Liverpool Care Pathway – From Death Path To Death List

Clive Seale, professor of sociology at Brunel University -
"Doctors were involved in as many as eight deaths a day from voluntary or "non-voluntary" euthanasia in Britain in 2004, according to academic research."


Your health, your choices.....

Depending on the circumstances, voluntary and non-voluntary euthanasia could be regarded as either voluntary manslaughter (where someone kills another person but circumstances can partly justify their actions) or murder. 

Today's news 18 January 2006

Doctors 'involved in eight euthanasia deaths a day'

Doctors were involved in as many as eight deaths a day from voluntary or "non-voluntary" euthanasia in Britain in 2004, according to academic research. A report by Clive Seale, professor of sociology at Brunel University, said 1,930 deaths were as a result of a doctor ending a patient's life without the patient's consent, a practice known as "non-voluntary euthanasia" or "mercy killing". This involves the ending of the life of a person who does not have the faculty to make such a decision, for instance when they are in a coma. Some 936 deaths were by voluntary euthanasia. Put together, these figures amount to 2,866 deaths or eight a day. 

We have said in these pages that the Liverpool Care Pathway gave a legal framework to a practice that has actually been in place for a long time. That is enough reason for its adoption. As if that wasn't enough...

We have pointed out in these pages that the DOH CQUIN payments system actually provides a financial incentive to roll out the LCP death path. The current media attention is focussed on the hospital setting.

From Death Path to Death List

We have pointed out in these pages that the LCP and similar 'gold standards' protocols have been adopted in other settings. The DOH has been instrumental in this, for instance, in formulating the death lists and providing guidance to GPs through 'tool kits' for their compilation.

It is a safe assumption, therefore, that the CQUIN incentives are involved in this. It is all about setting in place the organisational machinery to deliver up the required quota - another 'gold standard tool' to deliver quality care! 

Similarly, the much-applauded concerns and encouragements to permit that patients may die 'comfortably' at home will, actually, save a tidy penny. They are financially driven. It is well known that the elderly, the frail and the fragile of mind or body, the vulnerable, these are less likely to be offered the opportunity of access to procedures and treatments offered to those deemed more deserving. 

Therefore, such a list of those already psychologically prepared to accept their demise would obviate any demands from patients or family that access to these procedures and treatments be offered. They will happily die at home.

The Revisionists

The NHS Choices website, cited above, has updated the entry for the Liverpool Care Pathway to reflect the current media interest They still open their contribution with the claim that the LCP is - 

"a programme for delivering palliative care to people with a terminal illness."

when that is patently untrue. As we know, the LCP is 'delivered' to anyone deemed to be on their 'last legs', whether or not that is indeed the case, and they are then 'delivered' 'palliative care', whether or not that is indeed appropriate to their circumstance.

The revisionist continues -

However, its use for some has become controversial, with relatives reportedly claiming it has been used without consent, and some saying it is used inappropriately.

This criticism and the media emphasis on the supposed controversy is puzzling, as the LCP has been standard practice in most hospitals for a number of years. The LCP has also received recognition on both a national and international level as an example of good practice. 

While there have been allegations of individual failings on the part of healthcare professionals – mainly relating to a lack of communication with relatives and carers – the model of care itself appears to be both appropriate and humane. 

Many of the media stories about the LCP seem to be criticising its stated aim – to allow terminally ill patients with no hope of a cure to die with dignity.

As a GP put it in the British Medical Journal, the LCP “has transformed end of life care from an undignified, painful experience into a peaceful, dignified death at home”.

Do the people who author this verbiage live in cellophane wrapping, blissfully unaware of the real world around them or are they expert in the propaganda of the Goebbelsian lie? 

Liverpool Care Pathway –Its aims and purposes

Dedicated nurse professionals, keen to advance their nursing careers and add LCP to their portfolio of skills, become blinkered by the tunnel-vision concept of LCP. LCP is a bandwagon and industry which is swamping rational thinking to the contrary with the charge of denial of the basic human right of high-quality death. These dedicated nurse professionals stand in awe of its self-admiring plaudits and its blinkered logic. 

From the day of conception, from the day of birth, every day is a bonus, for every day is a day along the pathway of life that brings us one day closer to our eventual, inevitable demise. It is, or should be, the task of Healthcare to provide assistance along that pathway, to provide one more day and to protect and to provide assistance and guidance to avoid the obstacles and the impediments along the way.

The LCP actually removes the individual responsibility for care. It is a pathway of death. Adherence to a LCP flowchart eliminates that accountability demanded by personal clinical decision-making. Shirking personal accountability in favour of theteam approach to diagnosis that LCP provides denies the patient the option of an alternative to its predictive, ‘measurable’ outcomes.

The LCP can be discontinued it is claimed, for example if a dying patient improves, but as is logged in newspaper and on news bulletin, blogged as anecdote ondiscussion board and in discussion group,  the pathway is, generally, a one-way street of no return.

The misguided and the malicious, each sees in the LCP an opportunity.

It presents the possibility to mechanise and sanitise existence into a more bland and acceptable version for the one. It removes accountability and responsibility from the equation. Everything is reduced to the fine print of practice and procedure. Even grief itself becomes a predetermined outcome.

For the other, at a personal level, an unwanted and unwelcome  ‘nuisance’ may be removed without risk of disapproval or deprecation, neatly slotted into an acceptable ‘care’ environment under the kind ministrations of the recognised LCP protocols. At another level, healthcare in general and geriatric healthcare in particular has more finite and predictable outcomes; forward-planning becomes a less worrying, less onerous task in the management of its financial consequences.

This last may be the most certain of its aims and purposes.