Liverpool Care Pathway – Questions And Concerns

Not a pathway, but a compassionate and ethical provision of adequate palliative care.

"NHS is killing up to 130,000 patients a year by euthanasia, says senior physician" 

A Letter in The Tablet -

Letters Extra

Last updated 28 September 2012

In addition to the letters published in this week’s issue of the The Tablet you can find more correspondence here, available free.

Questions and concerns about the Liverpool Care Pathway

I would agree with many of Dr Howard's comments, including the impossibility of accurately predicting the timing of death. Having worked as a hospice nurse for over ten years and with previous experience of nursing patients at the end of life as a district nurse, I would like to offer some practical perspectives.

Whilst we might all wish to die peacefully, spending quality time with our loved ones gathered round as we quietly depart this world, this is not invariably the experience of all. Death, as life, is sometimes a messy business, with many distressing symptoms occurring as the body, mind and spirit struggle to cope with changes that can occur rapidly.

As professionals we always seek to respond to people as individuals and would never take any action to deliberately curtail their life. However, allowing for unintended consequences according to the long-established principle of double effect is vitally important in allowing the relief of suffering. I am concerned that if taken to its extreme conclusion, the reticence to use palliative medications appropriately or to continue artificial nutrition and hydration beyond their usefulness in symptom control could result in avoidable suffering.

The latter can become a burden for individuals and may lead to significant physical discomfort as a direct result of their use. Providing adequate pain relief and sedation to alleviate clear distress is a vital aspect of good care.

My own mother died in the community without the benefit of adequate morphine or midazolam (not due to any lack of clinical indication, but due to failures of service delivery in her area) and she most certainly did not have a good or peaceful death.

As Dr Howard reflects, how we care for the dying is of the greatest importance to us all and I am ever mindful of the privilege of serving in this specialty. I pray that all of us who work at the bedside day by day continue to make difficult treatment decisions with courage and compassion.

Janet Billingsley, Canterbury, Kent