratic medicine, has also criticised the guidance.
Its submission to Nice, signed by Dr Tony Cole, the chairman, said: “Fluids should be routinely given by mouth, tube or stomach if possible, or by the intravenous or subcutaneous route if necessary.
“We simply do not accept the view that the dying do not experience thirst. Nor do we accept that mouth hygiene relieves thirst.
“The draft guidelines say nothing about nutrition. Why is this? We have learnt of deaths that are caused by both dehydration and patients who have been starved over weeks.
“If such deaths are to be avoided, and they are all too obvious to relatives, the guidelines need to be much more robust. Nutrition and oral hydration should be patient-driven but there is a basic need for fluids.”
The Nice proposals recommend that medical staff in hospitals identify a list of symptoms and signs, as well as any changes, which could suggest that a patient is nearing death.
A plan for the care of the patient will then be drawn up and this could involve the withdrawal of food and fluids.
A spokesman for Nice has emphasised that the guideline is a draft which has been put out for public consultation.
He said: “We welcome any comments from healthcare professionals and stakeholders, as well as members of the public as they inform the final guidance.”
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