Social work and end-of-life care

Social work is important in end-of-life care

Campaign against the Liverpool Care Pathway: more common sense required?

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The anti-euthanasia charity ‘Alert’ is said to be issuing cards that say: ‘Please do not give me the Liverpool Care Pathway treatment without my informed consent or that of a relative.’ The Liverpool Care Pathway is a protocol (set of instructions) to health and social care staff on how to provide care to people in the last day or two before their death. The issue that has caused the controversy is that artificial feeding and hydration by tube is often withdrawn, as is customary in hospices, because the patient does not need food and water and is sometimes made uncomfortable by taking in food and water and by the tubes.

An article in the Daily Mail records the intention to issue the cards, which might form a viable advance decisions that services would have to take note of. Link to the Daily Mail article.

This refers back to correspondence in the Daily Telegraph from doctors who are mainly concerned to say that morphine often goes with dehydration and can lead to a more rapid death: they suggest in passing that the decision to use the Liverpool Care Pathway might be used by hospitals to speed up deaths, possibly because this would free up resource for other patients. The Telegraph took this up, saying rather more assertively than the doctors did:

Hospitals may be depriving elderly patients of food and drink to hasten their deaths as part of cost-cutting measures to free up bed space…

Link to the doctors’ letter.

Link to a subsequent Daily Telegraph article taking the issue up.

A couple of points about this Telegraph material: this comes from the Medical Ethics Alliance; a Christian charity, closely associated with Dr Gillian Craig, who has campaigned for some time in favour of continuing artificial feeding and hydration where people are in the process of dying , against what is probably the medical consensus, reflected in the fact that the Liverpool Care Pathway is recommended by the Department of Health’s National End-of-Life Care Programme.

What are we to make of this? For one thing, the allegations against hospital managements seem a bit far-fetched. I find it hard to imagine that they are organised enough to pursue a policy of killing off patients early, although I imagine that they probably do quite a lot by disorganisation. Experience in many hospices suggests that most hospitals actually find it quite difficult to identify when their patients are close to death, and probably go on treating people hopelessly for far too long. The campaigners seem to have got their Christian concerns a bit out of proportion.

But there is a legitimate point about the Liverpool Care Pathway. It was based originally on hospice policy with cancer patients, who have been shown to benefit from both regular morphine and the symptom and care management that hospices achieve. I suspect it is rather more doubtful that this practice can be transferred wholesale to patients who are not dying of an ‘advanced illness’, but are frail and have conditions other than cancer, but end up in a hospital ward, where the level of skill in handling symptom and pain management is probably less than  in hospices too. The LCP should probably be used with discretion and flexibility with the right patients rather than being imposed wholesale. One of the characteristics of government programmes is that they grab these ideas because they formulate a nice manageable system, ‘roll it out’ widely in the cause of greater efficiency, and people stop using their common sense.

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Written by Malcolm Payne

3 October 2012 at 12:22 pm

One Response

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