Thursday, March 14, 2013

Dying with Dignity

Every so often a piece of investigative journalism hits the national press and causes a storm of sensational outpourings because of its emotive content. Sometimes such reporting has much to commend it, bringing important issues into the open and exposing flaws and wrong-doings in our national systems. However, there are also times when unintended consequences occur, with readers being given an inaccurate picture resulting in confusion and unnecessary concern. Over the past few months we have seen such an occurrence in respect to the topic of the Liverpool Care Pathway.

Whilst it is likely that most readers of this paper will be familiar with the name of the pathway, it is possible that the details are hazy or unknown. I will therefore briefly explain what the pathway is before discussing the current controversy.

As the name implies, the pathway was developed in Liverpool in the late 1990s as a joint activity between the Royal Liverpool University Hospital and the Marie Curie Hospice in Liverpool. It was initially designed to aid the appropriate care of patients who were dying from cancer. However, since its origin, the care value of the pathway has been recognised and as a result, it has become more widely used in the care of many patients dying from other conditions.

The aim of the pathway is to ensure that dying patients are given appropriate treatment to ensure that they die with dignity and in peace, with any potentially distressing symptoms suppressed or controlled. No doubt this is something we would all want for ourselves and for our loved ones when the inevitable outcome to life catches up with us. Sadly, prior to the pathway being formulated, such control was not always the case, and many families no doubt have sad stories to relate about the less than dignified passing of a relative or friend. In recognition of the value of the pathway in terms of patient care, the government introduced a financial incentive to hospital trusts, so that they are rewarded for the use of the pathway. Incentives for good care are not new and are used throughout the health service in order to drive up care standards.

The problems that have recently been uncovered stem from occasions when the Liverpool Care Pathway may have been less than efficiently utilised, resulting in accusations of professional mismanagement, lack of communication with relatives and the patient, and even charges of its inappropriate use for the purpose of financial gain by the hospital trust. Understandably, this has caused outrage in some quarters, and certainly widespread national concern that people are being put on the pathway when more can be done to treat their condition and possibly allow them to live a little longer.

Whether the above is true or not, I cannot judge. However, there is nothing inherently wrong with the Liverpool Care Pathway when used appropriately by experienced professionals. It is also appropriate that tax-payers’ money is used to improve standards of care. As always, the secret is in communication. If a patient is deemed to be dying, and a multidisciplinary team is in agreement that nothing more can sensibly be done to treat their condition, then the patient (whenever possible) and family members need to be included in the conversation, so that everyone understands what is being done and why.

With understanding comes acceptance and freedom from fear, anxiety and anger. With the Liverpool Care Pathway comes a dignified death. Both aspects should be part of the same package.
(First published in the Scunthorpe Telegraph, Thursday, 24th January 2013)

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