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Liverpool Care Pathway has 'transformed' end-of-life care


The controversial Liverpool care pathway has “transformed” end-of-life care, according to an article in a leading medical journal.

The Liverpool care pathway, which recommends that in some circumstances nurses withold treatment, food and water from sedated patients in their final days, means that they can have a “peaceful, pain-free, dignified death” at home, said Glasgow-based general practitioner Dr Des Spence.

The method has come under close scrutiny recently. Reports suggest that doctors are establishing “death lists” of patients to put on the pathway.

Articles also claim that hospitals may be employing the method to cut costs and save on bed spaces.

But Dr Spence said the pathway can offer a “good death” when used properly.

He states that 25 years ago doctors received no training in end of life care, adding: “In hospitals far from their loved ones, patients were left screaming in pain in the dark, and behind unmarked curtains were undignified and peace-less deaths.”

Writing in the British Medical Journal (BMJ), Dr Spence continued: “But in recent years care has improved.

“The Liverpool care pathway and committed district nursing teams are transforming care. We talk about death in an open way and decide where patients die.

“Used properly with senior supervision, the pathway offers structure to a peaceful, pain-free, dignified death at home - a good death.

“The ‘death lists’ exist to tackle a taboo: they facilitate discussion about death with patients and families.

“But the newspapers are right: this pathway must be used with full explanation and the consent of all involved. If it has not been used in this way, then a review is welcome if only to reassure the public.

“Lastly, the media should reflect on this: there were no good old days in end of life care, and so we need the Liverpool care pathway.”


Readers' comments (8)

  • Anonymous

    It is the 'consent/communication/clarity' issues of the LCP, that cause the problems we read about in the press.

    The objective of relieving suffering during dying, isn't any sort of a problem for me !

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  • Ellen Watters

    The dreadful sensationalist articles in some of the press recently is akin to scaremongering and I am upset at the distress that has been caused.

    Death and dying is a very emotive, senstiive issue and the LCP, if used correctly, is much needed to make it a less traumatic time for all concerned.

    I agree with DIM above consent, communication and clarity should be the focus.

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  • At last a positive article on the LCP! Now, if we can only stop the Daily Fail from frightening its readers and get back to what it is good at-articles about Princess' Di and Kate.

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  • shock, horror - what will the daily wail have to say about this now. 'death list' - where is the proof, any evidence to prove this is happening anywhere?

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  • bob cat

    Paddy: Daily Wail and the Telegraph this morning. Incredibly unkind, insensitive and irresponsible reporting.

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  • bob
    nowt new there then

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  • Sensationalist reporting has resulted in the LCP being discredited.

    Linking the introduction of the LCP to "performance payments " was one of the more stupid acts of "Management" and makes the task of writing the headline about Granny being "killed" very easy !

    Referring to the LCP should now be banned.

    Terminally ill Patients and their relatives should be told the naked facts using unambiguous language and any treatment from that point on undertaken only on the basis of informed (and signed for) consent.

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  • michael stone

    Jenny Jones | 2-Nov-2012 8:55 am

    I cannot be certain of this, but I strongly suspect that the DH 'performance payments' will in theory be for the demonstration of something like 'better recognition and treatment of end-of-life situations'.

    Unfortunately, hospitals probably 'demonstrate' that, by saying 'we had 43% of patients who died here on the LCP'.

    The DH is not entirely stupid - often it happens once the instruction leaves the DH.

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