NICE [The Institute for Health and Care Excellence] printed guidelines on end of life care this week. These aimed to replace the Liverpool Care Pathway.

What is the Liverpool Care Pathway – this ‘pathway to death’ as the Daily Mail described 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. Unfortunately it was in some cases poorly applied and in particular some patients were deprived drinks unnecessarily. In such cases it seemed ‘self- fulfilling’ as starvation and dehydration can be factors that lead to death. NICE – in its new guidelines highlighted three main areas of concern.

  • The decision that a person was dying was not always supported by an experienced clinician and not reliably reviewed, even if the person may have had potential to improve.
  • The dying person may have been unduly sedated as a result of inappropriately prescribed medication.
  • Concerns that hydration and some essential medicines may have been withheld or withdrawn, resulting in a negative effect on the dying person.

NICE recommended that doctors had more conversations about dying with their patients earlier to find out their wishes. Too often such difficult conversations are left too late and till patients are too unwell to have full capacity and the ability to make informed choices.

I really recommend you watch this short TED talk on this subject.