"It is not the function of the government to keep the citizen from falling into error; it is the function of the citizen to keep the government from falling into error."
Supreme Court Justice Robert H. Jackson U.S.
Every patient is an individual and every patient is an individual case. Whatever ‘signs’ the LCP defines as being an indication of approaching and encroaching death, none of these ‘signs’ are so atypical that they can be excluded from being due to any other cause.
Myoclonic jerking is seen more frequently at the end of life, but its appearance can be related to at least 21 other medical conditions. Opioid-induced myoclonus is also not uncommon. Requiring a diagnosis of ‘dying’ such as that which LCP expects of the clinician is difficult, therefore, and fraught with peril.
Mum had experienced annoying respiratory tract secretions (RTS) for some four years and more which her GPs had failed to treat adequately or at all. This bothersome catarrh would sit at the back of her throat and she would treat it herself with proprietary medicines and home-made remedies that were no less effective than those supplied by her GPs and which, certainly, did her no harm. That cannot be said of the appliance one doctor prescribed for her!
A steroid nasal inhaler was supplied to her by Dr gg . This only succeeded in producing a severe reaction. That night, mum was awoken with what she described as a ‘banging’ in her head and accompanying dizziness and distress, and no relief whatsoever from the catarrhal condition. She became nauseous and actually thought her last hour had come.
For some reason, the GP took my mother’s report of the incident personally, as though any criticism of the prescribed treatment was a personal criticism of him. Instead of reporting the adverse side-effect as is advised in the BNF, Dr gg blatantly denied any connection of cause and effect. However, it was later suggested by Dr gggg that it may have been the case that there had been a reaction to the steroid content of the inhaler.
The Liverpool Care Pathway, as stated in Liverpool Care Pathway - A One-Way Street Of No Return, requires that two of the following ‘signs’ are looked for -
- The patient is bed bound
- The patient is semi-comatose
- The patient is only able to take sips of fluid
- The patient is no longer able to take tablets
Well, let’s see now -
- Mum was bed bound
Over a period of some two weeks and more, my mother had become confined to bed for the reason that she could no longer face the steep stairs up to her bedroom. The stairs up and down each day had become a formidable ordeal, a hurdle and barrier in her daily life. Her GP, Dr g , had himself remarked upon how steep they were and so it was not just a matter of the frailty of a lady of elderly years. This confinement had physically wasted her legs. Mum had intended sleeping downstairs as a temporary measure, but she had been advised against this. Thus it was that the medical advice served no useful purpose except to create the predicament in which she found herself.
- Mum was semi-comatose
Mum was of an age at which she would spend many pleasant hours happily dozing in her chair at home, and did so in her bedroom where she was confined. But she had had all her medication withdrawn, without anyone's knowledge; her hearing aid had been damaged by person or persons unknown; and she was ‘morphed’ into a condition of utter insensibility; reduced to the condition of a virtual vegetable. Her last words to me in this world haunt me to this day, that she didn’t like them in there!
And she was old. Alas, a prime candidate for the pathway . . !