The Trial of Lucy Letby

[Magnus McGinty]

I've always thought the oft told tale of doctors ending people's lives by slowly increasing dose of morphine was bollocks because opiates don't kill you incrementally, they shut down your lungs when you've had too much.

And someone’s tolerance rises incrementally also.
Although maybe not if they’re severely ill.

 

[Indeliblelink]

Have you got any evidence for that, it's a bit of an urban myth in the general population tbh, medication is used for symptom relief and not for 'hastening death'.

Didn't a Doctor get off a murder charge in the 80s for effectively euthanasing a child with [severe] Downs Syndrome [with the parents permission]?
ETA this - Leonard Arthur - Wikipedia

"The outcome of the trial confirmed that ‘nursing care only’ is an acceptable form of treatment, and that administering a drug to relieve suffering is not an offence, even if it accelerates death. Ambiguities remain, however, about what is legally permissible in the treatment of disabled infants: if a doctor or anyone else intentionally kills a child, however disadvantaged, this would still be considered to be murder.[4]'

 

[LDC]

Didn't a Doctor get off a murder charge in the 80s for effectively euthanasing a child with [severe] Downs Syndrome [with the parents permission].
ETA this - Leonard Arthur - Wikipedia

Yeah, but we're talking about whether it's common practice rather than just the odd isolated case. Links from that Wikipedia article discuss its practice though.

 

[cesare]

Have you got any evidence for that, it's a bit of an urban myth in the general population tbh, medication is used for symptom relief and not for 'hastening death'.

You've not been on the receiving end of the "it's time to let them go" "she's going to suffer more if we keep doing X y.and/or z" "it's our decision but we prefer you assent to it" "she can have as much painkiller as she needs" ? You can see how the urban myth arises (if that's what it is)

 

[LDC]

You've not been on the receiving end of the "it's time to let them go" "she's going to suffer more if we keep doing X y.and/or z" "it's our decision but we prefer you assent to it" "she can have as much painkiller as she needs" ? You can see how the urban myth arises (if that's what it is)

Yes, care and interventions have limits and have to be clinically justified, like someone can't demand they'll be resuscitated or given certain things if clinicians say it's not appropriate and can justify that.

But what you say is quite different, even if it seems subtlely so, and I do accept there's some gray area around medication usage in the final hours or maybe days and how that impacts with length of life and why, but I still think that's quite different to administering medication with the express intention of hastening death.

But I'll stop, it's out of my area really.

 

[cesare]

Yes, care and interventions have limits and have to be clinically justified, like someone can't demand they'll be resuscitated or given certain things if clinicians say it's not appropriate and can justify that.

But what you say is quite different, even if it seems subtlely so, and I do accept there's some gray area around medication usage in the final hours or maybe days and how that impacts with length of life and why, but I still think that's quite different to administering medication with the express intention of hastening death.

But I'll stop, it's out of my area really.

Thank you. It's an ongoing concern of mine because the first time this particular consultant had "that talk" with us, my mother went on to have another couple of years life with happiness albeit restricted by her condition. But the ultimate time we were persuaded by the same consultant and it plays on my mind, a lot.

 

[LDC]

Thank you. It's an ongoing concern of mine because the first time this particular consultant had "that talk" with us, my mother went on to have another couple of years life with happiness albeit restricted by her condition. But the ultimate time we were persuaded by the same consultant and it plays on my mind, a lot.

A massive bugbear of mine is mis/communication with patients, I think it's often shockingly bad tbh. It's not done on purpose of course, it's just easy to forget how mystified the medical system and care is, be rushed for time in explaining it, use jargon, etc. I've seen it so many times, even on here I can see misunderstandings and where they come from when there are certain stock phrases and words we use that make sense to us as we get the reasoning and meaning underlying them, but they often cause complete confusion and worry among patients and their relatives and friends.

I remember early on I saw someone who'd had an abdomen operation and they literally couldn't tell me what they'd had done a few years previously. I ended up asking if they'd had something taken in or taken out, and they still didn't know. And this was someone in their mid-50s with no cognitive impairment, they'd just trusted the HCPs and probably didn't dare ask for a clear and simple explanation after the surgeon has breezed in and given them a rapid fire and jargon laced 30 seconds of what they were going to do.

And that's without the impact of the emotional situation making their retention of knowledge much less reliable than it might otherwise be.

 

[cesare]

A massive bugbear of mine is mis/communication with patients, I think it's often shockingly bad tbh. It's not done on purpose of course, it's just easy to forget how mystified the medical system and care is, be rushed for time in explaining it, use jargon, etc. I've seen it so many times, even on here I can see misunderstandings and where they come from when there are certain stock phrases and words we use that make sense to us as we get the reasoning and meaning underlying them, but they often cause complete confusion and worry among patients and their relatives and friends.

I remember early on I saw someone who'd had an abdomen operation and they literally couldn't tell me what they'd had done a few years previously. I ended up asking if they'd had something taken in or taken out, and they still didn't know. And this was someone in their mid-50s with no cognitive impairment, they'd just trusted the HCPs and probably didn't dare ask for a clear and simple explanation after the surgeon has breezed in and gven them a rapid fire and jargon laced 30 seconds of what they were going to do.

And that's without the impact of the emotional situation making their retention of knowledge much less reliable than it might otherwise be.

Oh, for sure. But having the same "end of life' conversation with the same consultant two years later would give relatives pause for thought perhaps?

 

[LDC]

Oh, for sure. But having the same "end of life' conversation with the same consultant two years later would give relatives pause for thought perhaps?

It's not an exact science, and maybe they were trying to do it ahead of time, which is good as there's much less stress and emotion flying about and people then get time to consider it and discuss with the patient rather than making a rushed decision they might regret (obviously don't know the specifics with what you're talking about). Does go much better if done with plenty of time to go, I think it's someone everyone should discuss with their close relatives and friends well in advance.

The last A&E department I worked in had a palliative care consultant that checked every patient that came in and identified those who might have a few years (or less) left and then intiated a discussion (if they wanted it) about the future of their care and what they wanted that they then documented and communicated with their GP and other people involved. Worked absolutely brilliantly and I expect made the end of many people's lives much 'better' and more what they wanted (which not suprisingly tended to be at home, not alone, and not in pain).

 

[cesare]

It's not an exact science, and maybe they were trying to do it ahead of time, which is good as there's much less stress and emotion flying about and people then get time to consider it and discuss with the patient rather than making a rushed decision they might regret (obviously don't know the specifics with what you're talking about). Does go much better if done with plenty of time to go, I think it's someone everyone should discuss with their close relatives and friends well in advance.

I'm concerned that there is an active "end of life" medical conversation that brings patients' lives to an end whether or not they are due to expire immediately or very soon. Are you saying that this "end of life" conversation only happens when their end of life is clinically and indisputably near?

 

[LDC]

I'm concerned that there is an active "end of life" medical conversation that brings patients' lives to an end whether or not they are due to expire immediately or very soon.

Not exactly sure what you mean? If I get you right I don't think this first sentence is true at all.

Are you saying that this "end of life" conversation only happens when their end of life is clinically and indisputably near?

I think if anything the 'end of life' conversation usually doesn't happen early enough, and I've only ever seen it when it's very clear the patient is likely to die, not necessarily in the next hours or days (although that is most common) but when they have a condition that is only going to get worse and will likely kill them.

 

[romeo2001]

Easy. The NHS can't afford to be that picky - there's a staffing shortage already, and someone will be going "yebbut, a 1 in a million chance of a nutter doesn't mean we have to screen out loads of otherwise capable staff".

I understand that - just wondering if anybody had some inside info on why the initial project wasn't continued

 

[Plumdaff]

There's been a lot of work around values based recruitment and appraisal, certainly where I work, but it's all done by staff with minimal specialist training and time because a/ spending money on stuff like this is unpopular with the media and 'general public' as these are non clinical roles and b/ there's a limit to how choosy you can be, it's desperately hard to recruit into the NHS as it is and c/ there's no money anyway.

 

[Knotted]

It’s difficult to know where to begin with this subject. There is so much I want to say, but nobody wants to read an essay.

Let me start by saying that the most fascinating* part to me of this whole story is in seeing the social reaction to the crime, rather than the crime itself. Humans, to me, are defined by two key attributes — we are irreducably social, and we are innately meaning-making. These attributes come together at a time like this, with a groundswell of social discourse that aims to make sense of what seems senseless. I see in this thread (and elsewhere) all the usual questions being discussed and argued about. Why did she do it? What were her reasons? What made her like this? What can we do about it? How do we feel about it? Could I have ended up like her?

People engage sociocultural tools to answer these questions. These include stories and mythology; the assumptions embedded in social norms, practices and rituals; commonalities in upbringing; and the subjectivity that derives from being subjected to particular developmental institutions. These create social representations of “rational” that suggest particular types of cause and effect. They suggest that somebody does something because they are trying to achieve something, and that something comes from a set of things that we understand. They suggest that people don’t act outside of the norms and assumptions that comprise what we view as “reality”

This is all very understandable. However, if you want to understand a situation like this, you have to engage in a process of stripping away such assumptions. Very, very few people go around killing babies. So if you want to understand somebody that kills babies, you can’t use the tools that work for 99.99% of the population. The edge case defies usual rationality. This makes something like A-level psychology particularly dangerous as the way to understand someone like Letby. When I did A-level physics, that gave me the tools to understand the physical world I can see around me. However, it would be dangerous to apply those to relativistic or quantum mechanics.

One of the assumptions you have to let go of is the idea that “reality” exists in the way that most of us experience it. Even at the most banal, we are used to the idea that there is an inside of our head where thoughts happen and an outside where actions occur, and the boundary between these is “me”. We don’t really reflect on the idea that thoughts are internalised models formed from all our past relationships and experiences (and even that is just my clumsy metaphor for what is really happening), meaning that the divide between self and other is fuzzy at best. We can see the effect on the schizophrenic when this divide is confused, however. The human being is a surfer attempting to balance a small rational surfboard on a boiling ocean of madness. And then we’re surprised when we see somebody whose surfboard has capsized.

And that’s before we start considering the delicate instrument that is the brain and the myriad ways that it can be physically damaged, with psychological consequences.

All this is to say that the more I study psychology, the less capable I feel to form quick conclusions about who, why and how Letby is what she is. I think you would need to spend a significant amount of time gaining her trust (and not in a manipulative way either — to gain trust, you have to be trustworthy). You would need to talk to her extensively about how she understands the world. You would have to understand the systems within which she has operated — her family system, her school system, her friendship systems, her workplace systems and so on. You would have to do a lot of work, and even then you might well not understand it because what counts as “rational” to her might not actually be explicable without being her.

Not that we should stop trying. But in the final analysis, I agree with those saying that the most useful thing we can do is address the risk systems that healthcare workers operate in, to try to make sure that edge cases like this can‘t do so much damage. We may not ever understand Letby, but we can think about our systems of controls, whistleblowing, monitoring and escalation. I couldn’t or wouldn’t want to stop the speculation — that’s what makes a society — but I also wouldn’t want us to take our eye off the ball of what is really important for our future safety.

*academically fascinating. I recognise that there is an unbearable tragedy at the heart of this, which is not fascinating at all. It’s just really sad.

The answer to the question of why she did it is likely to be complex and it may not be in any way relatable (but then again it actually might be!) and it is indeed tempting to come up with theories which are likely to be far too simplistic.

But I would put it that the why she did it is not where the explanatory heavy lifting is. The main explanatory factor is that she didn't have the ethical inhibitions not to do it and that's not a thing to be understood because it's not a thing it's just an absence, and how that absence came about is a whole question but it is literally a nothing. I don't feel there is a mystery to solve, it's a just a horrorific reality to behold.

 

[Indeliblelink]

I've been interested in the morality of DNR notices since some issues came up during the pandemic. Eg

Fury at ‘do not resuscitate’ notices given to Covid patients with learning disabilities

Vulnerable people have encountered ‘shocking discrimination’ during pandemic, says Mencap charity

www.google.co.uk

Probably one for a separate thread.

 

[Aladdin]

It's a bit shocking you find that so surprising. People are alone loads with patients in health and social care. And all sorts of other places where they could cause harm to people. You're a bit losing the plot with this direction of thought.

Am I?
I don't think I've lost the plot?

 

[kenny g]

Any job which gives power over other people is bound to attract people who want to have power over other people. The answer is in the question, it's the same problem in health and social care as there is in the police or prison service or the forces, or even education. I don't have an answer btw but society isn't honestly addressing the issue anyway, nor IMO will we because we aren't ready to deal with it.

Presumably having a culture where everyone's moral compass is nurtured and developed would go some way to assist. Nearly every job has a capacity to cause pain and misery to some extent.

 

[existentialist]

A thoughtful piece from a forensic psychologist, which sets the parameters somewhat, in that it doesn't say anything definitive.

Was Lucy Letby an unlikely serial killer? To most people, yes – but not psychologists | Marissa Harrison

Forensic profiles aren’t infallible, but science can help challenge our preconceived notions of what a murderer looks like, says psychologist Marissa Harrison

www.theguardian.com

 

[frogwoman]

Episode 312 - Lucy Letby: “Trust me, I’m a nurse”
RedHanded
Duration: 1:25:50
Published: Thu, 24 Aug 2023 10:08:14 -0000
Episode: Episode 312 - Lucy Letby: “Trust me, I’m a nurse” Podcast Republic

Media: https://dts.podtrac.com/redirect.mp...VQ=--c4601358e78e5fc61c47a38ee8654ebfc6e2ed07

Podcast: https://www.podcastrepublic.net/podcast/1250599915

This is really worth a listen - goes into the evidence and the failings at the hospital

 

[Magnus McGinty]

Sorry for Mail link but are handwriting experts kosher or part of the loon fraternity? Seems this is being studied retrospectively rather than criminal profiling.

Lucy Letby's notes show she is a 'narcissist', expert says

According to graphologist Tracey Trussell, Lucy Letby (pictured) was repressing anger, harbouring 'lethal' energy, lacked empathy and had no perspective on her actions.

www.dailymail.co.uk

 

[maomao]

Sorry for Mail link but are handwriting experts kosher or part of the loon fraternity?

Paid woo. I don't think Trussel's mad, just shameless. If you gave me Letby's handwriting I could tell you she was a murderer too.

 

[Elpenor]

Sorry for Mail link but are handwriting experts kosher or part of the loon fraternity? Seems this is being studied retrospectively rather than criminal profiling.

Lucy Letby's notes show she is a 'narcissist', expert says

According to graphologist Tracey Trussell, Lucy Letby (pictured) was repressing anger, harbouring 'lethal' energy, lacked empathy and had no perspective on her actions.

www.dailymail.co.uk

Probably last used in the Nicola Bulley case I’d think

 

[Magnus McGinty]

Paid woo. I don't think Trussel's mad, just shameless. If you gave me Letby's handwriting I could tell you she was a murderer too.

Well yeah, exactly.

 

[danny la rouge]

Sorry for Mail link but are handwriting experts kosher or part of the loon fraternity? Seems this is being studied retrospectively rather than criminal profiling.

Lucy Letby's notes show she is a 'narcissist', expert says

According to graphologist Tracey Trussell, Lucy Letby (pictured) was repressing anger, harbouring 'lethal' energy, lacked empathy and had no perspective on her actions.

www.dailymail.co.uk

Spirits, can you hear me? Spirits? <shudders theatrically> I’m in touch… a word is coming through. I’m getting the letter G. It’s definitely a G. Then an U. I have a feeling this is the verdict. Is that an I? Yes, it’s I next! The spirits are postdicting the verdict!

 

[LDC]

Sorry for Mail link but are handwriting experts kosher or part of the loon fraternity? Seems this is being studied retrospectively rather than criminal profiling.

Lucy Letby's notes show she is a 'narcissist', expert says

According to graphologist Tracey Trussell, Lucy Letby (pictured) was repressing anger, harbouring 'lethal' energy, lacked empathy and had no perspective on her actions.

www.dailymail.co.uk

QUACK LOON x 1 million. Surprised they get the time of day, what's next phrenology ffs.

 

[littlebabyjesus]

Sorry for Mail link but are handwriting experts kosher or part of the loon fraternity? Seems this is being studied retrospectively rather than criminal profiling.

Lucy Letby's notes show she is a 'narcissist', expert says

According to graphologist Tracey Trussell, Lucy Letby (pictured) was repressing anger, harbouring 'lethal' energy, lacked empathy and had no perspective on her actions.

www.dailymail.co.uk

Part of the loon fraternity. Graphology is not a real thing.

 

[Cid]

Damn it, the house in which the British Institute of Graphologist (BIG, you can get an M.BIG, although it's some kind of diploma) is based is off down some private road and unstreetviewable.

Chalfont St Peter in case anyone was wondering. Probably not.

 

[Dystopiary]

After doctors had raised concerns about the possibility of Letby being involved in babies' deaths, hospital managers who dismissed their concerns and forced them to apologise proposed offering her an "observational role" at Alder Hey children's hospital and given support for a master’s degree or advanced nurse training.

(Alder Hey said they have no records of being approached about Letby.)

The managers really need to be held to account.

A Lucy Letby inquiry must answer this: why was she seen as a victim, not a killer? | Gaby Hinsliff

Times article on flies showing how Letby was treated as a victim

 

[kenny g]

Damn it, the house in which the British Institute of Graphologist (BIG, you can get an M.BIG, although it's some kind of diploma) is based is off down some private road and unstreetviewable.

Chalfont St Peter in case anyone was wondering. Probably not.

There is also a BAG, the British Academy of Graphology, so if you dual card you can have BIG BAG after your name.

 

[Cid]

There is also a BAG, the British Academy of Graphology, so if you dual card you can have BIG BAG after your name.

Seems apt; a big bag of bollocks is what graphology amounts to after all.

e2a: these absolute fuckers all have their HQs down private residential streets into which streetview cars will not venture.