Euthanasia by the Backdoor?: End of Life, Care of the Dying in the UK: The Liverpool Care Pathway

Reading a fabulous Hub about Human Beings, by James Watkins prompted this Hub. Although I am not medically trained, I work in a UK hospital, in an administration role. This means that I have gained some medical knowledge, simply through my job.

My current role has led to me coming across the Liverpool Care Pathway for the dying, (LCP for short), which is often followed when an elderly patient is terminally ill. As with all of these things, of course, there are pros and cons. Many people may feel that the LCP is cruel and not justified but, consider someone who is perhaps 95 years old, has no living family or friends, is terminally ill and is in great pain.

Despite such a person's age, the body may be frail but the spirit may be strong. A long, lingering, extremely painful death may be the only prognosis. Put yourself in this person's shoes, for one minute, if you can.

If you have an animal, for a pet, and its health becomes so compromised you will, out of kindness, help it on its way, by euthanizing it. Now, I am not advocating euthanasia. I am just making an objective comparison. It would seem that if you wear a fur coat, that is you are an animal, we cannot bear to see you suffer. However heartbreaking it is, we make the right choice, to end the beloved animal's suffering.

What can we do about such Human suffering though?

Whether you believe in God or not common sense will tell you that it is not good for people to play God.

Such terrible suffering is not really acceptable though, is it?

This pathway was developed for use in hospitals but it can also be used in similar care settings. The training in the use of The Liverpool Care Pathway is undertaken by specialist palliative care teams. Once the LCP has been implemented it allows generalists to care for the dying. This can also be transferred to non-cancer patients.

However, it is estimated that 22 of the 34 cancer networks in England, are using the LCP, in at least one area. The LCP Programme now runs across the U.K. It is also now widely used in the care of the terminally ill, elderly patient.

This does not mean though that patients who are elderly are regularly put onto this pathway.

What it does mean, on a Medical Elderly Ward, is that those patients who are slowly dying, a little at a time, in dreadful pain, with no chance of a positive outcome, may be treat this way.

Recently I have read some bad press regarding the LCP. The article stated that once a patient was put on the Liverpool Care of the Dying Pathway, there was no going back. The article claimed that even if the patient rallied they would die because of the LCP. I have to say that, at least where I work, that is not true. Patients are removed from the LCP and do return home.

The LCP is not about playing God and determining who shall live and who shall die but helping those who are going to die make the transition as easily as is possible. Obviously it will never be really easy. However, the LCP has helped many loving carers also who have been torn apart watching some-one's slow painful death.

So what is the Liverpool Care Pathway?

The LCP aims to bring the care of a good hospice into a hospital or care home. It lays down firm guidelines on the correct treatment of patients who are at the end of their life. Much as we should not play god, as far as death goes, neither should we play god and keep people alive who are not really alive.

The actual care is tailored though to suit the patients needs.

Although there is a pathway to follow the patient must be the prime consideration. Ensuring that the patient receives the appropriate level of pain relief is vital, for example.

The LCP has recently been updated and there is full information on line.

However painful the subject of End Of Life is, it affects us all. As someone once said the two things certain in life are death and taxes.

Whether it will be your death, that of an elderly grandparent or your parents, you will have to face it sometime. I do not state any of this to frighten you but as a plain fact of life.

If you have ever watched a close one die, perhaps with cancer, you will know how lingering and painful this can be. Even if the end is only brief it will feel an eternity. The end for my Dad was only a few weeks, after diagnosis, but it was horrible to see and must have been dreadful to endure.

As I was only a teenager I could not understand those who said that his eventual death was a blessing. It was not to me. All I wanted was my Dad back. With hindsight, age and experience I now know what they meant though.

There was not a hope in Hell that the outcome would have been any different for Dad but the journey from this world, could have been so much easier for him. These days Hospices have filled a much needed place in the care of the dying.

However, there is still the need to decide "How To Treat A Dying patient". Currently the LCP fills part of that requirement, in the UK. It may not yet be perfect but, it has to be better than the alternative used in the past. This, of course, was just to let nature runs its course which, inevitably, meant much distress for the patient and family.

Finally

I would like to say that I am neither advocating the use of the LCP or denying it. I simply write this brief article to make you aware of the LCP. It may be something which you will have to consider at some time or another.

In the spirit of differing opinions online there are negative articles about the LCP as well as more positive ones. If you are informed then at least when the time comes, you will know what is the right choice to make, given such dreadful circumstances.