Archbishop’s response to the review of the Liverpool Care Pathway

18 Jul

Following the publication of the Review of the Liverpool Care Pathway, The Most Rev Peter Smith, Archbishop of Southwark and Chair of the Bishops’ Conference Department of Christian Responsibility and Citizenship, has made the following response:

“The Catholic Church has a long tradition of care for the dying combining acknowledgement of death with care for vulnerable patients. It was in response to concerns raised by Catholics and by others about end of life care in England and Wales that I called for an enquiry into the use of the Liverpool Care Pathway (LCP).”

“I welcome the report of Baroness Neuberger into the implementation of the LCP and the initial response to that report from the government. It is clear that the committee has taken its responsibilities very seriously and has listened to patients, relatives, doctors and nurses. The committee has sought to protect the positive aspects of the LCP while proposing a new more flexible and personalised framework of ‘end of life care plans’. This report and its recommendations are worthy of careful consideration.”

“From a Catholic perspective, the key issue is that, whatever pathway, plan or framework is adopted, it must be implemented ethically, with care for the patient always as the first priority.”

Related

More Care, Less Pathway A review on gov.uk of the Liverpool Care Pathway

Catholic Medical Association UK statement on the Liverpool Care Pathway

16 Jul

Catholic Medical Association (UK)

 

NEWS RELEASE

FOR IMMEDIATE RELEASE: TUES 16 JULY 2013

 

The CMA(UK) notes with huge sadness the deep anxieties about poor care which the Neuberger inquiry  into  the Liverpool  Care Pathway  has identified. Patients who are coming towards the end of their lives require the best possible care and excellent symptom control as well as careful review of their treatments to assure that they are appropriate.

 As Catholic Clinicians and Healthcare Professionals we support the need for high quality, personalised care for people at the end of their life, which enables them to die with dignity, free from pain and thirst.

It is vital for our society to get end of life care right.  We recognise that the Liverpool Care Pathway was well intentioned but as the Neuberger report has identified there have been problems with implementation where poor care has happened, or the pathway has failed. This has unacceptably harmed patients and their relatives at a time when the priority should be to give good quality care.

 Consistent standards and compassion are needed

As work progresses towards phasing out the Liverpool Care Pathway, care towards the end of life in the UK remains too much of a patchwork and we call on Government to ensure that consistent high quality standards driven by best possible evidence, strong clinical practice, motivated by compassion and love for the human person are put at the centre of the care of patients approaching death whether in hospital, hospice or the community.

Tick box and formulaic approaches to the care of the dying are not acceptable. Any Care Pathway which is not underpinned by training, commitment, resourcing and effective clinical practice will be likely to fail. It is vital that support of those who are dying is based more clearly upon individual assessment of need which is regularly repeated and where treatment and care is shaped and adjusted accordingly.

The elements of good care towards the end of life

 Good care towards the end of life is not so much about death, rather it is about how someone lives in their last months, weeks and days.

 Patients who are coming towards the end of their lives require the best possible care and excellent symptom control as well as careful review of their treatments to assure that they are appropriate. The CMA therefore strongly supports the principles and good practice of palliative care.

The true outcome of care is comfort, dignity and living as well  as possible while people die. As well as that, preparation for and acceptance of death  is important for many.

In many ways “End of Life Care” is a misnomer which prompts people to think that the outcome of care is death.  “Palliative Care towards the end of life” is a better term than “End of Life Care” which would focus minds better upon living well until someone dies, with the excellent palliative care that it necessarily entails.

Our clinical experience and practice convinces us that the emphasis in end of life care must be placed upon needs of those who are dying rather than decisions based solely around prognosis.

Deprivation of consciousness (inappropriately sedating people) is a serious issue that is contrary to Catholic teaching and which deprives people of time with their loved ones as they die.

The CMA is committed to delivering best possible care

As work progresses towards a better way  of supporting people who  are coming towards the end of their lives, the CMA wishes to express its deep  commitment towards the best possible care in all clinical situations, from those dealing with the whole of people’s lives to those where patients are possibly approaching death.

We attempt to work with all systems of Health Care to improve the delivery of care using the Catholic Christian model for (the) excellence of care according to the inviolable nature of the dignity of the human person. We feel that Catholic insights on the dignity of the person, providing care from compassion tailored to the individual, and ensuring people can spend their last weeks and months in dignity are insights the healthcare system needs to re-learn.

 

Useful  Questions for Relatives and Families and Carers to ask

Relatives, families and carers of patients should be seen as partners in care at end of life.  While we work to improve care towards the  end of life care, we suggest  the following questions that  patients and their families may  find helpful  as they  discuss their loved ones care with  doctors and nurses to  ensure that  care is appropriate .

·         Are you sure that death is imminent?

·         Can the patient give consent to the treatment proposed?

·         Will the treatment reduce consciousness?

·         What effects will the treatment have, including the combined effects of the drugs proposed, and their effectiveness in reducing severely troublesome symptoms?

·         Will you assure that the patient will not experience thirst and can fluids be given by mouth or another way?

·         Will death be hastened by what is proposed?

Soundbite 1

“The CMA works towards the best possible care in all clinical situations, from those dealing with the whole of people’s lives to those where patients are possibly approaching death. We attempt to work with all systems of Health Care to improve the delivery of care using the Catholic Christian model for the excellence of care according to the inviolable nature of the dignity of the human person.”

 

Note for Editors: About the Catholic Medical  Association

The CMA exists to support Catholic Health Care Professionals and students of those professions in their daily working lives. It does this by mutual  support,  meetings and education as well  as working nationally and internationally with all systems of Health Care to improve the delivery of care using the Catholic Christian model for the excellence of care according to the inviolable nature of the dignity of the human person. We also publish  the Catholic Medical  Quarterly.

www.catholicmedicalassociation.org.uk

Mary, help of the sick

7 Jun

 

Fr James Hanvey, SJ

There are many icons of Catholicism. Apart from the crucifix, the statue of Our Lady of Lourdes might qualify as one of the most common. It can be seen in Churches or in homes and whether it takes the form of high accomplished art or just the plastic statue bottle that holds the Lourdes water that thousands of pilgrims bring home with them, the image and the reality to which it points remains constant. Lourdes is the great place of pilgrimage for the sick. Over the centuries Mary, the Mother of God, has acquired many beautiful titles that celebrate her continuing place in the unfolding of our redemption and in the community of faith, but in Lourdes we can see that she is ‘mother of the Kingdom’. It is there, most vividly and practically, that the beatitudes can be experienced, for Lourdes is about a reversal – here the sick, whatever the manner of their illness or physical condition, ability or social standing, all have first place. Here, too, you can see the healthy – of every age and nation – practically employed in care. Lourdes is an experience of an unembarrassed Catholicism and an unapologetic faith.

February 11th is the feast of Our Lady of Lourdes; it is also the day which the Catholic Church has marked as the World Day for the Sick. It is especially dedicated to people who are incurably sick or terminally ill. Although the whole Church is asked to make it a special day of prayer for the sick, it will be celebrated in Seoul with a series of liturgical events and conferences. Such days deepen our consciousness of a daily reality which is not just physical but spiritual and social. As always in the Church, liturgy and prayer lead to action and sustains it. It is a call to transform and transcend those structures and attitudes that block our human solidarity and deprive people of basic needs. The World Day for the Sick reminds us that so much sickness is preventable through basic hygiene and clean water. So much sickness and suffering is preventable if medicine is made affordable and available. In the case of terminal illness, we are asked to extend the great well of practical compassion and care, so evident at the waters of Lourdes, to all in society. In our own country and through the world so many die alone or without adequate palliative care, not because we do not have the economic means to prevent it, but because we do not have the vision to see them. How we die is as important as how we live and how we care for a person in the final stage of life is a measure of how we value every person in their vigour and productivity.

The World Day for the Sick is a moment when we experience the fact that sickness, even terminal illness, does not cut us off from the community. It also reminds us that illness is never just a physical event, it is unavoidability spiritual even when we don’t believe. Within it hovers the reality of our own frailty and mortality, our value and purpose. We realise that ultimately we are not autonomous and in control but dependent and in need – as the Zulu saying has it, ‘people are people through people’. Even more than in its physical dimension, sickness is a counter-cultural moment of terror. But within it comes this other reality, that there are those, maybe even those we do not know, on whom we have no special claim, who care for us. They will spend their time and energy in seeking our good and care enough to want what is right and just for us. Sickness crosses all our boundaries and opens up a world of unexpected gift. This world surrounds us even in our moment of dying, and whether we are conscious of it or not, keeps a vigil for us. All our life is lived in this communion. It does not come just from our common humanity but from the Love in whose image we are made.

This communion means that sickness, even if it leads to death, is never useless. In such moments Christian faith is not some ‘opiate’ for those who have not the stoic’s strength. Faith does not pretend that illness is other than it is, nor does it celebrate suffering. It just tries to let it become a moment of encounter. At this point faith must let itself become mystical.

Christianity does not ask that we should be heroic and self-determining when faced with suffering or death, only that we should trust and step out into the mystery of Christ – it is a moment when our life is given a Eucharistic form: “Through Him, with Him and in Him, the unity of the Holy Spirit, All Glory and Honour is Yours, Almighty Father.” Through such and offering in faith, a life can catch, hold, and reflect the redemptive light for us all.

The state of societies can be measured in many ways, but it may be in our care of the sick and the dying that we have the one of the best indications of our social health. The feast of our Lady of Lourdes and the World Day of the Sick may point us towards the sources of healing that we all need.

 

Prayer to Mary, Health of the Sick

 

O Virgin Mary, «Health of the sick»,

you who accompanied Jesus on the way to Calvary

and remained near the cross on which your Son died,

participating intimately in his suffering,

take our suffering and unite them with His,

so that the seeds sown during the Jubilee

continue to produce abundant fruits in the coming years.

 

Most tender Mother, we turn to you with confidence.

Obtain from your Son the strength to return soon,

completely restored, to our duties,

so that we be useful to our neighbour through our work.

Meanwhile stay with us at the moment of trial

and help us to repeat everyday with you our yes,

sure that God will bring out from every evil a greater goodness.

 

Immaculate Virgin, may the fruits of the Jubilee Year

be for us and for our dear ones

a pledge of renewed vigour in Christian life,

so that in the contemplation of the Face of the Risen Christ

we will find the abundance of the mercy of God

and the joy of a more complete union with the brethren,

the beginning of the joy without end in heaven. Amen.

 

Pope John Paul II

Drug trials must not abuse peoples’ rights, European Bishops tell EU

26 May

Drugs trials necessary but must respect the vulnerable

Drugs trials are necessary before drugs come to market, but those conducting them have ethical duties to obtain consent and respect the rights of those from developing countries, says a statement on behalf of all Catholic Churches in the European Union.

COMECE, the Commission of the Bishops’ Conferences of the European Union, issued the statement through its Bioethics committee in response to the EU Proposal for “A Regulation on clinical trials on medicinal products for human use’ which aims at re-launching clinical research within the EU while at the same time ensuring protection to participants as well as the reliability of the acquired data. The European Commission proposed regulation which will be submitted to a vote of the European Parliament next 29 May

The statement on Ethical assessment of clinical trials on medicinal products: Respect and protection of vulnerable persons and populations  was released by COMECE this week in English and French.

Importance of consent

“Many people who are unable to give consent as well as people from less-developed countries often participate in clinical trials.” The COMECE statement asks how we can better protect them and vulnerable populations against abuse in the process.

The COMECE bioethics team conclude that  EU proposal could go further in the protection of the people concerned. A spokesperson said:

“The COMECE Secretariat welcomes this proposal for a Regulation as it goes in the right direction. The COMECE Reflection Group on Bioethics has monitored the issue from the launch of the public consultation by the European Commission and publishes today its Opinion on this proposal for a Regulation. ”

Key ethical concerns and principles

The COMECE team underlined some principles which they feel should be implemented in the proposed EU Regulation :

Volunteering

“The appreciation of the value of voluntary participation in research projects for the good of the community:  granting financial incentives to any person agreeing to take part in some medical research therefore raises ethical issues.”

Protecting those particularly vulnerable

“A key ethical consideration for research carried out on human subjects is that of respecting and protecting particularly vulnerable people and populations who could be unduly used as easily-exploitable objects for experiments.”

Benefits for the population concerned, especially in developing countries

“Clinical research with a disadvantaged or vulnerable population or community is justified only if it responds to its health needs and priorities and if it is likely that such a population or community will benefit from the results of the research.”

Security of the participants to tests

“The subject of research may agree to become involved in a research protocol that does not fully respond to the individual’s own interests but will do so for the good of others, in the “medical interest of the community” and consequently for the “common good”, insofar as the patient’s physical or psychological integrity is not endangered.” This underlines the importance of full and informed consent.

Benefits to the person incapable of consent

“Trial medicinal products should not be given to persons who are not capable of giving their consent except in cases where the same results cannot be obtained by resorting to persons capable of giving their consent and if the foreseeable benefits/predictable risks ratio is to their advantage.”

Ethics of testing in emergency situations

As for clinical trials in emergency situations, “the only acceptable research is specific research on individuals placed in such a situation that one may have good grounds for anticipating a direct benefit with regard to their condition and that would present a minimal risk and only impose a minimal burden. It is also important to give a sufficiently precise definition of the terms “minimal risk” and “minimal burden”. ”

The full statement on Ethical assessment of clinical trials on medicinal products: Respect and protection of vulnerable persons and populations is available in English and French

Vatican supports new direction on health for World Health Organization

25 May

This week has seen several interventions by the Vatican delegation to the World Health Organization’s key decision making body.

The Sixty-sixth World Health Assembly , which is the  decision-making body of the World Health Organization , and in turn the  public health body of the United Nations was taking place this week in Geneva.

Catholic support for improving population health

Archbishop Zygmunt Zimowski,  head of the Holy See’s delegation, in a brief but wide-ranging speech

  • called on WHO to affirm the centrality of spiritual needs to any approach to universal health care
  • supported the WHO’s aims to prevent non-communicable diseases such as Heart Disease and Cancer
  • affirmed the need to control and prevent disease in older people
  • supported WHO intentions to further reduce preventable deaths especially in women and children but differed on emergency contraception from WHO’s suggested stance
  • reminded the WHO of the significance of the Catholic Church’s health care agencies and infrastructure (up to 25% of HIV care worldwide, over 50% of health care in some countries)

Archishop Zimowski’s intervention is covered in more detail on Catholics in Healthcare blog.

Responding to WHO General Secretary on health of women and children

Dr Margaret Chan, Director General, outlined her goals for her time as Director General as including  “the health of women and of the people of Africa.” Archbishop Silvo Tomasi, the Holy See’s Permanent Observer to the United Nations and part of the Holy See’s delegation at the Assembly expressed his support for these objectives, and went on to explain the Catholic Church’s global and local experience in those areas.

Health of the people of Africa

The Archbishop went on to offer the experience of the Church in support of Dr Chan’s goal for improving the health of the people of Africa. “[M]any nations are still in the grip of famine, war, racial and tribal tensions, political instability and the violation of human rights.” Pope Benedict XVI’s exhortation to the international community is also very appropriate, “we must not forget Africa ….”

Emphasising the care of the whole person

Tomasi finalised his intervention with a vision of health that reminded the WHO of it’s own aspirational definition of health. We should seek a deeper care for every aspect of the human person.

“My delegation urges a perspective on health security that is grounded on an anthropology respectful of the human person in his or her integrity and looks far beyond the absence of disease to the full harmony and sound balance of the physical, emotional, spiritual and social forces within the human person.”

In recent years the Vatican has moved to emphasise not only its stance on reproductive health at WHO events but has taken on a stronger public health focus. This latest WHO Assembly has seen Vatican interventions aimed at sharing the wider health and social justice concerns of the Church.

World Health Organization told spiritual needs “integral” to universal health care

25 May

The Sixty-sixth World Health Assembly was told this week that any integral approach to universal health care coverage must include addressing the spiritual needs of populations.

The Assembly is the decision-making body of the World Health Organization , the health and public health body of the United Nations and has universal health care coverage as one of its key strategic aims.

In a wide-ranging intervention which also signalled strong Vatican support for universal health-care measures, Archbishop Zygmunt Zimowski, President of the Vatican’s Pontifical Council for Health Care Workers and head of the Holy See’s delegation to the World Health Assembly said that any “integral” approach to healthcare need must focus on “the spiritual state of the person” and not just medical interventions or economic growth.

“Health and development ought to be integral if they are to respond fully to the needs of every human person. What we hold important is the human person – each person, each group of people, and humanity as a whole.”

The archbishop said that health care contributes to the development of nations “and benefits from it.” The Holy See “strongly believes” that universal health care coverage as a goal of government policy is a more certain way to achieve “the wide range of health concerns,” including preserving present advances.

The archbishop said that health care contributes to the development of nations “and benefits from it.” The Holy See “strongly believes” that universal health care coverage as a goal of government policy is a more certain way to achieve “the wide range of health concerns,” including preserving present advances.

Archbishop Zimowski then turned to efforts to save the lives of millions of people who die each year “from conditions that can easily be prevented.” He praised a resolution before the assembly to improve the quality, supply and use of 13 “life-saving commodities.”

“The Holy See strongly agrees with the need to achieve further reductions in the loss of life and prevention of illness through increased access to inexpensive interventions that are respectful of the life and dignity of all mothers and children at all stages of life, from conception to natural death,” he said.

However, he voiced “serious concerns” about the assembly’s secretariat report and its executive board-recommended resolution that includes “emergency contraception.” He said some of these drugs have an abortifacient effect.

“For my delegation, it is totally unacceptable to refer to a medical product that constitutes a direct attack on the life of the child in utero as a ‘life-saving commodity’ and, much worse, to encourage ‘increasing use of such substances in all parts of the world’,” he said.

The archbishop welcomed the assembly’s proposed global action plan to control non-communicable diseases. He said his delegation was “especially pleased” that the plan recognizes the “key role” of civil society institutions including faith-based organizations in encouraging the prevention and treatment of these diseases.

“Our delegation is aware that Catholic Church-inspired organizations and institutions throughout the world already have committed themselves to pursue such actions at global, regional, and local community levels,” he said.

Archbishop Zimowski also voiced interest in aspects of preventing and controlling diseases in older age, noting faith-based institutions’ long tradition of care for the aged and the rapid growth of the elderly population. He noted that the Vatican will host an international conference Nov. 21-23 about caring for the elderly with neurodegenerative diseases.

 

Happiness, Happiness….a practical take on psychology and wellbeing

18 May

Jim McManus

Jim McManus is a Chartered Psychologist, Chartered Scientist and Associate Fellow of the British Psychological Society. He is Editor of Catholics in Healthcare blog

Happiness has been a concern of psychology and public policy since Seligman’s work at least, and the development of new orientations in psychology studying not human problems, but human thriving is just one of the remarkable signs that psychology as a field of science is flourishing. It’s an exciting time to be a psychologist as we see applications of psychology range from long term illness to organizational innovation, child development and human happiness.

The field of psychology has recently seen the emergence of sub-fields like Community Psychology, Positive Psychology and other specialisms, working on human strengths and human flourishing…so seeking strengthen, not problematize, ordinary lives.

The advent of scientifically sound research on this has given impetus to policy developments at national and international level that what we need to do as health systems and communities is help people thrive. With this comes the well-researched insight that population mental wellbeing and resilience is important. This has seen expressions in the last few years (all with good evidence base) ranging from the 5 ways to wellbeing (New Economics Foundation) to the recent Government Strategy no health without mental health and the Royal College of Psychiatrists no health without public mental health.

Doing this practically can often seem to be easier said than done, but there have been a number of practical initiatives run in local areas seeking to put these concepts into practice. Positive Psychology is taking off, and the accredited mental health first aid movement is just one example of how people can turn these insights into a series of programmes. Catholics have a series of demonstration projects and initiatives on mental health, wellbeing and dementia in the Catholic Mental Health Project

But now comes a timely and sensible intervention for faith communities. John Bingham, writing in the news and religion section of today’s Daily Telegraph, tells the story of how Livability, the disability charity with a Christian ethos, is busy rolling out a “happiness” course in parishes and churches across the Country.

Bingham’s piece says “The so-called “Happiness Course” combines basic principles of secular popular psychology with ideas such as forgiveness and gratitude, promoted for centuries by Christianity. It is based on the principle that applying simple Biblical ideas such as “counting your blessings” or forgiving enemies could actively improve people’s psychological well-being.”

In fact, this is not secular popular psychology. This course has links to well researched psychological insight. What is different about positive psychology and the psychology of happiness is that there has been a significant impetus to popularize it while, for the most part, keeping faith with the underlying science.

Positive Psychology,  some of whose  insights the Livability course seems to derive from, is defined by the  Positive Psychology Center at the prestigious University of Pennsylvania as “the  scientific study of the strengths and virtues that enable individuals and communities to thrive. The field is founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, and to enhance their experiences of love, work, and play.”

The interesting thing is that Livability are synthesising faith concepts about what makes a healthy and happy life with sound scientific psychology, and finding not only that there is no conflict but that they work well together.

This too has a practical value well-grounded in research. Studies of organizational culture and take-up of health messages show that when people can relate scientifically sound messages to their own belief systems, there is more likelihood the messages will be seen to be salient and the messages will not only be taken up but sustained.

The Livability course is a neat innovation in the field of practical or pastoral theology, and an equally neat innovation in the field of public mental health.

We need to see more of this.

Some useful links

http://www.livability.org.uk/

http://www.ppc.sas.upenn.edu/

http://www.telegraph.co.uk/news/religion/10064228/Archbishops-daughter-spearheads-drive-to-teach-happiness-in-churches.html

http://www.mentalhealthproject.co.uk/

http://positivepsychology.org.uk/