Sunday, 24 March 2013

Liverpool Care Pathway - The Nine Out Of Ten

The article responded to here reported that of 3021 UK 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...
This is the BMJ -

Nine out of 10 palliative care experts would choose Liverpool care pathway for themselves

BMJ 2013; 346 doi: (Published 1 March 2013)
Cite this as: BMJ 2013;346:f1303

The Liverpool care pathway represents best practice for the care of dying patients, according to 89% of UK palliative medicine consultants in an online survey by theBMJ and Channel 4’s Dispatches programme.1
The same proportion of consultants said they would choose it for themselves if they were dying from a terminal illness, and over 97% of consultants thought that the pathway allows patients to die with dignity when used correctly.
The anonymous online survey was emailed to 3021 hospital doctors in early February. The results are based on responses from 563 doctors who had used the pathway in their practice. These respondents comprised 185 palliative medicine consultants (about 40% of the total UK consultant workforce …

Recent Rapid Responses

Felix ID Konotey-Ahulu, Kwegyir Aggrey Distinguished Professor of Human Genetics University of Cape Coast, Ghana
Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 9 Harley Street, Phoenix Hospital Group, London W1G 9AL

Liverpool care pathway BMJ and Channel Four News: Majority expert choice does not mean best choice
Something dangerous has descended upon British Medical Practice. Assemble some experts to agree on something, get it started somewhere, label it with a brand name, and recommend it as received wisdom. When the fallout produces a national uproar some doctors describe it as “adverse media coverage”. But any health care programme that denies drinking water to a thirsty patient presumed dying is cruel. I desist from enumerating again the dozen remarkable British Consultants I mentioned on 21st July 2012 who were great Role Models in my undergraduate and postgraduate years in the UK; they would have been shocked to read headlines in The Daily Telegraph like “Patient died after being left dehydrated” (Nov. 27 2012), “Dying not told care will be withheld” (Dec. 2), “My husband died in hospital like a battery hen” (Dec. 5), and “He died because people didn’t care” (December 6 2012).
Describing something as cruel as I have done is to make an ethical judgment. Appreciation of ethics does not depend on expertise, as I demonstrated with the case of two Fellows of the Royal Society using in entirely different ways my Mendelian Dominant genetic defect published in the BMJ which I used to make an ethical point. One FRS credited the BMJ with publishing the ethical basis of my personal genetic information, and used it for his chapter on Ethics in Genetics. The other FRS, equally brilliant, neither once mentioned the BMJ, nor the author (myself), nor Ethics in his entire book even when the word “ethics” was in the title of what I wrote. Nine of ten experts, March 2, p. 2 [1] may agree with a programme that I call cruel, but are they not behaving like the FRS who refused to mention ethics when the BMJ case he quoted had the word “ethics” in the title? Before anyone accuses me of being judgmental it must be pointed out that to accuse someone of being judgmental is also judgmental. Viewers of Channel Four Dispatches programme “Death on the wards” on Monday 4 March this week [2] were enormously grateful to see at least two UK Clinicians Professor Sam Ahmedzai and Professor Patrick Pullicino defy the usually cherished anonymity, and come out boldly to oppose The Liverpool Care Pathway. When the latter went on to say the Pathway “is going to be a thing of the past” [2], majority expert opinion or not, I reckoned not a few people in Great Britain would have been heard to say “Amen!”
Would the “9 experts out of ten” who support The Liverpool Pathway [1] be surprised if many distraught loved ones of those whose death was accelerated by The Liverpool Pathway were tempted to conclude that Great Britain was on the slippery road to what Professor Muller-Hill [3] described as MURDEROUS SCIENCE? Would these experts begrudge the reasonable demands of people (including myself) for an ethical dimension to patient care?
Felix I D Konotey-Ahulu MD(Lond) FRCP DTMH
1 Chinthapalli Krishna. Nine out of 10 palliative care experts would choose Liverpool care pathway. BMJ 2013; 346: f1303 (March 2, pages 2-3)
2 Channel Four (Television). Death in the wards - Dispatches, Monday 4 March 2013, 8 to 9 pm.
3 Muller-Hill Benno. Murderous Science. Elimination by Scientific Selection of Jews, Gypsies, and Others – Germany 1933-1945. [Translated from German by Professor George R Fraser] Oxford, Oxford University Press, 1988.
Competing interests: None declared

The LCP and other integrated pathways have been rolled out across the NHS and pretty much everywhere else, as reported in these pages. It would be surprising - given the high pressure sales pitch by the DoH EoLCP/NCPC and the indoctrination programmes that have been rolled out - if those using the LCP and who have undergone the programming and completed those six steps to success didn't support the LCP and want it for themselves when the doctors say it is time for them to die. Wouldn't it?

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