Wednesday, 30 November 2011

Liverpool Care Pathway - A Must Do

If there's a 'Must Do' in the To Do List in your diary for December, then make it this and circle it round. Please register your support for these petitions -

Remember, complacency always permits the unthinkable to become thinkable and the unacceptable to become possible.

Register your opposition here:           

Register your opposition here:        

Register your opposition here:        


Please register your opposition here now:-

Please register your opposition here now:-

To stand by and do nothing while a wrong proceeds unchallenged is to be complicit in it.

Saturday, 26 November 2011

Liverpool Care Pathway – Does The Pathway Have A Heart?

“Any path is only a path and there is no affront, to oneself or to others, in dropping it if that is what your heart tells you.

“Look at every path closely and deliberately. Try it as many times as you think necessary. Then ask yourself, and yourself alone, one question.

“Does the path have a heart? If it does, the path is good; if it does not, it is of no use.”

- Carlos Castaneda; The Teachings of Don Juan

The heart of this path, if it has a heart, is to provide a merciful release from cruel shackles of pain that otherwise might make our last moments in this life an unbearable torture – for us to bear and for our loved ones to watch.

The Pathway was designed at the Marie Curie Hospice in Liverpool specifically for the terminally diagnosed patient and to recognise when a point had been reached that death was near or imminent so as to provide as peaceful and gentle path from this world as might be provided. These patients were already diagnosed to be dying from cancer; the Pathway was not the tool used to make that diagnosis, but a means - a 'pathway' to follow - to determine that point.

The LCP has become a path without a heart. There is no affront, to oneself or to others, in dropping it if that is what your heart tells you.

Friday, 25 November 2011

Liverpool Care Pathway – One Step Beyond A Bradburian Fantasesque

A Bradburian or Barbarian world?

Dignity in Dying requires a physician’s commitment to embark upon the role of the ‘merciful executioner’.

Physicians are under oath to protect life and to do no harm. Assisting with or involvement in the actual taking of life is not a role for physicians to consider or should take on.

Physicians should be mindful of maintaining choices. Keeping the options open is always an imperative. Assisting with or involvement in the actual taking of life is a denial of choice. It is a one-way route to a final destination.

Palliative care, necessarily, may involve administering pain relieving medication even if that hastens death. Assisting with or involvement in the actual taking of life, however, is something rather beyond that; it is the administering of medication with the prime directive of and in order to hasten death. That is a leap in the dark, a step into the abyss that will lead who knows where.

LCP is not tantamount to assisting with a suicide, of course; it is something rather beyond even that, though. It is the decision, with purposeful intent, to terminate a life taken on the behalf of another and others; it is medical professionals playing God with others’ lives.

It is medical professionals taking it upon themselves to conclude that a person in their care has reached Death’s threshold and is dying. It is medical professionals ‘diagnosing’ death and using LCP as the tool with which to accomplish this.

Medical misdiagnoses can have fatal consequences

Errors not rare

Medical errors are far from rare, according to several comprehensive studies of the issue.

But diagnostic errors - a subset of the overall problem - haven't received nearly as much attention as other medical errors since the nationwide patient-safety movement began in 1999 with the publication of the landmark Institute of Medicine report, "To Err is Human."

"Diagnostic error is barely on anybody's radar screen," said Dr. Mark Graber, 62, a nephrologist in Long Island, N.Y., and an expert on diagnostic errors.

The "To Err" report estimated that at least 44,000 and as many as 98,000 Americans die each year from all types of medical errors. More recent studies indicate there has been little progress since 1999, with as many as one in three or one in four hospitalized patients being harmed in some way by medical errors.

The statistics indicate as many as 9 million patients nationwide and between 400,000 and 528,000 patients in Illinois are harmed each year.

These unreal, fantasesque statistics from the Springfield Journal Register on misdiagnosis are not drawn from any Bradburian nightmare. Misdiagnosis can have fatal consequences.
Even so, misdiagnosis may result in any of many outcomes. Misdiagnosing death that results in being placed on the LCP will have only one outcome. LCP is a one-way ticket on the NHS (National-socialist Health Service) into the next world.

Thursday, 24 November 2011

Liverpool Care Pathway – A Bradburian Nightmare

Fahrenheit 451

So, this is the 21st Century. It is not at all how I envisaged the world of the 21st Century might be.
Fifty years ago, science-fantasy writer, Ray Bradbury, wrote a futuristic tale of a world in which firemen are called out, not to attend to and extinguish fires, but to start them.

Fifty years on, we are but one step from paramedics rushing to the scene of an accident, not burning with an altruistic fire ablaze in their stomachs to make a difference and save a life, but actually permitting a victim to die (or even assisting in the process?) in order to facilitate a DNR directive in the ‘Living Will’ End of Life Plan which will be made available to them via the National Database of patient medical
records. This,
despite scares regarding erroneous information being kept on patient’s records; in which case, if the wrong details were accessed, or had been incorrectly inputted onto the system, the victim would not be revived. The victim would be a victim, indeed, of circumstance, the system and of common sense!

Fifty years on, we are, perhaps, just two steps from police crisis negotiators rushing to the scene of an attempting suicide and, not ‘talking them down’, but ‘pushing them off’ - persuading them, not to falter, but to jump! This, not literally, perhaps, but metaphorically, in order that their right to die might not be infringed but respected and complied with in line with a new ‘right to die’ assisted suicide law.

That is not so bizarre as it may sound. A ‘Death with Dignity’ Act might require this, to give encouragement, support and, perhaps, even aid in this endeavour. Who else will be permitted the ‘right to die’ under such legislation, only those who are about to die, or those also who are finding life unbearable, not through physical pain but through mental anguish? 

Police crisis negotiators in Washington State - where Initiative 1000, the Washington "Death with Dignity Act" has been passed into law, a law that is almost identical to Oregon's assisted-suicide law – have been advised by social workers mindful of this legislation about being able to assist people in killing themselves. In keeping with making accessible all options now available in the state, a brochure from Compassion & Choices (C & C), the assisted-suicide advocacy group (formerly called the Hemlock Society) has also been distributed. Such paradoxical incongruities fall neatly within the scope of this Bradburian context.

In Bradbury’s envisaged world, suicide is not an uncommon event, also. And fifty years on, there is a final note of irony: our books are e-books and they are called kindles. Is that, perhaps, with which to kindle the flames?

All this; so strangely fitting and in step with Bradbury’s dark vision of fire-setting firemen it is that Mr. Bradbury must be wearing a wry smile as he looks down upon us from that great library in the sky.

Sunday, 20 November 2011

Liverpool Care Pathway – A Loss Of Touch With the Final Reality Of Life

“If society begins to think of old people as needing to be tidied up and allowed to die when their useful lives are over, then we are preventing people experiencing looking after their loved ones with tenderness.”

Ross Coward in Mail Online:

If ever there were proof of the folly of doctors playing God, it's this man's barbaric death

Last Christmas, I attended a carol service at a church in London. Amid the festive bustle, I sat opposite a woman and her elderly mother.

The daughter placed a tender hand on her mother’s shoulder and gently guided her through the carols, helping her remember words that were now fading from the old lady’s memory.

I watched as the daughter looked after this tiny, fragile little bird of a mother — so frail she looked as if a puff of wind might have blown her away.

I found myself fighting back the tears as I watched this poignant scene of traditional roles reversed: daughter caring for mother.

It was a moment that encapsulated the very best of humanity.

Yet how it contrasts with the truly horrific story reported this week of Jack Jones, 76, a grandfather who beat cancer, then was wrongly told his disease had returned.

After this mistaken diagnosis, he was left to die at a hospice which has pioneered the controversial ‘death pathway’, under which dying patients have their life support taken away.

If ever there were a case illustrating the folly of doctors playing God, this was it.

A retired bricklayer, described as ‘a true gentleman’, Mr Jones had food and fluids withdrawn.

He died within two weeks — only for a post-mortem examination to reveal that he died of pneumonia, not cancer — an illness which could have been treated with antibiotics.

It is a shocking case. His widow Pat described his treatment as ‘barbaric’ and was this week awarded an £18,000 payout over her ordeal.

She has accused the doctors of manslaughter, while the hospice continues to deny liability.

It seems clear that the hospice did, indeed, make a terrible mistake — Mr Jones’s time had not yet come.

Of course, there is no compensation for the loss his wife has suffered. But this horrendous train of events is our loss, too, for it demonstrates just how far our society has degenerated, hastening our elderly as quickly as possible towards a neat and tidy death.

Official measures introduced to bring dignity to death and end long, drawn-out suffering appear to be going terribly wrong.

These policies came out of the same approach as the right-to-die movement.

The arguments sound so humane: perhaps people should be allowed to die more quickly. We should avoid pain around death in old age. Suffering should not be prolonged unnecessarily.

And yet, old age and dying is not always a negative experience. Indeed, they should be treated as part of life — not as a problem in need of a solution.

Because along the way, through caring for our elderly properly, we find something in ourselves that is very rewarding.

With my brother and sister, I care for my 86-year-old mother Sybil, who suffers from dementia.

She has lost her memory and has become increasingly frail. Caring for her is not without difficulties. Chasing your elderly parent into the bathroom to wash is an emotional minefield.

But looking after my mother has also been an opportunity to do things for her with love and affection, which was more difficult when life was rushing by.

It has not always been easy, but through looking after my mother in her declining years, I have discovered in myself a real compassion, empathy and tenderness — something tragically denied Mr Jones’s two daughters by Britain’s over-eager policy makers.

If society begins to think of old people as needing to be tidied up and allowed to die when their useful lives are over, then we are preventing people experiencing looking after their loved ones with tenderness.

As a society, we risk losing something of immeasurable value.

We have let our hospitals and social workers become obsessed with a person dying, and how to manage and control the actual moment of death. This is entirely the wrong focus.

Hospitals should not be concentrating on which people to save and which to let go, but on gentle care of the elderly.

They should be looked after with love. This might sound idealistic — but shouldn’t we be idealistic in this, if nothing else?

We have forgotten that elderly people are living — they need to be cared for and cherished, and in the process we can learn so much about empathy and the human condition.

Now, however, the medical profession has reached a point where scientific advances mean they can keep people alive, when in less advanced situations they might have died.

Sometimes life is being prolonged almost beyond nature. But to conclude that we should therefore stop intervening and allow people to die is a dangerous leap that we should not allow. It is nothing short of sanitised euthanasia.

Of course, there are situations where people have terrible illnesses, such as motor neurone disease. While I have extreme reservations about the right-to-die movement, it is understandable that these people might not want their suffering prolonged. But the great mass of our elderly population is simply old — with the accompanying decline in health one might expect.

What worries me most is that our elderly will begin to think they should die because they don’t want to cause unnecessary suffering or become a burden on their families.

Where will it end? Mr and Mrs Brown at the end of the road have cancer, should they be bumped off? Then what about their old neighbours — are they becoming a burden to their children, should they do the decent thing?

In general, it is shocking that we look after our old people so badly. I know from personal experience that carers of the old receive nothing like the support available to parents with young children.

When looking after your elderly parents, you have to battle. Everything conspires against you tending to them with dignity and respect.

Our elderly are often not allowed to stay in their own homes, where they would rather live.

Instead, they are made to sell up, they are herded into old people’s homes or hospital wards — and they are put away to die.

We regard the old as somehow repellent. It is perhaps the flip side of a society obsessed with the perfect body: you mustn’t have wrinkles or sag — above all, you must not look old.

We have lost our respect for the old. The elderly can give us so much — experience, wisdom, perspective and love. But increasingly, we give them so little.

That has led directly to the horrendous death pathway — such a convenient euphemism for denying food and medicine.

So much better economically, too — a group of doctors recently wrote to a newspaper regarding the policy, saying that ‘we are not discussing how we care for old people, just how we pay for them’.

In a stark warning, Professor Peter Millard, emeritus professor of geriatrics at the University of London, said: ‘The Government is rolling out palliative care — which is helping people die happy. 

'What we should be doing is rolling out support to help them live. What is going on could be seen as backdoor euthanasia.’

There is a feeling that the dying should hurry up and die, a ‘let’s get this over with’ mentality that devalues our society and betrays our elderly.

Our natural inclination is to cling to life, to fight — it is a strong instinct, and we should not let it be overruled by hospital managers who seek to usher our loved ones out of the final door with unseemly haste.

We must stop the inhuman attitude which led to the death of Jack Jones becoming all-pervasive — before it is too late.

Liverpool Care Pathway – Putting Names To The Faces And Faces To The Victims

Treating someone as a category instead of as a person.

Classifying someone as a candidate for the LCP places them in a particular category. Once they have been boarded on the bus, it blinkers the conductor’s vision to any other eventuality - that, perhaps, they may have been given the wrong ticket. The Pathway has a predetermined destination which finality cannot be emphasised enough. Fact: Death really is the final finality in life.

There are stories and reports of the LCP being a ‘Lazarus Care Pathway’ but these are cases where the patient recovers despite the treatment recommendations of LCP; what proportion of patients do not recover because of the treatment recommendations of LCP?

These recommendations do not pay attention to the symptoms as they present but actually advise to ‘Avoid Delay & Crisis’ by prescribing, even in the absence of the symptom(s), to pre-empt the predicted appearance of the symptom(s)!*

*(End of Life Care - Symptom Control documents from NHS Milton Keynes)

Intrusions and interventions are also discontinued under these treatment recommendations.

“It is one thing to discontinue an intravenous infusion when the end is imminent; quite another to restrict fluids based on a prediction of how much longer a patient has to live.”

The correlation to draw from this statement is that it is unsafe to withdraw an intervention solely on the basis of a prognostic forecast. Prediction is always a hit and miss affair, as any astrologer will tell you!

Then, how unsafe must it be to proceed with an intervention on the same basis? What are the real statistics? Can we know when outcomes are predetermined by therapy and the ‘therapy’ is to place the person on a Pathway to a predetermined destination which really is a final destination?

This is Mail Online:

My husband had beaten cancer, then doctors WRONGLY told him it had returned and sent him to a hospice who let him die

A grandfather who beat cancer was wrongly told the disease had returned and left to die at a hospice which pioneered a controversial 'death pathway'.

Doctors said there was nothing more they could do for 76-year- old Jack Jones, and his family claim he was denied food, water and medication except painkillers.

He died within two weeks. But tests after his death found that his cancer had not come back and he was in fact suffering from pneumonia brought on by a chest infection.

To his family's horror, they were told he could have recovered if he'd been given the correct treatment.

Pat Jones and her late husband Jack
Death pathway: Jack and Pat Jones pictured about ten years ago. Jack was left to die after
doctors decided his 'cancer' was terminal and stopped feeding him

Yesterday, after being given an £18,000 pay-out over her ordeal, his widow Pat branded his treatment 'barbaric' and accused the doctors of manslaughter.

Mr Jones was being cared for at a hospice which was central to the contentious Liverpool Care Pathway under which dying patients have their life support taken away, although the hospice claims it wasn't officially applied in his case.

The scheme is used by hundreds of hospitals and care homes, and is followed in as many as 20,000 deaths a year.

Supporters say it brings dignity to a patient's final hours, but critics fear that some are placed into it incorrectly.

Mr Jones, a retired bricklayer with two daughters, was diagnosed with stomach cancer in May 2005. After undergoing chemotherapy, he had his stomach removed by surgeons at Royal Liverpool Hospital that September.

He was told he was in remission from cancer, but the grandfather of two continued to suffer pain following the operation as well as difficulties in eating, and on January 3, 2006, he went to the city's Marie Curie hospice for respite care.

While there, however, his family were told the cancer had returned by Dr Alison Coackley, a palliative medicine consultant who played a key role in drawing up the Liverpool Care Pathway.

Despite the fact that no tests were carried out to confirm the diagnosis, his family say doctors instructed nurses to stop giving him food and fluids.

Misdiagnosed: Jack's widow Pat has been paid an £18,000 settlement
although health bosses refused to admit liability

The only medication he was permitted were painkillers, and he slipped into semi- consciousness without the chest infection being diagnosed and died on January 14.

But a post-mortem examination found he was free of cancer and had in fact died of pneumonia.

Reports commissioned by Mrs Jones's solicitor concluded that with antibiotics and a rehydrating drip he could have made a full recovery and survived for at least another two years.

The hospice and the doctors who treated Mr Jones continue to deny liability, but his widow has now accepted an £18,000 out-of-court settlement after being told she would otherwise lose her legal aid.

Yesterday she said: 'If they'd only treated his chest infection, my husband could well still be alive today.

'We fought in the hospice to get Jack the right treatment and they blocked us, making us feel we were a nuisance.

'I was worried it was pneumonia, I wanted them to check his chest, but they wouldn't.'

Mrs Jones and the family want to know whether her husband was treated under the Liverpool Care Pathway.

She added: 'Jack was the life and soul of the party. He was a true gentleman. As far as I'm concerned, his death was manslaughter. It's barbaric and I don't want any other family to go through what we've had to.'

The 75-year-old, of Childwall, Liverpool, plans to report Dr Coackley and another doctor to the General Medical Council. Dr Coackley, 45, worked with Professor John Ellershaw at the hospice in Liverpool at a time when he was heading the writing of the LCP policy.

One article they published together last year said: 'Futile treatments should . . . be discontinued at this time and consideration should be given to the discontinuation of antibiotics and blood tests.'

Mrs Jones's solicitor, Michael Danby, said: 'This is a particularly sad case as it was entirely preventable. If they had examinedhis chest, they would have diagnosed the infection, and he could have been treated.'

The hospice's lawyer, Dorothy Flower, said it had settled the case to enable Mrs Jones to grieve for her husband, but did not accept liability. 'Some things are done for economic reasons, and a case like this costs a huge amount of money, which would do nobody any good,' she said.

Marie Curie Cancer Care said it could not comment on Mr Jones's case due to patient confidentiality. However, it insists that the Liverpool Care Pathway requires doctors to monitor patients regularly.

Saturday, 19 November 2011

Liverpool Care Pathway – A Twenty-Eighth Amendment?

The LCP was originally developed in the United Kingdom and is now being implemented throughout the world with the support of the LCP Central team (UK).

There can be no-one who does not know of or is not acquainted with these famous lines:
Twenty-seven amendments have been ratified since the original signing of the Constitution, the first ten of which are known collectively as the Bill of Rights.

In order that the LCP may be introduced across the States, will it be necessary to ratify a further amendment, a twenty-eighth amendment - 

- the unalienable Right to Death?

Friday, 18 November 2011

Liverpool care Pathway – A Softening Up Strategy

In The American ThinkerRita L. Marker writes:

An Open Letter to Baroness Warnock on Assisted Suicide

When she said people with Alzheimer's should be able to appoint someone to request euthanasia for them, Britain's leading medical ethicist, Baroness Mary Warnock, caused a firestorm of controversy.   A similar, but little known, proposal was made by those in the forefront of Oregon's assisted-suicide law and the current Washington State initiative to legalize assisted suicide. 

The following open letter to Baroness Warnock explains how she will be far more likely to move toward her goal if she follows the Oregon model.  

Dear Baroness,

Your recent interview on a duty to die certainly caused a stir when you said you hope people will soon be licensed to "put down" those who are unable to look after themselves.         To hear the fuss from commentators around the world, one would think you'd never expressed that idea before.  But I imagine few people read about a lecture you gave at Giggleswick School in 1990 where you said virtually the same thing.  Truth be told, when I first read the account of that lecture in the Craven Herald and Pioneer, I thought it was a very bad joke.  Maybe that was due, in part, to the name of the school.  Not being a Brit, I didn't realize what a prestigious institution it is.  Still, I thought it was a bit radical to suggest that some people were "quite unambiguously entitled to end the life of those whose life chances are seen as very poor." 

I can see now that you really meant it then and that you haven't budged in your stance. However, in your latest call for designated death deciders you really went over the top when you pointed out that it would save money for the National Health Service.   And you hurt your own cause.  

Quite frankly, Baroness, it's time to face the fact that it has been eighteen years since you first voiced your proposal in an open forum and  you're no closer now than you were then to achieving your goal.  If you want to succeed, you really must change your approach. 

You may want to consider following a model that seems to be working here "across the pond." 

That model is from Oregon.  It started with a proposal much like yours.  In 1991, Senator Frank Roberts sponsored a measure (SB 1191) to permit "aid-in-dying," defined as "a medical procedure" performed by a physician "to end the life of a patient in a dignified, painless and humane manner."  Of course, it meant killing the patient with a lethal injection but, you'll note, that the soft phrase, "aid-in-dying," was used.  That's an important point since words like "euthanasia," "assisted suicide" or, as you say, "put others down" really turn people off.

Senator Roberts' legislative aide was Barbara Coombs Lee.  (Keep that name in mind, Baroness.  You really do want to emulate what she has done over the years.)  Lee worked to gain approval for the proposal.  But, despite the euphemistic phrases and Lee's hard work, the measure failed.  It had several fatal flaws that made it unpalatable.   

First, the printed version of the bill noted that it was sponsored "at the request of the Hemlock Society," making it far too clear that a special interest euthanasia advocacy group was behind it.  Second, it went too far, too fast.  It provided that an individual could give another person the right to "instruct my physician to provide assistance in ending my life in a painless, dignified and humane manner if I have a fatal disease such as advanced Alzheimer's disease that makes me unable to speak intelligibly...."

Sound familiar to you?   It should, since it's exactly what you're calling for. 

But, at the time, it was just too much for people in Oregon to swallow. 

The backers of the measure could have just kept proposing the same bill over and over, but they didn't.  Unlike your, dare I say, stubborn insistence on pushing for everything at once, assisted-suicide and euthanasia activists here learned from their failure.  They realized they had to change their image from that of Hemlockian activism to one of compassionate concern.

The players didn't change, but the script did.  Three years after Roberts' euthanasia-for-Alzheimer's-patients bill failed, Barbara Coombs Lee  became the chief petitioner for Measure 16, Oregon's "Death with Dignity Act."  By then she was vice president of a fast-growing managed care company and was working with Compassion in Dying (a spin-off of the Hemlock Society.)  Unlike the earlier legislative measure, this one went directly to the voters.  It was a scaled back proposal, permitting assisted suicide only (not euthanasia by lethal injection).  And it didn't make any provisions for a third party to request an incompetent patient's death.  Additionally, politically savvy campaigners made sure that the chilling name, "Hemlock," was  no longer attached to the push to legalize assisted suicide.

Another twist was added as well.  During the campaign prior to the vote, proponents of the assisted-suicide bill played on Oregon's anti-Catholic biases.  They deluged the airwaves, telling voters that the Catholic Church was behind all opposition to the bill and that one religion was trying to deny dying patients the right to choose death with dignity. 

The strategy worked.   Oregon's "Death with Dignity Act" passed by a vote of 51 - 49% in November 1994 and went into effect three years later.    

Baroness, can you see how this process works? 

It's really quite simple. 

Remember, you need to take things step-by-step; use carefully-chosen, comforting words to describe what you are proposing and find a bĂȘte noire (such as the Catholic Church or evangelical Christians).  Above all, you must be ready to make changes if something isn't working.

When Oregon's assisted-suicide law passed, those who share your views thought they would rapidly achieve similar victories, but that didn't happen.  In fact, in the ensuing years, Oregon-style laws were proposed in twenty-three states (multiple times in some of those states).  Yet, each and every one of them failed. 

That didn't stop your U.S. counterparts.  They forged ahead.  They solidified their organizational structure, changing their name to Compassion & Choices (by merging the Hemlock Society and Compassion in Dying).  And, most important, they collected "proof" that Oregon's law is working well.  

Under Oregon's law, doctors who prescribe lethal drugs for patients must file reports with the state and, then, that information is used to formulate official annual reports.  And, since Compassion & Choices has arranged and participated in 75% of the state's assisted-suicide deaths, it has maintainedcontrol of most information contained in annual reports.  (Oregon officials acknowledge that there is no way to verify whether the self-reporting by assisted-suicide-prescribing doctors is accurate or complete.) All that can be claimed with certainty, is that, after ten years of assisted suicide in Oregon, there have now been ten annual official reports which are, at best, questionable.  Nonetheless, this "proof" has become the most powerful tool for those who share your views.  They've been able to claim that there have been absolutely no problems or abuses. 

Baroness, you might think the Oregon statistics are not relevant to your efforts in Britain but, I assure you, those figures have and will continue to be an important part of the arsenal of anyone, anywhere, who is promoting assisted suicide and euthanasia. 

If you are wondering whether your statements - which have, until now, been counterproductive - have somehow disqualified you from being effective in the future, I want to reassure you. 

The same people who have previously failed can be very effective as long as they change their words and strategy.  Their experience with the 1991 euthanasia-for-Alzheimers'-patients proposal in Oregon did not require its early supporters to bow out of the action. 

For example, a few weeks ago, just as you were making your counterproductive "putting people down" statement, your far more savvy American counterparts - who are currently engaged in an assisted-suicide initiative campaign in Washington State (I-1000) - were pointing at Oregon as a model of compassion and choice.   In a letter to the editor of the Seattle Post-Intelligencer, former Oregon governor Barbara Roberts assured Washingtonians that "I-1000 is not a slippery slope."   Roberts is the widow of Senator Frank Roberts who, you recall, introduced the failed euthanasia-for-Alzheimers-patients measure. 

Omitted from her letter was any mention of the fact that, in Oregon, some patients are now being told that their health care plan will pay for assisted suicide, but not for life-saving treatment that their doctors prescribe. 

You see, Baroness, once an assisted-suicide law is passed, it can be used to save money.   But Roberts is smart enough to know that mentioning the cost containment aspect would cause Washington voters recoil from an Oregon-style assisted suicide law.   Instead, she painted the Oregon experience with rosy hues, describing "beautiful accounts of compassion, sharing, dignity and gentle exits." 

It should come as no surprise that she also failed to mention Barbara Coombs Lee's leadership in the Washington effort, even though Lee is the current president of Compassion & Choices, which has poured hundreds of thousands of dollars into the Washington State effort.  In a recent letter to supporters, Lee wrote, "Very soon - with your help, Washington State could be the next to pass an Oregon-style aid-in-dying law."   

By now you should realize that Lee has been very effective in the years since she first worked on a proposal that mirrored yours.  And, Baroness, you can also be effective.   All you need to do is remember a few crucial points: 
  • Be very careful with language. Use soothing phrases.
  • Don't try to achieve your entire goal at one time. Use a step-by-step approach.
  • Manufacture statistics. Use them to bolster your claims, whatever they are.
  • Portray any opposition as "anti-choice religious zealots."
  • Keep all focus on the current proposal. Never discuss your plans for expansion.
  • Always portray your motivation as caring and compassionate. Never, ever, let anyone know that you see legalized assisted suicide and euthanasia as a means of cost containment.
If you follow these few simple steps, you could be well on your way to achieving your end goal.  You might want to reflect on the sentiments expressed by Booth Gardner, the former governor of Washington State and the principle spokesperson for the current Washington campaign.  In December 2007, Gardner was interviewed by The New York Times Magazine.  According to that article:

Gardner's campaign is a compromise; he sees it as a first step.  If he can sway Washington to embrace a restrictive law, then other states will follow.  And gradually, he says, the nation's resistance will subside, the culture will shift and laws with more latitude will be passed...."
In closing, Baroness, I hope this advice has given you some guidance in how you can be more effective. 

However, more than that, I hope those who read this advice will see you as an ethics guru, grown arrogant by too much deference, whose agenda is a cold, cruel dismissal of the lives of those who are most vulnerable.  Furthermore, I hope they will recognize that Washington's assisted-suicide proposal and Oregon's law are rooted in the same mentality. 

Rita L. Marker

Rita L. Marker is an attorney and executive director of the International Task Force on Euthanasia and Assisted Suicide.
on "An Open Letter to Baroness Warnock on Assisted Suicide"

Rita L. Marker refers to the softening up of public opinion with innocuous terminology, association and appeal. The Liverpool care Pathway is part of the softening up strategy of applying euphemistic terminology to what is, in plain terms, nothing other than the decision with purposeful intent to terminate a life.