Liverpool Care Pathway - And The Necessity For The Hospice

Is Hospice a substitute for care? Has Hospice banished care from our hospitals? Is Hospice humane? Is Hospice just a one-way ticket...?

Let's face it: life is a one-way ticket! Birth and death are life experiences. The beginning and the end. And living matters all the way. Life is precious.

It is not we who love life who are scared of death and to talk about death; it is those who wish to hide it away in Hospice and make dying something to fear who fear death.

Death is a part of life. The dying are amongst us. They are our loved ones, our compatriots, our neighbours... strangers.

Does Hospice and LCP provide a cost-effective substitute to care?

While increased longevity is to be welcomed, doctors say not enough resources are being devoted to making the last days of the elderly as comfortable as possible. Doctors writing in the British Medical Journal Supportive and Palliative Care say gradual deaths from cancer and other chronic diseases are already “a considerable burden” for European countries. - The Telegraph

Has Hospice profoundly altered the mindset? Has Hospice made it 'okay' to kill people?

When they survey for 'customer satisfaction' - the so-called PROM (Patient Reported Outcome Measures) - do they ask the patient...? How can they? They will have successfully consigned the patient to the hereafter. That is the business of the Hospice and LCP.

They will ask the family...

Colin Tidy comments at Patient.co.uk upon symptoms that may be distressing for relatives, implying that control of such symptoms is necessary, not for the patient but as a cosmetic fix for the relatives.

Doctors are saying -

The Telegraph


Others disagree -

HOSPICES

I think that the real question has been overlooked... Just why are there Hospices? Up until the late 60's all hospital deaths occurred on the wards; patients were tended with dignity, compassion, and respect. As more people were taken away to die in a hospice, the experience available to the general nurse in caring for people with complex treatment or personal needs was removed. Coupled with a general almost inexorable decline in standards of care, passing away for most people became a hit and miss experience. Instead of addressing the problem and meeting the needs of both patients and staff, misguided attempts to correct the situation occurred, the latest of which is the L.C.P. We need more trained staff who are human enough to deliver what is needed...
- Graham Clarke

David Lawrence Dewey writes in Food for Thought and asks the question: Is Hospice care humane?

Hospice Care for the Dying - Is It Humane?
Is hospice care for the dying humane? I don't believe so, here's why.
This past summer, I had a friend whose mother was dying of cancer. She was placed in hospice care after remaining in a regular hospital room for over a week. This was in a medical facility in Minnesota. 

What then proceeds is a process not dissimilar to the LCP. Dewey comments:

If you have ever had any type of medical training, this is right the opposite of what you're taught. You feed the sick, not starve them to death. And this is exactly what happened to this wonderful woman. Sue was left to a slow, very painful death of dehydration and starvation that continued on for over six long painful weeks. This to me is simply a legal Dr. Kervorkian method for doctors to slowly kill people that are dying. 

The human body if it does not receive nutrition via food will literally start to "feed" on itself, regardless of the illness. It is even worse if the person is ill because the body is needing nutrients to try to heal itself, even to the last minute of life in people dying from cancer. Sue was literally starved to death. Even the doctors told the family they had not seen anything like this, someone that had held on that long. The reason why is that without the people receiving less than 4 ounces of water a day with morphine through a I.V. tube with no tube feeding will die from literal starvation within 7-10 days. The son related to me that at one point he had asked his mother pleaded when she had briefly come out of her drugged state to please feed her, she needed food. There was nothing the son could do, the doctors would not listen.

This is Tampa Bay Times -

Palliative care helps patients not ready for hospice

TAMPA — Dr. Chad Farmer sees patients with very serious, even terminal conditions, such as cancer, emphysema and heart disease. Many ask this question when he walks through the door:

You're not from hospice, are you?

They ask because they aren't ready for hospice.They may equate it with death. They may not want to stop medical treatments meant to cure or prolong life, even if their suffering is intense.

Quite simply, they’re not ready to give up yet. It's got nothing to do with not wanting to talk about 'that' subject. We all know we're headed for that big terminus in the sky. We're all on the same journey, even if we take different routes to get there. But if it ain't over yet, it ain't over.

According to KHN, Medicare has yet to set in place a three-year-old order to expand hospice care to include palliative options. This would encourage folk to take up their Medicare Hospice benefit -

KHN

People just don't want to give up on their chance of life and forgo curative treatments. People love life. Living Matters to them. To take up their Medicare Hospice benefit, they have to agree to give up. You go into Hospice to die.

e-hospice is saying that nurses are demanding better end of life care training -

At the RCN's annual congress this week, over 99% of delegates voted in favour of a resolution for the RCN council to lobby for improved training and education in end of life care.

Kiera Jones, a palliative care nurse, submitted the resolution following the recent criticism of the Liverpool Care Pathway (LCP) which led to the current independent review into the use of the end of life pathway.

Which is saying that the experiences published in the so-called Daily Fail rubbished disgracefully by pro-LCPers are not the rubbish they made them out to be. There is a problem.

There is a problem. Both with the training and the LCP!

Where will they get this training?

A survey of doctors last month by the BMJ also highlighted the need for training in the use of the pathway, in particular around recognising a dying patient and communicating this to patients and relatives.

Referring to these survey findings, David Praill, chief executive of Help the Hospices, said that the lack of training and understanding of the LCP must be addressed. He said: "Hospices can share learning about identifying patients most likely to benefit from being on the pathway, as well as the structures and processes which will ensure its best use.

"Hospices are well placed to share their expertise in working and talking with patients and families to achieve common goals for care at the end of life, and support for bereaved families and carers."

The RCN and Help the Hospices are among a number of organisations to have signed a consensus statement supporting the appropriate use of the LCP.

The RCN has also developed the joint end of life care patient charter with the Royal College of General Practitioners, and plans to deliver further training, following workshops on end of life care delivered with the National Council for Palliative Care and the National End of Life Programme last year.

It doesn't look promising.