Nigel Balchin wrote – sometime in the 1970s – ‘Beware of doctors – they will try to cure you even if it kills you.’
Prophetic words! We seem to have an NHS which now sees death as a treatment or cure.
It is apparently the best treatment for old age or disabling impairments. It is apparently the best treatment for impaired embryos, viable foetus and disabled babies.
Instead of reassuring patients that everything will be done to alleviate their pain and suffering, many hospitals give patients living wills to sign - forms that paint the horrors of life in a wheelchair, of a life unable to walk, being dependent and a burden on loved ones.
(I know these forms exist – I have seen them). Given this sort of emotional pressure who would not sign?
And now we have the Liverpool Pathway diagnosis of dying to put people into a coma!
Of course the NHS is strapped for cash. Treatments are increasingly expensive. People have raised expectations of what can be achieved medically and are more demanding.
Governments keep changing the goal posts and setting new targets. But none of these are reasons for so drastically changing a culture from one of cure and alleviation to one of cure or kill.
The NHS undoubtedly does some wonderful work. More people are surviving life threatening conditions, terrible accidents etc. Medical advances have improved the lives and potential of thousands.
Many doctors and nurses are dedicated to making a real difference in people’s lives and relieving their pain and suffering.
The whole premise of the NHS is to bring health care free to everyone from cradle to grave.
And for those who are seen as having potential to contribute to their societies I think this is still true, if they can escape the disabling effects of MRSA and C Dificile! But for those who are seen as dispensable it is not.
The reality is that it is the old and disabled people who are recipients of the new culture of kill and cure. It is the old and disabled people who get DNA notices on their notes without their permission.
It is the old and disabled people who are left without food and water – not always as a conscious medical decision but because nobody bothers to feed them. It is the old and disabled people who get pressure sores and ulcerations from lack of care – and from which they often die.
It is the old and disabled people who, if they get agitated or incoherent, get sedated and comatosed.
If you go into hospital able to speak for yourself, feed and wash yourself, you have got a chance of getting out alive and well.
If you cannot speak for yourself, cannot hear, have learning difficulties, Alzheimers, cannot walk or feed yourself – then heaven help you. The value put on your life is very low and the resultant care reflects that value.
I am not exaggerating and I am sure you agree. I am sure it has been the experience of many of your aging relatives and friends. It has happened to nearly all my disabled friends and has certainly happened to me.
[Research on and evidence of the violations of disabled and older people’s rights by the NHS has been done by the Disability Rights Commission, Mencap, People First, Disability Awareness in Action, Help the Aged]
NHS Care in the community is not much better – with old people being put into institutions as soon as they become too demanding on the NHS and disabled people being unable to get a GP because they are seen as too needy – and expensive.
And money is a major factor in all this. The NHS is big business. Patients are not people; they are commodities. They are the bottles of coke on the assembly line.
However much government may make policies on people-centred services – the providers of services cannot see the people they serve as other than a commodity.
The providers are the workers and it is their employment rights and conditions that are paramount. It is the success of the business and how it runs that matters – not the lives of the end product – the commodity – in reality, the person.
And this, of course, is why the kill or cure culture only focuses on old and disabled people – because we are not worthy to be commodities. We are bottles of coke without the fizz. We are past our sell by date!
The New Genetics will be crucial to the NHS of the future. And yet, these scientific advances also emphasise the commodity factor, particularly in arguments as to what policies should be in place regarding research such as the Human Fertilisation and Embryology Bill.
The basic premise for all this new work is one of curing the impairment or eliminating the disabling factor. Fine and relevant arguments if you are building a car in a factory – but not if you are building people.
So how do we really make services people centred? How do we build a health service that turns the commodity into human beings?
I believe that the only way we can do this is through making human rights a reality.
It is easy to talk the talk of human rights – but it is very much more difficult to walk the walk – economic, political and institutional factors get in the way.
The UN human rights instruments provide guidance and effective monitoring systems – but governments, however much they support a human rights system through their own national legislation or through policies and practices do not understand the nuances of implementation – particularly in regard to groups who have systematically and institutionally been set outside the mainstream human rights framework – as have old and disabled people within our NHS.
However, we now have the UN Convention on the Rights of Disabled People which is much more precise though based on the other UN Human Rights instruments. Because disabled people were significantly involved in the elaboration of the convention, it gives precise pointers to the main pitfalls.
And one of those pointers is that, under Article 25, the article on Health, the convention states that States Parties should:
‘Prevent discriminatory denial of health care or health services or food and fluids on the basis of disability.’
The UK was very active in the formation of this Convention and was among the first to sign on March 30 2007. Anne McGuire, Minister for Disabled People, is very keen to ratify by the end of this year.
However, there does seem to be a move to reserve on some articles – though we do not know which. (As human rights are universal and indivisible, how you can implement some rights and not others is beyond me!)
The Convention is quite clear in stating that full implementation by member states can be incremental – i.e. you don’t have to do it all on the day of ratification – only have the intention.
Not to ratify Article 25 and provide the NHS the guidance to change its present cure or kill culture - to ensure that it intends to no longer see old and disabled people as useless commodities but people who have the same right to health care and services, including food and fluids - would seem to me a blatant violation of our rights.
A violation that must not and should not happen in such a rich and influential country as ours.
To download a copy of The NHS - Kill or Cure click on one of the links below.