Liverpool Care Pathway - "Fear And Confusion"

Land of Confusion

I must have dreamed a thousand dreams
Been haunted by a million screams
But I can hear the marching feet
They're moving into the street 

Now, did you read the news today?
They say the danger has gone away
But I can see the fire's still alight
They're burning into the night 

There's too many men, too many people
Making too many problems
And there's not much love to go around
Can't you see this is a land of confusion?

         - Land Of Confusion: Tony Banks /Phil Collins/ Mike Rutherford.

A Review does not make the danger go away; it makes it only the more certain.

Public Service reports -

Liverpool Care Pathway: a licence to kill?

11 February 2013 

A version of the Liverpool Care Pathway (LCP) – meant to ease terminally ill patients towards their death – could be being used to remove the 'problem patient' under a starvation and dehydration quick-fix, one of the UK's leading experts in palliative care has said.

Brian Livesley, emeritus professor in the care of the elderly, Imperial College School of Medicine, said that inducing death by neglect exposes wilful and/or negligent clinical staff – as well as their administrators – to the certain risk of criminal charges.

On the other hand, fear and confusion over the pathway had prevented elderly patients receiving treatment they desperately needed and diagnostic medical technology could be hiding an ignorance around palliative and end-of-life care. Medical and nursing training could have produced too many high-tech oriented professionals, who are unwilling or inadequately trained to recognise when a patient is dying.

Livesley asked in the British Journal of Healthcare Management if the LCP was nothing more than a "licence to kill".

He wrote: "Does inadequacy among doctors and nurses allow a pseudo-form of the Liverpool Care Pathway to be used to remove the 'problem patient' under a 'starvation and dehydration quick-fix'? Is this one of the reasons why there is 'fear and confusion over [the] death pathway' which has been reported recently? Has this really made some patients reluctant to go to hospital to get the treatment they desperately need?"

He continued: "For all their expertise, clinical professionals can be at a loss about what to do and turn a blind eye to patient's difficulties. This paradoxical behaviour is partly the result of the virtual absence today of those life-threatening epidemic diseases that previously gave doctors and nurses experience with dying patients; as well as the easy availability of the diagnostic and therapeutic techniques associated with high technology medicine, among which ignorance about palliative care can be hidden. This allows the words 'not beneficial' be weaselled to mean 'nil by mouth'."

Livesley said that just as all bedside professionals are expected to have a basic knowledge of cardiac resuscitation, they should also be trained to at least the same degree in palliative care. And it should be remembered that palliation is not merely an immediate-end-of-life event. It is the time when doctors and nurses need the ability and humanity to give confidence to the dying patient and their family and friends by "being there".

"They should correctly make the diagnoses and treat appropriately any reversible clinical conditions," Livesley wrote, "while relieving symptoms and anxieties promptly. They need to do this even as unnecessary treatment and investigations are being discontinued – and allow conscious patients food and fluids as required; while continuing to provide effective palliative care. This is the real Liverpool Care Pathway."

"This is the real Liverpool Care Pathway." And which version is that...?