Thursday, October 29, 2009

British doctors engaged in ‘slow euthanasia’ for patients with terminal illnesses

Patients with terminal illness are being heavily sedated by doctors before their deaths in a form of “slow euthanasia”, research suggests. A poll of nearly 3,000 doctors found that almost one in five had administered infusions of drugs to keep patients unconscious for hours or days at a time.

In appropriate doses, sedatives and strong painkillers are considered a valuable way of easing the pain and anxiety of patients who are dying with conditions such as cancer. But 18.7 per cent of British doctors polled said they used drugs to invoke “continuous deep sedation” in a dying patient, a practice which in other countries is seen as an alternative to legalised euthanasia.

GPs and hospital doctors who are not palliative care specialists were more likely to report using high doses of sedatives or painkillers to keep patients asleep, leading to calls for all doctors to have mandatory training in the care of dying patients. Guidelines for care at the end of life emphasise that doctors should always act in a patient’s best interests and act within the law, which prohibits euthanasia or actively helping someone to die.

The study, published in the Journal of Pain and Symptom Management, also found that of the sample of 2,786 doctors, those who strongly supported the legalisation of assisted suicide were nearly 40 per cent more likely to employ continued deep sedation than the average. By contrast, doctors who reported strong religious beliefs or who actively opposed changing the law were less likely to report sedating patients before death.

In most cases sedation was used for between one and seven days or less than 24 hours. But in a significant minority of patients — 8 per cent — doctors reported sedating patients for more than a week before they died.

Clive Seale, a professor of medical sociology who led the study at Queen Mary, University of London, said that deliberately keeping patients unconscious until death was controversial, with some physicians viewing it as a form of “slow euthanasia”. “Sedation in itself not directly kill a patient, but it does put them to sleep and is associated with other things such as the withdrawal of fluids and ventilation,” he added. “In this country it can be seen as a form of treatment to relieve intractable suffering but in the Netherlands and Belgium, doctors also see it as an easier alternative to legalised euthanasia.”

Most doctors who sedated patients reported using midazolam, a drug which in high, continuous doses can cause loss of consciousness and memory loss. But nearly a quarter of those surveyed also reported using only opiate painkillers such as morphine or medical forms of heroin to sedate patients, which experts said suggested they misunderstood the effects of the drugs.

Rob George, of the Association for Palliative Medicine, said that rather than deliberately acting to bring on a patient’s death, some doctors may be misreporting the effect of the drugs. “Some doctors who are not specialists may be confused and incompetent in using these drugs but the study suggests they are misunderstanding what they are doing as well. "Dying patients are more likely to be drowsy or asleep in their final days and doctors might assume wrongly that this is a result of medication. “It does not mean that they are hastening a patient’s death. But we do have ample evidence that many doctors do not know what they are doing when it comes to palliative care, and whether or not [dying patients] get good control of their pain and symptoms is a lottery.”

The National Council for Palliative Care, which funded the study with medical charities, estimates that 300,000 people die each year without getting the specialist care and pain management they need. Simon Chapman, director of policy at the council, said that sedation was recognised as an appropriate part of end of life care for some patients.

An official for the Patients Association said: “There is no doubt that the vast majority of patients’ families who contact us after a death do so because they are haunted forever by watching their loved one not have the necessary care, including sedation. “It is imperative that everyone considers making a living will to make your views about end of life care clear and understood. “At the moment you have more training in pain relief as a vet than a doctor.”


Half of British doctors 'too busy using computers to look patients in the eye'

America's got some great things to look forward to under Obamacare!

Nearly half of GPs claim they are too busy to look patients in the eye during consultations, according to a shocking poll out today. A survey of family doctors found that 38 per cent are unable to give patients enough eye contact because they are spending so much time tapping information into their computers to meet Government targets. They say a third of their time with patients is spent on paperwork or data inputs - meaning there is less time to listen to patients.

Although the average length of consultations has increased in recent years, GPs are now working an average of seven hours a week less since a lucrative new contract negotiated in 2003.

The study also showed that half of GPs say their primary care trust did not actively support their practice in offering high-quality patient care, and 27 per cent said they were ‘actively obstructive’.

Last night critics said doctors would be able to spend more time with patients if they worked a bit longer.

The survey of 600 GPs in Pulse magazine found the computer-based work - such as the recording of data to meet Government targets - has left doctors struggling to deliver patients' personal care. Much of the information they are forced to input leads to bonus payments under the performance-related part of their contract.

The poll found that 38 per cent of GPs said they were unable to give patients enough eye contract during consultations. They said that just over half of each consultation - 55 per cent - is now spent speaking to patients and addressing their needs, while a third is spent on paperwork and data input.

Almost all - 97 per cent - said consultations had become more complex and intense over the past five years, with three quarters saying complexity had 'greatly increased'. Although the length of consultants has been increased to an average of 11 minutes, the GPs surveyed said they really needed 14 minutes to give the best service to their patients.

Dr Robert Baker, a GP in Swanage, Dorset, told Pulse that the bureaucratic burden was affecting the doctor-patient relationship. 'I could do with being split in two to manage prevention and curative aspects; both of which I am expected to address, for multiple systems, in 10 minutes,' he said. 'The demands of the patient's agenda, the Government's agenda and the requirement that everything I hear, say and do must be meticulously recorded make for an extremely crowded consultation.’

But Vanessa Bourne, of the Patients Association, said: 'GPs are the gatekeepers to all other healthcare. Patients must be able to trust that an accurate diagnosis is being made. At the very least that means having a proper look at the patient. 'If PCTs are to blame for the wrong priorities in a consultation, then patients risk being shortchanged twice over - once by their GP and again by the PCT. ‘For over a quarter of GPs to feel that their PCT is being “actively obstructive" tells patients that urgent action is needed.’

Richard Hoey, editor of Pulse, said: 'GPs' consultations with patients may have got a little longer, but they've failed to keep pace with the steep rise in computer work and the growing complexity of cases, as patients are managed in the community rather than in hospital. 'With 101 things to squeeze into a consultation, it's the personal elements that are being squeezed out - and that includes the real basics such as making eye contact with the patient.'


Reid's public option plan splits Democrats

Senate Democrats remain divided over Majority Leader Harry Reid's plan to establish a national health insurance program run by the government, signaling that Capitol Hill leaders could have a difficult time scraping together enough votes for passage. Sen. Joe Lieberman of Connecticut, an independent who typically votes with Democrats, became the first to declare that he would join a Republican filibuster to block passage of a bill that enacts a national public option. But he left room for negotiation, saying he doesn't oppose state-based programs or cooperatives.

Other moderate Democrats in both the House and Senate remain skeptical of plans to establish a government insurance program over concern that it would add to the federal deficit and increase private insurance rates, but didn't go so far as promise to block it. Many are waiting to see the details in the text of the bill, which hasn't been released yet.

Mr. Reid's announcement Monday that he would pursue a public option in his health care reform bill re-energized liberal Democrats, who say the plan is the only way to drive down costs and truly reform the nation's health care system. But all 40 Senate Republicans are expected to vote against the bill and any procedural votes required, meaning Democrats would need to keep all 60 of their members within the fold to overcome a filibuster.

Mr. Reid, Nevada Democrat, told reporters he thinks Mr. Lieberman and other Democrats will come around. "There are a lot of senators, Democrat and Republicans, who don't like part of what's in this bill," Mr. Reid said. "We're going to see what the final product is. We're not there yet."

In the House, conservative "Blue Dog" Democrats have been skeptical of the plan's cost and another group of 40 pro-life Democrats say they will block the bill from getting to the floor unless they are promised a chance to debate their proposal to ban government funding of abortions.

House leaders are trying to determine whether they have support for a "robust" public option, which is favored by liberals and reimburses doctors based on Medicare rates, plus 5 percent. There is wider support for a public option that negotiates its own rates with health providers, but it saves less money.

House Speaker Nancy Pelosi of California encouraged Democrats to come together to support the bill in a caucus meeting Tuesday and told members she expects the bill to be released this week, with floor debate beginning next week.

In the Senate, Democrats are already crafting alternatives in case their proposal to allow states to "opt out" of the public plan doesn't do enough to generate moderate support. Sen. Thomas R. Carper of Delaware is floating an "opt-in and opt-out" alternative that would only establish the public plan in states with expensive insurance rates or little competition and later allow other states to join or leave the program. "There's some senators, Democrats, who aren't going to vote for a public option in all 50 states," he said, calling the opt-in and out-out plan, "more acceptable to some of our centrists."

Republicans have pledged to vote against the reform plans if they include a public option, arguing that the proposals would drive up costs for people who already have health insurance and lead to a government takeover of the health care system. "We know that it will include a half a trillion dollars in Medicare cuts," Senate Minority Leader Mitch McConnell of Kentucky said of the pending legislation. "We know it will include $400 billion in new taxes. And we know that independent - independent groups taking a look at the effect on the insurance market have indicated that insurance for the 85 percent of Americans who have insurance - health insurance is going to go up."


Constitutionality of health overhaul questioned

On top of all the other obstacles facing President Obama in his quest to pass health reform is this one: Does the U.S. Constitution allow the government to require uninsured Americans to buy medical insurance or impose a tax penalty if they refuse? Congress has never before required citizens to purchase any good or service, but that is what both House and Senate health bills would mandate.

While this debate has been overshadowed by other issues involving the plan's nearly $1 trillion cost and its government-run option, the constitutional argument strikes at a pivotal part of the health care plan's finances. To make a government-run health care plan work, the nation's largely uninsured young adults would need to be covered to help subsidize medical care for older and typically less-healthy Americans, legislators say.

House Speaker Nancy Pelosi dismissed the complaint Thursday when she was asked by a reporter if the Democrats' health reform proposal was constitutional. "Are you serious? Are you serious?" Mrs. Pelosi replied.

But House Minority Leader John A. Boehner said the argument could not be ignored. "I'm not a lawyer, and I'm certainly not a constitutional lawyer, but I think it's wrong to mandate that the American people have to do anything," he told reporters at his own press briefing last week.

The question of the mandate's constitutionality "hasn't been part of the public debate, but the legal community has been debating it. It's been on all the legal blogs," said Michael Cannon, director of health-policy studies at the libertarian Cato Institute. He said "the Constitution does not grant Congress the power to force Americans to purchase health insurance."

In 1994, the nonpartisan Congressional Budget Office noted that a "mandate requiring all individuals to purchase health insurance would be an unprecedented form of federal action." "The government has never required people to buy any good or service as a condition of lawful residence in the United States," the CBO said. The statement was part of an analysis of then-President Clinton's ill-fated health care reform plan, which also required that all Americans purchase health insurance plans.

More here

Fraud plagues government health care

Two recent headlines convey a disturbing contradiction: "Medicare fraud: A $60 billion crime" ("60 Minutes"), and "Reid to announce push for public option" (Politico). The former is the latest in a long parade of similar articles about Medicare, the government's biggest health care program. The latter updates liberal Democrats' continued effort to expand government health care despite its long and dreary record of waste and fraud.

Indeed, Medicare corruption has been so extensive for so long that the terms "federal health care spending" and "waste, fraud and abuse" are virtually synonyms. In May 1986, for example, Department of Health and Human Services Inspector General Richard Kusserow reported that in the prior six months 65 people were convicted of attempting to defraud Medicare, Medicaid or Social Security, with savings of more than $50 million as a result. During his long tenure as the department IG from 1982 to 1991, Kusserow unearthed hundreds of millions of dollars in fraud and helped gain convictions of thousands of people.

Nothing much has changed in the 23 years since Kusserow's 1986 report. Last Sunday, "60 Minutes" broadcast a devastating segment featuring a depressing progression of government and private lawyers, law enforcement officers, auditors, investigators, and people convicted of Medicare fraud explaining why and how ripping off Medicare has become one of the easiest and most profitable crimes in America.

One of the criminals explained that Medicare management was so lax that he got $150,000 by claiming reimbursement 10 times for a "gas-powered prosthetic arm." The same criminal said there are "thousands" of companies in the Miami area being paid for such fraudulent claims every day. A lawyer with extensive experience defending those accused of Medicare scams told "60 Minutes" that Medicare fraud is bigger than the drug trade in South Florida.

Predictably, Attorney General Eric Holder told "60 Minutes" the government needs a bigger budget and more employees before it can stop the fraud. But HHS has worked for more than two decades to clean up Medicare fraud and currently has more than 63,000 employees. If, after working all those years -- with the Justice Department, FBI and state authorities -- HHS still can't stop Medicare fraud, why is hiring more people and fattening up the department's budget going to do the trick?

Kusserow told the San Francisco Chronicle in 2003 that every time the government nailed one abuse, three new ones soon took its place. We hear a lot these days about companies that are "too big to fail." We should worry even more about government that has grown too big to do anything but fail.


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