Universal Deathcare.

[Kyrshamarks]

So those that support Universal Healthcare and how great it is care to explain to us how it was great for Alfie Evans? Hopefully not coming soon to the America near you.

[broughden]

I know what cell lysis is. I was referring to the "cranial cavity full of water and lysed neurons" that you've repeated at least three times in this thread.

As you say you're a parent, I'm surprised at your attitude towards a dead child. It will be interesting to see how your views change as you progress through school and start working, especially if you end up in a position to handle death much.

I use the term repeatedly for two reasons. One because its the accurate descriptor for the condition. Two because maybe if I keep repeating it people will finally understand he wasnt going to recover. You seem to have some issue with my using the term, if so please just openly state it, because Im not sure what your point is in bringing it up.

I have handled death. Unfortunately all to much. After five combat tours you come to realize the body over there is no longer your fallen team mate, its just a body, and they have moved on. When you have to worry about getting yourself and the rest of the team out of an ambush alive, what happens to a body becomes low priority. Do we leave our fallen comrades behind? Never. But your frame of reference has to adjust to higher priorities.

Its evident that you and I are just going to have to agree to disagree. Will I show the proper respect for a deceased person in front of their family? Of course. Do I feel the need to do so on a nursing forum in the context of the present debate when people are arguing he needed to still be on life support? No.

Feel free to get in the last word, and enjoy your Sunday night.

[Coffee Nurse, BSN, RN]

I use the term repeatedly for two reasons. One because its the accurate descriptor for the condition. Two because maybe if I keep repeating it people will finally understand he wasnt going to recover. You seem to have some issue with my using the term, if so please just openly state it, because Im not sure what your point is in bringing it up.

I have handled death. Unfortunately all to much. After five combat tours you come to realize the body over there is no longer your fallen team mate, its just a body, and they have moved on. When you have to worry about getting yourself and the rest of the team out of an ambush alive, what happens to a body becomes low priority. Do we leave our fallen comrades behind? Never. But your frame of reference has to adjust to higher priorities.

Its evident that you and I are just going to have to agree to disagree. Will I show the proper respect for a deceased person in front of their family? Of course. Do I feel the need to do so on a nursing forum in the context of the present debate when people are arguing he needed to still be on life support? No.

Feel free to get in the last word, and enjoy your Sunday night.

I'm at work tonight, so rest assured I'm not staying up just to "get in the last word."

Your context of handling death is certainly different than mine. I appreciate the fact that no fallen soldier is left behind, although I do wonder about the point of that if they are just "hunks of meat." While I can see that retrieving a body is not the priority in a combat situation, I don't see that that translates to bodies in general are not deserving of respect. But as you say, we will have to agree to disagree on that.

I stand by my opinion that the descriptors you used were excessive. Maybe that's just me being too soft, or too female. But given that I am otherwise agreeing with your viewpoint *and* you are going into a female-dominated field, it's something for you to perhaps bear in mind. You could have made your point without dehumanizing.

Thank you for your service.

[Kooky Korky, BSN, RN]

This is a false conflation. As MunoRN said, it was the judiciary that decided Alfie's fate, and that of Charlie Gard before him. Fortunately I was never involved in as desperate a situation as this during my time in the UK, but if our team of attendings had reached a point of absolute impasse with parents, they would have appealed to the courts, not to the government. And the government, for that matter, is only involved in the healthcare system in the broadest, financial sense; it is not involved in any way in patient care decisions.

In Alfie's case, the question was about prolonging futile medical interventions in the face of irreversible, catastrophic brain damage. For Charlie, his parents wanted to take him abroad and subject him to treatment that amounted to human experimentation, also in the context of severe brain damage. In neither situation did the parents' wishes align with what was in the best interests of their children, as loving and well-intentioned as those wishes were.

Every tax-paying UK resident is well aware of the portion of their paycheck that goes to fund the NHS. What they are spared is the financial devastation that an unexpected diagnosis can inflict (Alfie spent 16 months in an ICU, can you imagine what that would have cost his parents in the US?). If anything, the single-payer system empowers people to explore every available avenue of care, if indicated, since they do not have to worry about how they are going to pay for it.

Are the Courts not part of the Government?

[Guest219794]

The parents should be the ones to determine what's in the best interests of the baby; not you, not the government.

You are not alone in this belief. The Turpins were exercising their parental rights, and those dang courts got involved.

Honestly, blanket and absolute statements have no real place in this discussion- Obviously there need to be laws limiting the "rights" of parents to do what they want with children. You and I may disagree on whether spanking should be legal, but I'll give you enough credit to assume that we would both agree that the use of cattle prods is out, even if the parents believe it is "in the best interests" of the child.

If you believe that parents have absolute rights regarding their children, how do you fulfill your legal obligation as a mandated reporter?

The courts are the last defense of the defenseless. Are you advocating that courts should no longer have jurisdiction in family matters?

[Guest219794]

I have worked in the UK for 30 years the last15 in very senior positions. In that whole time I have never encountered your so called "death panel"

We occasionally have disagreements between what families believe is in best interests and what the medical teams are advocating at which point we will hold a best interest meeting. At that meeting all interested parties are represented and all have the opportunity to input into that discussion. The views and beliefs of the family are very much considered and extremely important.

If no agreement is reached and all options to reach that agreement are exhausted (and from my experience w try all options seeking second and even third opinions ) then the medical teams would involve the hospital adult or child safeguarding teams for support. A strategy meeting would be held with an independent reviewer and if this was not able to find a way forward then they would contact the hospital legal team to ask for guidance.

The legal processes are independent of the hospital (and the government) and provide an impartial review of all of the information to support a decision which is in the best interest of the patient.

Do we always get it right - no

But this view that we have death panels is just not accurate.

There are many flaws in our system, it's not perfect.

We are underfunded, over stretched, many of us working in the NHS don't like the direction we are heading, driven by finance which sometimes feels at the detriment of quality. BUT most of us are passionate about our NHS because despite that the care we deliver in the main is excellent.

If you want to demonise Universal Healthcare there are many other reasons you could look a and use but, this case is not one.

Don't clutter up this discussion with facts.

And for god's sake, what has your extensive experience with the UK health system have to do with anything?

[morte, LPN, LVN]

Quality of life or not, the parents had their CHOICE and PARENTAL RIGHTS abrogated by a know-it-all National Health System. Their alternative for care in another country was independently funded. They should of had the choice. Socialized medicine equals death panels, plain and simple.

wrong, plain and simple.

[morte, LPN, LVN]

The parents should be the ones to determine what's in the best interests of the baby; not you, not the government.

and when the parents fail, who steps up?

[morte, LPN, LVN]

Can we temper our zeal for realistic descriptions with a little common decency please. Those of us advocating for Alfie on this thread are trying to argue his humanity. Language like this is crude and unnecessary.

if they had down votes, I would give you on.e

[psu_213, BSN, RN]

Are the Courts not part of the Government?

Full disclosure...I agree with the decision of the courts.

However, this has been bothering me to. Living in the US, I'm not sure of the set up of the judicial system in the UK...perhaps the courts are privatized. In the US, they are an branch of government equal to the legislative and executive branches.

It is accurate to say that the decision was not made by the NHS.

[psu_213, BSN, RN]

If you believe that parents have absolute rights regarding their children, how do you fulfill your legal obligation as a mandated reporter?

Well said.

[nrsang97, BSN, RN]

I completely agree with you!!

One of my professors gave me an amazing book to read: Atul Gawande - Being Mortal. It was an amazing read, and I wish more people would check it out.

On the topic of universal healthcare; I'm British and I moved to the USA when I was 21. It has its perks for sure, like I love the fact that if I got hit by a bus or a drunk driver, I'd have no bill at the end of the day. My wages were garnished each paycheck to cover 'national insurance' - so technically the care isn't free, but you do pay a small amount from each paycheck toward that care.

The wait lists can be kinda crappy though as my dad had to wait 2 weeks to have a transverse fracture of his left humerus plated :/

UH still has its limitations and isn't a perfect system, but I do miss it. I don't enjoy dropping $80+ on an inhaler. . .

I read that book as well for my Medical Ethics class for my BSN program. It was great. I think every healthcare professional needs to read this.

[broughden]

It is accurate to say that the decision was not made by the NHS.

Respectfully, thats not accurate at all. The hospital and attending physicians made the decision to withdraw treatment and provide only palliative care, all the courts did was enforce that decision and allow a date to be set.

It was the hospital themselves that turned to the courts to help enforce their decision.