Liverpool Care Pathway – When The Rule Is The Law, Is The Law Not The Rule?

This is The Mirror -

20 DEC 2012 00:00

MIRIAM STOPPARDDR MIRIAM STOPPARD COLUMNDying must be given protection and process needs to involve their families

Families and carers will be given new rights to be informed before hospitals can withhold food and drugs from patients thought to be close to death

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Recently, a friend asked me about the Liverpool Care Pathway – what it is, what it entails, who uses it.

After I’d explained what it was to him, he was appalled.

His mother had been placed on it and he hadn’t been told.

In fact, he had never even been consulted and he felt he should have been.

I found myself feeling aggrieved on his behalf and his mother’s.

Under the guidelines of the Liverpool Care Pathway, water, food and medication can be removed from sedated patients in their final days.

Doctors judge the patients to be too close to death to be resuscitated.

Putting a terminally ill person in the LCP is a big step for all concerned.

It’s not just a medical decision, it’s a moral one, and it’s also highly emotional, especially for the family.

In my mind, there are absolutely no ­circumstances when the family can be ­excluded from this decision process.

There should be no situations in which they are not consulted and their agreement is not sought on all matters.

Anything else is inhuman. Family members are the people who have to live with the death.

The majority of hospital trusts have now adopted the pathway, which is also supported by charities including Macmillan Cancer Support.

I’m pleased to say that families and carers will be given new rights to be informed before hospitals can withhold food and drugs from patients thought to be close to death.

The Health Secretary, Jeremy Hunt, says he wants new NHS rules to include such a right for families.

This move is an attempt to prevent the way some hospitals have put patients on the “death pathway” without letting their families know.

Let’s hope no more families will find themselves in the position of my friend, who hadn’t been told his relative had been placed on the pathway, which is tantamount to giving a patient only a few more days to live.

The Department of Health has said, in addition, there are plans to rewrite the NHS constitution to enshrine a new basic right for patients to be involved in end-of-life decisions.

It will be the first time this kind of care has been introduced into NHS practice.

Doctors will have to justify wanting to place patients on the regimen and obtain consent.

The LCP already states relatives should be informed about decisions concerning family members but these new proposals, which will go out to consultation, would ensure they are.

"Putting a terminally ill person in the LCP is a big step for all concerned.

It’s not just a medical decision, it’s a moral one, and it’s also highly emotional, especially for the family."

It is not just the 'terminally ill' but those 'adjudged' to be dying who are also placed on the Pathway.The verdict of the prescient is the precedent!

"In my mind, there are absolutely no ­circumstances when the family can be ­excluded from this decision process.

There should be no situations in which they are not consulted and their agreement is not sought on all matters. 

Anything else is inhuman. Family members are the people who have to live with the death."

The Mental Capacity Act, 2005, sets out very carefully the nature of patient capacity and their ability to consent.

Those patients possessing capacity are the only persons considered able to consent for themselves; those lacking capacity are treated in their own "best interests" by the medical team in charge of their care. Thus, in such cases, family or next of kin are informed only at the discretion of the medical team in charge.

Many doctors treat this Act as a Carte Blanche to act without any consideration to consult with family, next of kin, which is considered but a nuisance and impediment to their charge.

Furthermore, in particular consideration to 'patient confidentiality', the Data Protection Act and 'protocol', the medical team in charge may decide against sharing any information.

"The Health Secretary, Jeremy Hunt, says he wants new NHS rules to include such a right for families."

May a rule negate a law? 

The arrogant have already been made more arrogant...