Highway to heaven… or road to hell? The Liverpool Care Pathway
All of us want a ‘good death’, by which generally we mean free of pain and with our dignity preserved. Most of us do not want it be hastened by a premature assessment as to the quality of our lives that decides we are not worthy of care.
The Liverpool Care Pathway was famously first developed by specialists in palliative medicine, as the name suggests, in Liverpool. Using the principles of compassionate care and respect for the individual pioneered by Dame Cecily Saunders, the stated aim was apparently to enable patients ‘to live until they die’, free of pain.
Highly commendable. Or is it?
From a report in The Telegraph before Christmas, it has now emerged that of the 130,000 patients placed on the Pathway in NHS hospitals every year, 57,000 last year were given no hint that their treatment had been stopped and measures put in place to hasten death. It is of course possible to say, ‘So what?’ After all, if someone is in the last stages of terminal illness and facing agonising pain, surely it’s entirely justified to take whatever measures possible to help? The small fact of a preliminary conversation asking if they mind seems pretty irrelevant – even intrusive, given the fact the patient probably isn’t in much of a mood for a chat.
Wrong. The problem is that a lot of people put on this death highway are actually nowhere near this state and, with care, could live some considerable time – and live well. I’m not a doctor, but all of us know how notoriously difficult it is to predict with any certainly when someone’s going to die. And equally, it’s not unknown for people to make a complete and dramatic recovery, confounding the expectations of all. But not if they are on this pathway, because once on, there’s very little chance – short of a miracle – of ever coming back.
The reasons are simple. Treatment is withdrawn – which actually, personally, I don’t have a problem with, if administration is only going to prolong pain. But these days ‘treatment’ includes food and hydration, so it’s not just a case of the pills etc being stopped, but the decision is made to starve the patient to death. And then the whole process is helped along by massive doses of narcotics (which even by themselves can be lethal).
Believe me, not every patient happily accepts the prognosis that they’re on their way out – as I can testify personally, because it happened to my father. We weren’t asked if we wanted this process to happen; we were told that was what had been decided (at least we were told!). In my father’s case he had a simple stomach blockage, which could have been corrected very easily. Bizarrely, a friend of his was admitted to the same hospital on the same day with the exact same problem. He was ten years younger, however, so he had the op and was discharged a couple of days later. Not so my father. Because of his age, although admitting he had the ‘constitution of an ox’ (the consultant’s words, not mine), the doctors decided not to operate … and then, on grounds of compassion, to hasten his death.
I well remember sitting by my father’s bedside, listening as he begged the nurses for a cup of tea. I remember him clinging to consciousness, desperately trying to talk to me. I remember sitting beside him as the struggle got too much, watching him slide into unconsciousness. I remember deep anger. And pain.
So no, I do not support the Liverpool Care Pathway. I think it is a process that has at its heart good intentions, but that is being fearfully abused.
And I disagree most strongly with the cash incentives apparently being held out to NHS hospitals as an encouragement to meet Department of Health targets. Yes, we all want a good death. But this, it seems to me, is a variant of euthanasia; and we need safeguards.