JANE was clearly dying,
but when the family visited her, she could still talk a little.
When they came the next morning, they found that she had been moved
to a ward on her own, and all the tubes had been removed.
When they asked about
this, they were told she had been put on the Liverpool Care Pathway
(LCP). They had never heard the phrase before. It seemed to them
less a care pathway than a sentence of death. This impression was
reinforced when it became known that hospitals were receiving
financial incentives for the number of patients that they put on
Because of stories like
this, the Government set up a review panel chaired by Baroness
Neuberger, Senior Rabbi of the West London Synagogue and a
cross-bench peer. The panel set up four meetings with aggrieved
relatives in different parts of the country, had a number of other
meetings with people and organisations involved in the care of the
dying, and received 650 submissions. It reported on Monday.
One thing that needs to
be made quite clear is that the Liverpool Care Pathway was set up
on fundamentally sound principles, and the vast majority of
patients who were put on it were helped towards a dignified and
Good care for the dying was pioneered in the hospice
movement, which, from Dame Cicely Saunders onwards, has so often
had a Christian inspiration. The purpose of the LCP was to take
this good quality care for the dying into ordinary hospitals by
providing a series of alerts and checks about what is appropriate
when a person has only a few days or hours to live.
The Christian principles
on which this is based, which are reflected in all our medical
codes, are quite simple. It is wrong deliberately to hasten a
person's death, but it is entirely proper to stop treatment that is
burdensome and futile. There comes a point when a person is clearly
dying, and at that point the priority is to keep them free from
pain, and ensure that they have the food and liquid they can
In a world where so many
ethical issues are disputed, it is good to record unanimity on
these principles between the Roman Catholic, Anglican, and other
Churches, as well as the secular medical organisations.
BECAUSE of our human
reluctance, sometimes, to accept that someone we love is dying,
Christians have an important part to play in getting this message
across to the wider public. Good-quality care for a person in his
or her last days and hours is not "assisted dying".
This good-quality care
may involve the removal of all tubes, and at that point the patient
may not want anything to eat or drink. Provided the mouth is kept
moist, that may be all that good care requires at that stage.
So what kind of things
went wrong? In a way, the Liverpool Care Pathway was a victim of
its own success. Because it is based on fundamentally sound
principles, and has been rolled out in a big way by hospitals not
only in this country, but abroad, there has not been the necessary
training and monitoring of standards to ensure that those
principles have always been put into practice. The panel were
particularly concerned about:
The failure of too many doctors to explain to the relatives what
the situation was, and how the patient would be treated. One
relative, for example, was simply told in a very brief word over
the phone, when they had no idea what the LCP was.
The decision to put someone on the LCP's being made by a junior
doctor at night or over the weekend, rather than a designated
senior medic responsible for the person's care-plan in their last
days and hours.
The use of the LCP as a "tick-box" exercise rather than a prompt to
sensitive and personalised decision-making.
patient's not being allowed fluid by mouth when they were still
quite capable of taking it.
The panel made 44
recommendations, many of which require relevant doctors' and
nurses' organisations to improve training for people caring for the
dying, and continuing to ensure that those involved in that work
remain up to standard.
THE recommendation that
the LCP should be phased out and replaced by individual care-plans
for the dying will be a bitter blow to all those who have worked so
hard through it to improve the quality of dying in ordinary
hospitals. That work needs to be acknowledged.
But there is no doubt
that some things have gone badly wrong. Provided the doctors' and
nurses' organisations take seriously the recommendations of the
panel's report, we can be hopeful that care for those dying in
hospital will be exemplary for everyone.
Lord Harries of
Pentregarth was a member of the panel reviewing the Liverpool Care