Monday, October 08, 2012

Caring, or killing? A statement

Following complaints that hospital patients in Britain are dying unnecessarily because of careless use of the Liverpool Care Pathway, top healthcare organisations are calling for better supervision.

The LCP was designed to bring hospice-style care to patients in hospital in the last days or hours of life.

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

There have been complaints that patients have been put on the pathway unnecessarily, and that by withdrawing hydration and nutrition and sedating the patient, death has become a self-fulfilling prophecy. There have been suggestions of unofficial involuntary euthanasia.

Several months ago, senior consultant Professor Patrick Pullicino said too often elderly patients who could live longer were placed on the LCP, which had become an "assisted death pathway rather than a care pathway."

There was often a lack of clear evidence for putting the patient on the pathway. Pressure on beds and difficulty with handling difficult patients were involved.
"If we accept the pathway we accept that euthanasia is part of the standard way of dying, as it [the pathway] is now associated with 29 per cent of deaths. Very likely many elderly patients who could live substantially longer are killed by the LCP."

I wrote about deaths on the LCP here.

Currently a patient can be placed on the LCP on the say-so of one doctor.

More than 20 organisations, including the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Nursing, the National Council for Palliative Care, Macmillan Cancer Support, Age UK and the Alzheimer's Society, have now issued a joint statement. It points out that the LCP does not preclude the use of clinically-assisted nutrition or hydration, but prompts clinicians to consider whather it is needed and in the patient's best interest.

It says a decision to consider using the pathway should always be made by the most senior doctor available, with help from other staff involved, and should be countersigned as soon as possible by the doctor responsible for the patient's care. Carers and families should always be included in the decision-making process.

"We support the appropriate use of the Liverpool Care Pathway and make clear that it is not about ending life, but rather about supporting the delivery of excellent end of life care."