Thursday, 18 July 2013

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"?


  1. This is a subject about which I, too, have very strong feelings and a little experience. I won't go into detail in a comment on your blog Frances but I agree with you in many respects. However it is essential that there is something which enables people to die peacefully and with as little pain as possible (whatever some with 'beliefs' may say). It must also be a system which gives certainty and protection to professionals involved.

    I must make it clear that I am not passing any judgement or comment on the existing LCP situation which has emerged.

  2. Thank you for your thoughtful comment, GB.It's a very complex and emotive problem, isn't it.

  3. Speaking personally, at the end of life I would rather a gentle injection and a peaceful slipping away x

    1. It's one way, Teresa. Not sure I'd want it....but might be tempted at some stage in the future!