Old should NEVER be denied treatment

PLACING sick elderly patients who are diagnosed as ‘dying’ on end-of-life regimes – where they are deprived of fluids – is an ongoing scandal in the NHS and must not be allowed to continue.

The Ombudsman has just produced a report damning the failings of care in the case of Josef Boberek, who they admit would probably have survived but for the doctors’ erroneous interventions.

The importance of Mr Boberek’s case is that it is the first time an NHS trust has publicly acknowledged that they erred in making a diagnosis that a patient was ‘dying’. They also admitted they gave the patient inadequate fluids and that if they hadn’t made these errors, he would probably have been discharged alive. The failings in this case were the two main concerns of the 2013 Neuberger Report, which recommended the phasing out of the LCP: that there is no precise way of diagnosing if someone is dying and that patients should be supported with hydration and nutrition unless there is a strong reason not to.

These two lessons have not, however, been learned, since recent NICE guidelines continue to insist on diagnosing who is dying without providing any objective ways to do this. They also state that withdrawing fluids does not hasten death. Now that one of the top NHS trusts has admitted it was wrong to diagnose dying in Mr Boberek’s case and to withhold fluids, it is important that the findings are the impetus for ending the intentional dehydration of sick elderly patients in the NHS.

Elderly patients must not be intentionally dehydrated for any reason. A way to stop this is for NHS trusts to be required by the Care Quality Commission to report any instance of a patient not having fluids for more than 24 hours and to institute significant penalties. In addition, a diagnosis of ‘dying’ must never be allowed to be the basis for limiting care.

Otherwise, it is too easy to make a self-fulfilling prophecy in a patient who, like Mr Boberek, could be saved with more hydration and more care.