Liverpool Care Pathway – The Daily Mail vs Care for the Dying

An inevitable philosophical question:

I’ve been occasionally contributing to Angrymob for a few years now. Kevin (aka Uponnothing) very kindly gave me a login. I write because I care about the truth. I write because I believe that the lies and agenda of the Mail are pervasive and damaging. I write because I hope to share my thoughts with enough people to help change the story – to help people realise what the media in general and the Mail in particular are doing. To provide the facts – as best I can – so that people who know the Mail is lying have the ammunition to respond.

I have no idea really if I’m achieving anything.

But the question that I’ve pondered for sometime now – especially when I read stories like this one – is what is going on within the Mail? I wonder if they believe what they write? I wonder if they just want an agenda to push? And I wonder what level of research they do before holding a particular position?

Either way, what they publish is demonstrably false and often deeply poisonous. This is why I have written about vaccines so much. The recent events in Wales with measles have shown the real-world effects of the Mail’s agenda. And this is moreover true is so many areas – immigration, race relations, the Welfare State, the NHS, our attitudes to poverty…etc. etc.

So, whilst I continue to ponder that question, which I admit does intrigue me greatly, I will try to continue to respond when I have the time. For the most part I write about healthcare issues as this is what I know about.

On the subject of poverty I invite you to read this from my personal blog. (I make no apology for the theology).

 

The Liverpool Care Pathway

I think I should begin with a confession; I am not a big fan of the LCP. I will explain that comment in a moment but first I need to alter it slightly. My feelings have changed and I have become very keen to defend it because the attack by the Mail seeks to (well maybe not, see above, will- ) damage the way we care for the dying in this country. If you want to read about the pathway itself and to understand what it is and how it works, here is a good place to start.

Simply put, the LCP was designed to consolidate best practise in the care of dying patients. In the UK we have a hospice movement to be proud of. Most people, however don’t die in hospices – most people die in hospitals. Historically (by which I mean the last 30 years) and culturally, hospitals are not conditioned to best care in the process of dying. Hospitals are places for curing. Modern medicine particularly is built on the notion of curing everything. Trust me, doctors know this to be a lie. Most of us have had enough humbling experiences with meeting death to know that we can’t cure everything and that the old saw about medicine being the art of delaying the inevitable is not without its truth. However, and this is a vital and massive ‘however’ – we are in the business of healthcare. Providing curative treatment when possible and appropriate and dignity, compassion and comfort when not.

Recognising that a patient is dying is notoriously difficult but experienced nursing and medical staff will tell you that we often know that it’s time to stop. I graduated in a time when these kind of approaches were widely accepted and beginning to be more formalised. It is about the fact that most people die relatively slowly – by which I mean hours to days  and not the seconds to minutes we see in TV and movies. Given that putting everyone in a hospice is not practicable, I think most of us will agree that providing the best kind of end-of-life care in hospital is a priority.

The principals are this: When a patient is near to death; stop unnecessary and invasive interventions (like blood tests) and treat symptoms effectively. This usually means three things; analgesia, treating anxiety and treating secretions.

The Liverpool Care Pathway codifies these in a way designed to ensure that best possible care is provided. Feeding may be stopped as in the last few days as artificial feeding does more harm than good.

So why do I not like the LCP? Well, this is not really my area of medicine and as I’ve moved into my specialty of paediatric surgery, I haven’t done any adult work for over three years now. But I was a junior doctor on the wards – and anyone who has done that job will have dozens of stories of how the LCP is a really effective way of CARING for dying patients. My objection is the same as that of a professor of palliative care I know, the LCP is a little cumbersome and involves too much paperwork and it got a lot of national attention and funding  – potentially at the expense of other areas. But is does work. Really well.

The LCP is very very good at what it does. The LCP – or something like it – is exactly what I would want for me, for anyone I love – or for any human being near to death.

 

The Daily Mail’s latest Witchhunt.

Back in November, I picked up on Melanie Phillips evil comment piece on the LCP and its effects. I do not use the word ‘evil’ lightly but something so completely dishonest that increases distress and anxiety for people who are watching loved-ones die I think is evil. If someone wants to provide me a better word, please do. Again I don’t know if Phillips is being dishonest of just not bothering to research properly – but I suspect dishonesty as she has never effectively engaged with the debate or criticism – where it has been repeatedly demonstrated where she is wrong.

And so we come to this week’s piece. The British Medical Association has been discussing the LCP and the public’s perceptions leading to this Daily Mail headline:

‘Don’t call it the Liverpool Care Pathway’: Doctors admit it sounds like a one-way ticket to the grave

  • Leading doctors have admitted that there are problems with the controversial end of life care regime
  • Involves withholding food and water from the dying patient and is meant to help them die with dignity
  • Doctors admitted some patients have been left on it for weeks without having their case reviewed
As always, the culpability lies with the medical profession and not with the Daily Mail for printing misleading articles… The implications that doctors are killing patients or that they don’t care or that somehow this is a NHS initiative to save money are ———– well, I don’t know, I’ve run out of adjectives… (insulting, misleading, offensive, damaging, dangerous, horrific, indefensible, typical for the Mail, wrong, cynical, plain dishonest) – take your pick!
Well, actually I think all of those and then some more:  The implications that doctors are killing patients or that they don’t care or that somehow this is a NHS initiative to save money are insultmisleadinglyoffensivelydamaginglydangeroushorrificlyindefensiblelytypical-for-the-Mail-wronglycynicallyplain-dishonestetc!
As always the comments section provides a worrying perspective, but this is my favourite:
comment
No my dear-UKIP Supporter the reason they don’t have this ‘uncomfortable controversy’ in the States, is I suspect, because they are blessed enough not to have the Daily Mail.
AFZ

14 Comments

  • Maryam says:

    Over the years, I have looked after many patients who were cared for based on LCP. It is a widely respected piece of documentation amongst health care professionals caring for the dying. It is incredibly uncomfortable to read such nonsense (and all the above adjectives)printed in Daily Maily on a regular basis. Such lies make huge impact on patients’ perception of care they receive. The care that all of us health care workers do our very best to deliver in best quality we can. Such publications are very evil indeed.

  • sliepnir2006 says:

    “I write because I care about the truth. I write because I believe that the lies and agenda of the Mail are pervasive and damaging.”

    Shame you do not acknowledge the truth that hundreds have been physically maltreated as a result of the Liverpool Care Pathway being implemented. People have been abused, relatives have not been informed and worse there has been a significant number of human being who have been deprived food, medication and hydration, that is until they died. Not in a few hours, but weeks.

    All the Daily Mail has done is expose this. However, the stories the Mail has actually covered are not even as bad as some of the people who have joined our group. Their stories have yet been unpublished, as have many. The cruelty their loved ones have had to endure is beyond words or understanding, and it is all due to the implementation of the Liverpool Care Pathway.

    The simple fact is that our elderly are not safe in the care of OUR NHS services. There are no two ways about it.

    However this is what the NHS does not want to hear, with all its propaganda and lies it dishes out. On our group, there have been cases where people have been crying for water, those where food has been deliberately put out of reach, others who have seen their relatives turn into nothing more than a bag of bones after being left for literally weeks to die, without support, food, water or medication.

    Finally, there is nothing that the Mail could possibly write that could be more pervasive and more damaging than incorrect decision making which involves the use of the Liverpool Care Pathway. A written article has never killed anyone, but the use of the Liverpool Care Pathway most certainly has-

    I suggest that the NHS picks that great big beam out of its own eye before it criticises the Mail.

    Oh and by the way, I am one of those who experienced the early use of the Liverpool Care Pathway and to my way of thinking it was one of the most cruel, evil and vile things ever to crawl out of any civilized society.

  • Anon says:

    A good few hospice workers hate the damned thing…it is an attempt to automate the dying process….like its a ‘rinse cycle’ on a washing machine. The kick in palliative care used to be the challenge…this patient has been told that medicine can do nothing more for them….great challenge is to prove medicine is wrong…you can keep them symptom free for months and months if they want you to…trouble is , the state doesnt really want that type of hospice care anymore as its really expensive….the hospice has become a Graseby syringe with the LCP…habng worked very hard for an entire nursing career to turn it into something higher than that, I hate it, as I might add, do hospices in Italy, and Germany , who’se articles the press in the UK don’t appear to bother reading.

  • Dralienfromzog says:

    In February, the British Medical Journal conducted a survey of UK doctors on experience and views of the LCP. [http://www.bmj.com/content/346/bmj.f1303]

    “The Liverpool care pathway represents best practice for the care of dying patients, according to 89% of UK palliative medicine consultants” Similarly these doctors would chose the pathway for themselves.

    The following is completely in keeping with my professional experience:

    “Many commented on damaging misconceptions of the pathway that were perpetuated by the media, and one pointed out that ‘there is no barrier to eating, drinking, [taking] antibiotics and fluids while on the pathway, if deemed appropriate for symptom management.’ Furthermore, another said that ‘regular review does happen’ and the pathway should not be seen as a one way process”

    AFZ

  • Will says:

    I too, like Sliepnir, write because I care about truth, transparency, accountability and justice.
    I submitted my adverse experience to the LCP inquiry and suggested that the Liverpool Care Pathway should remain confined to Hospice settings to avoid unnecessarily hastening other’s death, as it did with my late wife.
    If the LCP had not been “rolled out” onto acute hospital wards, where my beloved late wife was being treated, for a day surgery procedure, and her pulmonary emboli had not been misdiagnosed as lung cancer, she would still be with me. FACT, that my case has never made the headlines in any national UK newspaper yet, because I sought the medical notes before initiating my complaint, which is now with Counsel proceeding with a charge for Corporate Manslaughter.
    A mistake many complainants make, when anything untoward happens in hospital, is to seek publicity.
    By doing so, a reporter having to approach a Trust for their version of events, to obtain a balanced report, has alerted the Trust of a pending formal complaint, thus running the risk of the hospital Trust who, time after time mislay, “doctor” or destroy vital evidence.

  • Yakoub says:

    My partner is a well regarded EMI Nursing Home manager and is trained in the use of LCP. She, everyone she knows professionally who care for people at the end of their lives, and relatives she has worked with have all been positive about LCP.

  • jl says:

    If this is the only solution a “civilised” society can come up with,I would hate to belong to an uncivilised one.The LCP takes lives in a barbaric and cruel way and if even one loved one’s life is lost in this cruel and lazy fashion,it is one too many.
    I feel ashamed of humanity and the medical profession for only being able to come up with this lacklustre nursing practise to end people’s lives.
    Incentivised by money for a life,appalling and inhuman,even animals treat each other better than this.
    As a nurse,I hope I will always have courage enough never to follow the herd,the sheeple who participate in this terrible so called end of life sanitised
    “care”,it is nothing short of state sponsored culling.

  • Dralienfromzog says:

    jl,

    I could not disagree with you more profoundly. You completely misrepresent the pathway and what it does.

    I find it intriguing that you link to ‘Care not Killing’ – an antieuthanasia site, they as an organisation are big supporters of the LCP as illustrated by this blog article linked to from thier homepage: http://drkategranger.wordpress.com/2012/11/04/end-of-life-care-through-the-eyes-of-a-doctor-and-a-patient/

    AFZ

  • It is barbaric sick evil and no less than torture…. The problem is who can tell when a patient is dying . Dehydrating someone to death is murder …

  • Dr Rob George, Professor of Palliative Care, Cicely Saunders Institute, was interviewed about end-of-life care following reports that Nelson Mandela’s condition in hospital is ‘critical’. He said dying is a ‘social event, not just a biological one’, adding that ‘goodbyes and thankyous are central to the experience of the person who is dying and the people left behind.’ Item begins at 7.30.

  • watchman says:

    its got nothing to do with papers saying it is wrong it is patients relatives and professors doctors and nurses condemn the liverpool pathway, they are called whistleblowers in other words persons woeking in the hostpitals lets get facts straight and stop telling porkies saying its the news media to blame, its rubbish the pathway is so cruel i would not inflict this on dogs cats or any animal just to save money.

  • nightwatchman says:

    L C P = Lying Common Purpose

  • watchman says:

    at long last the government have seen sense they are to scrap the liverpool back door euthanasia pathway, as i have said for the last 3 years it would be exterminated thanks to the professors doctors and nurses writing to the media in other words whistleblowing it is to be stopped thanks again newspapers and doctors.