Tuesday 8 November 2011

Liverpool Care Pathway - A Storm Of Controversy

Fighting for a peaceful, pain-free death
Heidi Blake reports in The Telegraph 

The Liverpool Care Pathway, a NHS programme for terminally ill patients close to death, has been at the centre of a storm of controversy. Now patients are demanding answers.

Pamela Goddard had her life ended, aged 82, in East Surrey Hospital.

She was suffering from septicaemia caused by a bedsore that had festered during her six-week stay following a broken leg. None of her three sons were informed when doctors diagnosed her as dying, withdrew her antibiotics, food and fluids, and put her on a morphine drip which left her unconscious in the last four days of her life.

Her son Adrian, a property developer based in New York, left his mother sitting up in bed in mid-October, chatting about her hopes to visit him at Christmas. When he returned a week later she was semi-conscious and unable to communicate except for a few barely perceptible groans.

The family watched Pamela die, mystified and distraught by the change in her condition. It was only when they demanded answers from the hospital after her death that they were informed that she had been placed on the LCP four days before she died.

"The thought that my mother could die without my being able to have some meaningful contact at that point of her life and to be deprived of the chance to say goodbye by these doctors is just unforgivable," said Adrian.

"That fact that a third party can make a decision as momentous as that in any case, but especially without consultation with the family, is mind-boggling."

When Don Alexander, 59, died of cancer in June in a hospice in Hampshire, his wife of 30 years, Elizabeth, 55, had no idea he had been placed on the LCP 24 hours before.

A chance remark was the only clue. "One of the nurses just said 'he's on the pathway now,'" said Elizabeth. "I didn't know what that meant until I read about the Liverpool Care Pathway later. It was a very distressing 24 hours.The doctors are the ones with the expertise but it's nice to feel you're being included in the decision-making, or at least some sort of explanation," she said. "After all, this is the person you love and respect. You don't want to be shut out of the last days of their life."

Peter Millard, Emeritus Professor of Geriatrics at St George's, University of London, believes the LCP encourages some doctors to give up on patients too quickly and place them on a death pathway when they might otherwise have survived.

"We're going down a pathway which is moving towards assisted death and away from pathways of assisted life," he said. "We are not motor cars: we're self-repairing bodies. When you get someone who you think is dying, they don't necessarily die. So if you continue to withdraw fluid and go on stopping everything which is helping them live then you will have shortened that person's life." But Debbie Murphy said there is nothing in the guidelines, if they are used properly, that could do harm.

Her son Adrian, a property developer based in New York, left his mother sitting up in bed in mid-October, chatting about her hopes to visit him at Christmas. When he returned a week later she was semi-conscious and unable to communicate except for a few barely perceptible groans.

The family watched Pamela die, mystified and distraught by the change in her condition. It was only when they demanded answers from the hospital after her death that they were informed that she had been placed on the LCP four days before she died.

"The thought that my mother could die without my being able to have some meaningful contact at that point of her life and to be deprived of the chance to say goodbye by these doctors is just unforgivable," said Adrian.

"That fact that a third party can make a decision as momentous as that in any case, but especially without consultation with the family, is mind-boggling."

When Don Alexander, 59, died of cancer in June in a hospice in Hampshire, his wife of 30 years, Elizabeth, 55, had no idea he had been placed on the LCP 24 hours before.

A chance remark was the only clue. "One of the nurses just said 'he's on the pathway now,'" said Elizabeth. "I didn't know what that meant until I read about the Liverpool Care Pathway later. It was a very distressing 24 hours.The doctors are the ones with the expertise but it's nice to feel you're being included in the decision-making, or at least some sort of explanation," she said. "After all, this is the person you love and respect. You don't want to be shut out of the last days of their life."

Peter Millard, Emeritus Professor of Geriatrics at St George's, University of London, believes the LCP encourages some doctors to give up on patients too quickly and place them on a death pathway when they might otherwise have survived.

"We're going down a pathway which is moving towards assisted death and away from pathways of assisted life," he said. "We are not motor cars: we're self-repairing bodies. When you get someone who you think is dying, they don't necessarily die. So if you continue to withdraw fluid and go on stopping everything which is helping them live then you will have shortened that person's life."

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