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End of life care

I am sure many of you will have read recent press reports about the Liverpool Care Pathway (LCP) and suggestions that in some way this is a pathway that hastens death. Given my recent move from Liverpool and the fact that I have known and worked with Professor John Ellershaw and his colleagues who developed the pathway, it has caused me to reflect on things.

I am sure many of you will have read recent press reports about the Liverpool Care Pathway (LCP) and suggestions that in some way this is a pathway that hastens death.

Given my recent move from Liverpool and the fact that I have known and worked with Professor John Ellershaw and his colleagues who developed the pathway, it has caused me to reflect on things.

Have we got this wrong? Have so many hospitals and health institutions internationally adopted something that is fundamentally flawed?

In tracing back the origin of the LCP it is clear that the pathway is a model of care. It is not a treatment, it is a framework developed to tailor care for the last days and hours of someone’s life.

The decision to use it should always be taken by a multi-disciplinary team taking everyone’s view about the best care management into account. Most importantly, where possible it must involve the patient, their family, and if necessary an advocate when the patient has no family or may not be able to communicate effectively.

The LCP is a model built around the best practice of hospice care developed by the Marie Curie Palliative Care Institute in Liverpool. There are no hard and fast rules about drugs, fluid therapy or diet and it does not replace clinical judgement—it is there to support it.

When I read some of the press stories and the language that is used it is clear to me that the media and perhaps the public have misunderstood the whole point of the pathway and its intention.

Its intention is to aid a peaceful death where there is no prospect of a recovery and death is the expected outcome. It’s a means of ensuring good communication and consistency of care and treatment so that everyone knows what is going on.

It underlines to me though how much we are still in our infancy in discussing such emotive issues as death and somehow a peaceful death can be viewed by the media as a failure in care rather than a success.

This week I received a letter from a grateful family whose relative had been cared for within the framework of the LCP. They wrote to say thank you and to say how much they felt involved and cared for.

As always it’s not the tool or the instrument, it’s the hands it is in and the care with which it is used that matters most. We still have a lot to do in getting this right for patients and their families.

I hope that we haven’t been party to the long-term damage of an integrated pathway for end of life care that promotes difficult discussions and decisions in a compassionate environment. It will be our great loss if that is the case and we must ensure our practice stands up to scrutiny.


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