The Decapitation of Care: The Healthcare Manifesto

February, 7, 2020 | 21 Comments


  1. “Responsibility, Care and Neuroscience”.

    Compelling Lecture, thank you.

    Slides very useful, especially those relating to the “misleading” randomised controlled trials.

    Why is it seemingly so difficult for prescribers to appreciate what is really happening? At least recognise bias by design? Implications just too enormous to even contemplate?
    Prescribers who are so reluctant to understand and recognise akathisia, and then continue to misdiagnose akathisia as “Serious Mental Illness”?

    Like PSSD. PGAD. all the other ADRs endured, or unendurable, the prescriber denial of our suffering adds to the endless grieving and unending sense of avoidable loss.

    Perhaps “The Pharmacist” series may inspire some greater understanding of the modus operandi of Pharma Marketing?

    I bought the Kindle version of “The Decapitation of Care”, but received only a small part, brilliant illustrations and the excellent reviews. Technical gliche? Will re-order.

    • Good Tim, this article goes a long way in support of ‘Decapitation of Care’ and the difficulties…

      “What kind of world is this?”

      The very fact that patients are organising themselves in survivor groups and various withdrawal-related initiatives around the world is a clear sign that psychiatrists ignore them, and Cochrane is no exception.

      James Moore Retweeted

      PAST (Prescription Awareness & Support Team) Wales

      More than 100 million people worldwide receive these pills every year. About half of the patients, or over 50 million people, will experience withdrawal reactions when they try to stop, and in half of these, the symptoms are severe.1

      The Review on Antidepressant Withdrawal That Cochrane Won’t Publish
      Peter Gøtzsche and Anders Sørensen on trying to get a review of methods for safe antidepressant withdrawal published in Cochrane: “They sent us on a mission that was impossible to accomplish” to “protect the psychiatric guild.”

      We changed “terrible” to “severe” and noted that the UK Royal College of Psychiatrists was recently forced to change their position totally, after the College had previously trivialised these symptoms.7

      It is very sad. This pattern often develops over time, not only in religious sects but also in charities like Cochrane.

  2. So Panorama do a show on Callie Lewis seeking to show ‘understaffed and overstretched system’. She was almost certainly on psych drugs: Is it known what she was on, for how long and if she was subject to polypharmacy? In an akathisic state the suicide ideation and compulsion is overwhelming.

    “Callie’s death comes at a time when many people with mental health issues continue to complain about their struggle to connect with the services they need.”

    If things stand as they are and if more money is pumped into the same system it will only lead to more psych drug induced deaths.

    When will the BBC understand that psych – and many other drugs – drug induced akathisia is an extremely serious condition that will bring people to this point, especially when they realise that the help they sought came in the form of a pill – forced onto them by the authority of the NHS system corrupted by pharma and other ‘stake holders’ – that did this to them and when they tried to tell the so called ‘experts’, were not only not believed but seen as having a worsening of the ‘illness’. They then see no way out… no help; forced to take a drug – as so often happens in psychiatric situations – becomes utter and total hell. The suicide forums obviously are not good, but that is not where this issue really is. It is being skillfully and craftily used by psych and these charities that have ‘popped up’ to deflect from the truth which is afferent to themselves.

    • Annie, I wonder if you could find the link for Worcester News, Saturday 15th Feb by Grace Walton, page 4, entitled something like ‘Mum speaks out, drug changed him’ It is my effort to raise the AKATHISIA awareness banner again, so it chimes well with Chris’s comment here. ‘Why are prescribers so reluctant to recognise…..’
      If we can’t get the prescribers to wake up, at least we can alert the general public using the axample of the suicide one of their own, someone wellknown and well respected in their town. We’ve had some interested and very supportive comments where the article has been shared. And amazingly, no counter diatribe from the manufacturers. Perhaps they haven’t noticed it yet….

      • So glad to help out, Heather

        We know the devastation that Olly experienced, by experience, and so glad this article had an impact

        ‘The drug changed him’ – Mum speaks out on what would have been son’s 40th birthday

        “There is no pain like the deep shock and sadness of losing your child by suicide. But over time, the emptiness and pain changes to a longing to do something to celebrate the lives of these brave youngsters, to further any aims they had to help others, to write about them, remember them, and to help each other see a positive way forward.—mum-speaks-sons-40th-birthday/

        sending thoughts at this incredibly sad time, and admiration as to what you have achieved.

      • I’m really sorry to read that Heather. I’ve had Akathisia.. it is beyond the most extreme horrific experience anyone could imagine. I think we all have a kill switch and being toxic on drugs switches it on… the suicide ideation from akathisia is something way beyond what ever the circumstances that may have led a person in a distressed anxious state to seek help and recieved a drug. GP’s, Psychiatry, coroners, pharma have gotten away with this because they can always say it was ‘mental illness’. I tell you all here and now: AKATHISIA is THE main cause of suicide today. You never ever want to go there to find out.

        • Chris – I guess you know there is a suicide forum. A few of the comments are pretty vile but in general are quite varied in response to people expressing suicidal thoughts. Do you think being able to offload safely with encouragement from others to hold on is doing more good than potential harm from having the site ?

  3. Limit of efficacy -yes the solution is saturated and causing precipitant to the likes of nuclear fallout. Problem though -there’s no explosion. We don’t know the full extent of how many early deaths are caused by polypharmacy imo. The cure for type II DM is diet and exercise which in turn lead to weight loss and in most cures the disease. Yet we see Drs on symposium panels discussing Januvia, SGL2inh etc etc & the latest and greatest RCTs as causing some weight loss, better heart health blah blah blah. Nothing on harms. If you are here in the US or New Zealand then let’s not forget the advertising that promotes the drug with model like people who’d never need the drug in the first place. The couple on the Viagra commercial does not exist and if they did, they wouldn’t need Viagra as they look like movie stars who seem to marry often enough that I’ll assume they likely aren’t having sexual issues not of that sort anyhow. What we should have is Drs telling patients this drug can do x y & z but will not cure your DM and may cause pancreatitis, increased risk of limb amputation & ketoacidosis or a very serious infection for very little gain. A missing limb is important if it’s your limb. The gold standard for treating DM type II now (not 1) is diet exercise but we have symposiums on RCT for drugs that don’t cure anything! Fabulous. Hocus pocus & the doctors believe it. Interestingly I read an article on SGL2 inh & the mechanism by which they cause euglycemic ketoacidosis. I was curious. It is not a condition we see in DM II but we do commonly see in Type 1 and it’s quite serious. We try to avoid it at all costs & it needs to be treated with insulin (a drug that works) & fluids, management of electrolytes etc. At any rate the SGL2 inhs cause ketoacidosis in T2DM & it is now recognized as an ADR of this class of drugs. There was a suggestion in the article for using SGL2 as possible txment in DM type1 because of heart benefits. I read a follow up article on this idea then between two expert endocrinologists -one making the case for this and the other against. To me seemed a terrible idea which is why I read the second article. As I was reading this I said to myself “can’t wait to see the drug company disclosures for the guy speaking to use these drugs in type 1s”. Sure enough the guy proposing we use these drugs for type 1s had three or four drug co. disclosures. The gentleman from Harvard against had none. But this is what happens. They are trying to convince normal rationale people that using a drug that causes the very condition ketoacidosis that we try to avoid in type 1s is a swell idea. Mind blowing. A sacrament indeed. Hypnosis. Doctors feel they always have to do something and they’ve been taught that that involves prescribing. Less is more.

  4. This little book is a gem.  Good for you for stepping around those who want to dictate what can and cannot be published.  I haven’t read very far but this is put together so well and it’s great that people are able to enjoy a hard copy. 

    I’d never heard of Sir William Petty but now that I’ve investigated, I like to imagine there’s a bit of hidden meaning to why he was chosen for the cover (aside from the skull which I don’t yet know the original meaning).

    It sounds like he’d be a great asset to just about any organization churning out fake news today.  If I’ve interpreted correctly it’s a delightful find, an opportunity to find humor in something that is otherwise deplorable. My son calls these Easter eggs and I’m hoping there are more for us to discover.  At any rate, great job to both of you for putting together a creative and unique publication.

    • The artist, had his fingers, on a book…

      Painted when Petty was in his twenties, this portrait shows him holding a skull in one hand with the other resting upon an edition of Adriaan van der Spiegel’s De Humani Corporis Fabrica (On the Fabric of the Human Body), 1627,open at Plate 3.

      Dominion of knowledge over darkness of ignorance

      Fuller was one of the most flamboyant artists of his time, producing large-scale history paintings and strikingly original portraits. He was an influential teacher and produced the earliest British drawing book (1654), but his bohemian lifestyle aroused controversy. John Evelyn described an altarpiece as ‘too full of nakeds for a chapell’ and Sir Peter Lely lamented ‘that so great a genius should besot or neglect so great a talent’. He ended his career painting decorative schemes for taverns, all of which are now lost.

      National Portrait Gallery

      The heart of medicine… Is it the caring concern of one person for another? It is detached statistical analysis? Is it motivated by love? Or driven by greed?

      Read Dr. David Healy’s parable about about a sister and a brother, and the winter and summer of medicine… The Snow Queen
      Illustration: The Heart of Medicine, © 2013 created by Billiam James. Based on original painting on Sacred Heart of Jesus with Saint Ignatius of Loyola and Saint Louis Gonzaga, circa 1770, José de Páez, Mexico, 1727-1790

      The heart of medicine…skull-capped illustrated, and, so close…

  5. ‘The BMJ should be praised in that it has always set the bar very high when it comes to whether pharmaceutical companies should be involved in influencing clinicians to use their products’ – but the bar not set so high it can’t easily be limboed under.

    Dear Editor,

    We write to ask if the BMJ should reflect on its choice of advertisements associated with the publication. This week’s edition of the BMJ (8th February 2020) came wrapped in an advert for liothyronine. The use of liothyronine (T3) for the management of hypothyroidism remains controversial, with little evidence-base for its use. Its prescription is not supported by latest NICE guidance on the management of hypothyroidism published in this week’s BMJ (BMJ 2020; 368 doi:

    Given that the power of pharmaceutical advertising is likely to promote product prescription, we question whether it is a wise decision for the BMJ to advertise a product that has a questionable evidence base. The accompanying manufacturers’ prescribing information suggests up to 60 mcg liothyronine a day, a dose not recommended by any UK or European guideline that would cost the NHS £11,576 per annum for a single patient taking 6 x 10 mcg tablets per day. By comparison, guidance recommended use of levothyroxine (T4) would cost £62 per annum for a patient requiring 100 mcg once daily receiving a prescription every 28 days (levothyroxine price obtained from the British National Formulary).

    The BMJ should be praised in that it has always set the bar very high when it comes to whether pharmaceutical companies should be involved in influencing clinicians to use their products. The cover of this week’s issue highlights an article questioning the involvement of industry in influencing indoor tanning research. The decision to advertise liothyroinine appears questionable and at odds with messages previously expressed by the BMJ. We would invite a review of the decision to advertise liothyronine in the very same issue in which guidance is published expressing caution against T3 use.

    Yours sincerely,
    Dr Augustin Brooks
    Consultant Physician Diabetes
    Royal Bournemouth Hospital

    Dr Tristan Richardson
    Consultant Physician Endocrinology
    Royal Bournemouth Hospital

  6. Abel Novoa Retweeted

    Marc Casañas Escarré

    Replying to @Firefly_fan and @AbelNovoa

    Manifesto” by @DrDavidHealy in @SamizdatHealth editorial.


    Spanish “[…] very soon after” :D.

    doing, in this case, rather than me, Ariane Denoyel for La santé décapitée and
    @AbelNovoa for El Fin del Cuidado may end up providing le mot juste, the key word, that makes a difference in the real world”:…

    “The decapitation of care: the Healthcare

  7. The Decapitation of HealthCare: Review

    February 18, 2020 by Samizdat Health Leave a Comment

    by John Dan Stone, Age of Autism, UK Editor

    A welcome for David Healy’s new, short polemical volume The Decapitation of Care. Healy as ever likes to express himself in terms of historical theatre — the comparison with oppressive political situations of past as well as the roots of this present oppressive situation in the past. Implicit in the torment of this keenly felt book is that there is still no wide recognition that this ought to be the great political issue of our time.

    By Pamela Stavropoulos

    Author: Living under Liberalism

    Significantly, psychiatrist and cultural critic David Healy characterises his most recent publication, A Short History of the Rise and Fall of Healthcare as ‘the Health care Manifesto’. Defined as ‘a written statement declaring publicly the intentions, motives, or views of its issuer’ a manifesto is generally both a short work and a clarion call.  It is relatively brief because fuelled by the urgency of conveying ideas and prescriptions in succinct and minimalist format.

    • Abel Novoa Retweeted

      @nogracias_eu 13h

      Gran texto de @DrDavidHealyTraducido al castellano por @AbelNovoa


      La decapitation del ciudado is now available from Amazon – we are looking for review in Spanish – as well as French and English and all other languages

      Samizdat Health Writer’s Co-operative Inc. is an international writers’ co-operative focused on issues thrown up by “health”

  8. BBC Newsnight‏Verified account @BBCNewsnight · 15h15 hours ago

     More

    The second in a series where it took whistleblowers yet again to expose this scandal First implicating The Lancet a few weeks ago and yesterday questioning thebmj editor Fiona Godlee. about their publication policies. Both claim to be the most prestigious medical journals globally – neither can be trusted F G’s contribution at BBC2 Newsnight on IPlayer 18.34

    Doctors working on a clinical trial for treatment of heart disease held back key data, Newsnight has been told.

    The trial suggested more people fitted with stents were dying after three years than those given surgery.

    #Newsnight | @deb_cohen | @Edsbrown 18/2/2020

  9. Peter Gøtzsche Exposes Big Pharma As Organized Crime

    By circle of mamas –

    Co-founder of the Cochrane Collaboration, Danish physician / medical researcher Peter Gøtzsche expresses his views on the criminality of pharmaceutical companies.

    Gøtzsche was expelled out of the Cochrane organization in 2018 shortly after co-authoring a critique ( of Cochrane’s HPV vaccine review
    (…/GYNAECA_hpv-vaccination-prevent-…) in which he pointed out that Cochrane’s researchers *excluded* nearly half the relevant trials and incompletely assessed certain adverse events and safety signals.

    More recently, he had a difficult time getting his latest book published in English “Survival in an Overmedicated World,” in which he advises:

    “You should not trust your doctor. You should look up the evidence yourself.”

    ‘You do not ask a barber if you need a haircut.’ Most people have heard this expression or something similar. Yet we willingly allow our doctors to subject us to various diagnostic investigations and treatments which may be financially beneficial for themselves. Health care is riddled with financial conflicts of interest, and even when your doctor does not directly benefit, there are many other reasons you should be on the alert.”

    His next book “Vaccines: Truth, Lies, and Controversy,” is coming out in February.

    #hpv #pharma #bigpharma #bias #biasinmedicine #vaccines #vaccinations #cochrane #petergotzsche

  10. I feel very uncomfortable that Molly is being used for political points …

    Simon Wessely

    Cracking editorial in @TheLancetPsych on @rcpsych report on social media.
    Both are must reads.

    In a moving introduction to the report, Ian Russell describes how, following his 14-year-old daughter’s death by suicide, he found “bleak depressive material, graphic self-harm content and suicide encouraging memes” that had been viewed and “liked” on her social media. He adds that “it is clear they would have normalised, encouraged and escalated her depression; persuaded Molly not to ask for help and instead keep it all to herself; and convinced her it was irreversible and that she had no hope”. To read Russell’s account leaves one in no doubt as to the urgency of the situation.

    In The Age of Surveillance Capitalism: The Fight for a Human Future at the New Frontier of Power, Shoshana Zuboff, professor emerita at Harvard Business School, traces how the financial pressures on technology companies at the turn of the last century led to the growth of a “rogue mutation of capitalism marked by concentrations of wealth, knowledge, and power unprecedented in human history”. This business model is based on the accumulation and retention of vast quantities of personal data, the manipulation of human behaviour, and a moral vacuum where there should be responsibility for content. Zuboff’s thesis is that these detrimental features are not an intrinsic part of digital technology, but an active choice. While the Royal College’s recommendations might be a useful stopgap, they should only be the start of a process in which mental health professionals and other stakeholders ask more fundamental questions about how, and why, technology companies operate in the way they do. The impact of these companies must be evaluated beyond the images and memes on social media, and in terms of their effect on the culture and economic balance of society as a whole. “If the digital future is to be our home”, Zuboff writes, “then it is we who must make it so.” Mental health researchers must go beyond standing on the doorstep, asking for a donation; they should help to build a better house.

    A good plug for a book; a good plug for RCP Report, and you have to wonder, who is impressionable?

  11. 21 February 2020
    Aitzaz Bin Sultan Rai
    Research fellow
    Javraria Sharafat, Shahid Hameed, Humayun Rasheed, Meher fatima, Usama bin Saif, Umme habiba
    University of oxford
    John radcliffe hospital

    Read all responses to this article in thebmj
    Re: Weight loss pill praised as “holy grail” is withdrawn from US market over cancer link Elisabeth Mahase. 368:doi 10.1136/bmj.m705
    On 13 February 2020, the FDA requested the withdraw from the U.S. market place a drug used for obesity – lorcaserin (Belviq) – due to concerns over an increased prevalence of cancer.

    The FDA states its mission as: “The FDA is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation’s food supply, cosmetics, and products that emit radiation.” [1].

    Our efforts to bring to the attention of the FDA, misinformation provided by a major pharmaceutical company, was completely ignored after the Center for Drug Evaluation and Research (CDER) reported the pharmaceutical company had declared to the FDA that the drug redistributed – while marketing the drug to doctors and hospitals as a drug which did not redistribute; a difference which was associated with tens of billions of increased sales of the drug, 3-million extra curies of radiation exposure and countless deaths [1].

    According to Forbes Magazine [2] the FDA approved a record number of 59 new drug therapies in 2018, up from 46 in 2017 [3]. We are aware of no drugs submitted to the FDA by BigPharma, which have ever been denied FDA approval. Since 5 October 2017, The FDA has recalled 234 drugs it had approved [4].

    Clearly whatever process, criteria, methods, protocols or verification is occurring at the FDA and CDER, something is amiss. Either there is some degree of incompetency or collusion between the FDA, CDER and BigPharma, or both. Either way, the problem with drug recall has now become an epidemic; raising alarming concerns as to whether doctors and their patients can trust the FDA and CDER to do their job.


    1. Fleming RM, Chaudhuri TK, McKusick A. The FDA, HHS, Sestamibi Redistribution and Quantification. Acta Scientific Pharmaceutical Sciences 2019;3(5):47-69. ISSN:2581-5423.
    2. Can the Record Breaking Number of FDA New Drug Approvals Continue? By John LaMattina
    3. Center for Drug Evaluation and Research Advancing Health Through Innovation 2017 New Drug Approvals. Janet Woodcock, MD, Director, Center for Drug Evaluation and Research. January 2018.
    4. U.S. Food & Drug Administration Website – Drug Recalls.

    Competing interests: We have previously reported to the FDA and CDER misinformation provided by BigPharma, which was associated with tens of billions of increased sales of the drug, 3-million extra curies of radiation exposure and countless deaths

  12. Quite breathtaking ‘Craftiness’ by ‘Big Tobacco on’ Dispatches Channel 4 24/2/2020….Are Dispatches… Braver than the BBC????

    • Channel 4 are much braver than the BBC. And go into more depth factually. I’m not sure why this should be the case. Are the BBC afraid of being sued and having to be hauled over the coals by Government, threatened with losing their licence fee?

  13. I think this statement in one media story needs ‘the ultimate decision’ – very ultimate Welsh GP are not in many areas, held in high regard but this is beyond disgusting.

    ‘Doctors in the UK must consult with patients or their families if they decide that resuscitation would not be effective or that complications would result in more pain. Families can seek a second opinion but the decision is ultimately a medical judgment to be made by a doctor.’

    How many people are being quietly shunted out of life without their or their families’ knowledge Older people often make observations that they are considered dispensable and fear how they will be ‘treated’ when vulnerable. This surgery has made it obvious that they are not the only ones. They could at least have asked all registered at the surgery to make an Advance Decision – they are not perfect but offer some safeguards. – but then the imperative to sign DNR would have been missed. Sending this letter out of the blue is just grotesque They also had sent a practice nurse with a request to sign a DNR without warning the person first.

    Llynfi Surgery, Maesteg
    Llynfi Surgery, Maesteg, wrote to patients with ‘significant life-limiting illnesses’ asking to complete a ‘do not attempt CPR’ form for them.
    A GP surgery in Maesteg has asked patients with “significant life-limiting illnesses” to sign a DNACPR (do not attempt CPR) form in the case they contract coronavirus.

    Llynfi Surgery on Llynfi Road sent a letter to patients with health conditions such as incurable cancer, motor neurone disease, and untreatable heart and lung conditions.

    It told those patients they are “unlikely to be offered hospital admission” if they become unwell with the virus

    Surgery asks patients with ‘significant life-limiting illnesses’ to sign form waiving CPR if they get Covid-19
    Llynfi Surgery, Maesteg
    Llynfi Surgery, Maesteg, wrote to patients with ‘significant life-limiting illnesses’ asking to complete a ‘do not attempt CPR’ form for them.
    A GP surgery in Maesteg has asked patients with “significant life-limiting illnesses” to sign a DNACPR (do not attempt CPR) form in the case they contract coronavirus.

    Llynfi Surgery on Llynfi Road sent a letter to patients with health conditions such as incurable cancer, motor neurone disease, and untreatable heart and lung conditions.

    It told those patients they are “unlikely to be offered hospital admission” if they become unwell with the virus and “certainly will not be offered a ventilator bed”.

    One patient who received the letter said: “It not only greatly upset me but my family and close friends.
    “It was like having my death warrant being sent by the grim reaper. It made me feel worthless.
    “I’ve lived with cancer for eight years and I want to live another couple of years. I’m not digging my grave yet.”

    The surgery opened the letter by writing “this is a very difficult letter for the practice to write to you”.

    It listed the benefits of signing a DNACPR as:

    Your GP and more importantly your friends and family will know not to
    call 999
    Scarce ambulance resources can be targeted to the young and fit who
    have chance of surviving the infection
    You reduce the risk of transmitting virus to friends, family and emergency responders from C

    Coronavirus: GP surgery apology over ‘do not resuscitate’ form
    1 hour ago

    The advice sent was not a health board recommendation, officials said
    A GP surgery has apologised after sending a letter asking patients with life-limiting illnesses to complete a “do not resuscitate” form.

    Llynfi Surgery, Maesteg, asks people to sign to ensure emergency services would not be called if their condition worsened due to coronavirus.

    “We will not abandon you.. but we have to be frank and realistic,”
    A copy of the letter was tweeted
    The letter says in an “ideal situation” doctors would have had this conversation in person but had written to them due to fears they were carrying the virus and were asymptomatic.

    “Completing a DNACPR will have several benefits,” the letter said.

    “1/ your GP and more importantly your friends and family will know not to call 999. 2/ scarce ambulance resources can be targeted to the young and fit who have a greater chance.”

    According to the Guardian newspaper, the letter was sent to a small number of patients and the staff at the surgery were apologising directly to those who had received it.

    Patient Elizabeth John, who has vaginal cancer which spread to her lungs and is incurable, said the letter has caused her family “great distress
    Elizabeth John was one of the patients to receive a letter
    “With treatment, my cancer can be kept at bay, so I am not ready to dig my grave even though I am a burden on society,” she said.
    “This letter made me feel worthless and I felt as if I had been sent a death warrant by the grim reaper.”

    But the 61-year-old, who has had the condition for eight years, added: “If there is a choice of a 20-year-old having a ventilator and myself having a ventilator, of course I would give that ventilator to that 20-year-old.” (No pressure then?) There is a campaign by cancer sufferers with treatable conditions already who are raising concerns about the intention of abandoning them in favour of treating people with covid 19

    Cwm Taf said the advice was not a health board recommendation.

    Coronavirus: Advice for people with health conditions
    Live: Latest news on coronavirus pandemic in Wales
    “The surgery have been made aware that the letter has caused upset to some of the patients who received it,” a statement said.

    “This was not their intent and they apologise for any distress caused. Staff at the surgery are speaking to those patients who received the letter to apologise directly and answer any concerns they may have.”

    Ogmore MP Chris Elmore, whose constituency covers Maesteg, said: “There is no getting around it, it is deeply concerning, the contents of this letter.”

    “The Welsh Assembly Member for Ogmore, Huw Irranca-Davies, and myself were made aware of it on Monday evening. We were straight on to the health board to find out what had gone on.

    “The board then investigated and it wasn’t a standard letter, so the health board spoke directly to the surgery.

    “They have now asked the surgery to contact patients who received the letter to apologise and more importantly offer appropriate advice of what actually could happen in the circumstances of their particular health conditions.

    “We are very concerned about the stress it has caused.”

    Helena Herklots, the Older People’s Commissioner for Wales, said she was “shocked” the letter was even written.

    “This is shameful and unacceptable,” she added.

    “Whilst difficult and painful decisions will need to be made in the weeks ahead, these must be taken on a case-by-case basis, through honest discussions between patients, doctors and their families that consider risks and benefits, as well as people’s own wishes.”

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