Criticisms about The Liverpool Care Pathway have been made in many of the newspapers in the last week. It has even been suggested by the Daily Mail that patients were being ‘killed off’ deliberately to free up beds. This led the Health Secretary to announce that NHS constitution was to be redrafted to give patients and relatives a legal right to be consulted.
What is the Liverpool Care Pathway – this ‘pathway to death’ as the Daily Mail describes it? The Liverpool Care Pathway [LCP] is a scheme that is intended to improve the final hours or days of a patient’s life. It is not a one way pathway – if patients improve they can be taken off it. It is often distressing for patients to be moved and made to drink and eat, have blood tests and investigations in their final hours. As I am sure you remember from your own experiences people who are ill usually have no appetite and do not want to eat. Sometimes those in the last stages of life do not want to drink and find swallowing difficult. The LPC provides palliative care – that is to ensure a peaceful comfortable death for those at the end of their life. If a patient does not wish to eat they are not pressured to eat, if they do not want to drink much they are not pushed to drink. They are given things like ice cubes or lemon flavoured swabs to suck so their mouth does not get dry and sore. It is ensured that patients are not in pain and are comfortable. They should not be refused fluids if they want them which unfortunately is what seems to have happened in a few reported cases.
Feeding your loved ones is an instinctive ritual of caring for many people and relatives may feel uncomfortable withdrawing nutrition. This seems to have caused distress to some. There is always a great deal of uncertainty in medicine. It is not possible to predict when patients will die or even whether all patients may be in their last moments. This is a major problem when talking to relatives who may feel mislead as result of a doctors ‘best guess’ being off the mark.
The Liverpool Care Pathway has enormously improved terminal care for many by allowing them peaceful dignified deaths. It is ‘the gold standard’ for doctors in this field. It is vitally important. In countries that have allowed Doctor assisted suicide such as Switzerland and the state of Oregon less than 0.5% opt for this .This issue affects almost all of us and is much more important than issue of euthanasia. There would far less demand and need for euthanasia if every one could be assured a comfortable, peaceful end. It is deeply worrying that criticism may lead to doctors being cautious about implementing the Liverpool Care Pathway.