posted on Nov, 1 2012 @ 05:00 PM
reply to post by Liberal1984
As a nurse with extensive experience in critical care including A&E and high dependency units I find this type of manipulation sickening. I use the
Liverpool Care Pathway daily in my work often in very difficult circumstances I find it offensive for people who quite clearly know nothing about the
nature of death and caring for the dying patient to be so critical about a care plan they know nothing about.
First let me address the OP and this issue of withholding nutrition and hydration form patients. In my experience, and the experience of my colleagues
this is often a necessity however I can understand why to a non-medical professional how this would seem abhorrent. Please allow me to explain, in the
case of the dying patient the objective is to maximise comfort and dignity ultimately that is the aim of the LCP to do this eventually it often
becomes necessary to withhold nutrition. This is done for a number of reasons, many of them ethical, in general it is widely accepted that it is
unethical to preform unnecessary procedures that will only cause harm to patients. For example it is not appropriate to insert a nasogastric tube into
a patient who is dying or to insert a central line to provide parenteral nutrition as this will only cause undue distress. Usually at this point the
patient is close to the end in any case however IV fluids are usually given (this may be hartments, dextrose or Saline it all depends) at this stage.
There is also a risk of cause a patient to aspirate and develop phenomena, or there could be other medical reasons such as dysphagia (swallowing
difficulties) following a CVA (Stroke) or perhaps the individual has undergone massive abdominal surgery and cannot eat. At the end of the day there
is always a very good medical and ethical reason behind withdrawing foods. I nor any of my colleagues have ever seen a patient on the LCP who is able
to take oral foods and fluids denied, however it is very rare that these patients can eat in the first place.
Now onto the article, it’s been written by a idiot who knows nothing about palliative care or how the system of NHS targets work. First off all he
talks about this “pathway to death”, death is not a event by a process, I don’t want to get into all the academics of this but that is a common
theme you will find in the literature. Speaking of which the LCP is a evidence based care pathway that has been used for years now, whoever has wrote
this is clearly cherry picking sources.
It is also very wrong the way this author as tried to implied that the NHS is paid to put patients on this pathway. This is a classic case of the NHS
doing something right. I know that in NHS Scotland we have HEAT targets that have to be met, if they are met there is a incentive for the NHS Board
this helps to maintain standards and it can by through providing further investment. But it is a percentage of patients I don’t know the number of
the top of my head but the target will say something like “80% of patients who go on to die put on LCP” and not “put 2000 people on LCP make
sure they die and get 12 million” as the article and OP seem to imply.
Another point I wish to make, regarding the involvement of families. There are occasions when patients don’t want any family involvement; you would
be surprised how often this happens, there are also times when a patient deteriorates very quickly and is put on the plan before the family are
involved. I know that in the version of the LCP that I use there is an entire page regarding involvement form “loved ones”. Also please note that
the family don’t HAVE to be told, if medical staff say “right this guy needs to be put on the LCP” he goes on it, we tell the family about it
later but we don’t need their consent.
Yes there are times when people are put on the LCP who are later taken off it because they fight through and live but this is rather rare, however I
have seen it happen.