Saturday, September 19, 2009

Vera’s story must be a warning to us all

This is the title of a feature article in this week's Catholic Herald. The writer, Felicity Smart, relates how she and her husband were left very concerned at the application of the Liverpool Care Pathway to their elderly friend.

She writes:
I ask about intravenous hydration and almost hope to be told that there would be no benefit, because then withholding it would be justified and I could stop asking questions. But the nurse says that in a case such as this, hydration is only given if the relatives request it because it just prolongs a life that would otherwise end sooner rather than later. So Vera could benefit from it.
"It just prolongs life!" So denying it shortens life!

Dehydration also causes distress, so:
A tube is inserted in her arm, which must be for pain relief - not only for the inflammation, but probably to allay the pain of dehydration. Pain relief is also a sedative. Dehydration, and the additional painkillers for it, could shorten her life.

During the course of discussions, Felicity Smart was told that her elderly friend, who was conscious at the time of admission, was informed by a doctor that
no further treatment (my emphasis) was possible, surgery being too risky for someone so frail.

Quite rightly, Felicity asks
if Vera know that "treatment" now includes nutrition and hydration. Did she really want to be dehydrated to death?

To which there was no answer.

The conversation with the palliative care specialist is also worrying:
She tries to tell me that very ill people don't want fluids anyway, so withholding them is not unkind. But did Vera know that dehydration is painful? Ah, but pain relief can make her "comfortable" (a word used several times as a euphemism for this kind of death).

This patient was treated according to the Liverpool Care Pathway, described as "the gold standard of care for the dying" and which "is being rolled out across the NHS.

Now I understand that care in these situations is an immensely complicated matter. If the patient's body is rejecting or not processing food and hydration, I daresay its administration can be ceased. But if the patient can use liquid, its administration is no more extraordinary than the pain relieving substances that are administered intraveniously.

I think we all need to ensure that we are registered with the Patients First Network that advised Felicity about the questions to raise with the medical professional.


  1. My dad was in a hospital near Liverpool when he had a 'bad turn' when he was suffering with cancer. We all went up to see him and prayed for him and he made a recovery but when we got there there was no 'nursing care'. His food and liquid was on a tray away from his bed untouched as he couldn't reach it. When I said something to the nurse in charge, she said to him 'he must keep his fluids up' but how was he to do that when they hadn't put them near enough for him to get them. And also they gave him his food but failed to put his false teeth in to eat with. Just basic nursing care. I think if we hadn't been there he probably could have taken a turn for the worse but as it was he was able to come home and live quite a few more months before passing peacefully away at home. But I felt sorry for the elderly in there who had no relatives to keep an eye on them.

  2. She tries to tell me that very ill people don't want fluids anyway, so withholding them is not unkind. But did Vera know that dehydration is painful?

    It might not have mattered to her if she did Father. My mother just died of ovarian cancer and despite all of my pleading, cajoling, encouraging and nagging she simply refused to eat and would only occasionally drink. She did want popsickles and I got her a big box of them and would help her eat as many of those as she could handle. Towards the end she simply couldn't eat those either.

    As for an IV, my mother did have one of those and a PEG tube for a while but the site on her arm was all bruised and swollen and she couldn't tolerate it. She was also nauseous all of the time and we were always trying to find the right balance to ease that.

    If she had been at home 100 years ago, she simply would have died in a lot of agony. I'm glad that at least in her nursing home we were able to abate her pain somewhat. But even with the efforts of hospice we were not entirely able to even control that and her last hours were still full of suffering.

  3. Thank you Elena for your very good comment, which illustrates the Church's teaching that it is not necessary to intervene agressively to prolong someone's life.

    When a patient refuses food and drink, one does not need to force it upon them. It is probably a sign that they cannot process it. And if her arms are bruised, clearly to find further spots for an IV drip would be cruel.

    Another case entirely is if a decision is made to deprive the patient of hydration and food when they are still able to process it and do not refuse it.

    I was talking today to a seminary student who had experience of a patient whose medical team had decided to withdraw fluids because she was 'terminal'. The family were concerned and, in the end, the medical team reluctantly agreed to restore the supply. The patient lived for a further 5 years.

    Each case needs to be taken on its merits. While we are not required to seek to prolong life by agressive means,any decision whose only motive is to hasten death can never be justified.

    Sounds like your mother was treated properly and in a dignifed manner.

    My own mother repeatedly removed the tube that was fed through her nose and down to her stomach. While she was lucid, we were able to explain to her that it was for her good, and she agreed to it being restored, even though the medical team were against it. A time came, of course, when such feeding was impossible.


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