Monday, September 17, 2012

Caring - or killing?

Arguments about the Liverpool Care Pathway continue.

The Liverpool Care Pathway - the LCP for short - was developed in the 1990s following collaboration between the Royal Liverpool Hospital and the Marie Curie hospice. It is intended to unite the fields of physical treatment, psychological support, spiritual care and support for carers, bringing hospice-style care to patients in hospital in the last days or hours of life, "once it is known that they are dying."

It aims to allow the patient to have a peaceful death by avoiding unnecessary and burdensome medical intervention at the last. It permits the removal of medication, hydration and nutrition and allows the patient to be sedated until death takes place.

No problem, say doctors, when the LCP is used in appropriate circumstances combined with high standards of care. But there are complaints that continuous deep sedation may be being used, even quite widely, as unofficial euthanasia.

One survey of records found that in 23 per cent of deaths of people put on the LCP in one city there had been no definite diagnosis at any stage.

The NHS says discussions should always be held with relatives before the patient is placed on the LCP, and the condition of the patient should be reviewed every four hours.

A review of palliative care in hospitals found that in one hospital trust, fewer than half of relatives were told that patients had been placed on the LCP. In a quarter of trusts, one in three families were not told.

One doctor said that medical ethics varied in different parts of the country. Patients should be treated with common sense and sensitivity, but these were being replaced, she complained, by slavishly following protocols - what she called "tickboxitus."

One doctor said: "The diagnosis of being 'within the last hours or days of life,' which is necessary for a person to be put on the LCP, has no scientific basis. This diagnosis is, in fact, a prediction and as such is likely to be in serious error about 50 per cent of the time.

"Although it is possible to discontinue the LCP if the patient improves, it becomes more difficult to detect changes in underlying illness as a patient becomes more drowsy on the LCP."

A second wrote: "If all doctors were trained in the care of the elderly and had all the time in the world to discuss end-of-life care with patients and relatives there would be less cause for anxiety about the LCP. But given the current pressure on hospital beds and the number of frail, elderly people needing attention, there is a very real danger that some who appear to be dying but have a treatable disorder will be put on the LCP with fatal results. . .

"Patients are in danger. . . The NHS is fast becoming a death service rather than a health service for the elderly. . . People can no longer be sure that the elderly will be treated well."

A third doctor added: "The question has never been whether the LCP offers a 'peaceful' death. . . The issue has always been whether patients are dying prematurely by being put on the LCP. While the LCP claims it is for those in the 'last few hours or days of life,' it is essential to realise that there is no accurate way of determining this, so that for most patients it is at best a guess with large margins of error. This is particularly true for the two thirds of patients who do not die of cancer. Such patients might well have had weeks or even many months more of life had they been properly supported rather than put on the LCP."

ALERT, the anti-euthanasia organisation, is producing cards that people can carry saying they do not wish to be placed on the Liverpool Care Pathway.

Some hospital patients are being treated by conscientious staff as carefully and as well as busy hospital conditions allow. Others are not.

You would be surprised how many cases have been brought to my attention of old people who have gone into hospital with relatively minor ailments and within a few days have been dying.

If you have a relative in hospital, ensure that he or she is being hydrated, and fed if appropriate. You would think it would be unnecessary to do that in this enlightened age, wouldn't you? It is not.