updated 9/3/2009 1:11:16 PM ET 2009-09-03T17:11:16

A group of senior British doctors expressed concern Thursday about the treatment of the terminally ill, saying some people are dying prematurely because of guidelines for dealing with patients in their final hours.

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In a letter to The Daily Telegraph newspaper, the six palliative care specialists criticized the "tick-box approach to the management of death" in guidelines used by hundreds of hospitals within Britain's universal health care system.

Britain's system has been at the center of debate at home and in the United States, where opponents of health care reform have used it to attack President Barack Obama's plan for national health insurance. U.S. conservatives have used the British system as a negative example, saying it provides rationed care and allows bureaucrats rather than doctors to make life-and-death decisions.

On Thursday, a leaked consultants' report recommended drastic cuts in the U.K.'s National Health Service to help cope with the ever-rising cost of supporting universal health care — a development that opponents of the U.S. health care reforms are likely to welcome.

Most in Britain defend their NHS, but complaints about bureaucracy are common.

The guidelines for the terminally ill, which are not mandatory, were designed by a hospice in Liverpool and recommended as a model in 2004 by the body that sets national health care standards.

They lay out signs that a patient is close to death — including loss of consciousness and difficulty swallowing — and say that once an assessment has been made doctors may remove medication or intravenous drips that are no longer effective.

Some fear signs of improvement could be missed
The letter-writers said the problem with the guidance was that "forecasting death is an inexact science" and that some patients might be denied food or fluids, or put under sedation with the result that signs of improvement might be missed.

"It is supposed to let people die with dignity, but it can become a self-fulfilling prophecy," said Dr. Peter Hargreaves, one of the signatories. "Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway."

Marie Curie Cancer Care, the charity that drew up the guidelines, said the procedures had "improved the end of life experience for thousands of people" and claimed the doctors' letter would cause unnecessary fear.

Most Britons strongly support the NHS, which provides free medical care for all. But the service also receives frequent criticism from doctors, politicians and patients, and funding it is a constant challenge for governments.

A magazine reported Thursday that management consultants McKinsey & Co. had advised the health service to cut a tenth of its 1.5 million-strong work force over the next five years to make up a budget shortfall.

It also suggested the NHS sell off hospitals and cut back on some services.

The government said it had rejected the proposals, which were among many submitted by consulting firms after the government asked for suggestions on how to make up a 20 billion pound ($33 billion) shortfall expected by 2014.

"The government does not believe the right answer to improving the NHS now or in the future is to cut the NHS work force," Health Minister Mike O'Brien said.

Details of the study were published Thursday by the Health Service Journal.

McKinsey & Co. refused to comment.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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