Liverpool Care Pathway – And Compromising Curative Options

This is Civil Service College -

This issue of Ethos Perspectives aims to highlight the complexities and dilemmas that surround end-of-life care and the assumptions behind it.

Reference 1: "The Solid Facts: Palliative Care" edited by Elizabeth Davies and Irene J. Higginson

This overview presents the best available evidence on the case for palliative care, the emerging trends, current gaps, and the policy implications of each. The review notes that with advances in public health and life expectancy, people in developed countries have become unfamiliar with death and dying. Medicine is charged with promoting death as a failure, rather than as something that can be delayed but is inevitable.

The report highlights a myriad of challenges of mainstreaming palliative care: the fact that most common chronic diseases (unlike cancer) have uncertain prognoses, which makes assessment of the need for palliative care difficult; the high degree of integration needed to deliver effective palliative care, not just across different professionals (specialists to palliative care doctors and counsellors) but also across healthcare institutions and homecare; the need for innovative public education so that people can consider their choices more realistically; and the lack of commitment towards research and development on palliative care. Currently, both the US and UK spend less than 1% of their cancer research budgets on palliative care research.

In expanding palliative care, one must, however, be mindful of vulnerable groups, such as the minorities or the disabled, and ensure that they have access to palliative treatment, without compromising their curative options.

Davies, E. and Irene J. Higginson, eds. The Solid Facts: Palliative Care. Denmark: World Health Organization, 2004. http://www.euro.who.int/document/E82931.pdf (accessed April 10, 2007).

This is worth repeating -

"The report highlights a myriad of challenges of mainstreaming palliative care: the fact that most common chronic diseases (unlike cancer) have uncertain prognoses, which makes assessment of the need for palliative care difficult..."

Say that again...?

"The report highlights a myriad of challenges of mainstreaming palliative care: the fact that most common chronic diseases (unlike cancer) have uncertain prognoses, which makes assessment of the need for palliative care difficult..."

This is important -

"In expanding palliative care, one must, however, be mindful of vulnerable groups, such as the minorities or the disabled, and ensure that they have access to palliative treatment, without compromising their curative options."

Say that again...?

"In expanding palliative care, one must, however, be mindful of vulnerable groups, such as the minorities or the disabled, and ensure that they have access to palliative treatment, without compromising their curative options."

Since most common chronic diseases (unlike cancer) have uncertain prognoses, is 'diagnosing' dying such a simple task? This is no easy matter to contemplate.There is a life at stake. And one must be mindful that, in 'diagnosing' dying, the "curative options are not compromised" and thrown out with the bath water!

Those consigned along the Pathway may be withdrawn from it. (The Lazarus Care Pathway)

Even so, "the LCP may be causing increased deaths due to its ‘deliberate circumvention’ " (Care Commentary)

And placing a patient on the Pathway "is a decision with an end in view. The patient is dying. Why? Because we say they are dying. Why? Because we have decided.” (Dr Philip Howard)

One last thought: Every case of a patient being withdrawn from the Pathway is a case of misdiagnosis!