The Liverpool Care Pathway is the recommended management of dying patients. Its supporters claim that it provides clear helpful criteria for assessing whether a patient is at the very end of life, whether further treatment is useful and if so what, whether sedation is needed to prevent pain or discomfort, and so on. The LCP has been carefully reviewed and monitored by the medical profession, including some whose pro-life credentials are impeccable, and the improved version 12 is now open for comment before it is issued in November. It never (contrary to some reports) advocates the withdrawal of treatment judged to be beneficial, never deliberately causes death; patients whose condition improves can be, and are, taken off it.
Critics say that it encourages a box-ticking approach, and that patients are too easily assumed to be dying, which becomes a self-fulfilling prophecy. They say that patients are sometimes sedated unnecessarily, and that only rarely should nutrition and especially hydration be withdrawn.
There may be some truth in this, but a recent audit assessed that on the whole the LCP was working well. It found a low level of deep sedation in British hospitals. To compare this with Holland, where it is admitted that sedation is deliberately used to kill patients, even more than officially reported, is scaremongering. Supporters emphasise that the LCP is not a substitute for individual assessment but a useful tool. Doctors know and admit that they are not infallible in diagnosing a patient’s condition , or whether he or she is terminally ill. (This is of course yet another reason why legalising the outright deliberate killing of “terminally ill” patients would be so disastrous.)
Mistaken diagnoses are bound to occur, and are of course disquieting, and deeply upsetting for relatives, but good practice should keep them to a minimum. It seems to us that although details of treatment are vitally important, the worst danger is the gradual increase in the idea that a patient’s death, rather than something which has to be accepted when further treatment would be of no benefit, may be the solution to a problem. There seems to have been some flavour of this in poor Kerrie Wooltorton’s death.
For further discussion of this important subject see www.carenotkilling.org.uk