You can see the factual details taken from the Medical Notes.

Now Sir Andrew Cash OBE, Chief Executive of the Sheffield Teaching Hospital Trust Foundation has sent a letter to the Family of Thomas Milner nearly 4 years after his death.

Sir Andrew lists the time of set up and refill of the syringe driver which are INCORRECT – we have the Medical Notes!

He has upto now failed to acknowledge his errors. They are hiding.
Gross Errors were made.

The system is CORRUPT!

My father Thomas Milner – Case No. 6 of the Patients Association Report (http://www.patients-association.org.uk/) was NOT on the LCP – Liverpool Care Pathway.

He did NOT receive enough medication and went to his death twisting and turning, pulling at the sheets (this written in the Medical notes), with tears coming down his face.

The Palliative Care Consultant had failed to titrate (gradually increase) the amount of morphine in his syringe driver.

Palliative Care/MacMillan nurses wouldn’t give him anything 2 hours prior to death. We had to call G.P. to summon some help and a Junior Doctor arrived, doubled the dose in the syringe driver and Thomas Milner died 1 hour later.

The syringe driver from set up to death (55 hours) held ONLY 10mgs. morphine which the Healthcare Commission found to be ‘low in the circumstances’. The doubling of the dose (to 20mgs. )is NOT standard Palliative Care Practice.

I don’t think they really know what they are doing. Death like Birth cannot be endured according to ‘guidelines’ or ‘in vogue’ thinking!

God Help us All and Shame on Them!

I’ve been reading through the exchange of messages here. I’m desperately sorry for your loss and hope that you’ve found some little consolation between the loss of your daughter and now.

Anna

I’m in agreement with you on the current legally allowable method of allowing someone to die through malnutrition. I’ve been ill for years and would never allow the medical profession to starve me in the event that I am unable to make my own decisions so I’ve made a living will.

My argument is with the Houses of Parliament which would prefer to ignore the fact that starvation and thirst is an unpleasant way in which to die – although ameliorated in some cases by sedation – rather than have an honest debate as to whether Doctors might be permitted to assist a death – a short painless and decent death – when the patient requested it. If Church and State were separated, I don’t believe that we would be in this position.

I also argue extensively against the Mental Capacity Act which has handed power over such sensitive decision making to unknown persons conducted behind a veil of secrecy – when it is the one subject that should be coruscatingly transparent.

I am appalled. I thought a consequence of our going to war (70 years ago) was to stop states doing this sort of thing?

I do hope you are not assuming that if a patient had a next of kin you would be able to circumvent the Mental Capacity Act, because that simply isn’t true.

Whilst it has been the accepted practice, and simple common sense, for many years, to refer to the next of kin, it is not legally correct. The Act was essential simply because that common sense approach has never been legally correct. A next of kin has no more legal right to pick you up and decide to plonk you down in a residential home the other side of the country just because you are confused and unable to effectively resist than has any other person. We all have our own legal autonomy, and the Act theoretically extends that autonomy by proxy.

In the circumstances you describe – the elderly patient with dementia unable to give informed consent to be moved to the residential home, it is a ‘good thing’, not least for the nursing profession because it gives you legal power to do something that could be considered abduction and denial of liberty in other circumstances. However, the Act is equally capable of being used in less obvious circumstances and there is only obscure and difficult to operate redress for the person concerned who may not wish to be moved or have their monies controlled by others.

You will be aware that traditionally the law does not interfere with a Doctors opinion, except in exceptional circumstances. Were you therefore aware that when you sign the CP5 form

Firstly, the Mental Capacity Act is essential in some limited circumstances. As an example- an elderly gentleman who is increasingly confused with Alzheimer’s Disease. The Act enables him to make informed decisions about his care whilst he still has capacity to comprehend the situation, and to have these decisions respected in the future with his enduring power of attorney.

It is also useful to enable medics to make a decision in a patients best interests if they are unable to decide for themselves. Again as an example, this commonly occurs with elderly people with dementia who are admitted from home and unable to cope on their own anymore. They may be unable to give informed consent to be moved to a residential home and in this instance we would apply to the Court to nominate a third party to make decisions in the best interests of the patient. (assuming they have no next of kin). The Act allows a safe and transparent method of making difficult decisions in difficult circumstances.

With regard to the Liverpool Care Pathway (LCP), I completely disagree that we are doing patients a disservice in their last days by using his protocol.

A patient must fulfil stringent criteria to be placed on the LCP. The idea is that we do everything we can to give a patient a peaceful and dignified death. It is only used when the clinical prognosis is very poor ie less than a couple of days usually, and that they are unable to eat/drink safely or are unconscious (there are other inclusion criteria these are examples).

A patient isn’t simply left to rot, they are evaluated at a minimum of every 4 hours to ensure they are comfortable, pain free and that any symptoms are being dealt with. Yes, they often have a syringe driver because that is the least invasive to administer medications in semi-conscious people. To clarify a syringe driver may have any medicines in it, in a palliative setting this would commonly include anti-nausea drugs and pain killers which are titrated to effect.

I would disagree that we are inhumanely starving people- if they are unconscious then of course we won’t feed them. The average time a patient is on the LCP at my hospital is 23 hours before death- unlikely to be long enough to inflict the kind of suffering you describe. Additionally in the vast majority of instances, giving fluids will only delay death by a very short period.

I wholeheartedly agree with the line in the published letter ‘Experienced doctors know that sometimes, when all but essential drugs are stopped,

We release those convicted of terrorist atrocities on the grounds of compassion, but murder those in most need of compassion.

We release those convicted of terrorist attrocities on the grounds of compassion, but murder those in most need of compassion.

Brown’s Britain.

Isn’t that rather like saying ‘well it might have been murder, but the victim was a useless piece of scum so it doesn’t matter’?

The law that allows them to do that to someone who is in a coma also allows them to do that to someone who has had a stroke and is not able to demonstrate their mental ability, or someone who has always been considered mentally challenged, or any number of other categories of economically useless people.

Everyone will probably have a favourite category of perons to whom they wouldn’t mind it happening, I would imagine there are a few politiicans in that bracket – but when it is your much loved granny who has just had a stroke, you might feel differently.

And when it is you, I’ll guarantee you will feel differently.