Comment on: No system of nurse checks could 'prevent murder'
Of course it isn't possible to prevent 'all bad things' - regulators/trusts should not be blamed for things they could not reasonably have prevented, but they should be blamed for being incompetent (for example, by having clearly dubious systems in place). I don't know enough, to decide if someone 'was incompetent' here or not.
Anonymous | 21-May-2015 6:47 pm No, it is all 'very complicated' - 'asking' is very problematic. Which is why I'm less than enthusiastic, about 'a heavy reliance on EPaCCS', which seems to be the current idea for EoL at home (it might work, if everyone did talk to each other, so that EPaCCS did reflect 'what is going on' - but at the moment, there is no way that 'EPaCCS can know enough, and be up-to-date often enough'). My objection to the above piece - why I wrote my comment- comes from: “For older patients admitted to hospital with progressive or persistent levels of severe disability… clinicians might consider a palliative care approach to facilitate discussions about advance care planning and to better deal with personal care needs,” said the study authors. It isn't the clinicians who should be 'considering the approach' - the patient should, where possible, 'consider' the benefits or otherwise, of active v palliative. Saying that the clinicians have got to talk to their patients, and find out what the patients want, is exactly the opposite to 'the conveyor belt system of healthcare', by the way !
Clinicians might consider describing prognoses to the patient, with and without any possible/offered treatments, and then asking the patient what the patient wants - just a thought !
Anonymous | 20-May-2015 1:53 pm The issue of 'pain relief which MIGHT hasten a death' is just one of the things, which needs to be sorted out: in my opinion, so long as the situation is 'might' and not 'definitely will', then provided the patient is informed of the risk and asks for the pain relief, there should not be an issue (but the police, who seem to have a limited grasp of legal concepts, might disagree). I was reading the PHSO report 'Dying with dignity' yesterday evening: http://www.ombudsman.org.uk/reports-and-consultations/reports/health/dying-without-dignity I have asked the PHSO, if it would make clearer what it was saying about 'Mr J' - this is my e-mail to the PHSO: firstname.lastname@example.org Dear Sir or Madam, I heard the Ombudsman talking about your report 'Dying without dignity' on BBC Radio 4 yesterday morning, and I read the report yesterday evening (because I am engaged in 'this EoL debate'). Can you please clear something up for me ? When you describe the 'Mr J' case, on page 15, you tell us that: 'Two months later, Mr J was admitted to hospital because he was struggling to breathe. Once he was on a ward, his pain relief was stopped because it was thought he was becoming too dependent on it. He was started on pain relief again the next day, but by that point Mr J was severely agitated and in pain. He died in the early hours of the following morning. ' In your 'findings' you state: 'Mr J’s pain relief was inappropriately stopped' I would like to be 100% clear, about what you are saying (further on, you write 'In addition, we found that the clinicians treating Mr J recognised that he was at the end of his life but did not explain this to his family in a way they could understand.'). Are you stating, that THE CLINICIANS WHO 'stopped his pain relief because they felt he was becoming too dependent on it' KNEW WHEN THEY WITHDREW the pain relief, that Mr J would die within a few days ? Because IF THEY DID, then my comment is more 'visceral' than your 'inappropriately' - I've just sent an e-mail to Bee Wee at NHS England about 'Mr J' (see below my sign off), Regards, Mike Stone The PHSO says: 'Mr J’s pain relief was inappropriately stopped ' AND later 'we found that the clinicians treating Mr J recognised that he was at the end of his life '. It isn't 100% clear, whether the PHSO are saying that the clinicians who withdrew the pain relief, knew that Mr J was in the final days of life - I intend to ask the PHSO (which doesn't mean I'll get an answer). I don't apologise for my language, if they did - how the hell can someone be 'too dependent on pain relief' during the final days of life !!!
Steve, Getting these decisions about 'dying' from the patient, is very difficult at the best of times. But it becomes increasingly necessary - and is an increasingly urgent requirement - the close the patient is to dying. Currently, the NHS wants what I would describe as 'a formalisation of the discussions', which is very difficult even if the patient is in a hospital or hospice, and as an approach that is ABSOLUTELY HOPELESS if the patient is dying in his/her own home. The problems differ for mentally-capable and long-term demented [end-of-life] patients: but I won't go into how, here.