Wednesday, 10 August 2011

Liverpool Care Pathway – The Underlying Policy

Palliative care is exactly that: it is to ease suffering and pain. It should always be given in that context. 

The Daily Mail reports that family doctor, William Bassett, is before a tribunal to look into his actions in the treatment of his terminally ill patient in 2009.

Every patient is an individual case and every case warrants individual judgement on what measure of response is warranted. To ask whether this doctor administered the dose he administered to end his patient’s pain or to end his patient’s life is not just semantics. It is for the family, the doctor and his peers, and the court to determine what was the case. It is a gross error to make a blanket policy of 'diagnosing' end of life and setting those thus diagnosed on a pathway to death as with the LCP and it is a gross error to cite this case as good reason to support it.

The Liverpool Care Pathway, (LCP), is in widespread use in the UK. It is flawed and dangerous. The Daily Telegraph has referred to it as the Death Pathway. There have been calls from victims’ families to have it banned. The old are particularly vulnerable because many of the so-called signs that are looked for to put a patient on the death pathway, such as frailty and declining mobility, are symptomatic of old-age in any case. In fact, age is one of the factors also taken into consideration in putting the patient on the LCP! Every patient is an individual and deserves that individual consideration of their condition.

As it stands, anyone who falls into the clutches of the proponents of LCP and ticks all the boxes will be given assisted passage into the next world care of the NHS. No doctor has the god-given right to play god. It is a sad irony that, in this case, the doctor would appear to have been paying particular concern to the individual case of his patient and not following some check-box pathway and yet is to be meted dire punishment for that.

The Liverpool Care Pathway began its life as a palliative care pathway within a hospice framework. It is fitting in that aspect. It is necessary in that aspect for those medical personnel to know that they may respond in an effective way to deal with pain and suffering and not be placed in the particular position of this GP.

What began life as a palliative care pathway is now a death care pathway. It is a grotesque caricature of its former self. This Death Care Pathway is being steamrollered into policy throughout the NHS. What, then, has gone wrong? More to the point, why? What agenda or underlying policy is at work? Or is it just a case of 'the Emperor's new clothes'?

These lines are written from a particular position of authority. The NHS donned its hangman's cap and passed death sentence on my dear mother in 2007. Like accounts by other families are regularly reported in the press. Those using this report as an argument in favour of LCP should give careful consideration to what they propose.

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