Belfast Telegraph

Monday 14 July 2014

Plan 'transformed' end of life care

The Liverpool care pathway can ensure patients have a 'peaceful, pain-free, dignified death', a doctor said

The controversial method of withholding food and drink from terminally ill patients so they die more quickly has "transformed" end of life care, according to an article in a leading medical journal.

The Liverpool care pathway, which recommends that in some circumstances doctors withdraw treatment, food and water from sedated patients in their final days, means that they can have a "peaceful, pain-free, dignified death" at home, said Glasgow-based general practitioner Dr Des Spence.

The method has come under close scrutiny recently. Reports suggest that doctors are establishing "death lists" of patients to put on the pathway. Articles also claim that hospitals may be employing the method to cut costs and save on bed spaces.

But Dr Spence said the pathway can offer a "good death" when used properly.

He states that 25 years ago doctors received no training in end of life care, adding: "In hospitals far from their loved ones, patients were left screaming in pain in the dark, and behind unmarked curtains were undignified and peace-less deaths."

Writing in the British Medical Journal (BMJ), Dr Spence continued: "But in recent years care has improved. The Liverpool care pathway and committed district nursing teams are transforming care. We talk about death in an open way and decide where patients die.

"Used properly with senior supervision, the pathway offers structure to a peaceful, pain-free, dignified death at home - a good death.

"The 'death lists' exist to tackle a taboo: they facilitate discussion about death with patients and families. But the newspapers are right: this pathway must be used with full explanation and the consent of all involved. If it has not been used in this way, then a review is welcome if only to reassure the public.

"Lastly, the media should reflect on this: there were no good old days in end of life care, and so we need the Liverpool care pathway."

Conservative peer Baroness Knight, who campaigns on care issues, called for an independent inquiry into the pathway. She told BBC Breakfast: "What I think has happened is that a good idea at the beginning has now translated into some very, very heartbroken people who have seen their relative die when actually they could have saved them."

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