Supporters defend end-of-life scheme

Supporters of an end-of-life treatment scheme have defended it against recent criticism, arguing that when properly used it can improve patient care.

The Liverpool Care Pathway (LCP) became the centre of controversy earlier this month after a group of doctors warned it could result in patients dying prematurely if they are wrongly diagnosed.

But the campaign group Care Not Killing (CNK), which opposes euthanasia, says that in the hands of well-trained staff the LCP can result in good care for patients who are dying.

Dr Peter Saunders, CNK’s Director, said: “Any tool is only as good as the workman who uses it.

“It is important to remember, however, that clinical decisions in end-of-life care are not made in isolation and that palliative care hospital support teams are available throughout the country to support other specialities in this work.

“These teams include physicians who also practice in the local hospice or palliative care unit.”

Dr Bill Noble, President of the Association for Palliative Medicine also denied suggestions that the LCP can cause signs of recovery to be overlooked.

Dr Noble said: “The Liverpool Care Pathway is not a one-way street and, when further deterioration does not occur, it is common practice to take the patient off the Pathway and re-institute previous treatment.”

CNK points to a recent audit of the LCP by the Marie Curie Palliative Care Institute Liverpool in collaboration with the Royal College of Physicians, which found that it was providing a high standard of care for those at the end of life.

However, the same audit also revealed that in 2008-09 relatives were only told that patients had entered “the dying phase” of the LCP in 76 per cent of cases.

Dr Gillian Craig, Vice Chair of the Medical Ethics Alliance, has written to today’s Times newspaper warning that the LCP can be used “inappropriately, leaving relatives in despair”.

Katherine Murphy, Director of the Patients Association, warned last week of a lack of palliative care training among NHS staff.

“The LCP should be used to support decision making — not take over from it. Clinicians should always be acutely sensitive to the needs of their individual patients”, she wrote in The Times.

But defending the scheme, Rob George of Health for London said: “It has nothing to do with therapeutic killing such as euthanasia or assisted suicide; it has everything to do with giving dignity to dying patients.”

He added: “In this period of fiscal famine, training and education must be the last things to go.

“Frontline staff are no good if they are incompetent.

“Dying patients deserve better and so do those who look after them.”

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