The Liverpool Care Pathway
Published in: Melanie's blog
My column in last week’s Daily Mail, on the abuse of the Liverpool Care Pathway, has generated a very large response both from patients’ relatives with their own stories to tell and from doctors and other health care staff.
As I wrote in that piece, it is an important principle of medical ethics that dying should not be artificially prolonged, since this is as pointless as it is degrading and even cruel. Accordingly, I have been puzzling over why the LCP was ever thought necessary at all, since the principles upon which it is based – that inappropriate interventions should be avoided with people who are dying -- should surely be axiomatic in caring for those whose lives are drawing to a close.
One of the most thoughtful responses I received came from a hospice doctor, who wrote:
‘I myself was one of the people who objected to the introduction of the Liverpool Care Pathway to our hospice. My objection was on the grounds that we were already doing everything that it recommends; so why did we have to fill out a 17 page form, just to confirm that, for each and every one of our dying patients?
‘However, the way we deal with dying patients in the hospice is often very different from the care they tend to receive, if they are being looked after in hospital, on a busy surgical or medical ward; and the Pathway was brought out to ensure that patients dying in hospitals, at home, and in nursing homes, received the same high standard of care that dying patients receive in hospices.
‘And in spite of the concerns that have been voiced regarding incorrect implementation of the pathway, it is generally acknowledged that its introduction has raised the standard of care being offered to dying patients on a hospital ward. The Liverpool Care Pathway, when used correctly, does ensure that the dying patient is always provided with adequate analgesia, the relatives are always kept informed of developments, and no unnecessary tests and procedures are done in the dying phase.’
As I wrote in my article, when the LCP is used correctly on patients who are dying it is a laudable and appropriate programme. Relatives of patients who really are at the end of their lives can doubtless be confident that the LCP is an entirely humane way of caring for their loved ones, since it seems merely to be an embodiment of good practice in care for the dying. The problem -- as I made clear – is that it is often used on patients who are not dying, which is an abuse of the programme and may lead to highly disturbing results.
The crucial issue is to distinguish correctly between those who are indeed dying and those who are not. Where this distinction is made correctly – and hospices doubtless lead the way in this, as they do in best practice generally in care for the dying – the LCP may well be a model of its kind. But where the distinction is not made correctly, the result is abuse.