The Liverpool Care Pathway

This has been much in the news in the last week. For the uninitiated, it is a regime set up for the seriously ill, usually dying, patient, and is about to be abandoned in most hospitals. But what other scheme will take its place? I dread to think.

The whole idea of the LCP makes me deeply uncomfortable. I have no first hand experience of it, but I have cared for many dying patients in my time, and I cannot see that a one-size-fits-all regime can possibly work. Each person is different; each death is different. If practitioners go by the book, then mistakes are bound to be made. We have an excellent hospice movement in the country, and while only a minority of us will die in a hospice, those who run them are experts. Surely this expertise could at least be used, even in a hospital ward?

I believe (back to my hobby horse) that much of this comes down to nurses. Nurses know (or used to know)  patients in a way that doctors never can. They care for them every day. A good nurse should have a pretty good idea of what's best for the patient. And yet the LCP is decreed by the consultant in charge, and often relayed to the staff by a junior doctor.

Furthermore, I don't believe that the waithdrawal of fluids can ever be justified. Dehydration can cause appalling suffering, and no one knows how much even a deeply unconscious patient can feel. Terminal care should,  I'm convinced, be tailored to the individual, taking into account his/her wishes (if known),  those of the family, and the input of those in charge of the care. When I was working in hospitals, we wouldn't have dreamt of applying one rule to every patient.

I am fortunate in having a nurse and three doctors in my immediate family, and have made my wishes known to them. But what about those who have no one, and depend entirely on the "experts"?