Wednesday, 24 October 2012

Liverpool Care Pathway – All Smoke And Mirrors

Should matters of life and death really be the subject of guesswork? Do doctors really have such high opinions of themselves that they think they may determine, god-like, what shall be the span of another's life?

They hide behind the jargon of their trade.

With pretence and with platitude, they may pronounce another to be dying, in certain knowledge that they know not for certain that this is the case.

It is all 'smoke and mirrors' given formal procedure and practice via a ritualised 'pathway' to the next world.

Doctors do not have to live with their decisions; we do.

And doctors always bury their mistakes.

Here is The Telegraph -

Patient death pathway 'based on guesswork’
The controversial “death pathway” has come under renewed attack from doctors, lawyers and campaigners who said staff using it had to guess when patients were nearing the end of life.

Loved ones not always told their relative is on controversial 'death pathway'
In a quarter of hospitals trusts, discussions were not held with one in three families Photo: Getty Images

The Liverpool Care Pathway is aimed at providing a comfortable death for patients in their last days and hours by not subjecting them to futile treatments, but many fear it is being used inappropriately and has become “self-fulfilling”.
Campaigners have criticised a consensus statement signed by 22 organisations in support of the pathway, which said it was good medical practice and did not hasten death. In their response to the agreement, the group opposing the pathway, led by Prof Patrick Pullicino, a neurologist from East Kent Hospitals, argued that it was fatally flawed.
There was no scientific basis underpinning the prognoses that patients were dying, they said. “It is self-evident that stopping fluids whilst giving narcotics and sedatives hastens death,” the group said in a statement.
The group also pointed out that the latest pathway audit showed that just 16 per cent of patients had fluids continued on the pathway and none had fluids started. “The median time to death on the Liverpool Care Pathway is now 29 hours,” the group said. “Statistics show that even patients with terminal cancer and a poor prognosis may survive months or more if not put on the LCP.”
They added: “The fact is that there is no scientific evidence to support the diagnosis of impending death and there are no published criteria that allow this diagnosis to be made in an evidence-based manner.
“This diagnosis is a prediction, which is at best an educated guess.”
The group concluded: “Patients should not be deprived of consciousness, but receive such treatment that is aimed at relieving all their symptoms including thirst. Nothing should be done which intentionally hastens death. An individual care plan based on best evidence is preferable to a rigid pathway.”
Besides Prof Pullicino, the statement was signed by a barrister, Jamie Bogle, and Dr Philip Howard, both of the Catholic Union of Great Britain.
It was also signed by Dr Tony Cole, chairman of the Medical Ethics Alliance, and by Dr Robert Hardie, president of the Catholic Medical Association; Mary Knowles of the World Federation of Doctors who Respect Human Life; Nora McCarthy of the Catholic Nurses Association, Teresa Lynch of Nurses Opposed to Euthanasia, and Elspeth Chowdharay-Best of First Do No Harm.
The Department of Health stood by the pathway, saying that it “fully supported its proper use”. The pathway was introduced throughout the country from 2004 but within five years doctors began to air their dissatisfaction.
Concern was highlighted recently when Peter Tulloch made a complaint of attempted murder to police after he discovered his mother Jean, 83, had been isolated and disconnected from her food and fluid by doctors in a hospital in Edinburgh even though she was not imminently dying.
He demanded that her sustenance was restored and it began again after 30 hours but she died two weeks later.

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