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'We must recognise when medical intervention is inappropriate'

  • Comments (18)

One parent has cancer, and has been on the Liverpool Care Pathway for weeks. She and her family have received excellent care and support, which has focused on keeping her comfortable and offering emotional and practical support to her and her loved ones.

Of course they are all finding this period difficult, but my friend told me that the team caring for his Mum has enabled the family to find pleasure in their remaining time together. She is comfortable and able to satisfy herself that she is attending to things that are important to her, while her family are reassured that any distressing symptoms will be addressed promptly by professionals who understand end-of-life care.

My other friend’s Dad has advanced dementia and is now frail and declining before our eyes. He is in a nursing care home yet he has been taken to A&E twice in the past couple of months, and then admitted to hospital where he has had arterial blood gas analysis and aggressive antibiotic treatment which was distressing for him and therefore his family. After the first trip to A&E my friend asked the home not to take him in again. She understands that he is dying, and that heroic interventions simply prolong a life that is devoid of any pleasure, yet he was taken in a second time and the process was repeated causing the same levels of distress to all concerned.

These two situations reminded me of a paper at last week’s RCN Research conference, in which Karen Waters reported on a study of the end-of-life care received by patients with dementia. Like my friend’s Dad, 78% of her retrospective sample received burdensome interventions.

Like my first friend’s Mum, many people with cancer or other diseases that are recognised as being potentially terminal receive excellent end-of-life care that gives them both physical and emotional comfort and supports their family. No one tries to “save” them because it is accepted that this is both inappropriate and impossible. Shouldn’t those who are simply reaching the end of their life be able to expect the same?

Some details have been changed to protect confidentiality.

  • Comments (18)

Readers' comments (18)

  • Anonymous

    I thought the LCP was only to be used in the last 72 hours of life, not for weeks?

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  • It seems that that course of antibiotic did the trick. And that your dad'friend benefit of it! Probably going through GP would have made life easier for patient and everybody else but as a carer/ nurse I can uderstand why this happened! You don't let someone die just because has Dementia!This is asking for a strong care plan to be in place where everyone including GP, staff and next of kin and everyone involved in the care of patient will sit down and draw a line where to put the ceiling!It seems to me that it's more likely to be a lack of training recognising the dying patient of different causes!And LCP should be implemented to all dying patient regardles of cause!

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  • Anonymous

    if there is a lack of resources for treating and nursing patients adequately how come they do not reserve the right to choose when they die? it does not add up. However, those who wish to live are being left to die as well through inadequate care, criminal negligence and errors, and hospital induced diseases.

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  • Anonymous

    The 'End of Life Pathway' is what it says it is. It isnt supposed to be used for those who, although they may be unwell, frail or have dementia are not near to death. Yes it is to be used for the last 72 hrs of life, and someone can be taken off the pathway if their condition improves. Maybe more discussion needs to take place with patients and their families around whether they want intervention at a certain stage of life. We need to be brave enough to raise the subject with patients/families and be able to have frank and open discussions.

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  • Anonymous

    Anonymous | 2-May-2012 4:22 pm

    how can anybody be sure that somebody is at their last 72 hours of life?

    sounds like this pathway is another excuse to provide conveyor belt type care and follow ?'best practice'? guidelines and repeating and mimicking like parrots what managers and superiors say instead of the caring team thinking for themselves and identifying and respectfully meeting the needs of each individual patient and offering the relevant support to their families.

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  • MeThinks

    Anonymous | 2-May-2012 4:38 pm

    Anonymous | 2-May-2012 4:22 pm

    how can anybody be sure that somebody is at their last 72 hours of life?

    Quite - it isn't possible to sensibly employ that degree of precision. Your 'identifying and respectfully meeting the needs of each individual patient and offering the relevant support to their families' should be the objective - not at all easy to describe in advance of events, nor are 'tick-box lists' all that sensible.

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  • Anonymous

    My Nan died quietly in her residential home. She had had previous, distressing visits to hospital which frightened her but did nothing to add to the quality of her life. She spent her last few months dozing in her armchair, eating what she fancied, often not getting up until the afternoon and grumbling about evryone and everything - pretty much what she had done for the last few years!
    Yes she could have had a final admission to hospital, to be re-hydrated and fed more supplements, but quite frankly neither the home, GP or any of her family (6 of which are nurses) thought it would be in her best interested.
    She died in her own home!

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  • Anonymous

    As an end of life care facilitator for care homes I find it sad that the gentleman with Dementia has been sent to hospital twice if he is indeed at the end of life.
    The family need to speak to the care home staff about a "Best interest at the End of Life " that will allow for discussion with all members of the MDT including the GP.
    With reference to the LCP this documet is a guide to providing holistic care for the person who is at the end of life not a tick-box exercise.
    maybe the person who fels it is " conveyor belt type care" should actually look at version 12 to see what is involved.

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  • Anonymous

    Sometimes people have no choice but to call an ambulance. It's not being vindictive or uncaring, they did what they thought was best at the time. If someone is reaching the end of their life then symptom control is the main priority, that may include antibiotics to help clear up a very nasty chest infection.

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  • Anonymous

    Anonymous | 3-May-2012 12:02 pm


    James LeFanu: Clinging to a Pathway can lead care off track
    Doctor's diary



    7:00AM BST 20 Sep

    2010http://www.telegraph.co.uk/health/healthadvice/jameslefanu/8008866/James-LeFanu-Clinging-to-a-Pathway-can-lead-care-off-track.html

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