Archive for the ‘UK’ Category
November 6, 2012
In the light of the recent criticisms of the Care Pathways in the UK, this case of the “Do Not Resuscitate” orders by doctors – against the patient’s wishes – and Janet Tracy’s subsequent death is more than a little disturbing. She was suffering from terminal cancer but her death was surely accelerated by the DNR.
When a patient’s death is apparently deliberately caused – by inaction and prematurely – by the “policies” of a hospital (and its doctors), we are entering into the murky realm of institutionally mandated executions.
I don’t live in the UK but the National Health Service is held up as a model in so many other countries that what is practised at hospitals in the UK today will be quickly justified and adopted in many other places.
The Independent:
Doctors twice placed ‘do not resuscitate’ orders on medical notes of Janet Tracey, against her and her family’s wishes
A dying woman was “badgered” by doctors so much about agreeing to a do not resuscitate order that she was reduced to terrified tears, her husband said today.
Janet Tracey, 63, had been determined to fight cancer but within days of being admitted to hospital after a car crash, she became “anxious and distressed”.
“At one point she told me they were trying to get rid of her and I told her not to be silly, which proved to be a mistake. She was panicked. They were questioning her all the time about a DNACPR (do not attempt cardio-pulmonary resuscitation order),” her widower David Tracey told the High Court today as he explained that he and his daughters asked for the order to be removed.
Days later, on 7 March last year, Mrs Tracey died after second DNR was placed on her files, explicitly against her family’s wishes. …..
Something is not quite right if the death of a patient – even a terminally ill patient – is caused deliberately and prematurely – whether by action or by inaction – against the patient’s wishes. This comes perilously close to an execution being mandated by an institution’s “policies”.
Related articles
Tags:Addenbrooke's Hospital, Care Pathways, Do not resuscitate, institutional execution, Janet Tracey
Posted in Ethics, Medicine, UK | 1 Comment »
November 1, 2012
I have posted earlier about the disturbing ethical questions with the “Care Pathways” in the UK which operate in the grey zone between euthanasia and execution.
But it is more than just disturbing when UK hospitals run by NHS trusts apparently get financial benefits if they increase the number of terminally-ill patients who are put onto the so-called “Care Pathways”. Once someone is “put on a Care Pathway” they are effectively written off. Medication may be withdrawn, water and food may be withheld and any chance of continuing to live or of any recovery are removed – intentionally – from the equation. “Care” is provided but now with the intention of causing death. The sooner such patients die the better the use of resources!
I cannot see how any “Care Pathway” where there is an incentive to ensure that a patient dies and dies quickly can be anything other than an intentional termination of life. But is it euthanasia or is it murder or is it an execution?
Where the patient truly wishes to die it is effectively euthanasia. But where the patient would wish to live if he could only get better we get into a dangerous zone between euthanasia and execution. Can all attempts to “make the patient better” be abandoned by a hospital because someone other than the patient has decided that the patient cannot get better? When it is relatives who are pushing to get the patient onto a “Care Pathway” it comes close to murder. And when it is the hospitals or the hospital staff who are “incentivised” to get the patient onto the “Care Pathway” it gets close to being an execution. The decision to put someone onto a “Care Pathway” is itself then an irrevocable sentence of death. Why not – having passed sentence – just give them a quick, quiet lethal injection after putting them on a “Care Pathway”? Why go through the charade of care while ensuring the patients rapid demise? The 33 hours these patients survive on average after being put on a “Care Pathway” could be reduced to zero. Why not provide incentives to hospitals to
- maximise the number of patients put onto a “Care Pathway”, and then
- minimise the amount of time spent on such a Pathway?
This could get rid of many hundreds – if not thousands – of problematic and elderly patients who only absorb resources, no longer provide any useful contribution to society and are just a pain for their relatives. It would not be a very large step to converting the corpses to Soylent Green.
The Telegraph:
The majority of hospitals in England are being given financial rewards for placing terminally-ill patients on a controversial “pathway” to death…
Almost two thirds of NHS trusts using the Liverpool Care Pathway have received payouts totalling millions of pounds for hitting targets related to its use, research for The Daily Telegraph shows.
The figures, obtained under the Freedom of Information Act, reveal the full scale of financial inducements for the first time.
They suggest that about 85 per cent of trusts have now adopted the regime, which can involve the removal of hydration and nutrition from dying patients.
More than six out of 10 of those trusts – just over half of the total – have received or are due to receive financial rewards for doing so amounting to at least £12million.
At many hospitals more than 50 per cent of all patients who died had been placed on the pathway and in one case the proportion of forseeable deaths on the pathway was almost nine out of 10.
Last night the Department of Health insisted that the payments could help ensure that people were “treated with dignity in their final days and hours”.
But opponents described it as “absolutely shocking” that hospitals could be paid to employ potentially “lethal” treatments. ……
Tags:Care Pathway, Euthanasia, execution, Liverpool Care Pathway for the dying patient, murder, NHS, NHS trust
Posted in Behaviour, Ethics, Medicine, UK | 2 Comments »
October 17, 2012
An article in The Telegraph caught my eye while watching the US Presidential debate at my hotel.
A rather disturbing development in the UK and I don’t like the ethics of the situation. Euthanasia is voluntary but I am not sure that the Liverpool Care Pathway is. It is a pathway which leads to the death of the patient /victim in about 33 hours. I wonder who this pathway serves? At first sight it seems to be primarily for the benefit of hospitals and doctors and health care system costs. Perhaps for relatives.
The Telegraph:
Mary Cooper, 79, died a few days after being put on the Liverpool Care Pathway at the Queen Elizabeth Hospital in King’s Lynn, Norfolk.
The pathway, originally designed to ease the suffering of terminally ill cancer patients in their very last days, is being used more and more widely in NHS hospitals.
The idea behind the LCP is to give patients a ‘good death’ by avoiding unnecessary and burdensome medical interventions.
However, there have been accusations it hastens death because it can involve the removal of hydration and nutrition.
The LCP leads over 100,000 people to death every year – just in the UK. It smacks of execution of the elderly for convenience.
Daily Mail:
There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP. …. Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’.
An assisted death for someone who does not wish to die is an execution.
Tags:ethics, Euthanasia, execution of the elderly, Liverpool Care Pathway, National Health Service
Posted in Behaviour, Ethics, Medicine, UK | 3 Comments »
October 8, 2012
Thirty years ago when living in the UK I was a daily purchaser of The Times. Three years ago I was a daily visitor to the The Times website and an occasional purchaser of the newspaper (around 30 copies per year when I was travelling). Then they introduced their hard paywall and I abstained. But withdrawal symptoms did not last too long and I don’t miss them very much – if at all. In fact, the absence of The Times from my daily reading has had far less impact than I would have imagined. Nowadays it is very rarely that I find any references to articles in The Times that I would like to follow up on. The Times is no longer the paper of record in the UK and its restricted access makes it of little value as a reference for others.
I have a theory that the simplistic introduction of paywalls is not the model which will work for a very complex behavioural change in reading and news gathering and reference habits that is currently evolving. I suspect that the successful models will probably be those that involve an expansion of what can be viewed freely, but where this expanded readership can then be enticed into an increase in the purchase of valuable downloadable content. Restricting the initial readership – I think – can only lead to a collapsing spiral of interest and a destruction of brand value. The total circulation of The Times today for both the online and the paper versions together is less than the paper circulation before the paywall.
In an article actually about the Bonniers struggling to find their own model, Svenska Dagbladet writes about The Times:
It is well understood that for putting value on journalism it is central to be creative in the development of payment models. However, there are some really bad examples. Worst of all is the newspaper that really listened to Jeanette Bonnier.
End the free reading! Close the store! If you want to read, you must pay!
Which paper was that then? A certain paper called The Times, owned by Rupert Murdoch / News International. Just over two years ago they introduced a so-called hard pay wall. Not a thing was released over the fence without payment. The decision to completely close the site for open access – and even to the search engines, which they were forced to back down from the other week – possibly was by following Jeanette Bonnier’s intuition. Or was it a way for Murdoch to provoke the industry to act. Either way, it was a gigantic failure.
Before the pay wall The Times Online had 21 million readers each month. Today, they have … drum roll! … 130 000 paying customers. Nowhere else in the history of journalism have so many readers – and so many advertisers – been scared away so effectively.
Even more interesting is the effect on the paper version. Its circulation during the same period fell from 570,000 per day to 397000. It is much more than what other newspapers have lost.
The explanation?
- A brand fatally weakened as fewer and fewer read the content, and
- Subscribers to the paper version shifting their allegiance to the much cheaper on-line, pay-walled version
The result was fewer subscribers, sharply lower revenues and a significantly depleted brand. And that’s what happens if you’re looking for simple solutions to handle a complex situation.
I have the strong “guesstimate” and rather more than just a belief, that if The Times had increased their online (free) readership they could have bucked the trend and even increased their paper circulation – by offering more content in the paper version where such content was also available on-line – but for a fee.
Tags:brand equity, media, Paywall, Rupert Murdoch, Subscription business model, Svenska Dagbladet, Times
Posted in Behaviour, Media, UK | Comments Off on The Times’ paywall has destroyed its brand equity and its circulation
October 3, 2012
Large public contracts in India are often plagued by claims of favouritism, rigged specifications to suit a particular bidder, rigged evaluations, bid cancellations, vicious publicity campaigns by the protagonists and innumerable rebids. It is not uncommon for high profile complaints by a bidder after losing a bid to lead to a reversal of an award decision. The more high profile the complaint is and the closer in time a complaint is to an election, the more likely it is that a reversal of a decision can be achieved. The sales process in India does not end when a contract is awarded and any self-respecting sales manager does not stop until he has tried all available avenues to reverse an award decision which has gone against his bid. The primary avenues available are through approaches to politicians and the bureaucrats involved in the evaluation and award (and these approaches are not always without the appropriate lubricating flows of money). For politicians, the bureaucrats are both the potential scapegoats and the potential justification for reversals of decisions. For good and bad, the Indian Civil Service is modeled on the British Civil Service and the interactions between politicians and bureaucrats in India today have their roots in the methods of the British Raj. Bidding flaws and reversals of contract awards are usually a good indicator for the presence of corruption.
Phases of approval reversals
This story in the UK where high profile complaints from Richard Branson and Virgin Rail has led to the reversal of a decision to award a contract to a competitor could be a story lifted directly from an Indian newspaper. I note that in this case the politicians who have reversed their decision are using bureaucrats as their scapegoat. Who else? And when they make a new award they will surely justify their new decision on the pronouncements of other, more senior bureaucrats. It would seem that the methods of UK politicians and bureaucrats even today are not so different from those of their Indian counterparts. In India though, the opportunities afforded to bureaucrats and politicians by the bidding process have been raised to a much higher level.
The Telegraph:
Government cancels West Coast Mainline contract due to ‘flaws’ in bidding process
FirstGroup’s contract to run the West Coast Mainline has been cancelled by the Government due to “significant technical flaws” in the bidding process, which will be re-run. Transport Secretary Patrick McLoughlin said that the flaws “stem from the way the level of risk in the bids was evaluated”.
Tags:bidding process, Civil service, contract reversal, FirstGroup, India, Richard Branson, UK, Virgin Trains, West Coast Main Line
Posted in Business, Corruption, India, Politics, UK | Comments Off on UK cancellation of rail contract is in the style of Indian contracts
August 10, 2012
Three days of competition left and then I can get back to a normal routine again. But Usain Bolt and David Rudisha were well worth waiting for last night. And behind David Rudisha in the 800m came two unheralded teenagers. What is left to say about Usain Bolt? The sprint double at successive Games is unprecedented and will not be repeated for a long time. From day one – and long before the athletics had even begun – it has been the Usain Bolt show even if the Team GB performance has been quite remarkable. Almost a fairy tale for the host nation. The organisation of the games has – to all appearances – been a great success. Journalists still look for negative stories but London has coped and coped quite easily. But London 2012 will be – should be – known as the Bolt Games.
Of course Usain Bolt has the 4 x 100m relay yet to come but that does not carry the majesty that the 100m and the 200m does. Rudisha vs. Bolt at the compromise distance of 400m could be interesting.
But – and without any disrespect to the proponents – there are far too many events which just don’t feel Olympian to me. I think I would prefer to see the emphasis on the performance of individuals. Faster, higher, stronger. All team events then feel wrong. This would remove football and hockey and volleyball and handball and basketball and beach volleyball. Even the doubles events in the racquet games would go (and do we really need three racquet games?). Wrestling and boxing are surely enough of the “combat sports” without having to suffer the judo and Tae-kwon-do bouts. Even wrestling has become quite unintelligible for the uninitiated. Pairs and fours in rowing could go. Events where performance is entirely subjective have no place here I think. This would remove artistic gymnastics and synchronised diving for example. And synchronised swimming would die a natural death if it was not an Olympic event. The equestrian events are interesting and dressage is an equine ballet that can be a joy to watch. But for riders to be feted for the performance of their horses seems a little ridiculous.
The Olympics must be the celebration of individual performance – I think – rather than team performances (with their nationalistic overtones).
Faster, Higher and Stronger!
And Tae-kwon-do, Wrestling, Judo, Water polo and all team events would be the first to go if I could choose.
Tags:David Rudisha, London 2012, Olympic Games, Usain Bolt
Posted in Sport, UK | Comments Off on The Bolt Games are coming to an end …… and some events need to go
July 29, 2012
Maybe it’s just teething troubles on Day 1, but yesterday’s coverage of the cycling road race was pathetic. Coverage of the boxing was bad and the rowing and swimming graphics were amateur. Their choice of pictures generally from their many cameras managed to miss many of the critical moments.
Olympic Broadcasting Services – OBS – provides all pictures from the Olympics to broadcasters around the world.
Of course, OBS is a wholly-owned subsidiary of the International Olympic Committee and hosts the broadcasting operation for several major sporting events.
The coverage was amateur rather than incompetent – but for the premier sporting event it needs to be at a different level. It certainly cannot get much worse.
The Guardian
Tags:IOC, London 2012, OBS, Olympics, TV coverage
Posted in Sport, UK | 1 Comment »
July 28, 2012
London 2012 has begun.
London 2012
A pretty good start with the opening ceremony last night. The industrial revolution and the molten metal and the rise of the rings was superb.
Execution was fine but I thought the NHS section was ill conceived and Mr. Bean was a little self-indulgent. The Queen and James Bond was actually nondescript. It was an impressive bit of film making – but only because it was the Queen. Her corgis did well. Home crowd of course but not a very “sporting” reception for some of the “unknown countries”. Excusable because some of the “countries” were not countries at all.
The “Former Yugoslav Republic of Macedonia” sorted under “F” was ridiculous but that can be put down to the IOC rather than to the London organisers.
The Beijing opening ceremony was far more spectacular but humourless. Some of the London themes were more “socialist” than at Beijing. Beijing was trying to hide its “socialism” while London seemed to be doing the opposite. The ceremony had some humour – but some of which fell flat.
The raising of the rings in London though will stick in my memory.
Blogging will be extremely light for the next 3 weeks.
Tags:Beijing, London, Olympics, Opening ceremony
Posted in Sport, UK | Comments Off on Olympics have started – blogging will be light
March 25, 2012
The UK press led by Murdoch’s Sunday Times – is going to town with the story.
But why is anybody surprised?
The Tory Party co-treasurer, Peter Cruddas, was caught on film by some intrepid Murdoch reporters from the Sunday Times pointing out the benefits of paying for access. He has now resigned – for being caught on tape it would seem. He surely did not resign for doing what was expected of him in his job.
“One hundred grand is not Premier League… it’s not bad… But two hundred grand to 250 is premier league… what you would get is, when we talk about your donations the first thing we want to do is get you at the Cameron/Osborne dinners.”
“It’ll be awesome for your business. You’ll be… well pleased. Because your guests will be photographed with David Cameron. We do that, you know.”
“If you’re unhappy about something, we will listen to you and put it into the policy committee at number 10 – we feed all feedback to the policy committee.”
(more…)
Tags:Cash for access, David Cameron, Peter Cruddas, political corruption, Sunday Times, UK corruption
Posted in Corruption, Ethics, European Union, Politics, UK | Comments Off on Who’s surprised? £250k for dinner with Cameron and Osborne and some policy input
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