Monday, February 27, 2023

Our Dying Rooms

 Is it incompetence or is it official policy for hospitals to kill the old?

Actually, not just the old. Long pre-Covid times, the wife of a friend of mine contracted an infection and was taken to hospital. When her husband got there he found her unattended and untubed in bed (this was when hospitals had beds.) She needed fluids to flush out the toxins, but had nothing and the nurses seemed unable or unwilling to do anything and there was no doctor in sight.

My friend is a big and - when he chooses to be - a formidable person; he said he wanted a line run into her immediately and made it clear he would be taking names and was prepared to inflict thorough procedural wrath if staff didn’t jump to it. I’m perfectly convinced that she would not be alive today had it not been for her lion of a man.

She was, I think, in her thirties at the time.

I’ve written before about another friend who didn’t feel safe in hospital and how his equally formidable brother had to push for him to get home again. It was a story of reluctance to treat, crucial X-ray evidence overlooked, prizing ward tidiness over patient nurture, staff clumsiness and failure to follow the post-operative programme set by the surgeon; of supplying equipment for use at home and then recommending it not be used by the family; of an incompetently monitored drug regime. He was a good, brilliant man and died prematurely, but mercifully in a hospice, at the age of 77.

Last month I lost another, also aged 77. He had been a keen skier and qualified instructor, but had apparently started to suffer from heart failure. I hadn’t known he was in hospital until his daughter messaged me to say he was terminally ill but was ‘being made comfortable.’

When I visited the ward I had to don a plastic gown and gloves: he now had c.diff. as well as his heart problem - acquired how? From where? His eyes were half open but unseeing; I told him about his just-born grandson and left a congratulations card; he seemed unconscious throughout until just at the end, when his eyes turned in my direction, but I’m not sure he recognised me.

The second time, a day or two later, I brought some flowers and put them on his chest, because I’d remembered that Bertrand Russell’s wife did that for her husband when he lay semi-comatose (his eyes welled up with tears; he eventually recovered.) Sadly in January most flowers have no appreciable scent, but it made no difference: my friend’s eyes were shut and he was breathing stertorously; he knew nothing.

Why did he know nothing? He was heavily drugged. I asked about hydration; the nurse told me all fluids were now withheld. He was dead a couple of days afterwards.

For that is the ‘care’ he had been receiving. The system previously known as the Liverpool Care Pathway became infamous, but all the NHS has done is to change the name to ‘end-of-life care’; I hope my friend’s daughter didn’t understand the implications. ‘Care’ is a vile medical euphemism - like the ‘harvest’ of organs from dead children, whose parents agreed to the use of what was misleadingly called ‘tissue samples.’

The patient is given powerful analgesics and allowed to perish from hunger and especially thirst; it is assumed that he cannot feel what would otherwise be the agonies of dehydration and of the consequent collapse of his organs.

And it tidies him out of the way. ‘Die faster, we need the beds.’

For in today’s soulless world, if we are nothing after we die, we are nothing now. We - and especially the old - are persons of no importance. You may as well put us out with the bins. All is okay as long as you use the right language, keep smiling and make sure the paperwork is straight.

The above cases are a pattern, and not localised: the examples I’ve given are from three hospitals in different parts of the country.

Yesterday I learned of a fourth, but one who got away, just. Another elderly man - a fellow writer and internet pal, very bright, widely experienced and full of life - was suddenly taken ill before Christmas and went into hospital in the east of England, to have emergency brain and bowel operations.

Actually, not an emergency; not at first. For when he was admitted unconscious, a different decision was taken; a Dying Room decision, of which he learned only a few days ago. Here is his account:

The wife received a phone call to be at the hospital, when I had been moved to [XXX], the following morning to have a meeting with the same doctor. She turned up at 10.00 but the doctor was not there: he had been called away on an emergency!

While she waited she found the room I had been put in, to find I was alone with no tubes, wires etc attached; very strange…

Despite her waiting for hours the doctor never appeared and another appointment was made for the following day.

She arrived with her friend, my neighbour and again the doctor was missing (?) She spoke to one of the nurses who was attending me and asked why there was no equipment attached to me; the nurse in a roundabout way said the doctor had removed the equipment and said no resuscitation (?)

Still no doctor, which annoyed the wife who started to ask questions. The nurse said she would try and contact him and would also try to contact his superior who was in the hospital that day.

Again, after hours, the other doctor turned up and after talking to the wife and nurses went in to see me. 15 minutes later he reappeared to say he did not understand the decision to not resuscitate as I showed more than enough life and had in my delirium attempted to get out of bed and leave!

He then arranged to take over my care with the two nurses who had been with me from the start and had me moved to a general ward. I was also for the first time given some food, which I had been deliberately starved of by the other doctor. The new doctor supervised me back to some sort of life and the rest is history.

The original doctor was not seen again in my vicinity. How come someone like that decides one's fate? If it hadn't been for the wife insisting on getting someone to look at me I would not be here.

I await further tales from these days when I was sedated or out of it; apparently there is more. One thing stands out: the good staff are very good but there is a percentage of those who should not be in the profession.

I was furious on his behalf and asked whether he would be making an official complaint. He replied:

My wife did consider suing the first doctor, but the advice was 'only if you have a recording of instructions.’ As he was not available at any time this would have been impossible and would have required statements from the two nurses which would not have happened. If she had been informed of the decision it might have been a different matter.

Naively I had thought that a ‘Do Not Resuscitate’ order (DNR) has to be agreed with next of kin; it may possibly have been like that once (remember how during the Covid panic there was a scandal about DNRs being completed without relatives’ knowledge?), but I’ve looked it up and it’s not so now.

However this goes beyond DNR: it’s ‘don’t bother.’ Perhaps the NHS should come up with a snappy mnemonic for the guidance of staff:

Do not feed and don’t hydrate
And then do not resuscitate

Oldies clutter up the place, costing money in pensions, healthcare and housing. Living too long in this country is a crime meriting capital punishment; but in the nicest possible way.

Compare that with the wonderful care Spectator columnist Jeremy Clarke, terminally ill with cancer, has received from the French medical system. Rather than face being culled here, I am beginning to give serious consideration to moving abroad, somewhere that has respect for life.

I understand there are lots of rubber boats going a-begging at Dover.

Saturday, February 25, 2023

The magic solution to asylum seekers

The latest wheeze from the Government (temporary prop: R. Sunak) to deal with the huge backlog of asylum claims, is to rubber-stamp them via written questionnaires:

Asylum seekers involved will be sent a 10-page questionnaire to fill out and asked to return it within an initial 20 working days.

Some campaigners criticised the plans as “clumsy" amid reports that asylum seekers will be told to fill out the form in English.

The language barrier is unlikely to be a problem, even though this system is for applicants from ‘Afghanistan, Eritrea, Libya, Syria and Yemen’ because - I guess - there will be an army of lawyers on Legal Aid who will compose the answers for them.

In any case, those applicants ‘usually have 95 per cent of their asylum claims accepted’ under the present arrangement involving face-to-face interviews.

Why do they come to us from so far away, though? Can they really be stopped?

It seems that despite what the Home Secretary Sajid Javid said on 2 January 2019 when he made a photo-op visit to Dover, international law did not then invalidate the claims of the rubber-boat people:

… there is no obligation in the Refugee Convention, either explicit or implicit, to claim asylum in the first safe country reached by a refugee.

On 28 April last year the UK’s Nationality and Borders Bill became law, aiming for tighter control, but the Law Society says:

We have significant concerns that a number of the act's measures are, or are likely to:

  • - be incompatible with international law

  • - damage access to justice, and

  • - negatively impact on the role of lawyers in immigration cases

In particular, we're concerned that penalising refugees who arrive in the UK via irregular means is incompatible with the Refugee Convention 1951.

In the year to September 2022, only 23% of asylum applications were refused at first; historically (2004-2020), three-quarters of rejected applicants have appealed and a third of those appeals were allowed; thus, overwhelmingly, applicants tend to succeed.

But in any case, foreign asylum seekers are only a small part of immigration to the UK: 6% of the total in 2019, 17% last year. Most immigration is legal.

Overall net migration in the year to June 2022 is estimated at 504,000; in 2019 some 14% of the resident British population were born abroad.

In addition, we have recently made welcome refugees from the war in Ukraine and opened the door for up to 5 million Hong Kong citizens ‘threatened by draconian security laws.’

As to ‘illegal’ immigrants:

there are between 594,000 and 745,000 illegal immigrants in UK. In contrast a total of approximately 30,000 people came in on small boats in the calendar year 2021 and of these only approximately 10% are illegal immigrants (90% are legitimate refugees with a legal right to asylum in UK).

So the images we see in the papers so often, of hi-viz-jacketed groups arriving by boat, are almost a distraction. If the Home Secretary ever actually succeeds in stopping the rubber flotillas, it will be little more than a PR victory to impress the British punters.

The real issue is official policy on immigration. The Government’s ‘New Plan For Immigration’, issued last March, opens with fine-sounding sentiments:

The UK has a proud history of being open to the world. Global Britain will continue in that tradition.

Our society is enriched by legal immigration. We are a better country for it.

We recognise the contribution of those who have come to the UK lawfully and helped build our public services, businesses, culture and communities and we always will.

Further in, it considers the challenges of illegal immigration, including criminal people-smuggling operations and the dangers to the migrants; but also says

if left unchecked, illegal immigration puts unsustainable pressures on public services.

Yet as we have seen, the total number of illegals in Britain, accumulated over many years, may be as low as one single year’s worth of net migration. The ‘unsustainable' pressures’ can hardly be attributed to the relatively small subset of ‘irregular’ incomers.

What’s the big picture?

Do we need, can we afford, the importation of people on the current scale? What are the benefits and disadvantages, long-term as well as short?

Is it an argument about demographics?

To sustain the country’s population at its present level, we would need an average birth rate of 2.08 children per woman; at the moment it’s 1.754. Without immigration, our population would gradually shrink. Would that be a good thing?

Why do we have so few children? Would we have more if houses were not so expensive and employment more abundant and better-paid?

Is the immigration issue merely a symptom of systemic economic failures that none of our governments in recent decades have addressed?