Law Commission MCA/DoLS Interim Policy Statement
The Law Commission has published its 'thoughts about how to move forwards' (which it calls 'an Interim Policy Statement) on its website: I somehow did not follow up on an e-mail the LC sent to me about a month ago (something must have distracted me, for long enough for me to 'have forgotten about' the LC e-mail), but a couple of days ago they sent a second e-mail about the publication of a 'easy-read' version:
Both an EasyRead version and a Welsh language version of our Interim Policy Statement have been published on the Law Commission website today. You can download them via this link:
http://www.lawcom.gov.uk/project/mental-capacity-and-deprivation-of-liberty/
The Interim Policy Statements are in the 'Other documents and more information' section at the bottom of the webpage.
The LC mentions this issue of what can be termed 'the investigation of 'expected deaths'' in two sections of its longer (the 'normal' version, as opposed to the easy-read version) report - the two sections are:
1.31 We also received many responses to our provisional proposals regarding coroner's inquests. The current law - which requires an inquest where a person dies while under a DoLS, even if the cause of their death was entirely natural - was seen to be causing unnecessary work for coroners and upset to families. We received reports, for example, of police arriving at the deceased's deathbed; one consultee reported their impression of a "crime scene"; another referred to issues over whether the deceased's body should be taken to the official mortuary rather than by the family's preferred funeral director.
1.46 We have also concluded that the Coroners and Justice Act 2009 should be amended to remove our proposed scheme from the definition of state detention. In conjunction with the Department of Health's proposals for a medical examiner system, this will mean that deaths of people subject to our new scheme are reported to medical examiners, who will be under a duty to make enquiries and
refer the death to a coroner if the medical examiner forms the opinion that the death was attributable, amongst other matters, to a failure of care.8 The coroner
will have the power to conduct an inquest in an appropriate case but will not be obliged to do so.
This issue was discussed here on DIC - and I personally 'was very vexed by it' in the thread at:
But these proposed 'medical examiners' will not remove the problem - they were in essence 'requested by coroners' because coroners wanted to have fewer deaths referred to them for investigation: the problem is the 'attitude of the police when they become involved'. That is reasonably clear if you read 1.31 above.
The necessary solution to this, would not require that the police are excluded from such deaths - the solution is to do what I have suggested in my piece at:
While I'm writing about this Interim Policy Statement, it seems that the Law Commission is dropping its plans to introduce a new scheme which would operate 'earlier than DoLS' and will instead just suggest a 'single direct replacement for DoLS', and I think the LC is not going to propose a separate scheme for hospitals (I strongly disliked the idea of any separate scheme for hospitals - the idea is very unsatisfactory in connection with end-of-life).
Good morning all I am sorry to ask but as I am new ish to this site who is Mike Stone and what is his job title. I was keen to join the dignity in care site in order to improve clients care in this lifetime not spend my lifetime reading over long and frankly unfollowable comments we need action and improved policies and procedures . Each Health Board should set up a working party to agree these policies and improve clients dignity in care. Lets actualy do something.Please
Also I know we have a duty of care to dying clients relatives but sure our living clients and their time before death is more important. Is it not more important that a client is clean, warm, hydrated and feels loved as they are in the final stages of life if this care is being given then the relatives would be content that a policeman arrives to check all is as it should be as they will have been witnesses to good care.
How many times have you walked onto a busy ward and seen clients not covered with even a sheet and a drink so far away they would need to be a gorilla with 6 foot arms to reach it . Lets discuss real dignity in care.
I am new to this site too,and love to discuss things...Quite agree with you Kirsty( as above comments) but would like to add, that usually decisions are often made without consulting the people who actually do the caring-never really understood this.
Hi Kirsty and Chianta,
Answer to 'who is Mike Stone' - no job title, no job, I'm a quite annoyed 'pain-in-the-backside' layman. See my short piece on BMJ for a bit more on 'who I am':
http://www.bmj.com/content/350/bmj.h1846/rr
I 100% agree that 'we need action and improved policies and procedures'.
I'll recount something, which is connected to your 'Is it not more important that a client is clean, warm, hydrated and feels loved as they are in the final stages of life'.
A few days before 'One Chance to Get it Right' was published, I had a phone conversation with Bee Wee, NHS England's end-of-life lead, and the person leading on One Chance to Get It Right (which was 'the replacement for' the Liverpool Care Pathway). Bee had sent me something before the call, asking for any comments. They wanted 'simple banner headlines', and one of those, from memory, was:
'Comfort Comes First'.
I told Bee 'I'm not happy with it' and explained why. It seems to 'make perfect sense' - patients are dying, so 'make it clear to the nurses, that the patient's comfort comes first'.
But I sent to Bee, a piece which had appeared in the letters section of a newspaper. A GP's wife was dying, and she had been in hospital. She was transferred to a hospice, for the final stages of her life. When the wife and her husband arrived at the hospice, they spent a long time (I think about an hour) discussing what they wanted to happen, with a doctor at the hospice. The wife was very tired, the husband had sat by her hospital bedside for the previous night.
The husband briefly went home, for a shower and a change of clothes. When he returned to the hospice, he discovered that his wife was deeply sedated - it seems the nurses had administered this deep sedation, without asking her, or the doctor, or talking to her husband. The wife never again 'regained enough altertness' to properly talk to her husband.
This sedation, had 'robbed the wife and husband' of the type of end-of-life they had hoped for, and it prevented them 'from properly saying goodbye to each other'.
My point to Bee - it seems 'the nurses decided on their own, to deeply sedate the wife 'because she would be 'more comfortable sedated''.
That SHOULDN'T be a decision the nurses make - it should be up to the dying wife whether she prefers discomfort and alertness, to sedation.
So it isn't 'Comfort Comes First'.
Bee 'took my point' once I'd sent her the GP's letter to the newspaper, about that, and about how upset he was about it.
The letter that rather angry bereaved husband sent to the Times, follows.
If 'Comfort Comes First' is the principle those nurses were applying, then they were wrong - it is 'what the patient wants comes first' for many things:
Sir,
As a recently retired GP I am aware of the Liverpool Care Pathway as the gold standard for end-of-life care of patients dying at home.
As a recently bereaved husband I am also aware of the high standards of hospice-based palliative care. My wife was transferred from an oncology ward at our local hospital to our local hospice to enable us to maximise her remaining days in a more relaxed and appropriate environment.
We discussed our hopes for the admission with the duty doctor for more than an hour, after which my wife was visibly exhausted. I returned home briefly to shower and change, having slept in a chair at my wife's bedside overnight.
On my return my wife was heavily sedated and unable to converse. I found that the nursing staff had administered strong pain relief and sedation by injection to facilitate nursing care and without prior discussion. My wife never regained her previous level of consciousness and passed away peacefully with her family at her bedside three days later.
As an ex-professional I recognise the important impact of the Liverpool Care Pathway in improving the care of the dying patient. However, its application must take note of the fully informed wishes of close relatives, many of whom have been nursing their seriously ill relatives for some time at home in difficult circumstances.
I implore hospital and hospice staff and primary care practitioners to involve patients and relatives throughout each step in the pathway, thus avoiding the inevitable deep disappointment and anger which may ensue from its unilateral application. As with every branch of medical practice good communication is essential.
Keith Price (GP ret, York) The Times page 35 Friday November 9 2012 Letters Section