Sunday, 28 October 2012

Liverpool Care Pathway – An Unforgivable Offence

Don't Play Ball!

An article in the Express demeans and diminishes our suffering. We are dismissed thus:
So a small number of inexcusable communication breakdowns have been strung together to imply evidence of medical genocide on our wards.
This article is a disgrace. This issue is not a football to kick around to make political capital, to gain credence for the sake of circulation by turning this into a battle between one group and another. Would The Express really sell its soul to the Devil for the sake of numbers?

This is not about pro-life, pro-death, RC or PVC, God or anti-Christ –

It’s not about Right and Left –

It’s all about right and wrong!

Shame on this ill-thought diatribe, shame on this hack.

Shame on The Express!

It is The Express and it’s Hack that owes an apology.

The debate is about what is happening, on the ground and behind closed doors. To single out someone's religion is to detract from the argument and, actually, indicates that you have no argument. That is a very dangerous path to go down. We have walked that path before.

In that particular, then, an apology, please!

An apology, please, to all these good people who have suffered and perished and to their families who continue to suffer, in pain and in silence.

This is all going to turn into a stitch-up. Dr. Bee Wee wrote

"There are some very real anxieties amongst the public and some professionals about this whole concept. Instead of simply defending the concept, or reiterating that if only it were used properly, it would be OK, it might be more helpful to stand back a bit, identify and explore the concerns properly, and find ways of addressing those concerns and improve practice."

This is quite clear and unequivocal. How is it possible to 'misinterpret' this? Dr. Bee Wee is surely intelligent enough in her grasp of the written word. This statement plainly says that the problem is not one of making the concept work properly  but with the concept itself! Can that be misinterpreted? And yet it was retracted.

Here is the offending article - - Home of the Daily and Sunday Express Express - Breaking news, sport and showbiz from the World's Greatest Newspaper


Sunday October 28 2012

By Kirsty Buchanan                 

IF YOU are lucky enough never to have lost a close family member, you may not have heard of the Liverpool Care Pathway (LCP). Pioneered by the Marie Curie Palliative Care Institute in Liverpool, it is the national and internationally recognised gold standard in end-of-life care designed to provide dignity and comfort in a patient’s final days.

Since it was rolled out across the country in 2004, it has received three glowing audits, the endorsement of this Government and, just this month, the public support of 20 respected organisations representing millions of patients, carers, doctors and nurses.
Yet last week the Association of Palliative Medicine bowed to pressure from a lobby of Roman Catholic doctors, pro-life groups, some media and a small number of distressed and grieving relatives to order a review into the Pathway.
Was this a victory for patients’ rights or capitulation to media hysteria and public misunderstanding?
More than half of all deaths in England occur in hospitals and the intention behind the Pathway roll out was to produce the same high standards of end-of-life care you can expect in a hospice across the whole medical profession. How­ever stories like that of Peter Tulloch have turned medical best practice into a media storm. Tulloch called in the police after his 83-year-old mother was placed on the LCP at the Western General Hospital in Edinburgh without his consent. 
Was this a victory for patients’ rights or capitulation to media hysteria and public misunderstanding?
He says food and fluids were withdrawn without his agreement even though she was “far from being dead” and this “extremely cruel” treatment amounted to attempted murder. Mrs Tulloch was removed from the Pathway after 30 hours and died two weeks later.
Other grieving relatives have talked about family members being placed on LCP without their knowledge, fights with doctors to get them removed from the Pathway and their loved one’s subsequent revival, giving them more precious time together before death. Internet discussion groups are laced with venom. The Pathway is “disgusting”, “a licence to kill”, “backdoor euthanasia” and “murder”.
Welcoming the Association of Palliative Medicine’s review last week, one newspaper declared that as more than 100,000 people “are dying on the LCP” every year “the suspicion inevitably arises that the Pathway is being used to hasten death and free up beds”. Really? Let us consider what is being claimed here: that the Pathway is being used, on an industrial scale, to ease bed blocking; that our doctors and nurses have such scant regard for human life they are murdering patients who stubbornly refuse to die fast enough.
Anti-Pathway lobbyists insist that once food, medicine and fluids are withheld from a patient a diagnosis of impending death becomes a self-fulfilling certainty, while relatives who have wrongly been kept in the dark suspect sinister motives, rather than poor communication by overburdened hospital staff. So a small number of inexcusable communication breakdowns have been strung together to imply evidence of medical genocide on our wards.

Is that really what we as rational people should believe? That industrial euthanasia of the sick and elderly is being practised as a matter of routine to free up beds? That, were it not for LCP, your 85-year-old grandmother would have made a full recovery, skipped out of hospital and lived to the ripe old age of 92 had she not been bumped off to make way for another patient?
There is a silent majority here which is not being represented in this debate. The most recent Pathway audit looked at the records of almost 4,000 patients in 155 hospitals. It found 94 per cent of families were content and informed about their loved one’s end-of-life care. It is easy to feel for Mr Tulloch but the reality is thousands of families are kept fully informed while their loved ones die natural, pain-free and dignified deaths on the Pathway in hospices, hospitals and even in their own homes.
Doctors spearheading this campaign not only owe their colleagues an apology for an outrageous slur on the profession’s integrity and compassion but they have committed a disservice to families by calling into question a procedure that’s helped thousands to die with dignity.
So never mind the hysteria, here are some facts. Once a medical team considers a patient is nearing the end of life, discussions begin with relatives or carers (and when possible with the patient themselves), about when “inappropriate interventions” should be stopped because the “burden of treatment outweighs the benefit”.
Patients are not dying of dehydration or starving to death, they are being spared the indignity and often pain of pointless IV drips being forced into veins and bloating their bodies, of nasogastric tubes being shoved down their nose even though there is no hope of rehabilitation.
Dying is not an exact science but then the Pathway is not a one-way street, patients who show signs of recovery are taken off. Above all, with just “one opportunity to get it right” the Pathway stresses that “good comprehensive clear communic­ation is pivotal”. 
After all, the LCP “is only as good as the teams using it”. So let us call those cases of poor Pathway practice what they are: evidence of occasional bad practice, not wholesale malpractice.

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