Here is IJCP (International Journal of Care pathways) -
Welsh Collaborative Care Pathway Project; 10 years experience of implementing and maintaining a care pathway for the last days of life
As a result of "widespread adverse publicity, a fundamental rewrite of the pathway was carried out." Really...?
"There has been a drop in the number of recorded variances of symptom problems. As a result of widespread adverse publicity, a fundamental re-write of the pathway was carried out. The new pathway was launched at a national conference and all teams provided with new documentation and explanation for the need to change. "We are talking here about the the placing of a living human being on a program of protocols that is going to end their life. What 'adverse publicity' would that be that forced a 'fundamental rewrite'? A medical protocol should be grounded in and founded on the hard facts and disciplines of medical science, not subject to and amended at whim by way of a reaction to some 'adverse publicity' reported anecdotally. Meanwhile, the actual anecdotal evidence mounting up goes mostly unreported and ignored.
Is it that there is no hard and fast 'science' involved, perhaps? After all -
"We know that prognosis is not accurate and we often get our predictions of prognosis wrong. A tool based upon prognosis is therefore dangerous as it may become a decision that a person will die. " ((Dr Philip Howard)And nothing is ever a foregone conclusion. We are not Gods: we cannot tell with certainty, but must work with the situation and the individual.
"Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically." (Professor Pullicino)And from the CARE2 LCP Petition site -
23:40, Dec 02, Dr. Patrick Pullicino, United KingdomGiving the ship a fresh coat of paint will not disguise its purpose nor remove its flaws!
It is not scientifically possible to diagnose impending death as the LCP purports to do. The LCP is instead an assessment of the perceived quality of life of the patient by the medical team and as such is euthanasia.
A 'robust' implementation of the protocols must also ensure a conformity of outcomes and 'a drop in the number of recorded variances of symptom problems.' Patients are being treated as falling into a category rather than as individuals.
This is MAX PEMBERTON in The Telegraph:
I have often seen this happen; patients you are convinced will follow a clear, definable illness-trajectory prove you wrong. It's this unpredictability that makes medicine so fascinating; the fact that the body has a remarkable capacity to confound expectations. Even for those with a terminal illness, there can be no certainties. It's for this reason that I despair of the Government's new treatment pattern for palliative care. The "Liverpool Care Pathway" involves a series of tick-box assessments, which aim to assess the likelihood of death in patients deemed to be terminally ill in hospitals, nursing and residential homes.