Euthanasia Appeal Addenbrookes

[Mike Davis]

I've just received the following information from CitizenGo, which, if
true, is very worrying! Especially at such a prestigious hospital.

https://citizengo.org/en-gb/lf/205011-addenbrookes-hospital-must-respect-right-life-everyone

Mike
--
Mike Davis

[Kendall K. Down]

Thanks, Mike. I've signed.

For those who are curious but not curious enough to click the link,
apparently there is a woman with severe covid but who is conscious.
Addenbrooks have applied to the courts for permission to switch off her
life-support, even though both the patient herself and her relatives do
not wish that to happen. Presumably, seeing as she isn't a racing car
driver or a film star (or film star's husband), she is expendable.

Unfortunately the URL does not give the reasons why Addenbrooke feel
this is the appropriate course to take, but it does seem sufficiently
wrong for me to sign it and to urge everyone else to do so too.

God bless,
Kendall K. Down

[steve hague]

Done.

[Jason]

Another terribly, terribly tragic case. The local Cambridge paper gives a
slightly take on it, in particular it doesn't mention whether she herself
has (or even was able to) expressed any wishes (is it the same one?):

https://www.cambridge-news.co.uk/news/cambridge-news/addenbrookes-
hospital-most-complex-covid-21482307

And I certainly don't want to split linguistic hairs when discussing such
a tragic case, but I'm not sure this is 'euthanasia' in the way we have
been discussing recently. I would imagine that stopping a life-
prolonging treatment (such as a ventilator) is always extremely traumatic
for all involved, but if the treatment is "adding to the patient's
distress and there is no hope for improvement" as the medics think,
should this not also be taken into account to some degree?

I don't know of an answer, I guess all we can do is keep her and her
family in our prayers.

[Kendall K. Down]

On 06/11/2021 13:08, Jason wrote:

> Another terribly, terribly tragic case. The local Cambridge paper gives a
> slightly take on it, in particular it doesn't mention whether she herself
> has (or even was able to) expressed any wishes (is it the same one?):

Thanks, Jason.

> And I certainly don't want to split linguistic hairs when discussing such
> a tragic case, but I'm not sure this is 'euthanasia' in the way we have
> been discussing recently.

I agree that stopping treatment is not the same as deliberately killing.

> I would imagine that stopping a life-
> prolonging treatment (such as a ventilator) is always extremely traumatic
> for all involved, but if the treatment is "adding to the patient's
> distress and there is no hope for improvement" as the medics think,
> should this not also be taken into account to some degree?

If it was merely the patient's relatives, I would agree with you.
However the petition clearly stated that the patient herself had
expressed a desire for treatment to continue and *that* is why I signed.

Bear in mind the cases of Michael Schumaker (or however his name is
spelled) and of the husband of Kate Garraway. Would Addenbrokes be
adopting the same attitude if this woman or her relatives were famous?

[Jason]

On Sun, 07 Nov 2021 09:26:38 +0000, Kendall K. Down wrote:

> On 06/11/2021 13:08, Jason wrote:

>> I would imagine that stopping a life-
>> prolonging treatment (such as a ventilator) is always extremely
>> traumatic for all involved, but if the treatment is "adding to the
>> patient's distress and there is no hope for improvement" as the medics
>> think, should this not also be taken into account to some degree?
>
> If it was merely the patient's relatives, I would agree with you.
> However the petition clearly stated that the patient herself had
> expressed a desire for treatment to continue and *that* is why I signed.

Yes, I completely agree with you, that if the patient themselves were to
say "don't turn me off, I'm not dead yet" there ought to be no question
of doing so. I wasn't completely clear what the original letter was
actually saying there. For example, if I were to go into hospital with a
serious illness, I would say at the outset when they were asking me for
my consent to "go for it, do all you can, try everything". I wasn't sure
if the article was saying more than that.

> Bear in mind the cases of Michael Schumaker (or however his name is
> spelled) and of the husband of Kate Garraway. Would Addenbrokes be
> adopting the same attitude if this woman or her relatives were famous?

I would like to think that everyone is treated equally by the NHS, and I
don't have any personal experience of reasons where a famous person would
be treated one way, but a non-famous one given lesser options. If this
is not the case, then I also agree with you here too and I can't think of
any excuse for it.

[Kendall K. Down]

On 11/11/2021 19:04, Jason wrote:

> I would like to think that everyone is treated equally by the NHS, and I
> don't have any personal experience of reasons where a famous person would
> be treated one way, but a non-famous one given lesser options. If this
> is not the case, then I also agree with you here too and I can't think of
> any excuse for it.

I would like to think that too - and I am sure that the doctors and
nurses do (more or less) treat everyone equally. It's the overpaid bean
counters in management who are the problem.

[Mike Davis]

Evidence? Not hearsay? Or are you just repeating gossip?

Mike
--
Mike Davis

[Kendall K. Down]

On 11/11/2021 22:29, Mike Davis wrote:

> Evidence? Not hearsay? Or are you just repeating gossip?

Just remind me, is it the nurses bringing the court action to let them
turn of this lady's life-support?

Or were you questioning the "over-paid" bit?

[John]

Kendall K. Down wrote:
> On 06/11/2021 13:08, Jason wrote:


>> I would imagine that stopping a life-
>> prolonging treatment (such as a ventilator) is always extremely traumatic
>> for all involved, but if the treatment is "adding to the patient's
>> distress and there is no hope for improvement" as the medics think,
>> should this not also be taken into account to some degree?
>
> If it was merely the patient's relatives, I would agree with you.
> However the petition clearly stated that the patient herself had
> expressed a desire for treatment to continue and *that* is why I signed.

Which wasn't true. The whole point of the court case was because the
patient was unable to make the decision herself.

It may be interesting to read a more complete study of the court case.

https://openjusticecourtofprotection.org/2021/09/06/best-interests-in-a-contested-end-of-life-case-cambridge-university-hospitals-nhs-foundation-trust-v-ah-ors-2021-ewcop-51/

Shortened link if that doesn't work https://bit.ly/3c7wzYc

> Bear in mind the cases of Michael Schumaker (or however his name is
> spelled) and of the husband of Kate Garraway. Would Addenbrokes be
> adopting the same attitude if this woman or her relatives were famous?

In both cases the life support was only temporary, and in Michael
Schumacher's case, private care in a different country.

[Mike Davis]

On 12/11/2021 05:34, Kendall K. Down wrote:
> On 11/11/2021 22:29, Mike Davis wrote:
>
>> Evidence? Not hearsay? Or are you just repeating gossip?
>
> Just remind me, is it the nurses bringing the court action to let them
> turn of this lady's life-support?
>
> Or were you questioning the "over-paid" bit?

It was the *generalisation* that I was querying, one bad apple doesn't
mean the crop is ruined.

Mike
--
Mike Davis

[Kendall K. Down]

On 12/11/2021 13:12, Mike Davis wrote:

>> Just remind me, is it the nurses bringing the court action to let them
>> turn of this lady's life-support?
>> Or were you questioning the "over-paid" bit?

> It was the *generalisation* that I was querying, one bad apple doesn't
> mean the crop is ruined.

Management being overpaid may be a generalisation, but it is also
terribly true. As well as draining resources better spent on hiring more
nurses (or paying nurses more), they make everyone's life a misery by
inventing new targets and new ways of harrassing those doing the actual
work.

I notice that you carefully avoided answering my first question, as you
know jolly well that it is not the nurses and probably not the doctors;
it's the bean counters.

[Kendall K. Down]

On 12/11/2021 11:27, John wrote:

> It may be interesting to read a more complete study of the court case.
> https://openjusticecourtofprotection.org/2021/09/06/best-interests-in-a-contested-end-of-life-case-cambridge-university-hospitals-nhs-foundation-trust-v-ah-ors-2021-ewcop-51/

Thanks for that, John. It makes harrowing reading and I am still not
convinced that the right decision was made.

"Son : I think she’s well aware of her existence now and has accepted
it. You say that it would be for her best interest and for our interest
to bury her. We would rather have a mum we can look after than one that
we can visit at a grave."

What is more, the judge merely ordered that the ventilator be turned
off. Rather hypocritically he declared, "The other is that she moves to
a calm, quiet and private place, where the close of her life in this
world can come to pass when she is back where she has always wanted to
be – at the heart of her family – surrounded by their love, in an
atmosphere of prayerful peace and togetherness.”

That might be the case if he had ordered that she receive a fatal dose
of some sedative, but my understanding is that if a ventilator is turned
off, the unfortunate person dies of suffocation - hardly the "calm and
quiet" ending to which he referred.

That said, I am just glad I didn't have to decide the case.

[Mike Davis]

No disagreeing! However, having a Master's degree in 'Management' I DO
make a distinction between 'management' and 'accountants'. But all admin
staff get lumped together as 'management'. I also recognise that 'middle
management' in many organisations is often very weak.

I'll start a new thread about 'Team building'...

Mike
--
Mike Davis

[Jason]

On Fri, 12 Nov 2021 20:11:59 +0000, Kendall K. Down wrote:

> On 12/11/2021 13:12, Mike Davis wrote:
>
>>> Just remind me, is it the nurses bringing the court action to let them
>>> turn of this lady's life-support?
>>> Or were you questioning the "over-paid" bit?
>
>> It was the *generalisation* that I was querying, one bad apple doesn't
>> mean the crop is ruined.
>
> Management being overpaid may be a generalisation, but it is also
> terribly true. As well as draining resources better spent on hiring more
> nurses (or paying nurses more), they make everyone's life a misery by
> inventing new targets and new ways of harrassing those doing the actual
> work.

I do agree that management, and more specifically, the senior management
is in general overpaid compared to the rest of the workforce. As another
generalisation, whether in the public or private sector, when cost
cutting needs to take place, it is very rarely the senior managers that
go first.

> I notice that you carefully avoided answering my first question, as you
> know jolly well that it is not the nurses and probably not the doctors;
> it's the bean counters.

I think that question can be difficult to answer. If the statement is
true that continuing a treatment would "prolong the agony with no hope of
improvement" (I'm speaking in general, not for this particular case) then
I suggest that turning off the ventilator would be a medical decision,
not an administrative one. Unless someone had evidence to the contrary,
I would suspect that most such decisions would be made by medical staff.

[Kendall K. Down]

On 13/11/2021 12:04, Mike Davis wrote:

> No disagreeing!  However, having a Master's degree in 'Management' I DO
> make a distinction between 'management' and 'accountants'. But all admin
> staff get lumped together as 'management'. I also recognise that 'middle
> management' in many organisations is often very weak.

Thinking of hospitals - which is what this thread is about - I agree
that there is a need for ward matrons. There is also a need for an
accountant and an unpaid board. But that's it.

Someone I know worked for the NHS and after getting on with the job for
many years - but falling behind as a department because there were too
few workers - upper management decided that the solution was to appoint
a new manager rather than a new worker. The new manager was on a higher
grade salary than any of the workers he managed. He installed a big
screen in his office opposite his desk and insisted that the workers use
Psions to log in when they started seeing a patient and log off when
they stopped. Anyone who failed to log in and out or who took more than
5 mins to write up the notes got a rocket.

So this new manager did nothing but sit in his office watching the
screen and feeling smug as "his" workers logged in and out in real time
and firing off the occasional rebuke when some frazzled worker took too
long to write up the notes or dared to take a toilet break.

Having to turn the Psion on and off and enter the details took time. As
appointments were strictly limited to a certain number of minutes, that
means that patient care suffered. To cram in more patients, the number
of minutes was cut - further reduction in patient care. Then the number
of sessions allowed per patient was set (whereas previously the number
of sessions varied according to need) and then cut.

At the end of a year the waiting list had been reduced, the workers were
stressed and the following year there was a rash of resignations and
people going off with ill-health. Worker dissatisfaction reached new
heights as instead of being treated like professionals they were being
treated like naughty children. Patients who required more than the
allowed number of sessions were reappearing, but now worse off than
before thanks to the gap between one tranche of treatment sessions and
the next allowed.

At the end of two years the waiting list had soared to new heights, the
staffing level had fallen to new lows, and the manager was given a
productivity bonus (I kid you not).

[Kendall K. Down]

On 13/11/2021 18:23, Jason wrote:

> I think that question can be difficult to answer. If the statement is
> true that continuing a treatment would "prolong the agony with no hope of
> improvement" (I'm speaking in general, not for this particular case) then
> I suggest that turning off the ventilator would be a medical decision,
> not an administrative one. Unless someone had evidence to the contrary,
> I would suspect that most such decisions would be made by medical staff.

I think there is a difference between "made by medical staff" and "made
with the agreement of medical staff".

[Mike Davis]

Indeed, events like that are depressing, with the management
(effectively middle levels) are ignorant, but worse is the fact that the
superiors are unable to set proper standards.

One occurrence that seems repeated is to try to match the supply (of
services) to the demand (i.e. patients). The fallacy with this is that,
if at any time, there is a minor backlog, it can never be recovered, and
so waiting times trend to infinity. Anyone who's studied queuing theory
knows that, but I constantly hear of service industries (eg NHS) trying
to match the service to the demand. It can't be done - one missed
appointment proves that!!

Mike
--
Mike Davis

[Kendall K. Down]

On 13/11/2021 21:24, Mike Davis wrote:

> Indeed, events like that are depressing, with the management
> (effectively middle levels) are ignorant, but worse is the fact that the
> superiors are unable to set proper standards.

What is depressing is that upper management thought that the cure for
the problem was to appoint another manager instead of another worker -
or, given the manager's salary, 1.5 workers! Management breeds
management and, of course, managers invent work (done by others, of
course) to justify their own existence.

> One occurrence that seems repeated is to try to match the supply (of
> services) to the demand (i.e. patients). The fallacy with this is that,
> if at any time, there is a minor backlog, it can never be recovered, and
> so waiting times trend to infinity. Anyone who's studied queuing theory
> knows that, but I constantly hear of service industries (eg NHS) trying
> to match the service to the demand. It can't be done - one missed
> appointment proves that!!

Not being a manager, I don't understand what you mean by "matching
supply to demand". That would seem to me to be entirely sensible -
unless you mean that when demand goes down (ie. the backlog is zero) you
promptly reduce services instead of giving the hard-pressed workers a
much-needed break.

[Mike Davis]

OK, let's take a very oversimplified scenario.

A post office has three counters, and it takes (an average of) 5 minutes
per customer per transaction. The counters are manned during opening
times for 10 hours per day (eg 8am to 6pm). That means 120 (12 per hour
x 10) transactions per day at each desk or 3 x 120 = 360 transactions
per day across all 3 desks. So the PO sets up to man the 3 desks for 10
hours per day.

But of course, that's the average - some transactions are longer, some
shorter. Also some customers carry out more than one transaction during
their visit. Now look at the queue lengths, customers don't arrive at
1.66 minute intervals (i.e. 5/3), they arrive randomly! So at opening
time there may be a rush, the doors open with a small queue outside, say
12 people, this is dealt with and arrival of customers may increase
until, say 11am, when the desks have caught up with the backlog. Then
things are quiet until the 1:00pm lunchtime rush and instead of the
'planned' 72 customers, only 48 arrive. The staff have a breather, but
they are 24 transactions short of the 'plan'. When the afternoon rush
brings the 'missing' 24 customer transactions. the queue length is now 8
per desk or 40 minutes! By the end of the day, counters are closed and
some customers asked to 'come back tomorrow'. The service efficiency is
judged at (360-24)/360 = 93.3% and a number of customers somewhat
disgruntled.

That may seem complicated (and easy to get round!) but of course real
life is much more random & unpredictable. In the situation described it
can be resolved by the manager manning a temporary desk during the peak
for 2 hours to deal with the 24 customers who might otherwise be turned
away.

My point was that waiting time will always increase, because as we
balance supply with demand, anytime a customer is late, the waiting time
increases, anytime an operative is off sick, the waiting time increases,
etc. If management 'MATCH' supply to demand - the waiting time will
always increase and never decrease! Indeed, I've heard of maternity
wards so busy that there's a 12 month waiting time for a bed! Geddit?

So once we get to the NHS, we have triage to sort out the different
urgencies and decide which can wait and which can't; and get them to the
right specialism. And there's no 'average time per transaction', AND no
'manager' to step in, we can see how difficult it is to balance supply
and demand.

Mike
--
Mike Davis

[Jason]

I agree that there is a difference, but still think it will be someone on
the shop floor saying "it's time to think about stopping this treatment"
rather someone at head office.

[Kendall K. Down]

On 14/11/2021 15:58, Jason wrote:

> I agree that there is a difference, but still think it will be someone on
> the shop floor saying "it's time to think about stopping this treatment"
> rather someone at head office.

I think that such a decision would be taken at a case conference. I
would be interested to know whether the bean counters are present at
such conferences. If so, then they may very well be the ones suggesting
that treatment be stopped. If they are clever, they do so in such a way
that the medics think it was their idea all along ...

[Kendall K. Down]

On 14/11/2021 16:47, Mike Davis wrote:

> That may seem complicated

No, I understand what you are saying.

> My point was that waiting time will always increase, because as we
> balance supply with demand, anytime a customer is late, the waiting time
> increases, anytime an operative is off sick, the waiting time increases,
> etc.  If management 'MATCH' supply to demand - the waiting time will
> always increase and never decrease! Indeed, I've heard of maternity
> wards so busy that there's a 12 month waiting time for a bed! Geddit?

Yes, you are talking about exactly matching supply to demand with no
slack in the system. That may be desirable from the efficiency
standpoint, but as you say, it is a recipe for disaster.

> So once we get to the NHS, we have triage to sort out the different
> urgencies and decide which can wait and which can't; and get them to the
> right specialism. And there's no 'average time per transaction', AND no
> 'manager' to step in, we can see how difficult it is to balance supply
> and demand.

I do so agree.