The decision to jettison the controversial approach to dying known as the Liverpool Care Pathway was "too extreme" given that its principles were considered by proponents as the best examples of palliative care in the world, argues a senior ethicist in the Journal of Medical Ethics.


Ethicists have been in favor of the Liverpool Care Pathway, though they are also in favor of infanticide and abortion based on gender so factor their beliefs accordingly.

The
Liverpool Care Pathway
 was intended to transfer hospice care to hospitals but once that separation between doctors and end of life care occurred, it quickly fell out of favor due to poor application and horror stories about people doomed to die. It was all a big misunderstanding, argues Dr. Anthony Wrigley of the Centre for Professional Ethics at Keele University.

The UK government decided to abandon the
Liverpool Care Pathway
 last year following an independent review which found that the
Liverpool Care Pathway
was deliberately being used to hasten the end of life rather than ease suffering.

The Neuberger Review recommended the
Liverpool Care Pathway
be phased out and replaced with individually tailored care plans after identifying that it had been associated with poor communication with relatives and a failure to treat patients with compassion and/or dignity.

Yet published evidence found that its correct use improves end of life care. Various professional bodies endorsed it, Wrigley points out.

"One reason why this [recommendation] seems too extreme is that end of life care in the UK is of a quality that is world-leading, recently being ranked as having the best overall palliative care in the world," he writes. "There was widespread agreement, he says, "that before the introduction of the Liverpool Care Pathway, "poor care and suffering were the norm for patients dying in hospitals." 


So if the The 
Liverpool Care Pathway
 was always intended as a framework to support healthcare professionals to provide holistic care tailored to the individual's needs in their last few hours or days, why did it replace ethical decision-making? For obvious reasons - doctors are controlled by the government in the UK. The USA faces similar future issues as its 'teach to the protocol' environment now carries the full force of federal government prosecution, along with existing defensive medicine and malpractice issues.

The most common complaints leveled against the LCP were that it denied food and water to the dying, irrespective of the patient's desires, causing untold distress to the patient and his/her relatives. But the Liverpool Care Pathway does not recommend this at all, says Wrigley. And it recommends the use of morphine to relieve pain, not to hasten the death of the patient. Furthermore, it says that the patient's relatives should be involved in the decision to administer morphine - a recommendation that some hospital staff apparently ignored.

"That hospital staff were purportedly using a care pathway that explicitly states the importance of good communication, highlights an underlying problem over care provision in hospitals rather than with the LCP," he points out.


In other words, the policy is good but all of those doctors and nurses misunderstood the instructions they were given.

"Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care," he concludes.


Source: BMJ