Everyday Ethics hosts a debate
between Dr.Peter Saunders, CEO Christian Medical Fellowship, and Professor
Patrick Pullicino, consultant neurologist at East Kent Hospitals and Professor
of Clinical Neurosciences at the University of Kent.
William Crawley, the Everyday Ethics host, very cleverly and very skilfully draws on the Christian ethics of both men to question the ethics of the
Sadly, Dr.Peter Saunders deemed it necessary to misrepresent the facts of the BMJ survey for Dispatches; and so forthrightly did he speak and with such authority that no-one dared to question him:
"Ninety-eight percent of over 3000 doctors who were surveyed for the British medical journal in the last week...Ninety-eight percent said that, if appropriately used, it can help people to die much more comfortably."
The BMJ feature asked last week -
The feature mentioned that, of 3021UK
hospital doctors emailed for an anonymous online survey of their views on the Liverpool Care Pathway, only 647 responded. That's only
21.4%. That being the case, that nine out of ten 90% doesn't look nearly so
good... And it's certainly not 98% of the 3021!
Crawley from his vowed intent to keep
this debate on track. The good doctor, in agreeing to appear on the programme,
plainly, was either not aware that this programme was titled Everyday Ethics or
- but surely no - in ignorance of the word 'ethics'.
Dr. Saunders reveals himself to be a cold and clinical man; Professor Pullicino, however comes across as a very human human-being, his voice faltering and emotional as stories spring from the well of his own very personal experience.
This is BBC Radio Ulster -
The Liverpool care pathway: what do specialists think?
It
must be said, a marvellous array of graphs were provided to give, well... a
graphical illustration of the results.
The feature mentioned that, of 3021
Who are these 3021 doctors? Why were they singled out for the
survey? There are, apparently, some 231,000 doctors on the Medical Register as
at 2010.
Fortunately, Mr. Crawley was not
going to be drawn into an argument about statistics and brought the discussion
back on track. Even a complaint from the doctor that Mr. Crawley had not heeded
his encouragement -
"to get some people who are actually experienced in managing dying patients and the program didn't do that."This controlled explosion of Dr. Saunders verbal tantrum did not deter Mr.
Dr. Saunders reveals himself to be a cold and clinical man; Professor Pullicino, however comes across as a very human human-being, his voice faltering and emotional as stories spring from the well of his own very personal experience.
This is BBC Radio Ulster -
Everyday Ethics
Provocative weekly debate with William Crawley on moral, religious and ethical issues.
Dying With Dignity Download 16MB (right click & "save target as / link as")
Sun, 3 Mar 13
On this week's Everyday Ethics with William Crawley - Dying with dignity or pushed along to meet hospital targets? We're debating the pathway to a peaceful end. And observing the sons of Ulster - just where are they marching to?Duration: Available:
33 mins 27 days remaining
Transcription follows -
William Crawley -
Hello and welcome to Everyday Ethics, your weekly free ethical download from the BBC with me, William Crawley. On this week's podcast, 'dying with dignity' or 'pushed along to meet hospital targets'? We're debating the pathway to a peaceful end.
It is an all too sad a fact that, at some time in our life, we will watch a loved one die, probably in hospital, often, the duration of their pain is lessened by an increase in their morphine intake and the withdrawal of food and water.That practice can be known as the Liverpool Care Pathway; it's said to be the merciful way but is it really just another form of euthanasia? Let's explore that. A very difficult subject. With us, Professor Patrick Pullicino, consultant neurologist at East Kent Hospitals Trust. Good morning to you.
Professor Patrick Pullicino
Good morning.
William Crawley -
Dr.Peter Saunders -
Good morning.
William Crawley -
And, let's start with you, Peter; how do you see this care pathway? Do you think it' s euthanasia by the back door?
Dr.Peter Saunders -
No, I most definitely don't see it as that. I think the Liverpool Care Pathway, which has attracted a huge amount of controversy, some of it justifiable, was developed really to ensure that patients dying in general hospitals would get the same excellent end of life care as those dying in hospices under the care of a skilled palliative care physician. And the Liverpool Care pathway is meant to deal with such issues to give guidance on an individualised basis about pain relief, sedation, fluid management, mouth care, spiritual care to people in the very last hours or days of life. And it has the support of over twenty organisations, including three Royal Colleges, the British Geriatric Society, the Macmillan, Age UK, all of these end of life organisations. It has the overwhelming support of doctors. But I think where the problems come are when people are placed on this pathway, or under this protocol, inappropriately; people who aren't in the very last hours or, at most, few days of life, or there has been inadequate discussion with relatives or in cases where people have not been properly trained to manage dying patients. But like any tool, the tool can be misused; you can kill someone with insulin, but insulin saves many lives and the Liverpool Care Pathway is something when, I believe, properly used can improve the experience of dying patients.
William Crawley -
Patrick, what do you say to those who look at this and say, well, this is a passive form of euthanasia when we use palliative care, when we use increased morphine doses and the person is drifting further and further away and we're protecting them, we're making them comfortable and we're using all this, kind of, morally distancing language, but we're also managing a quickening of the death process.
Professor Patrick Pullicino -
Well euthanasia is a very emotive but It's clear that people who are put on this pathway, um, die because of it.
William Crawley -
Because of the Pathway?
Professor Patrick Pullicino -
Because of the Pathway.
William Crawley -
So, we're quickening the death?
Professor Patrick Pullicino -
Yes, definitely, quickening the death. Well you're killing them, really, but if it's quickening, what's the difference between killing and quickening death? It's just language, really.
William Crawley -
Do you see no moral difference between killing and quickening death?
Professor Patrick Pullicino -
No, I don't; I mean I um...To tell you a story, my wife died about five years ago, and er, you know, in her last day, if someone had come up to me and said, let's put her on this pathway and, er, make her comfortable... um, you know, I would have been completely against that because when someone is in that, in that state, they're very vulnerable; the last thing you want to do is to harm them in any way. And, no, I would have thought, you know, if that had happened, um, I wouldn't have seen any difference between killing them just because they're a couple of days maybe before when their disease is going to kill them
William Crawley -
mmm, mmm
Professor Patrick Pullicino -
I, I really, you know, maybe em, [pauses] Certainly, the, the... You know, there are people who are put on this pathway who, from the other end of the spectrum, are basically very far from death. They are er... misdiagnosis in, in this pathway is very frequent. So, at the other end of the spectrum, you have people who would live for much longer who are put on the pathway and because it is so difficult to diagnose when somebody is dying, um, you know, that... People who could live for much longer are, are... have been killed by this pathway we have seen from the press. And, and I have seen a... I have seen a patient myself who I took off the pathway who then went on to live a for fourteen months. I mean this pathway is very dangerous. Um... and er...
William Crawley -
It's a pathway, It's a pathway to an earlier death; it's a managed death pathway.
Professor Patrick Pullicino -
Oh, it's definitely a managed death pathway. Yes.
William Crawley -
Let me put that to Peter Saunders. Peter, those are very, em difficult... terms to distinguish. Killing someone and quickening their death; managing their death; assisted dying. And there will be people who say, this is all, all simply moral gymnastics of a linguistic kind. What, what we're doing here is we're killing people. And maybe we should. that may be the argument they'd make. Maybe we should, it's the right thing to do, but let's be honest about it. Let's be honest about what we're doing.
Dr.Peter Saunders -
Well, I think we do need to be honest. And we need to realise that BBC Belfast, when this programme was put together, I encouraged you to get some people who are actually experienced in managing dying patients and the program didn't do that. Patrick's view is a very small minority view. Ninety-eight percent of over 3000 doctors who were surveyed for the British medical journal in the last week...
William Crawley -
It doesn't really mat... [intervenes]
William Crawley -
It doesn't really matter to us, Peter, if he has a minority view or a majority view, or indeed if your view is a minority or majority; it's an interesting view, which makes the conversation...
Dr.Peter Saunders -
Well, it's an interesting view and that's why he's been given a huge national platform, but there are only point four percent of doctors who actually agree with him. Nine out of ten doctors say they would like to be managed with this at the end of life. Ninety-eight percent said that, if appropriately used, it can help people to die much more comfortably. And so it is a very small minority view that yo're hearing. I, I disagree entirely that it''s killing people when properly used; I disagree that it's quickening death; I think the doses of morphine and sedatives that are used are not of that level. It is the overwhelming consensus of the medical profession and of all these organisations that are involved that, when properly used by trained, adequately supervised people, the Liverpool Care Pathway can improve the dying experience, which means that people are dying much more comfortably than they were doing before, now...
William Crawley -
But are they dying faster, as well? [intervenes]
Dr.Peter Saunders -
... But Patrick, when people who are not imminently dying are given sedatives and pain relief inappropriately, then that is abuse and that, that should be stamped out, and that is exactly why the government has set up an extensive inquiry; they they're hearing evidence, it's being chaired by Baroness Noiberger; it's reporting in April this year and it's going to look into all of these aspects.The Association for Palliative Medicine are involved, Dying Matters are involved, the End of Life Care Strategy are involved, patient groups and relatives are going to be able to give evidence. There are cases of abuse; I, I absolutely agree with that; but this, I believe, is a good clinical tool that has actually helped many patients to a much better death; it does not if properly used kill people; it does not quicken death. There is a huge moral difference between...
William Crawley -
Can I ask, can I ask you... [intervenes]
Dr.Peter Saunders -
...on the one hand...
William Crawley -
Peter... [intervenes]
Dr.Peter Saunders -
but on the other hand...
William Crawley -
Sorry, Peter, I need to interrupt... [intervenes]
William Crawley -
We need to put some questions in here. When you try to analyse the cause effect of someone dying, and why they died, clearly, people who are in hospital or at home who are being treated in terminal illness or other conditions...They may have all kinds of conditions which are leading to their death. But isn't it also the case that, if you put someone through a pathway where you increase morphine intake, and you withdraw food and water, where you withdraw medical interventions at times, then, if they eventually die, and die sooner than they might with those interventions, your lack of interventions or the actions you have taken on the pathway are actually causal factors in their death; you have quickened their death
Dr.Peter Saunders -
I think the key phrase there in what you've just said is 'quicker than they might.' And the key question to ask about any individual patient is this: Are they dying as a result of the disease progression, or are they dying as a result of the withdrawal of
treatment or giving of inappropriate treatment. And when a person is in the last twenty-four, forty-eight hours of life, the have pain, they're anxious, they're not wanting to drink, they're not wanting to take take fluids, then it can be quite appropriate to give pain relief, to give a treatment for anxiety in terms of low-dose sedatives, not to be forcing fluids on people; what happens is they then die as a result of the disease; it's the disease that kills them, not lack of treatment. Now, of course, if someone's not imminently dying, you put them in a side room, you give them pain relief, sedate them and withhold food and fluids, then that, obviously, that's abuse and that's, that should be stamped out, but we're talking about two completely different scenarios here and Patrick's in a very, very small minority of doctors on this.
William Crawley -
Well it may be a small minority of doctors who are right, of course. Dr. Patrick Pullicino, consultant neurologist at East Kent Hospitals Trust. We'll be discussing his description of what Peter Saunders has been praising, the Liverpool Care Pathway. What's your response to that, Patrick?
Professor Patrick Pullicino -
Well, you know, this pathway is supposed to restore dignity to dying. But it in fact does the opposite. You know, it sedates patients, it takes away their individualty at a very critical time in their life. In the last few days in your life, er, Kublar-Ross says that a lot of people do not begin to live life to the full until they actually appreciate the day they're going to die and then everything suddenly switches. So you put these people on sedation and you take away those most important days. Em, I'll just tell you a story, my... about my father when he died. He was in terrible pain from an aneurysm that had burst. And em, I was lucky enough to be able to help him and I em asked the doctor in the unit for a syringe of morphine and I just started to push it in. And his pain melted away. And I stopped. And then, once his pain had gone, ah, the family gathered round his bed and, em, you know, you know, we prayed together, we said the rosaries. His last few hours were, you know, something I'll always remember. Whereas, if we had put him on a sedative, on, on, you know, on midazolam and put him on the pathway, em, that would have all been lost. And, and unfortunately, this is happening time and over again and, you know, it's not only what, ah... you know, dignity is being warped, basically, people say dignity is when you see a patient who is completely asleep, quiet and they look very peaceful and you say that's dignified.
William Crawley -
So, what's... So, do you think, Patrick, there are times when you put people in a managed death scenario because it's easier for us to deal with it rather than focussing on the patient.
Professor Patrick Pullicino -
Yes, well I did, the reasons are right, you know, there are multiple reasons why we put people.. and how this pathway ever got into the NHS, I do not know. It's a total warping of palliative care. Britain had a wonderful palliative care system set up by Dame Cicely Saunders but, you know, she said we will do all that we can to help you to die peacefully but also to live until you die. This is not allowing people to live until they die. This is, as you say, managed death.
William Crawley -
And Patrick, can I ask, in addition to your clinical concerns and your ethical concerns about this, are you also driven by a particular religious perspective on these issues?
Professor Patrick Pullicino -
I have a religious perspective, certainly, em, but ah, what is driving me is what is right and what is wrong. You know...
William Crawley -
And would you describe yourself as Christian, just to be clear.
Professor Patrick Pullicino -
I am a Catholic.
William Crawley -
You're a Catholic Christian. So, you're concerned partly because of your Catholic commitments to social justice as well. Peter, Peter Saunders of the Christian Medical Fellowship, a fellow Christian is raising concerns about the ethics of what we are doing to people in the name of dignity.
Dr.Peter Saunders -
Ah, yes, of course he is. Em, but I disagree with his particular view on it and I, as an Evangelical Christian myself, I can tell you that there are many Christians who, who take a different view from Patrick. I agree about the cases of inappropriate use and abuse, but they think that this treatment pattern is something that is useful and if I could just pick up on something that Patrick said there, the Liverpool Care Pathway does not prescribe that everybody must have this pain relief, this sedative, this withdrawal of treatment and so on. It simply encourages people to ask the question each of those elements. People who are not anxious don't need sedatives; people who are not in pain, don't need pain relief; people who want a drink do not, should be given fluid, and that's all within the pathway and... And I come back to my main point again that when it's used appropriately, and people are put on it under good supervision, it will improve care at the end of life.
William Crawley -
Do you feel concerned at all about it?
Dr.Peter Saunders -
I, I have said many times, during this interview that I do have real concerns about the inappropriate use of the LCP.
William Crawley -
Yes... Yes, but what about things like timing...?
Dr.Peter Saunders -
If you've been put on it to ultimately die without proper discussion from relatives, without properly trained supervising staff, absolutely I have concerns and that's why there has to be a government inquiry and I hope it will get to the bottom of all this.
William Crawley -
Are you worried about what you're hearing about hospitals
Dr.Peter Saunders -
The difference between Patrick and I is whether we should be throwing out the entire pathway and approach at the end of life or not and that's where we disagree. He thinks that the pathway kills people and should never be used. I think it gives a useful framework of questions that people managing dying patients should be asking... to better care.
William Crawley -
Are you concerned, Peter about what you're hearing about hospital targets in this area?
Dr.Peter Saunders -
Yes. And I think that if... I do not think the number of people placed on the pathway should be linked to financial targets at all and that's a strong criticism that we've made. We think that any financial targets should be linked to adequate training of people, not placement on the pathway. But, again, that same question was asked of the three thousand and twenty doctors who were interviewed this week and ninety-eight percent of them, in their experience said that em, that money and bed shortages were not actually an issue in their view. Now I know that there are some who think that there are and I think that there have been cases of abuse, but again this is not the majority view.
William Crawley -
Would it be fair to say, Peter, to say that when a decision is made to put someone on the Liverpool Pathway, the decision is - this person is dying; he's on a journey to death. And we're going to help them, we're going to assist them, we're going to try to make them comfortable, we're going to deal with their pain; we're going to deal with dignity issues. There's a lot to be said for this. And, in helping them, it might actually have the effect that their death comes sooner, there's a quickening of the process towards death; maybe not necessarily, but in some cases. Is that fair?
Dr.Peter Saunders -
People that... The LCP makes it very clear that people should not be placed on it unless they're in the very last hours, or at most few days away from death. And the doses of morphine which are used, the doses of sedatives, do not actually quicken death they're not high enough to be doing that.
William Crawley -
Well, you have the example from Patrick of, one of his em... one of his examples was his examples was of somebody who was taken off the pathway when he lived for another year'
Dr.Peter Saunders -
Yes, and that was someone who clearly should never have been put on the pathway in the first case and there are cases of abuse like that. But that's about bad care; that's not about damning the whole pathway.
William Crawley -
Is it about more than that, Patrick? In a case like that, do you look at the morality of this to say, we are drifting steadily, bit by bit, down a slippery slope towards this defacto euthanasia, even though we use other kinds of language to disguise what we're doing?
Professor Patrick Pullicino -Well... You know, I would say that the major cause for the lack of compassion in care that we're seeing in the NHS in our days is this Liverpool Care Pathway. Ah, you know, I think, em, you cannot... The problem about the LCP is that it is not evidence-based. You know. when you put a pathway into a hospital like that, a heart-failure pathway, or a stroke pathway, you start off with a very clear scientific underpinning of your diagnosis...stroke, whatever, and you make that diagnosis. Now, there is nothing like that in this pathway. You know, somebody has to be, so-called, imminently dying to get onto this pathway, but there is nothing; you can trawl the medical literature and there is nothing that will tell you, ah, how to make that diagnosis. Although people say they can do it, um, you know, they, they have to write this up and publish it...
William Crawley -
Patrick...
Professor Patrick Pullicino -
to show what these statistics are...
William Crawley -
Dr.Peter Saunders -
...on the one hand...
William Crawley -
Peter... [intervenes]
Dr.Peter Saunders -
but on the other hand...
William Crawley -
Sorry, Peter, I need to interrupt... [intervenes]
William Crawley -
We need to put some questions in here. When you try to analyse the cause effect of someone dying, and why they died, clearly, people who are in hospital or at home who are being treated in terminal illness or other conditions...They may have all kinds of conditions which are leading to their death. But isn't it also the case that, if you put someone through a pathway where you increase morphine intake, and you withdraw food and water, where you withdraw medical interventions at times, then, if they eventually die, and die sooner than they might with those interventions, your lack of interventions or the actions you have taken on the pathway are actually causal factors in their death; you have quickened their death
Dr.Peter Saunders -
I think the key phrase there in what you've just said is 'quicker than they might.' And the key question to ask about any individual patient is this: Are they dying as a result of the disease progression, or are they dying as a result of the withdrawal of
treatment or giving of inappropriate treatment. And when a person is in the last twenty-four, forty-eight hours of life, the have pain, they're anxious, they're not wanting to drink, they're not wanting to take take fluids, then it can be quite appropriate to give pain relief, to give a treatment for anxiety in terms of low-dose sedatives, not to be forcing fluids on people; what happens is they then die as a result of the disease; it's the disease that kills them, not lack of treatment. Now, of course, if someone's not imminently dying, you put them in a side room, you give them pain relief, sedate them and withhold food and fluids, then that, obviously, that's abuse and that's, that should be stamped out, but we're talking about two completely different scenarios here and Patrick's in a very, very small minority of doctors on this.
William Crawley -
Well it may be a small minority of doctors who are right, of course. Dr. Patrick Pullicino, consultant neurologist at East Kent Hospitals Trust. We'll be discussing his description of what Peter Saunders has been praising, the Liverpool Care Pathway. What's your response to that, Patrick?
Professor Patrick Pullicino -
Well, you know, this pathway is supposed to restore dignity to dying. But it in fact does the opposite. You know, it sedates patients, it takes away their individualty at a very critical time in their life. In the last few days in your life, er, Kublar-Ross says that a lot of people do not begin to live life to the full until they actually appreciate the day they're going to die and then everything suddenly switches. So you put these people on sedation and you take away those most important days. Em, I'll just tell you a story, my... about my father when he died. He was in terrible pain from an aneurysm that had burst. And em, I was lucky enough to be able to help him and I em asked the doctor in the unit for a syringe of morphine and I just started to push it in. And his pain melted away. And I stopped. And then, once his pain had gone, ah, the family gathered round his bed and, em, you know, you know, we prayed together, we said the rosaries. His last few hours were, you know, something I'll always remember. Whereas, if we had put him on a sedative, on, on, you know, on midazolam and put him on the pathway, em, that would have all been lost. And, and unfortunately, this is happening time and over again and, you know, it's not only what, ah... you know, dignity is being warped, basically, people say dignity is when you see a patient who is completely asleep, quiet and they look very peaceful and you say that's dignified.
William Crawley -
So, what's... So, do you think, Patrick, there are times when you put people in a managed death scenario because it's easier for us to deal with it rather than focussing on the patient.
Professor Patrick Pullicino -
Yes, well I did, the reasons are right, you know, there are multiple reasons why we put people.. and how this pathway ever got into the NHS, I do not know. It's a total warping of palliative care. Britain had a wonderful palliative care system set up by Dame Cicely Saunders but, you know, she said we will do all that we can to help you to die peacefully but also to live until you die. This is not allowing people to live until they die. This is, as you say, managed death.
William Crawley -
And Patrick, can I ask, in addition to your clinical concerns and your ethical concerns about this, are you also driven by a particular religious perspective on these issues?
Professor Patrick Pullicino -
I have a religious perspective, certainly, em, but ah, what is driving me is what is right and what is wrong. You know...
William Crawley -
And would you describe yourself as Christian, just to be clear.
Professor Patrick Pullicino -
I am a Catholic.
William Crawley -
You're a Catholic Christian. So, you're concerned partly because of your Catholic commitments to social justice as well. Peter, Peter Saunders of the Christian Medical Fellowship, a fellow Christian is raising concerns about the ethics of what we are doing to people in the name of dignity.
Dr.Peter Saunders -
Ah, yes, of course he is. Em, but I disagree with his particular view on it and I, as an Evangelical Christian myself, I can tell you that there are many Christians who, who take a different view from Patrick. I agree about the cases of inappropriate use and abuse, but they think that this treatment pattern is something that is useful and if I could just pick up on something that Patrick said there, the Liverpool Care Pathway does not prescribe that everybody must have this pain relief, this sedative, this withdrawal of treatment and so on. It simply encourages people to ask the question each of those elements. People who are not anxious don't need sedatives; people who are not in pain, don't need pain relief; people who want a drink do not, should be given fluid, and that's all within the pathway and... And I come back to my main point again that when it's used appropriately, and people are put on it under good supervision, it will improve care at the end of life.
William Crawley -
Do you feel concerned at all about it?
Dr.Peter Saunders -
I, I have said many times, during this interview that I do have real concerns about the inappropriate use of the LCP.
William Crawley -
Yes... Yes, but what about things like timing...?
Dr.Peter Saunders -
If you've been put on it to ultimately die without proper discussion from relatives, without properly trained supervising staff, absolutely I have concerns and that's why there has to be a government inquiry and I hope it will get to the bottom of all this.
William Crawley -
Are you worried about what you're hearing about hospitals
Dr.Peter Saunders -
The difference between Patrick and I is whether we should be throwing out the entire pathway and approach at the end of life or not and that's where we disagree. He thinks that the pathway kills people and should never be used. I think it gives a useful framework of questions that people managing dying patients should be asking... to better care.
William Crawley -
Are you concerned, Peter about what you're hearing about hospital targets in this area?
Dr.Peter Saunders -
Yes. And I think that if... I do not think the number of people placed on the pathway should be linked to financial targets at all and that's a strong criticism that we've made. We think that any financial targets should be linked to adequate training of people, not placement on the pathway. But, again, that same question was asked of the three thousand and twenty doctors who were interviewed this week and ninety-eight percent of them, in their experience said that em, that money and bed shortages were not actually an issue in their view. Now I know that there are some who think that there are and I think that there have been cases of abuse, but again this is not the majority view.
William Crawley -
Would it be fair to say, Peter, to say that when a decision is made to put someone on the Liverpool Pathway, the decision is - this person is dying; he's on a journey to death. And we're going to help them, we're going to assist them, we're going to try to make them comfortable, we're going to deal with their pain; we're going to deal with dignity issues. There's a lot to be said for this. And, in helping them, it might actually have the effect that their death comes sooner, there's a quickening of the process towards death; maybe not necessarily, but in some cases. Is that fair?
Dr.Peter Saunders -
People that... The LCP makes it very clear that people should not be placed on it unless they're in the very last hours, or at most few days away from death. And the doses of morphine which are used, the doses of sedatives, do not actually quicken death they're not high enough to be doing that.
William Crawley -
Well, you have the example from Patrick of, one of his em... one of his examples was his examples was of somebody who was taken off the pathway when he lived for another year'
Dr.Peter Saunders -
Yes, and that was someone who clearly should never have been put on the pathway in the first case and there are cases of abuse like that. But that's about bad care; that's not about damning the whole pathway.
William Crawley -
Is it about more than that, Patrick? In a case like that, do you look at the morality of this to say, we are drifting steadily, bit by bit, down a slippery slope towards this defacto euthanasia, even though we use other kinds of language to disguise what we're doing?
Professor Patrick Pullicino -Well... You know, I would say that the major cause for the lack of compassion in care that we're seeing in the NHS in our days is this Liverpool Care Pathway. Ah, you know, I think, em, you cannot... The problem about the LCP is that it is not evidence-based. You know. when you put a pathway into a hospital like that, a heart-failure pathway, or a stroke pathway, you start off with a very clear scientific underpinning of your diagnosis...stroke, whatever, and you make that diagnosis. Now, there is nothing like that in this pathway. You know, somebody has to be, so-called, imminently dying to get onto this pathway, but there is nothing; you can trawl the medical literature and there is nothing that will tell you, ah, how to make that diagnosis. Although people say they can do it, um, you know, they, they have to write this up and publish it...
William Crawley -
Patrick...
Professor Patrick Pullicino -
to show what these statistics are...
William Crawley -
I'm afraid that's where we have to leave it, Professor Patrick Pullicino, consultant neurologist at East Kent Hospitals Trust and Dr. Peter Saunders, Chief Executive of the Christian Medical Fellowship, thankyou both.
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