Tuesday, 1 January 2013

Liverpool Care Pathway – The Crucial Questions

Katharine Whitehorn writes in

The Guardian homeThe Observer home
The Observer, 

A thirst for palliative care: the Liverpool Care Pathway and withholding sustenance

Caring for the dying through the controversial Liverpool Care Pathway involves crucial questions about how to see them humanely through their last moments
Whether it is true or not that in the middle ages nuns who had sinned were shut up with no food or water, thus freeing their superiors from the sin of actual killing, we can be sure that nowadays we would of course condemn such hypocritical thinking. Or would we?
I'm not so sure now that the details of the well-known Liverpool Care Pathway have been explained to me. This is a procedure for the care of terminally ill patients, including children. When there is no hope of recovery and it's judged that the patient is going to die within three days, all treatment can be stopped except to alleviate pain. And that includes sustenance.
Which sounds all right, until you think of an ill person – an ill child – denied water. Hospital visitors, one of them tells me, are not allowed to do much except fix the flowers and read aloud. Though it is only unconscious patients, the medics assure me, who are ever denied water, I can't help but think of children parched with thirst.
Withholding liquid, of course, kills you quicker than withholding food, which was why hunger strikers take so long to kill themselves. If you believe in euthanasia, by the way, a painless death can easily be achieved with a glass of barbiturate. But that would be killing, wouldn't it – and so out of the question.

The 'terminally ill' patient: this is so oft repeated...

It is the patient diagnosed as 'dying', also, so oft embarked, sets forth upon the Pathway; it is not just the patient diagnosed with a terminal illness, an illness that will result in ending life, that treads that way.

This murderous practice, encouraged and demanded by the CQUIN payments, must cease. May the New Year see this come to pass.

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 Solid Facts: Palliative Care" edited by Elizabeth Davies and Irene J. Higginson - Ethos Perspectives) — May 2007 Soh Tze Min and Sheila Ng

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)

Without a doubt, end-of-life care is fraught with complexity and controversy. For example, there is continuing debate whether it devalues life by abandoning curative efforts too early, or is more respectful of life as it seeks to give the dying greater dignity and quality of life. While most respect individual choice and one's right to die with dignity, interpretations—whether individual, societal, cultural, religious or clinical—of what constitutes "quality of life" in one's dying years vary greatly. There is also a lingering perception that palliative care can result in substandard medical treatment, or is a way to end the burden of caregivers.
Ethos Perspectives — May 2007
Soh Tze Min and Sheila Ng
Social Policy

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