A mammoth undertaking

There has been a great deal in the press over the last few months about the Liverpool Care Pathway, a method of treating dying patients with sedation and withdrawal of both food and active treatment once it is recognised that they are very close to death. The pathway was developed out of methods of treatment used in hospices, which are used to palliative care of the terminally ill, and has become widely used within the NHS including in general hospital settings.

Too widely used, apparently. The papers have been full of horror stories of elderly people being put on the Pathway under inappropriate circumstances – when they weren’t actually dying, without the knowledge and agreement of their next of kin, and allegedly to “unblock” beds and for monetary reward for targets met. If true, the allegations are shocking and a classic example of dysfunctional targets leading to dysfunctional corporate behaviours. There has been a high-level report into the practice, and the politicians have decreed that It Must Stop Forthwith. So the Liverpool Care Pathway is going to be withdrawn from use.

On the one hand, that’s good, if it stops the apparent abuses of the system. But I do wonder what will replace it. There has to be some way of recognising when active treatment has done all it can and that death is inevitable, and in my view it should be made as untraumatic as possible, both for the patient and their family.

I have a personal interest here. Although it wasn’t actually given that name, I’m pretty sure that Christopher was on the Liverpool Care Pathway for the last two days at the hospice. It wasn’t pleasant (and that’s an understatement), but I could tell he wasn’t suffering. The difference from the horror stories was that the Palliative Care consultant sat me down, explained what the options were and why she was recommending sedation etc, and made sure I understood what it meant. She said that it was her decision that Christopher had reached the point where active treatment was no longer appropriate, but I corrected her. I said that I was Next of Kin, and that the decision and responsibility for it was a joint one between me and her. But I agreed wholeheartedly with the decision. Christopher had told me the day before, in a lucid moment, that he had had enough, and all he wanted to do was die. So it was clearly my duty not to encourage the hospice staff to prolong the inevitable.

So in our case, and I believe in many others, the Liverpool Care Pathway or a variant thereof was used appropriately, compassionately, and with the informed consent of the Next of Kin. Once Christopher had said he wanted to die, it would have been wrong to aggressively treat him and prolong the inevitable, not to mention being even harder on me to watch him suffer. So, although I find it brings back very unhappy memories when I read the newspaper articles about the Pathway and see the fuss the Press has kicked up about it, I shall continue to follow the story to see what the Powers That Be propose to do to replace it. When used correctly, it was a reasonable solution to a very tricky problem, and if it gets banned completely I think a lot of terminally ill people may suffer unnecessarily.