Fear mongering headlines can harm end of life care

The Daily Mail is the most read English language newspaper site in the world. The website is incredibly user friendly and interactive. It runs features on healthcare and wellbeing. It’s a major influence on public perceptions of health services and on politicians’ responses.

In 2010 HSJ reflected this by naming Mail group editor Paul Dacre 13^th in the HSJ100.

With power, surely comes responsibility?

Newspapers are an increasingly unviable commercial venture. Yet the Mail makes a profit – albeit via an editorial policy that sometimes appears to be “every second story should make readers more angry and more fearful”.  

By rights, I should be pleased to see the long running Dignity for the Elderly campaign although ageist phrase “the elderly” makes this as self-defeating as “equality for babes”.

‘Often the Mail raises worthy issues but spin them so hard that sensible dialogue is impossible’

Yet so many of the stories run under this banner amount to scandals, scares and sensationalism.  

The shame is, they often raise important issues worthy of serious debate then spin them so hard that sensible dialogue becomes impossible as outraged readers line up against defensive clinicians.

• HSJ commission final report: Are you doing enough for frail elderly people?
• Visit the commission’s website for more resources

Not much room for prose

Anyone challenging risks being slapped down and vilified – just check journalist Melanie Phillips’ condemnation of clinicians who took issue with her initial Liverpool Care Pathway “exposés” in 2013.

These created the momentum that ultimately led to the pathway being killed off after the Neuberger report – though it was, in effect, resuscitated. 

Hospitals continue to document palliative care decision making in dying patients much as they did before rather than pretending it doesn’t matter for fear of further accusations. The Mail seems to find this a problem.

I never thought I’d see the headline “Hospitals bribed to put patients on the pathway to death” outdone, but the Mail’s front page on 27 April managed it. In bold 60 font “Over 75? Sign here if you’re ready for death”.

‘Perhaps more misleading was the notion that “the NHS” was imposing all of this’

This didn’t leave much room for prose but those not already choking on their breakfast with indignation could turn to page 4 for the detail.

Reading on, the story concerned “new NHS guidelines urging GPs to draw up end of life care plans for over 75s and younger people suffering from cancer, dementia, heart disease or serious lung conditions” and allegedly doctors being “told” to ask all over 75s if they “agree to a do not resuscitate order”. 

I got pretty concerned myself then reading of “nurses in some surgeries cold calling patients and asking them over the phone if they want resuscitation”.

Let me be clear, if this has been happening anywhere, I find it as unacceptable and insensitive as the Mail does. Its bound to upset many older people and their families.

The article carried on with barely related “while we’re at it” content – harking back to 2013 “Liverpool Care Pathway-gate”.

It repeated the myth that it, and by extension all palliative care, is “a practice where food and fluids are deliberately withdrawn from patients who are close to death, they are usually sedated” and that inpatient palliative care was being “used to free up bed space or claim financial incentives” with no evidence to support this stunning assertion.

The Mail misleads

It hinted that hospital do not resuscitate orders for dying or seriously ill patients were somehow another piece of scandalous news.

Perhaps more misleading was the notion that “the NHS” was imposing all of this, whereas ordinary “clinical staff” were suitably opposed and horrified.

In fact, only two clinicians were named, one a known opponent of the pathway and there was no mention that experienced, expert clinicians who I’m sure care just as much as those interviewed for the story advise NHS England extensively in development of care planning and palliative care.

Are they only “good” clinicians if they agree with the Mail?

I don’t seek to defend insensitivity, poor communication and poor judgement by clinicians.  

I don’t approve of unthinking, blanket application of box ticking policies linked to performance incentives with no regard to the individuals they affect.

‘If you are really serious about Dignity for the Elderly try saying that for a change’

I would never defend some of the practice gathered by the Neuberger report - for instance, families mechanistically told their loved one has been “put on the pathway” without their involvement. I don’t think do not attempt resuscitation decisions should be made behind the backs of mentally competent individuals.

But guess what, Daily Mail? I and many other clinicians try every day to help patients with incurable conditions and their families to exercise some choice and control, to try to die in the place of their choosing - generally not in a hospital if they can help it. Good advance planning can enhance people’s chances of dying in their own homes or care homes or making it to a hospice.

We have also been there at numerous undignified and futile cardiac arrest calls for people who should have had proper decisions in place.

Resuscitation mostly succeeds in TV medical shows, but in real life, success rates are low - lower still in older, frailer people with chronic disease. Also, failed attempts can lead to permanent brain damage and disability.   We’ve also had to help patients and families with harrowing decisions about limits of treatment, feeding or fluids too late in the illness because these things were never discussed properly in advance.

Dignity for the Elderly

Advance care planning done well is a mass force for good.

Many doctors would want to ensure it’s in place for themselves or their families.

Good, structured palliative care is right and embodies the very best of the hospice movement - it allows people to die with dignity and free of distress. 

‘Ramping up fear and anger to sell papers will prevent us from having the discussions’

It does not entail deliberately denying people food or fluids – show me the part of the document that says we shouldn’t allow people to eat or drink.

“Do not resuscitate” orders discussed fully and sensitively with patients or their carers can also prevent an undignified and over-medicalised end to older people’s lives. 

Ramping up fear and anger to sell papers will prevent us from having the discussions, making the decisions and giving the care that will help people have better deaths.

If you are really serious about dignity for the elderly try saying that for a change.

David Oliver is a hospital doctor, a visiting professor at City University London and a former DH national clinical director