"patients might well have had weeks or even many months more of life had they been properly supported rather than put on the LCP."Letters, The Catholic Herald, 10 August 2012
From Dr R J Clearkin
SIR – Quentin de la Bédoyère (Science and Faith, July 27) mis-states the concerns that many physicians have with the Liverpool Care Pathway. It might be helpful to consider a few of these concerns.
The question has never been whether the LCP offers a “peaceful” death. After all, euthanised patients can die peacefully. The issue has always been whether patients are dying prematurely by being put on the LCP. While the LCP claims it is for those in the “last few hours or days of life”, it is essential to realise that there is no accurate way of determining this, so that for most patients it is at best a guess with large margins of error. This is particularly true for the two thirds of patients who do not die of cancer. Such patients might well have had weeks or even many months more of life had they been properly supported rather than put on the LCP. The article makes reassuring noises about audits but fails to explain that the audits are conducted by the very body which developed and still fervently promotes the LCP. Unsurprisingly, these audits fail to critically address such vital areas as patient selection and use of the LCP in non-cancer patients. As other interested parties cannot access the raw data they are unable to audit the LCP themselves. Sadly, conflicts of interest are repeatedly encountered with the LCP and obstruct the close and necessary examination of a “pathway” which is literally a matter of life and death for tens of thousands of patients.
Count de la Bédoyère incorrectly claims that the LCP relies on the “principle of double effect”. But it has long been recognised that agents like morphine, employed correctly, do not shorten life. The same cannot be said of deliberate dehydration, which is almost always a means of accelerating death. Furthermore, many, even most, patients are not made aware of either their diagnosis or their selection for the LCP.
As for “spiritual care”, this, for most patients, is conspicuous by its absence.
R J CLEARKIN
Market Harborough, Leicestershire
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