Liverpool Care Pathway

[malumbu]

This is an end of life procedure at hospitals and hospices where they remove all but the essential services (ie that needed to keep the dying person'comfortable'.

I'd never heard of this until my mother passed away in April. The hospital and staff could not have been helpful and she only moved onto this in the last 24 hours, after it was clear that any further intervention would not work and would actually cause discomfort. They explained every thing to us, and we had separate 'end of life' support. This helped the family at a difficult time.

I am therefore surprised to hear that the NHS/Government are prohibiting this procedure.

It would be interesting to hear others' views.

I've just contacted the Beeb and happy to share our experience. The family do not regret it for one moment. We never thought that our mother was on some sort of conveyor belt and have nothing but praise for the staff.

[first mate]

malambu,

I think that the expert view is that if used properly the LCP is a good thing but there are serious concerns that is has been used inappropriately and has therefore caused/hastened death where this was not the best/only outcome.

[Pugwash]

Working in the health and social care sector, many people I deal with are on LCP - I work mainly at Kings who are excellent in general in keeping families informed and seeking their co operation/consent. PEACE is another initiative in the health sector in working with people with limited life spans. St. Christopher's Hospice have been working with many health and social care organisations in training staff in End of Life Care. part of the scheme is for people to talk with their nearest and dearest as to their wishes when it comes to the inevitable - would they wish to die at home/care home/hospital - who they wish to be with them, any advance decisions, arrangements for funerals etc.

I have recently worked with someone in St. Helier's Hospital and found the ward depressing and no real emphasis on the patient or his relatives.

[JohnL]

A close relative died last year and I actually did have

a 'do not go gentle' moment (felt - well that was quick

- can't they allow a fight).

Obviously no 'pathway' was involved there, but something in

me says if you fight hard enough, occasionally you might

win against the odds and enjoy a few more years.

That's the reaction that's happened I think - a feeling

some people are being steamrollered into not fighting.

[first mate]

I think the key point is that it is patient led- therefore if the patient communicates that they are at the end then the LCP can help the last few days/hours. The patient has already started to refuse nutrition and possibly fluids too, this has not been imposed on them. Should they then ask to drink they would be allowed to.

It is my understanding that the LCP has been abused/misunderstood and, for instance, seriously ill patients wanting to drink have been refused because they are on the LCP- that is clearly wrong and scary and not the way the LCP is meant to be used.

[malumbu]

My experience was that this was not patient led. My mother had lost consciousness a day or more before and was not going to recover. Of course there had been some hope earlier. The decision was the family's and the hospital was excellent. Not the slightest indication that they were trying to free a bed. Of course mine is not a scientific study.

I saw a wonderful documentary on a nameless hospice (clearly St Christophers) a number of years ago. The nurses in my experience reminded me of the care that was shown at St Christophers.

All rather sad, but of course necessary.

[first mate]

malambu,

With your mother the signs were clear that she would not recover and as she was not conscious the decision to withdraw nutrition and fluids would make sense.

I think the LCP has been used with patients who are conscious and who request fluids but have been refused them. It seems to me that the issue is not with the LCP so much as a lack of training by some who have used it incorrectly.

[JohnL]

My experience was that everything was 'switched off' very quickly

within hours without consultation.

I know this person was scared of being 'a vegetable' - but it left

me worried - especially as the police apparently appeared and very quickly

disappeared - so somebody referred it to them.

Nobody wanted to talk about it much - so got left with questions on my mind

even though I was one of the closest relatives - wonder if there was a living

will.

malumbu Wrote:

-------------------------------------------------------

> My experience was that this was not patient led.

> My mother had lost consciousness a day or more

> before and was not going to recover. Of course

> there had been some hope earlier. The decision

> was the family's and the hospital was excellent.

> Not the slightest indication that they were trying

> to free a bed. Of course mine is not a scientific

> study.

>

> I saw a wonderful documentary on a nameless

> hospice (clearly St Christophers) a number of

> years ago. The nurses in my experience reminded

> me of the care that was shown at St Christophers.

>

> All rather sad, but of course necessary.