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.

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