The plan as laid out by socialized medicine NHS in England - basically a plan to murder.

https://twitter.com/Elizabe32413720/status/1389146156169637890

"[link to www.nice.org.uk (secure)]

Pharmacological measures: end of life (last days / hours)

Use a combination of levomepromazine and midazolam in a syringe driver

Levomepromazine (helpful for delirium)

• start 25mg SC stat and q1h prn (12.5mg in the elderly) • if necessary, titrate dose according to response • maintain with 50-200mg / 24h CSCI • alternatively, smaller doses given as an SC bolus at bedtime, bd and prn

Midazolam (helpful for anxiety)

• start with 2.5-5mg SC/IV stat and q1h prn • if necessary, increase progressively to 10mg SC/IV q1h prn • maintain with 10-60mg / 24h CSCI

If the above is ineffective, seek specialist palliative care advice

• in the last days of life

o morphine 2.5-5mg SC prn o midazolam 2.5mg SC prn o consider morphine 10mg and or midazolam 10mg over 24 hours via syringe driver, increasing to morphine 30mg/midazolam 60mg"

For those who are dying as a consequence of coronavirus and/or who do not wish to have active or invasive treatments, the switch in focus to high quality, compassionate, palliative care at the end of their life is equally important.

Treatment escalation planning

In the context of the coronavirus pandemic, decisions about further treatment escalation or shifting the focus to palliative care will need to take place rapidly. It may not be possible to have joint discussions involving the patient, those close to them and the clinicians because:

• the patient may have become ill and deteriorated very quickly, so they may not be able to fully participate in the decision-making.

• the patient’s family and those closest to them may not be able to be present because of hospital infection control procedures, or they may be in self-isolation or looking after family members who are ill.

Conversations with the patient’s family may well have to take place remotely. They are likely to be anxious and shocked by what has happened. These are not easy conversations to have but it is important that honest and timely conversations do take place.

Senior clinicians should role model these conversations and support their teams to do so. Palliative care teams are skilled at these conversations and will do their best to support colleagues in doing so, but there will not be enough capacity for palliative care teams to undertake all conversations themselves.