The Liverpool Care Pathway is a doctor's prescription to allow a patient death. Like anything else the Devil is in the detail of death, it is how the LCP is administered which matters. Therefore taking this decision is not a light choice. LCP is the conscious withdrawal of medication, liquid and food for someone considered to be hanging on to life but would not have much of a life if they were fully compis mentis, who has little chance of recovery. Morphine may be given, which will conveniently keep the patient on an opiate high and prevent them from acting in a concerned disagreeable manner. After all anyone working or visiting would not want to be greeted by a dying person who in pain is doing nothing but moan and groan. They should die in piece.
If a patient has life, has some kind of mental ability even comatose, LCP should not be taken. An example is seen in stories of comatose patients who have come to consciousness after a time, possibly weeks or months. To be awake and conversant with those around them, when nearly everyone had given up. In addition to this it is remarkable how the human body can survive when it is not fully functioning. Only having one lung, half your body or more paralyzed, the late Christopher Reeve comes to mind. There are individuals walking about, talking, laughing, contributing to the world who physiologically are well below par, but they are part of it, they are here, their ability to communicate is probably what stops them from being put directly into a morgue.
Secondly, is the conviction with which a decision is made, the confidence and consensus of the decision. To take this choice immediately becomes part of the grieving process. Also if I were the patient in these circumstances I'd not want the decision to be made by most of relatives. Some of whom I am surprised can get up in the morning and make their own breakfast. These are people who are walking, conscious and alive but might as well be dead with the way they live their life and the constant pain of their existence. Just as it is a pain to accept they are my own family. They may know me but they are not qualified to make a decision about my life or certainly my death.
Thirdly, and importantly is the type and amount of care which takes place after the decision is made to use LCP, or any other form of end-of-life prescription. For this should be with compassion and dignity, some palliative care is given to make the patient comfortable. Giving them washes, water when needed, soothing ointments which stop pain from continuing illnesses which are painful but don't kill. A rash, a bee sting, arthritis etc etc.
With the state of the NHS as it is, there is always a need for beds to be free to be taken up by another patient. Everything has a cost as well. Hospitals cannot afford for lingering deaths to happen, it is to their advantage to allow LCP decisions to take place. They may not be entirely neutral in the advice they give. OK there may be an alleged oath they give to save life, to heal, to give hope, but to believe this without question is naive. Everyone has a right to question, the problem is being emotional and overcome by devastating thoughts and consequences takes the edge off. To then ask questions, to disagree with medical professionals becomes a difficult task.
Then lastly there are stories of hospitals who use the LCP in a callous way, stories of relatives who have seen their loved ones die in pain from uncaring authority figures who are no more than providing the statistics politicians ask for. But what has to be done, just has to be done. These are the people who should be in court, facing a judge, and considered murderers.
