Sunday, 2 December 2012

Liverpool Care Pathway – And The Third Option

Just two stark options of choice do we have? This or that? A fork on the road, the left or the right hand path?

This: The expected certainty of the Liverpool Care Pathway;

Or that: the certain expectation of the euthanasist's poison draft?

This is the Express -


Author Sir Terry Pratchett
Author Sir Terry Pratchett

Saturday December 1,2012

By Richard and Judy

AT a lunch do the other day I was struck by the main topic of conversation. It was a literary lunch so I kind of expected the chat would be dominated by gossip about Hilary Mantel, JK Rowling and Fifty Shades Of Grey.

Not a bit of it. All my fellow guests wanted to talk about was the Liverpool Care Pathway, the controversial policy adopted by the medical profession to provide end-of-life care for the terminally ill.

Mind you, everyone at the table was a baby boomer of a certain age, and apart from a brief diversion into the horrors of Alzheimer’s, the LCP was clearly a topic of concern.

With a rapidly ageing population – currently 130,000 elderly and terminally ill adult patients die on the Pathway every year – the system is now the subject of an independent inquiry.

Critics say it is inhumane, as it deprives the patient of medically‑aided nutrition and hydration. Surely, everyone at the table asked, no one wants to die of thirst?

It is very difficult though. When my mother was close to death she begged me to give her some water.
When the time comes for me I’d like to end it myself or for a loved one to help me do so
She was in a good care home and I was horribly distressed that she was so thirsty.

The care supervisor explained that she could no longer swallow. I nevertheless tried to give her sips of water on a teaspoon.

But the supervisor was right: it didn’t work – the water just dribbled down her chin.

So should she have been on a drip to hydrate her? Yes, now I think she should, although she was very close to the end.

She died of old age (she was 93) just days later.

How to care for people at the end of their lives is a huge subject of debate as so many of us face the prospect ourselves.

It is right that there should be an inquiry and that we should all think carefully about how we wish our own lives to end.

From my lunch I got the feeling that increasing numbers of us are breaking the taboo of talking about death. Myself, I agree with Sir Terry Pratchett. 

When the time comes for me I’d like to end it myself or for a loved one to help me do so.

I would prefer a huge overdose of morphine to help me go in my own home, surrounded by my family.

Painless, quick and definitely not begging for water.

This is the Brave New World of Huxley that even Aldous could never have foreseen.

Everything controlled and under Human direction. How comforting.

Ending, as it begins, with induction, the preclusion of inconvenience.

Just two stark choices, then, and all else is terror and pain?

"When the time comes for me I’d like to end it myself or for a loved one to help me do so."

When 'the end' comes is an unknowable uncertainty. And life is precious.

The Temerity Of Arrogance possessed of medical practitioners has no bounds.

The certainty of uncertainty in prognosis is well known, but this compounded by diagnostic error (Institute of Medicine report, "To Err is Human.") is an alarm bell sounding.

This applied in the setting of an end of life pathway is a clear and present danger.


These are the hollow men, these are the stuffed men. ... 

And this is the way the world ends: This is the way the world ends: Not with a bang but a whimper. ..

The Hollow Men (1925) by T. S. Eliot

1 comment:

  1. Excellent post, Eldoel.

    "The Temerity Of Arrogance possessed of medical practitioners has no bounds."

    Exactly. I recall a time when many doctors had the humility to admit how little they really knew and that they too often fumbled around in the dark, hoping for the best. But those were the days when our much loved GP used to have a glass of scotch with us at Christmas...and we trusted him totally. My grandmother had a doctor, John Salter, who was so greatly loved by the people of his village that they crowned him May King one year. These days, too many doctors appear to believe they're Gods.

    Good old Dr Mackie and Dr Salter, where are you when we need you most...?

    I'll tell you where they are, Eldoel, their spirits are still blazing in the professor Pullicinos, the Dr Pals and the Dr Glasers of this world - and in all of those other doctors and nurses who have had the courage to speak out and to tell the truth. I am heartened that the Muslim and Catholic doctors appear to be speaking with one voice on this: for decency and humanity. God bless them all.