Tuesday, 29 May 2012

Liverpool Care Pathway – A Catholic Perspective

The following is a personal view from  ORA PRO NOBIS


Catholics & The Liverpool Care Pathway Disaster - The Bishops are going against
Humanae Vitae

What is the LCP? - The Basics

The Liverpool Care Pathway for the Dying Patient (LCP) is a care pathway which a patient can expect in the final days and hours of life, which also becomes a structured record of the actions and outcomes that develop. It aims to help doctors and nurses provide end-of-life care.

A 2008 article in The American Journal of Hospice and Palliative carecriticised the Liverpool Pathway for its approach and not taking an explicit position on the artificial hydration for critically ill patients. In 2009 The Daily Telegraph wrote that the pathway has been blamed by some doctors for hastening the death of some terminally ill patients, and possibly masking signs that the patient is improving. Version 12 of the LCP was launched on 8 December 2009, after over two years of consultation. An editorial in the BMJ judged the new release did "much to tackle recent criticisms". There are of course numerous articles/organisations for and against, including Care Not Killing.org that supports LCP. However, many positive pro-LCP reports do not deal with the reported fluctuations in the quality of care in different hospitals. They do not deal with family concerns, media condemnation, and medical professional's concerns that strong sedation being given until the death of patients always mask signs of improvement. Nor do they deal with the concerns that  that LCP is encouraging a ‘tick box’ attitude whereby signs of improvement are missed.


For most Catholics the LCP is an unknown quantity. It is only when a relative reaches the end of life that it is discussed with them for the first time. There is now a growing concern amongst Catholics, non-Catholics & non-Christians as to the merits of this process. LCP begins when doctors and nurses agree that the patient will not recover, they start to remove medications and intravenous drips and withdraw food and fluids. The patient may also be kept under sedation until death.  This in itself has ramifications for Catholics and Humanae Vitae which will be discussed later. The Bishops Conference has rubber stamped this process. They argue that they have had a panel of medical experts that have re-assured them that LCP is acceptable within the teachings of the Catholic Church. The individual medical aspects will be discussed in part 2.  

However (and it is a big however),
 the CBCEW seem to have have consistently turned a blind eye to numerous reports regarding the quality of implementation of the LCP guidelines. 

This included the report in January 2010 by the Royal College of Physicians and the British Society of Gastroenterology that was produced in reaction to the lack of agreement on when artificial nutrition and hydration is appropriate. They considered evidence of substandard practice both in relation to stopping and inappropriately continuing feeding. They were also made aware of disagreements between the medical profession and patients’ relatives when patients were unable to express their wishes. There are numerous examples on the internet where LCP guidelines (even updated guidelines) have not been adhered to.

The CBCEW would normally have to just consider the guidelines on their own merit. However, in the case of LCP there are medical professionals & bodies, as well as numerous families who are clearly stating that the guidelines are not being adhered to. The weight and volume of information supporting these views is continually increasing. The CBCEW have consistently ignored these concerns and as a consequence an increasing number of Catholics believe that the Bishops have gone against Humanae Vitae and hence against Church teaching. 

There are priests out there now clearly stating a clear NO to LCP. 

It is deemed that the CBCEW are now dicing with Catholic dignity in death and meddling with the end of life that God has prescribed for every individual.

Tuesday, 22 May 2012

Liverpool Care Pathway - STILL The Mission For 2012

Complacency permits the unthinkable to become thinkable and the unacceptable to become possible.

End this scandal NOW! 

Please do continue to register your support for these petitions.

Register your opposition here:           

Register your opposition here:

Register your opposition here:

Please register your opposition here now:-

Please register your opposition here now:-

To stand idly by and do nothing whilst a wrong proceeds unchallenged is to make yourself complicit in it.

Liverpool Care Pathway – An 'Inappropriate' Pathway

An RGN has signed the LCP petition at CHANGE and commented thus:

I am a RGN and totally agree, it is used inappropriately.

This 'inappropriate use' is well illustrated here -

The Liverpool Care Pathway, The Dirty Secret of the NHS.

I’ve always made a distinction between my ‘online’ activity,  and my real life, and when I set this blog up I was determined to maintain that partition but I have to accept that all of us are a product of our own personal experience and that the truest things that any of us say are those that have touched us the closest.
Yesterday my mother-in-law died of complications due to pancreatic cancer. She was one of the most formidable, intelligent, incisive, and eloquent people that I have ever met, she could hold her own in any conversation or argument, we both shared an interest in politics and current affairs, and so we hit it off immediately. I can’t say we always agreed, that would be boring, mostly we duelled and I’d hope that she’d concede that honours were generally even.
But this article is not a eulogy to my mother-in-law, nor is it a criticism of the care she received, at the hands of the NHS, since she was diagnosed with pancreatic cancer two years ago. This article is about the manner in which this fine lady was allowed to die, and it’s written in the hope that anyone who reads this who has a close relative with a terminal condition, might become alert when they hear a doctor or a nurse talk of the euphemism that is ‘the Liverpool Care Pathway’.
Under these cicumstances my mother-in-law is just a case study and if I deviate from objectivity then I hope you will forgive me but it will not be my intention to do so.
My mother-in-law, from this point onwards to be refered to as J, was admitted to hospital on the 2nd of this month after becoming extremely sick due to an infection, later diagnosed as gastroenteritus, to be frank her life expectancy at that point was probably only measured in weeks at worst, and months at the very best anyway, and that was understood by J and everyone close to her.
Initially, J was put in an isolation ward and the infection was treated with antibiotics, steadily J improved and she was moved to a public ward but unfortunately due to complications related to J’s terminal condition her liver was no longer processing correctly and J’s condition deteriorated. The day before yesterday, the day before her death, my wife went to see her again, J was as lucid and eloquent as ever though my wife did comment, on her return, on the yellowing of her complexion.
Up until this point, I make little criticism of the care and treatment at the hands of the NHS, in fact I would commend them, but it is from this point onwards that the care ceased to be appropriate even for a dog, let alone a decent, hard working human being who had always payed her taxes and played by society’s rules.
At 10 am the next morning my wife received a telephone call from a Dr C, a doctor at Southampton General Hospital, requesting that she and her sister attend a meeting at the hospital at mid-day because J’s condition had deteriorated overnight. We all arrived at the ward, prompt, at noon but as no doctor was to be found, we all went to see J.
It is extremely difficult to visit a person you know well and respect, and to recognise that they no longer possess the faculties, the sentience, which define us all as human beings. It is a horror beyonds words, to recognise the frame but not the characteristics of humanity, to see a writhing, restless animal in pain. There is still compassion but dear God, the horror of it.
The three of us, my wife, her sister and myself sat around J waiting for Dr C, I walked away after five minutes, love and duty compelled the others to stay. It won’t come as a surprise to you if I say that both my wife and her sister are very intelligent people, the apple, afterall, doesn’t fall too far from the tree, and while waiting, sitting by their mother’s side, in that time, they realised that the ’plugs’ or ‘temporary intravenous ingress’, or whatever they are called, which allow the intravenous infusion of drugs and antibiotics, which had been in her left wrist for two weeks were no longer there. I was there long enough to see the look of recognition on their faces. Something had changed and it wasn’t just the deterioration of J’s condition.
Obviously, the stark deterioration in J’s condition in the last 24 hours was uppermost in all of our minds as we met Dr C and a specialist nurse in a side room, in hindsite, would it be so unreasonable to consider that the half an hour delay was a form of emotional/psychological conditioning ? I’ll leave it to you to decide whether we’d been emotionally ‘softened up’ for what was to come.
The very young Dr C talked too much, the specialist nurse kept quiet and smiled convincingly. It was couched as a question, open to J’s daughters to decide, but really under the circumstances, there appeared to me only the confirmation of a decision already made.
I attended as a husband of one of the daughters and I was determined not to intervene in any decision making, though for a long time neither could bring themselves to say the words that Dr C wanted to hear, that didn’t stop me from asking questions. “I’ve heard terrible stories of patients who have not been fed or hydrated”, I ventured. The smiling nurse intervened, “We will treat her in compliance with the Liverpool Care Pathway”. Those last three words were said quickly (evasively ?).
No one can know everything, and I’d not heard of the ‘Liverpool Care Pathway’ before, my wife had heard of it, but she was so emotionally pummelled by that time, that she’d forgotten its context. Little did I know that the ‘Liverpool Care Pathway’ was exactly the kind of programme I’d been worried about, I’d been seduced, in my ignorance, into accepting what I most feared.
Eventually, the two daughters agreed and the verbose Dr C congratulated them on making their difficult but ‘correct’ decision, the nurse smiled.
In hindsite, my wife and I both realise that the decision to withdraw all medication, painkillers,, food, and water, unless explicitly requested by the patient (this is what the ‘Liverpool Care Pathway’ is) had already been taken quite some time ago and that she had been allowed to deteriorate to that lamentable condition before the family had met her, probably so that they would find the decision ‘easier’ to make.
A palliative nurse talked to us then, reassuring us that J would receive the best palliative care in the time that was left to her. My wife and her sister wanted her to go to the local Macmillan hospice, as she had been registered with them  but they were told that she’d receive the appropriate care at the hospital. ”How many palliative nurses are there in the hospital ?” I asked,”Four” came the reply (I found out later that at least half of these were part time). “How can you ensure that she gets the appropriate care if there are only four of you in such a large hospital ?” I countered, There was a hestitation before, “All the nursing staff have had training.” “If they’ve all had training then what’s the point of specialised palliative nurses like yourself ? Palliative care is not only about the dying but also about the bereaved, how can a nurse on a ward with five other patients ensure that ?” I pursued. There was no satisfactory answer but it was clear that J would not be moved.
I went home an hour after that, but the two girls remained by their mother’s side. My wife returned home around six o’clock as she was led to believe that her mothers condition was stable. Around eight she received a phone call to come into the hospital as her mother was getting even worse.
When she and her sister arrived an east asian nurse was behind the ward desk. ”Is our mother  here ?”, my wife asked. “Yeh, she still here”. “In the ward?” “Yeh, behind curtain.”
They made their  way to J’s bed and sat down, J appeared to be sleeping. My wife’s sister  commented on how peaceful she looked in comparison to earlier  in the day. They held her hand, waiting for her to wake up. After ten minutes they realised that J, was dead. But they sought the nurses confirmation. “Nurse, is my mother dead ?”, “Yeh, she dead”- “But couldn’t you have told us that she was dead?”- “I tell you, she dead-” “No you didn’t”, ” No, I tell you, she gone.”……………………………………………………………………..”Did my mum die peacefully?”- “Oh no, she vomit blood.”
Needless to say that both sisters are traumatised after the day’s events.
Now, I’m not sure whether or not this falls beneath the standard of NHS palliative care but I’m pretty certain it falls well below most peoples expectation of it.
As for my own view, this halfway house between continued care and euthanasia, which is the Liverpool Care Pathway, ensures all of the negatives of both alternatives, while delivering none of the benefits of either.
J was not alone, this practice is going on in every NHS hospital across the country every day, in some respects J was lucky, she lasted less than a day, others can survive for alot longer. I suspect the staff have become hardened to the reality and have ceased long ago to ask themselves whether it’s morally right.
If you decided to embark on the ‘Liverpool Care Pathway’ yourself as a form of suicide, you’d be sectioned and forcibly medicated. If you did it to another, you’d be locked up for murder.
If you have a loved one who is terminally ill, then please don’t wait until the end before talking to someone about this, otherwise you’ll not be able to rationally understand what’s going on, and watch that the hospital staff don’t embark on the Liverpool Care Pathway before talking to you first, as they most certainly did in J’s case.
Update- Since writing this I’ve discovered that 18 countries have adopted the Liverpool Care Pathway (LPC) procedures, it may be called something different in your country

Good God help us all…

Thursday, 17 May 2012

Liverpool Care Pathway – A Matter Of Life Or Death

Edgar Allen Poe, creator of the macabre, became obsessed - or took advantage of a wave of obsession at the time to cultivate his popularity as an author - with catalepsy, a condition which mimics actual death. The condition may convince a doctor, apparently, to pronounce the victim dead.

Today, the LCP permits the doctor to pronounce the victim as dying even whilst there is every sign of life. What would Poe have made of that? What macabre tale of horror would his pen have conjured..?

There is Always Hope

The METRO of July 4, 2006 reported:

The same story from WorldNetDaily:



New study of man who spent
19 years in 'vegetative state'

In a new medical study sure to remind the world of the debate surrounding the forced dehydration death of Terri Schiavo, researchers found the injured brain of a man in a “vegetative state” for 19 years rewired itself, permitting him to renew communication with his loved ones.

The findings by Nicholas Schiff and his colleagues at Weill Medical College at Cornell University suggest the human brain shows far greater potential for recovery and regeneration then ever before suspected.
In 1984, 19-year-old Terry Wallis was thrown from his pick-up truck in an accident near his Massachusetts home. He was not found until 24 hours later, in a coma with massive brain injuries.
Within a few weeks he had stabilized in what was alternately characterized as a “minimally conscious state” or a “permanent vegetative state.” Most doctors saw little hope he would ever improve.
And he didn’t – for 19 years. Then, in 2003, he started to speak.
Over a three-day period, Wallis regained the ability to move and communicate, and started getting to know his 20-year-old daughter, only 1 year old at the time of the accident. Wallis awoke believing Ronald Reagan was still president.
To find out what was happening in Wallis’s brain, Schiff and other researchers used a new brain imaging technique called diffusion tensor imaging. The system tracks water molecules, revealing the brain’s white matter tracts – like a wiring diagram. They combined this with more traditional PET scanning, to show which brain areas were active.
The team’s findings suggest Wallis’ brain had gradually developed new pathways and unusual anatomical structures to re-establish functional connections, compensating for the normal brain pathways lost in the accident.
They found that new axons – the branches that connect neurons together – seemed to have grown, establishing new working brain circuits. In short, his brain had rewired itself.
Wallis was frequently classified as being in a permanent vegetative state. Though his family, like Schiavo’s, fought for a re-evaluation after seeing many promising signs that he was trying to communicate, their requests were turned down.
Wallis, now 42, still needs help eating and cannot walk, but his speech continues to improve and he can count to 25 without interruption.
Wallis’ sudden recovery happened three years ago at a rehabilitation center in Mountain View, Ark.
Wallis’ father said his son is now able to make jokes.
“That was something he wasn’t able to do early in his recovery,” Jerry Wallis said. “He now seems almost exactly like his old self. And he very often tells us how glad he is to be alive.”

And what would Poe have made of that..?

The Village Voice reported this:

Terri Schiavo: Judicial Murder

Her crime was being disabled, voiceless, and at the disposal of our media

For all the world to see, a 41-year-old woman, who has committed no crime, will die of dehydration and starvation in the longest public execution in American history.
She is not brain-dead or comatose, and breathes naturally on her own. Although brain-damaged, she is not in a persistent vegetative state, according to an increasing number of radiologists and neurologists.
Among many other violations of her due process rights, Terri Schiavo has never been allowed by the primary judge in her case—Florida Circuit Judge George Greer, whose conclusions have been robotically upheld by all the courts above him—to have her own lawyer represent her.
Greer has declared Terri Schiavo to be in a persistent vegetative state, but he has never gone to see her. His eyesight is very poor, but surely he could have visited her along with another member of his staff. Unlike people in a persistent vegetative state, Terri Schiavo is indeed responsive beyond mere reflexes.
While lawyers and judges have engaged in a minuet of death, the American Civil Liberties Union, which would be passionately criticizing state court decisions and demanding due process if Terri were a convict on death row, has shamefully served as co-counsel for her husband, Michael Schiavo, in his insistent desire to have her die.
Months ago, in discussing this case with ACLU executive director Anthony Romero, and later reading ACLU statements, I saw no sign that this bastion of the Bill of Rights has ever examined the facts concerning the egregious conflicts of interest of her husband and guardian Michael Schiavo, who has been living with another woman for years, with whom he has two children, and has violated a long list of his legal responsibilities as her guardian, some of them directly preventing her chances for improvement. Judge Greer has ignored all of them.
In February, Florida's Department of Children and Families presented Judge Greer with a 34-page document listing charges of neglect, abuse, and exploitation of Terri by her husband, with a request for 60 days to fully investigate the charges. Judge Greer, soon to remove Terri's feeding tube for the third time, rejected the 60-day extension. (The media have ignored these charges, and much of what follows in this article.)
Michael Schiavo, who says he loves and continues to be devoted to Terri, has provided no therapy or rehabilitation for his wife (the legal one) since 1993. He did have her tested for a time, but stopped all testing in 1993. He insists she once told him she didn't want to survive by artificial means, but he didn't mention her alleged wishes for years after her brain damage, while saying he would care for her for the rest of his life.
Terri Schiavo has never had an MRI or a PET scan, nor a thorough neurological examination. Republican Senate leader Bill Frist, a specialist in heart-lung transplant surgery, has, as The New York Times reported on March 23, "certified [in his practice] that patients were brain dead so that their organs could be transplanted." He is not just "playing doctor" on this case.
During a speech on the Senate floor on March 17, Frist, speaking of Judge Greer's denial of a request for new testing and examinations of Terri, said reasonably, "I would think you would want a complete neurological exam" before determining she must die.
Frist added: "The attorneys for Terri's parents have submitted 33 affidavits from doctors and other medical professionals,all of whom say that Terri should be re-evaluated."
In death penalty cases, defense counsel for retarded and otherwise mentally disabled clients submit extensive medical tests. Ignoring the absence of complete neurological exams, supporters of the deadly decisions by Judge Greer and the trail of appellate jurists keep reminding us how extensive the litigation in this case has been—19 judges in six courts is the mantra. And more have been added. So too in many death penalty cases, but increasingly, close to execution, inmates have been saved by DNA.
As David Gibbs, the lawyer for Terri's parents, has pointed out, there has been a manifest need for a new federal, Fourteenth Amendment review of the case because Terri's death sentence has been based on seven years of "fatally flawed" state court findings—all based on the invincible neglect of elementary due process by Judge George Greer.
I will be returning to the legacy of Terri Schiavo in the weeks ahead because there will certainly be long-term reverberations from this case and its fracturing of the rule of law in the Florida courts and then the federal courts—as well as the disgracefully ignorant coverage of the case by the great majority of the media, including such pillars of the trade as The New York TimesThe Washington PostThe Miami Herald, and the Los Angeles Timesas they copied each other's misinformation, like Terri Schiavo being "in a persistent vegetative state."
Do you know that nearly every major disability rights organization in the country has filed a legal brief in support of Terri's right to live?
But before I go back to other Liberty Beats—the CIA's torture renditions and the whitewashing of the landmark ACLU and Human Rights First's lawsuit against Donald Rumsfeld for his accountability in the widespread abuse of detainees, including evidence of torture—I must correct the media and various "qualified experts" on how a person dies of dehydration if he or she is sentient, as Terri Schiavo demonstrably is.
On March 15's Nightline, in an appallingly one-sided, distorted account of the Schiavo case, Terri's husband, Michael—who'd like to marry the woman he's now living with—said that once Terri's feeding tube is removed at his insistent command, Terri "will drift off into a nice little sleep and eventually pass on and be with God."
As an atheist, I cannot speak to what he describes as his abandoned wife's ultimate destination, but I can tell how Wesley Smith (consultant to the Center for Bioethics and Culture)—whom I often consult on these bitterly controversial cases because of his carefully researched books and articles—describes death by dehydration.
In his book Forced Exit (Times Books), Wesley quotes neurologist William Burke: "A conscious person would feel it [dehydration] just as you and I would. . . . Their skin cracks, their tongue cracks, their lips crack. They may have nosebleeds because of the drying of the mucous membranes, and heaving and vomiting might ensue because of the drying out of the stomach lining.
"They feel the pangs of hunger and thirst. Imagine going one day without a glass of water! . . . It is an extremely agonizing death."
On March 23, outside the hospice where Terri Schiavo was growing steadily weaker, her mother, Mary, said to the courts and to anyone who would listen and maybe somehow save her daughter:
"Please stop this cruelty!"
While this cruelty was going on in the hospice, Michael Schiavo's serpentine lawyer,George Felos, said to one and all: "Terri is stable, peaceful, and calm. . . . She looked beautiful."
During the March 21 hearing before FederalJudge James D. Whittemore, who was soon to be another accomplice in the dehydration of Terri, the relentless Mr. Felos, anticipating the end of the deathwatch, said to the judge:
"Yes, life is sacred, but so is liberty, your honor, especially in this country."
It would be useless, but nonetheless, I would like to inform George Felos that, as Supreme Court Justice William O. Douglas said: "The history of liberty is the history of due process"—fundamental fairness.
Contrary to what you've read and seen in most of the media, due process has been lethally absent in Terri Schiavo's long merciless journey through the American court system.
"As to legal concerns," writes William Anderson—a senior psychiatrist at Massachusetts General Hospital and a lecturer at Harvard University—"a guardian may refuse any medical treatment, but drinking water is not such a procedure. It is not within the power of a guardian to withhold, and not in the power of a rational court to prohibit."
Ralph Nader agrees. In a statement on March 24, he and Wesley Smith (author of, among other books, Culture of Death: The Assault of Medical Ethics in America) said: "The court is imposing process over justice. After the first trial [before Judge Greer], much evidence has been produced that should allow for a new trial—which was the point of the hasty federal legislation.
"If this were a death penalty case, this evidence would demand reconsideration. Yet, an innocent, disabled woman is receiving less justice. . . . This case is rife with doubt. Justice demands that Terri be permitted to live." (Emphasis added.)
But the polls around the country cried out that a considerable majority of Americans wanted her to die without Congress butting in.
A March 20 ABC poll showed that 60 percent of the 501 adults consulted opposed the ultimately unsuccessful federal legislation, and only 35 percent approved. Moreover, 70 percent felt strongly that it was wrong for Congress to get into such personal, private matters—and interfere with what some advocates of euthanasia call "death with dignity." (So much for the Fourteenth Amendment's guarantee of due process and equal protection of the laws.)
But, as Cathy Cleaver Ruse of the Secretariat for Pro-Life Activities of the United States Conference of Catholic Bishops pointed out:
"The poll [questions] say she's 'on life support,' which is not true [since all she needs is water], and that she has 'no consciousness,' which her family and dozens of doctors dispute in sworn affidavits."
Many readers of this column are pro-choice, pro-abortion rights. But what choice did Terri Schiavo have under our vaunted rule of law—which the president is eagerly trying to export to the rest of the world? She had not left a living will or a durable power of attorney, and so could not speak for herself. But the American system of justice would not slake her thirst as she, on television, was dying in front of us all.
What kind of a nation are we becoming? The CIA outsources torture—in violation of American and international law—in the name of the freedoms we are fighting to protect against terrorism. And we have watched as this woman, whose only crime is that she is disabled, is tortured to death by judges, all the way to the Supreme Court.
And keep in mind from the Ralph Nader-Wesley Smith report: "The courts . . . have [also] ordered that no attempts be made to provide her water or food by mouth. Terri swallows her own saliva. Spoon feeding is not medical treatment. This outrageous order proves that the courts are not merely permitting medical treatment to be withheld, they have ordered her to be made dead."
In this country, even condemned serial killers are not executed in this way.
The article claims the president is "eagerly trying to export the rule of law to the rest of the world." The president is also trying to import the protocols of the LCP and, by all accounts of this report, has succeeded!
The article claims that "in this country, even condemned serial killers are not executed in this way." In Scotland, according to the Daily Record,
A DRUG given to US Death Row prisoners is being used on dying old folk in Scotland's hospitals.
Medics use the sedative midazolam as part of a highlycontroversial "pathway to death" care plan for people judged by doctors to be in the last hours of their lives.
But patients' leaders warned yesterday that the widespread use of the Liverpool Care Pathway (LCP) in Scotland's NHS is robbing pensioners of the chance of life.
The macabre is become reality and truth is truly more the stuff of any horror that Poe could ever have conjured.

Thursday, 10 May 2012

Liverpool Care Pathway – "Not A Convincing Answer"

This is from Eulogy -

On the Liverpool Care Pathway

By Sam Goddard

"Establishing that a person is incontestably nearing death is in no way an exact science."

1 April

Sam Goddard’s grandmother was a resident at the infamous home described by some to dish out "death sentences" to its patients. He shares his first-hand experience of an NHS-institution accused of misdiagnosing and mistreating patients.

In October 2008 my grandma, Pamela Goddard, died painfully in hospital. Her death was unnecessary. She had been wrongly placed on the Liverpool Care Pathway, the controversial Department of Health approved scheme for end of life care. Once on the Pathway, fluid and drugs are withdrawn and the patient is sedated continuously until death. The scheme is accused of forcing some terminally ill patients to die prematurely, whilst masking any potential signs of improvement in their condition.

After contracting breast cancer in the 1960s, my grandma overcame several recurrences of the disease, but was diagnosed with cancer once again in June 2008 while being treated in hospital for a broken leg. Cancer treatment appeared to be working, and she was fully expected to survive. However during the course of her treatment she developed a painful bedsore which, as a result of inadequate treatment, became infected. Her care was then switched to palliative without consulting the family; what resulted was four weeks of torture before she finally died, pumped full of painkillers and deprived of water and medication.

Developed by Marie Curie in the organisation’s Liverpool hospice in the late 90s, the Pathway was originally established as a mechanism for ensuring that cancer patients nearing the end of their lives receive the same level of nursing expertise in hospital as they would in a hospice. The initial idea has now been expanded to include other terminal conditions and, with a recommendation from the National Institute for Health and Clinical Excellence in 2004, has been gradually adopted nationwide. As of 2009, more than 300 hospitals, 560 care homes and 130 hospices in England were using this system.

Establishing that a person is incontestably nearing death is in no way an exact science. Diagnosis is based on a number of factors, which can be symptoms of other illnesses or conditions. The result is what Dr Peter Hargreaves, Consultant in Palliative Medicine, describes as a ‘self fulfilling prophecy’: patients who are allowed to become dehydrated and confused are then wrongly placed on the pathway, thus assuring, rather than just facilitating, their death. Worryingly, as many as 4 percent of patients initially placed on the Liverpool Care Pathway actually get better and fully recover.

Continuous deep sedation until death, advocated as part of the Pathway, is another cause for concern. According to research conducted in 2009 by Clive Seale, professor of medical sociology at Bart's and the London School of Medicine and Dentistry, 16.5 percent of all deaths in the UK occurred under continuous deep sedation – twice the number as in Belgium or the Netherlands. Sedation of this kind can often make it much more difficult to assess whether or not a patient is getting better.

Such concerns were dismissed by a number of palliative care professionals. Professor John Ellershaw, Director of the Marie Curie Palliative Care Institute, said: ‘The Liverpool Care Pathway does not endorse continuous deep sedation nor, as has been misreported in some places, the removal from dying patients of beneficial medication.’ Peter Saunders, Director of Care not Killing, gave a more qualified defence of the scheme: ‘There is a need for continuing education of health care professionals, at all levels and in all aspects of modern palliative care,’ he said. ‘This includes diagnosing correctly that patients are imminently dying, and detecting reversible causes of deterioration in patients in advanced illness.’

My grandma’s case was far from an unfortunate one off; in recent years there have been several high profile instances of patients in NHS hospitals being wrongly placed on the pathway. In October 2009, 76 year-old Jack Jones, after beating cancer, was told, without any tests, that the disease had returned and, so his family claims, was denied food and medication. After his death two weeks later, tests revealed that he had been suffering from pneumonia and could have recovered had the correct treatment been administered.

Elevating the quality of end of life care in hospitals by bringing in hospice practices is a laudable aim. According to National Mortality Statistics 2004, only 16 percent of cancer deaths occur in a hospice; for non-cancer related deaths, only 5 percent of patients die in hospice care. There is clearly a need to redress the balance, but the Liverpool Care Pathway is not a convincing answer. On the lack of palliative care expertise among hospital staff, Dr Saunders said that ‘Any tool is only as good as the workman who uses it’, and this is unconscionable. The overall attempt to develop a one size fits all approach has resulted in a system that lets patients and their families down all too often.