Private Business Intermediaries

Media scare stories about the Liverpool Care End of life Pathway

01/11/2012 | By Peter Walker
There has been quite a bit of coverage recently in the Press & TV news about the Liverpool Care Pathway and the sums hospitals have been given to end patients lives early. The Telegraph ran a story that focuses on payments to hospitals and not on how this pathway has helped reduce the suffering of tens of thousands of people.  Whilst the BBC’s story was about helping people to die, as if that was a very bad thing, the Liverpool Care Pathway is not assisted suicide or euthanasia, if you or I were put on the pathway or even a person who is fighting a serious cancer were put on the pathway for weeks, very little would happen, we would still eat and drink as per that pathway and  we would accept the medicines we needed. The pathway only has an effect on those who are at the end of their lives and who choose not to eat and drink, and choose, with their family, for end of life care vs. fighting for life interventions. Dying is the one certainty, and sadly it’s something that the medical community were very bad at dealing with in the past. Modern medical technology is wonderful, we can perform ever increasingly complex interventions to keep someone alive, such as ventilate a person when they stop breathing, feed them via a drip, regulate organ function using a wide range of drugs.

There does however come a time, when modern medicine needs to step back and realise that the person is dying and do all it can to make that death as stress and pain free as possible, this is not an admission of failure to save the person, just accepting the reality of death.

The Liverpool Care Pathway, simply recognises that a person is coming to the end of their lives, and starts to step back from tests and treatments toward care and compassion.  This is something that the Hospice movement have understood and practiced for a long time, the fact that hospitals are being encouraged to follow the best practice of the hospice movement, should be applauded not feared. People die in Hospices with as much dignity and as little pain as possible. People also leave Hospices, having got their pain under control to return to the community to carry on with life, knowing that in the end the help, support and care will be there.

The press talk about the scandal of people who are on the pathway going on to survive, a core part of the pathway is recognising that some people do have a reverse of fortunes and this is not failure of the pathway, it is part of the pathway, it is not a one way street, yet for most who are coming to the end of their lives though cancer, stroke or simply old age where their organs known to be shutting down, a question is asked “Should we keep fighting for life with all the tools at our disposal, perhaps prolonging what otherwise would be a natural  and peaceful death’ or ‘do we all agree, family and medical team, that we are close to the end and now is the time to admit that, and spend the time that is left saying goodby, providing peace and working hard towards reducing distress and pain’. When we ask the questions of the patient ‘Do you think you're dying?  What would you like us to do for you?  many know all too well and want little in the way of treatment, hoping simply for no pain and distress and to be with their loved ones.

It is a reality that some people would live longer with no pain relief, and others would live longer once they stop wanting to eat by feeding them via a tube, but does that make this treatment better?

One day we will all sadly stop wanting to eat, we will all stop wanting to drink and eventually we will all take our last breath.  I see far too many people whose last minutes are spent having ribs broken by a cardiac arrest team, who should have been allowed to pass with dignity, if only we had asked what they wanted.

Of course there is a fine balance, many a 75 Year old has a cardiac arrest  and lives to tell the tale years later, yet you don’t go from digging your garden one day to being on an end of life care pathway the next. The Liverpool Care Pathway is for people who, by agreement of the medical team, with many safeguards, have problems that cannot be reversed and who will almost certainly not live for much longer.

Food & water is not withheld, relatives are encouraged to help with drinking and eating while the patient wants to eat or drink. What is avoided is feeding by artificial means, and fighting with tests and drugs to prolong life.  Again consider artificially prolonging life for a few weeks by intravenous methods, when the quality of life has gone. When are efforts to prolong life merely prolonging death.

Money does come into the picture, if we all die in intensive care in our old age having been kept alive for weeks on life support, the NHS and private sectors would go bankrupt many times over. 

There is a real peace from admitting that someone is dying and the care pathway does result in that death being peaceful where possible and to some degree predictable, as we know when we stop drinking because we are too tired to do so, life will end within a day or two.

For more information about the Liverpool Care Pathway, especially for healthcare professionals, please visit this link.

If you have any questions or would like information of organisations who can offer advice you can contact me by clicking here.

Thanks to the Royal Berkshire Hospital NHS Foundation Trust end of life care team  and the Duchess of Kent Hospice Team for the End of Life care training and support that help many medical staff provide better end of life care.