Dehydrate dementia patients to death to save money: British Medical Journal editorial

LifeSiteNews ^ | 07/16/12 | Hilary White

[Dr. Brian Kopp]

Dehydrate dementia patients to death to save money: British Medical Journal editorial

by Hilary White, Rome CorrespondentMon Jul 16, 2012 15:38 EST

July 16, 2012 (LifeSiteNews.com) – The courts should not interfere with doctors who want to dehydrate to death incapacitated patients who are a drain on scarce financial resources, according to an editorial in this week’s edition of the prestigious British Medical Journal.

Raanan Gillon, emeritus professor of medical ethics and former chairman of the Institute of Medical Ethics governing body, wrote that a ruling last year by the High Court against dehydrating an incapacitated patient to death was “profoundly disturbing” because it took the life and death decision-making power out of the hands of doctors and required that the principle of the “sanctity of life” take precedence over other considerations.

The judgment, he said, “threaten[s] to skew the delivery of severely resource-limited healthcare services towards providing non-beneficial or minimally beneficial life prolonging treatments including artificial nutrition and hydration to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment”.

He complained that the ruling required that, under the “stringent” Mental Capacity Act, in order to remove “life prolonging treatment” like a feeding and hydration tube, the patient himself must have left a legally binding “advance decision” in writing, and that previous casual or unrecorded statements to relatives were not sufficient grounds. 

The editorial, titled, “Sanctity of life law has gone too far,” said that unless it is overturned, the court ruling “will gradually and detrimentally distort healthcare provision, healthcare values, and common sense.”

Its logical implication, Gillon wrote, is that “doctors should no longer decide, in consultation with those who know their incapacitated patients, whether life prolonging treatment including artificial nutrition and hydration will be in their patients’ best interests.”

Furthermore, he said, the ruling logically means that those patients in “a higher than minimal state of consciousness must be similarly protected”.

The court ruling in question was that in the M Case, in which the family of a 52-year-old woman who was found to be in a “minimally conscious state” and who was “otherwise clinically stable,” were petitioning the court to have her feeding and hydration tube removed. The Court of Protection ruled that all patients in such a state must be referred individually to the Court of Protection if “life prolonging treatment” by artificial nutrition and hydration is to be withheld or withdrawn.

Mr. Justice Baker said in the September 2011 decision, “The factor which does carry substantial weight, in my judgment, is the preservation of life. Although not an absolute rule, the law regards the preservation of life as a fundamental principle.”

Justice Baker wrote that the courts should not “attach significant weight” to the patient’s previous statements unless they had been expressed in a way that could stand up to legal scrutiny. As in the case of Terri Schiavo in the U.S., M’s family had argued that her alleged previous statements indicated that she would not want to be dependent on such care.

Baker responded to this by ruling, “[Given] the importance of the sanctity of life, and the fatal consequences of withdrawing treatment, and the absence of an advance decision that complied with the requirements previously specified by the common law and now under statute, it would in my judgment be wrong to attach significant weight to those statements made prior to her collapse.”

Anthony Ozimic, communications manager for the Society for the Protection of Unborn Children, said that the ideology being espoused by Gillon and the British Medical Journal is indistinguishable from the materialist utilitarian ethic that led to the elimination of the “unfit” by eugenicists in the early 20th century, including in pre-World War II Germany. 

“What is particularly disturbing about Professor Gillon’s opinions is that he is judging certain disabled people as having lives unworthy of life, balancing those lives against the needs of other patients and seeking to justify killing the disabled on the grounds of rationing,” Ozimic told LifeSiteNews.com.

“Such a utilitarian calculus is in substance no difference to the calculus made during World War II by the German authorities: that the disabled should die so that wounded soldiers could live. In any case, assisted food and fluids are basic nursing care, not futile medical treatments.”

As shocking as such pronouncements are to the general public, the idea that disabled patients should be euthanized, either directly or by the removal of food and hydration, is actually a mainstream of thought among many of the western world’s medical ethicists. Gillon himself is a major voice in the field as a former editor of the Journal of Medical Ethics and the author of the 1985 book “Philosophical Medical Ethics”.

Classical medical ethics, that held as paramount the principle “Do no harm,” has in large part been set aside in favor of the new utilitarian-based Bioethics, a formal or “normative” branch of ethical philosophy that seeks “the greatest good for the greatest number” according to the “principles” of “justice, beneficence and autonomy”.

[Dr. Brian Kopp]

Friday, 13 July 2012

People with severe dementia should be starved and dehydrated to death to save money says BMJ editorial

There is an editorial in the British Medical Journal this week by a retired professor of philosophy titled ‘Sanctity of life law has gone too far’.

Raanan Gillon (pictured) reviews the case of M, a woman in minimally conscious state, who was the subject of a court of protection ruling last year.

I have written about the case before on this site, both before and after the judgement, and spoke to the Telegraph about it earlier today so I won’t repeat all the details again here.

Essentially the judge decided that M’s feeding tube should not be removed as she did not have a valid and applicable advance directive in place. Instead he gave priority to preserving her life.

Gillon didn’t like the judgement for two reasons.

First he felt that the judge ‘did not accord “significant weight” to the patient’s previously expressed values, wishes, and views’. But in fact these were not sufficiently clear and in the absence of a clear statement of the patient’s wishes, Justice Baker was simply giving precedence to the preservation of life over uncertain autonomy.

Second, Gillon was unhappy that decisions about starting or stopping life prolonging treatment, including the withholding or withdrawal of artificial nutrition and hydration, for all incapacitated patients should be brought to the Court of Protection. But in so doing the judge was simply acting in accordance with precedent laid down in the Tony Bland case (involving a man in persistent vegetative state) and outlined in the Mental Capacity Act 2005.

Gillon’s real problem is that he doesn’t like the current law and considers that the lives of some seriously brain-damaged people are not worth living. He thinks that giving nutrition and hydration to people with severe brain damage or dementia is not beneficial and that they should have this basic care withdrawn and allowed to die.

His real reasons come out later in the editorial:

‘The logical implications of this judgment threaten to skew the delivery of severely resource limited healthcare services towards providing non-beneficial or minimally beneficial life prolonging treatments including artificial nutrition and hydration to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment. The opportunity cost will probably be reduced provision of indisputably beneficial treatments to people who do want them.’

Now this statement is very interesting indeed as M was not actually demented, just seriously brain damaged. In addition she had some degree of residual brain function.

It is noteworthy that Gillon is very selective in his reporting of these facts and conveniently does not mention that M had some awareness of herself and her environment, some understanding of language, occasionally spoke, appeared to be able to appreciate some things that were said to her and responded to music. Although she regularly experienced pain, this was not constant or extreme, and her condition was stable. And unlike dementia patients, who are terminally ill, she had a non-progressive condition.

Gillon's suggestion, that severely demented and brain-damaged people should be sedated, starved and dehydrated to death on the basis of their friends and relatives vague and contradictory recollections of 'what they would have wanted' would create a most dangerous precedent and place us on a very slippery slope indeed.

His implication that we should be withholding nutrition and hydration from such people so that we can spend the money elsewhere is chilling and demonstrates precisely why we don't give doctors, politicians and most importantly philosophers (like Gillon!) the power and authority to make such decisions on utilitarian grounds.

People who are severely brain-damaged or suffering from dementia, but not imminently dying, should be given nutrition, hydration, symptom relief and warm human interaction until the day that they die peacefully and naturally.

We don’t kill them either by giving them lethal injections or dehydrating them to death and we ensure that there is adequate legal protection in place so that no one who has an interest in their deaths, whether financial or emotional or to get rid of an unwelcome care burden, should be able to exploit or harm them in any way.

The law is there primarily to protect vulnerable individuals from exploitation and abuse and as such it needs the strength to deter individuals and institutions who have something to gain, financially or otherwise, from another person's death.

It does not need changing and the involvement of the Court of Protection in difficult cases is a necessary and effective safeguard.

[Lady Lucky]

Lives not worth living = not worth anything to him.
Allowed to die when they are not even dying = killed.

[Dr. Brian Kopp]

Coming to an ObamaCare Independent Payment Advisory Board (IPAB = Death Panel) near you soon!

NATIONAL REVIEW ONLINE

IPAB, Obamacare’s Super-Legislature

By Michael F. Cannon & Diane Cohen

June 15, 2012 4:00 A.M.

EXCERPT:

The individual mandate isn’t Obamacare’s only unconstitutional provision, or even its most unconstitutional provision. That distinction belongs to the Independent Payment Advisory Board. A heretofore unreported feature of this super-legislature makes it even more authoritarian and dangerous than anyone knew.

IPAB consists of up to 15 unelected government “experts.” Its stated purpose is to restrain Medicare spending. If projected spending exceeds certain targets, Obamacare requires IPAB to issue “legislative proposals” to reduce future spending. Those proposals could include drastic cuts that jeopardize seniors’ access to care, leading some critics to label IPAB a “death panel.”

But the really dangerous part is that these are not mere “proposals.” Obamacare requires the secretary of Health and Human Services to implement them — which means they become law automatically — unless Congress takes certain steps to head them off. Congress may replace the Board’s proposal with its own cuts, at least initially. But Obamacare requires a three-fifths vote in the Senate to pass any replacement that spends more than the Board’s proposal. In other words, to override IPAB’s proposal completely, opponents must assemble a simple majority in the House and a three-fifths majority in the Senate and the president’s signature.

That makes IPAB more than an advisory board. It’s a super-legislature whose members are more powerful than members of Congress. If eight members of Congress propose a bill, all that’s necessary to block it is a majority of either chamber, or one-third of either chamber plus the president.

Worse, Obamacare forbids Congress to repeal IPAB outside of a brief window in the year 2017 — and even then requires a three-fifths supermajority in both chambers plus a presidential signature. Under Obamacare, after 2017 Congress could repeal Medicare, but not the board it created to run Medicare. Congress and the states could repeal the Bill of Rights — but not IPAB.

What kind of laws will these super-legislators impose? Obamacare supposedly prohibits these super-legislators from raising taxes or rationing care. Yet those restrictions are unenforceable and meaningless. For instance, the statute lets IPAB define “rationing” and protects that definition — along with the secretary’s implementation of IPAB’s edicts — from administrative or judicial review. The prohibition on raising taxes is likewise toothless. IPAB can raise taxes as surely as it can cut Medicare spending.

In effect, Obamacare gives IPAB the power to raise taxes, spend money, place conditions on federal grants to states, and exercise other powers the Constitution reserves solely to Congress. If the Supreme Court upholds Obamacare’s mandated Medicaid expansion, states may soon see IPAB imposing similar mandates on states. And if President Obama fails to appoint any IPAB members, all these powers fall to Secretary of Health and Human Services Kathleen Sebelius...

[basil]

Coming soon to a hospital near you.

I’m sure I don’t need to tell you that dehydration is a painful thing—very painful.....

[muawiyah]

Raanan Gillon should be among the first to personally undergo this treatment to demonstrate the efficacy of this policy ~ as soon as possible.

Time is being wasted.

[eak3]

To even have this discussion shows how disgusting and vile humanity has become.

[Adder]

Why not just stab ‘em to death? Why make them suffer? Afraid you will spend too much washing the sheets?

D!ckhead...hope its you one day.....

[musicman]

Help End The Obama Era In 2012
Your Monthly and Quarterly Donations
Help Keep FR In the Battle!

Sponsoring FReepers are contributing
$10 Each time a New Monthly Donor signs up!
Get more bang for your FR buck!
Click Here To Sign Up Now!

[Doe Eyes]

Coming soon to a hospital near you.

If you don't have money or insurance, you should die. Who is willing to pay for the deadbeats?

[faithhopecharity]

Why in hell did the Brits try to defend themselves in WW2?
The Nazis would have provided the same standard of “medical care” for them....

[Dr. Brian Kopp]

When my mother-in-law was dying of cancer last summer, a nurse with the local hospice thrust a sheet of paper into my wife's hands with the following text (because we insisted on continuing a simply IV for comfort measures, as my mother-in-law was frequently complaining of thirst in her last two weeks of life and had lost the ability to swallow):

Changing Pattern of Feeding and Hydration Needs in Terminal Care

[snip]

Dehydration is nature at work and can bring relief from distressing symptoms such as
Hiccough
Abdominal Bloating
Vomiting from increased stomach secretions
Pressure from the tumor causing pain
Shortness of breath
Lung congestion
Rattling secretions
Impaired consciousness

There are certain circumstances where some of these statements may be true, but to use this across the board to discourage or refuse simple IV hydration among all cancer patients is wrong.

I won't even go into the details of the battle we had to fight just to get her the IV in the first place.

[Fred Hayek]

All you need is a fast and loose definition of dementia.

Look up how Yuri Andropov utilized the “psychiatric hospitals”.

[Dr. Brian Kopp]

If you don't have money or insurance, you should die. Who is willing to pay for the deadbeats?

Food and water are basic human rights, not medical treatments that can arbitrarily be withdrawn at whim. Denying folks water and food is murder.

By the way, this is a pro-Life forum.

[a fool in paradise]

The NAZIs began with terminating the patients they thought were a drain on society and then expanded that program to gypsies, Jews, and further expanded it to troublemakers and those who refused to go along with the program.

The Weather Underground figured they would need to kill 25 million Americans who would refuse to be “re-educated”.

[Talisker]

Dehydrate dementia patients to death to save money: British Medical Journal editorial

Demons.

[Dr. Brian Kopp]

Indeed.

Under ObamaCare, voting for the wrong party might eventually be interpreted as a sign of dementia...

Why any retiree or anyone nearing retirement would vote for Obama is beyond comprehension.

[Talisker]

If you don't have money or insurance, you should die. Who is willing to pay for the deadbeats?

Shut up, scumbag.

[yefragetuwrabrumuy]

To offer government healthcare, then to use that system to kill patients negates any justification for it in the first place.

At this point, religions need to enter the situation as “no kill” caregivers, who, while not offering technological dehumanization, either, will only tolerate natural death.

The only thing the government has to do is to offer people a choice. It does not want to do this, because now it has an effective monopoly over life and death. And it invariably chooses death.

[familyop]

Hmmm. At the other end of the default process, we could dehydrate the more educated members of the political sturgeon class.

[WashingtonSource]

Dementia patient don’t actually require much “medical care” — they just need plain old care from nurses’ aides and plain old caregivers. So, the whole premise is buncomb.

[a fool in paradise]

Under ObamaCare, voting for the wrong party might eventually be interpreted as a sign of dementia...

Communist nations have been known to lock up political prisoners in insane asylums. It discredits their beliefs and permits them to be tortured with electric and chemical shock treatment, sleep deprivation, psychotropic drugs, and locking them up together with the criminally insane.

[Doe Eyes]

Denying folks water and food is murder.

So hospitals should be required to provide food and water to dieing people free of charge. Many sufferers of dementia would also require food and water via IV. Who pays?

What about antibiotics?

Cancer treatments?

When do you cut off the deadbeat losers without insurance or money?

[Leep]

If you don’t have money or insurance, you should die. Who is willing to pay for the deadbeats?

---

Its not the government’s decision to make. PERIOD.

[Dr. Brian Kopp]

religions need to enter the situation as “no kill” caregivers, who, while not offering technological dehumanization, either, will only tolerate natural death.

This movement is starting. I'm involved in it. But we have one heck of an uphill battle ahead of us.

[Dr. Brian Kopp]

At some point, when you no longer pay into the system, you too will be a “deadbeat loser.”

Hope for your sake dehydration is as much fun as the death peddlers are trying to convince us it is.

[Doe Eyes]

Hope for your sake dehydration is as much fun as the death peddlers are trying to convince us it is.

Who do you propose pay for these people?

Obamacare?

[Dr. Brian Kopp]

We already pay for them, without ObamaCare.

Before the government usurped this role, families, churches and communities took care of them. After this government and culture collapses, families, churches and communities will once again care of them.

"The measure of a civilization is how it treats its weakest members."

You individually don't measure up, judging by the drivel you're posting on this thread.

[cableguymn]

already happened here. terry schivo.

[GOPJ]

Being deprived of food and water is a form of torture.

The only reason for killing a person by torture is to 'comfort' the doctor doing it. He can have the illusion the death is 'natural'. It's not - there's nothing 'natural' about being starved to death.

Doctors need to man up.

If doctors are going to kill patients they ought to have to balls to do it right - take them down to the basement and shoot them - it's less painful for the patient and a whole lot more dignified...

[RetiredTexasVet]

Doesn’t sound like the Court of Protection does much protection .... sorta like a death panel, but that term might be too accurate.

[Doe Eyes]

We already pay for them, without ObamaCare.

So all people do, or at least should receive the medical care they require, and it should be provided for by the government, families, churches, communities ...

Do you really believe that all people in the United States actually get the medical treatment they need? Are you kidding?

[GreyFriar]

These two articles just prove that Sarah Palin didn’t know what she was talking about when she said that Obamauncare would have death panels. (sarc off)

[Dr. Brian Kopp]

The only reason for killing a person by torture is to 'comfort' the doctor doing it.

Not necessarily true. I know a number of doctors who routinely have to sign off on cases because they refuse to participate in the family's wishes to kill a patient. Too few physicians stand up against this growing euthanasia movement, but heirs are just as much a force in the growth of this movement as the physicians themselves. Don't underestimate the childrens' desire that the estate survive their parents' illness as a driving force in these cases.

It was clearly the primary motive for the husband in the killing of Terri Schiavo.

[Lizavetta]

Oh, he's all for it.

Until the demented person is his parent, child or other person he loves.

[cableguymn]

well that and he wanted to run off with his new women and he was still married to Terri.

[Dr. Brian Kopp]

If doctors are going to kill patients they ought to have to balls to do it right - take them down to the basement and shoot them - it's less painful for the patient and a whole lot more dignified...

Did you ever notice that almost all legislation that outlaws physician assisted suicide also indemnifies from prosecution those physicians who kill their patients by withdrawal of nutrition and hydration and terminal sedation? Ever wonder at that? Then read on...

Repackaging Death as Life – The Third Path to Imposed Death

[Jude in WV]

AMEN, Dr. Kopp!

[Dr. Brian Kopp]

“The measure of a civilization is how it treats its weakest members.”

[GOPJ]

If you don't have money or insurance, you should die. Who is willing to pay for the deadbeats?

Don't kid yourself - 'the poor' vote democrat - same with drug addicts, alcoholics, street bums etc. They will get care - that's what 'ObamaCare' is all about - helping the folks who never did anything for our country but take, take and take some more. Dems want them to live long and healthy voting lives...

The people ObamaCare plans on 'offing' are old white people - the one's who have supported all these 'care' programs all these years - the responsible one - the one's with money... and with nice homes that can be taxed out of existence.

Trust me, ghetto dwellers, illegal immigrants, their families, the homeless, etc will be taken care of just fine... Gays are democrats too - they'll be fine. Gays have more health care dollars spent on them than any other group (per person). No expense will be spared - they vote dem and donate money. That will continue.

Again, the ONLY large group dems want to deny care to are white and elderly - and conservative. Think - the greatest generation - think - grandmothers...

[lovesdogs]

When do you cut off the deadbeat losers without insurance or money?

According to planned (non) parenthood, prior to their birth.

Seriously we are not talking huge expensive intervention...that might be a debate for another day. All we are talking is food and water. I would hate to meet the person who would deny a dying man a drink of water. That would have to be one mean miserable SOB.

[LibsRJerks]

Trust me, ghetto dwellers, illegal immigrants, their families, the homeless, etc will be taken care of just fine... Gays are democrats too - they’ll be fine. Gays have more health care dollars spent on them than any other group (per person). No expense will be spared - they vote dem and donate money. That will continue.

**
Yes, that is, until they run out of OPM.

Then what?

[Dr. Brian Kopp]

I would hate to meet the person who would deny a dying man a drink of water. That would have to be one mean miserable SOB.

Or a radical libertarian. But probably both.

[EEGator]

Primum non nocere.

[Doe Eyes]

I would hate to meet the person who would deny a dying man a drink of water. That would have to be one mean miserable SOB.

What about about antibiotics that would cure a serious infection?

[tbw2]

Obamacare - healthcare is a right, but life is not

[Dr. Brian Kopp]

Few medical schools today require students to recite the classical version of the oath.

Hippocratic Oath: Classical Version

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

[bgill]

Coming soon to a hospital bed near you.

[marron]

I’ve seen it happening here already.

[GGpaX4DumpedTea]

Raanan Gillon must immediately be determined to be insanly demented and refused all hydration.

[EEGator]

“But it may also be within my power to take a life;”

Does that mean on purpose?