Where did the hysteria over the Liverpool Care Pathway originate?

As a staunch and outspoken supporter and defender of the LCP I have recently been contemplating a great deal why the whole furore started. We have been using the pathway for years so why now? I seem to recollect that a few years ago the approach was criticised by some eminent doctors in the national press but after a couple of articles and a little disquiet the debate simmered down and we as practising clinicians continued to use what is considered the framework for best practice when delivering end of life care. The issue certainly was not debated in every mainstream current affairs media outlet and politicised with numerous relatives stepping out into the arena to tell their own horror stories.

So what has happened in those few years? The LCP itself has not really changed. Perhaps the document has been developed a little but the fundamental principles of care remain the same. Maybe it is society’s expectations that have changed. There remains a huge taboo surrounding discussing death and dying openly despite the work of fantastic organisations such as ‘Dying Matters’ and ‘Good Life Good Death Good Grief’. Because of this taboo acceptance that all illness cannot be cured is sometimes limited and this can lead to huge friction between health professionals and devastated relatives when we reach the end of the line in terms of active treatment of a condition.

Perhaps it is because the press love to indulge in a little of what I glibly call ‘doctor bashing’ and feel that we as doctors must have some sinister, ulterior motives underlying our work in end of life care. By sowing these seeds of doubt that we as a profession should not be trusted and praying on society’s deep seated fears about dying news stories that sell papers are created. There is also perhaps a perception more and more that everything done in the NHS is underpinned by monetary factors, bed pressures and lack of resources and that these issues motivate us as doctors rather than our patient’s best interests, is which something I find very sad as I go to work primarily to look after people.

Perhaps the pressure on the NHS in recent years has led to such a time deprived environment in some hospitals that communication has suffered as a result and that is why families have not perhaps felt as cared for and as informed as they should have. This may have led to misunderstandings about the intentions of using an LCP approach as communicating in this area especially about the uncertainties surrounding dying is complex and takes time.

So for whatever reason the sparks of the story did ignite and the irresponsible handling by some of the media has left us as clinicians in a hugely difficult and worrying place. As a doctor I would hope that the relationship I have with my patients and their families is based on a solid foundation of trust; a trust that I am there solely to act in their best interests and to care for them. As a patient myself I trust my own GP and Oncologist implicitly. But when the press and sometimes the politicians start to undermine this trust then we are left in an extremely worrying and dark situation.

How do we fix it? I do not believe the problem itself has anything to do with the actual LCP. I think the solution is really very simple and yet difficult to achieve. When someone is diagnosed with a condition that is going to limit their lifespan such as heart failure, dementia, metastatic cancer or MND for example I believe early, open and honest discussion about prognosis is a necessity. This allows the patient choice and some degree of control over what will happen in their life. Investment in Palliative Care services so that these highly skilled professionals can be involved early on in life limiting illnesses would undoubtedly help in these discussions. This would replace the current scenario which often arises and is best illustrated by using cancer care as an example. A patient is diagnosed with a metastatic cancer. The Oncologists treat them. Eventually the Oncologist’s treatments become futile and their care is then handed over to the Palliative Care team at this point, who are then only involved for relatively little time in that patient’s journey. In my model the Palliative Care practitioner would be in the clinic when the patient is first diagnosed and work in partnership all the way with that patient. I am reminded of a quote from Dame Cicely Saunders, the founder of the hospice movement, “you matter because you are you, and you matter until the last moment of your life. We will do all we can, not only to help you die peacefully, but also to live until you die.”

Therefore when we reach the point where the LCP becomes appropriate we would have patients and families who are well informed and hopefully accepting of their situation enabling the partnership work to continue seamlessly into the final hours and days. Because of the openness agenda the wishes of the patient would be known and could have been planned for enabling us to achieve that Holy Grail ‘a good death’.

So it is not fancy technologies or complicated research that is going to fix the problem. It is quite simply some good quality talking and a culture and environment that allows this to happen. One of the reasons I have been so open about my own dying both in public and in private with those I love is that I believe openness is inextricably linked to achieving ‘a good death’ and perhaps more importantly ‘good grief’ for those left behind.


76 thoughts on “Where did the hysteria over the Liverpool Care Pathway originate?

  1. My lovely wife passed away in a hospice whilst on the LCP last year when she died of a brain tumour. I was not informed of her being on the LCP until I saw documentation and asked them what that was. They explained it to me and it made perfect sense. I did not even mind they did not tell me she was on the LCP because the whole point of her being in the hospice was so that she could have a good death and I trusted the staff to make that happen. So if the way they did that was by using a protocol for it, then I totally trusted them. She was on the LCP for a long time (nearly 2 weeks) but was unable to swallow for all that time so food and drink was not an option.

    I am convinced she had a ‘good as possible’ death. But also, importantly, it was good for me. The excellent End of Life team that helped me look after my wfe at home for her last 8 weeks before going in to the hospice was always there with advice, rapid response nurses and health care assistants. The pressure as a carer/wife was enormous but thanks to the excellent support, I never really felt abandoned.

    If people are desperate to focus on the cost of dying, they should take in to account that due to the excellent help I received, and due to the LCP making my wife’s death as peaceful as it could be, a lot of money has been saved. Because I was not as traumatised as I could have been. I had good support before and after her death. So I did not need lengthy spells off work. I did not need extensive mental health or medication for depression. I was able to quickly return to being a productive member of society.

    And the excellent experience I have had inspired me to re-train. I am now in my first year of university to become a nurse. My aim is to go in to palliative care and help others have a good death and a good grief experience.

    The LCP is a good thing. The press is lazy and goes for the quick sensationalist story. All of this just shows that people are ill-informed about death and unprepared for a frank discussion about the painful truth that death is never going to be pretty. And that not everyone is lucky enough to die peacefully in their sleep. I just wish that people would realise the the LCP can help dying people to achieve something as close to that as possible.

    • hi marieke, sorry you have been misinformed, it was not the media who got the deathpathway way scrapped, it was two professors, and Fiona bruce and hundreds of others telling in writing to the press which is fact, also like me with petitions to prime minister david Cameron also bribary giving millions of pounds to put patients on the l c p, if you want the Liverpool barbaric pathway back why don’t you organise petitions, I am afraid you people who agree are the minority not the majority, and the proof is in the pudding its being phased out in six to twelve months a more humane method by treating each patient different not to put everyone on the tick box fiasco, it also proves there is a god.

  2. I wouldn’t be surprised if part of the issue is steeped in the deepening public conflict between secularism and religion. The faith schools issue, along with the right to die debate, which some see as immoral ‘ending’ of life care and the Bishops in the house of Lords scenario mean that high profile figures such as Michael Gove are latching on to ‘relevant’ subjects.

    History shows political/religious conflict trends to impact on public services and take hostages of established, previously embedded systems for bartering and martyring.

    Whilst it might sound conspiratorial to suggest bigger forces are using the LCP it is to be considered that all across the world religion is rearing up, and as death has traditionally been the expertise of the church, it is tactically wise to embroil other institutional practices into the their tactical manoeuvring.

    Power is not attained directly as much as it is by sleight of hand. I suggest we are about to see many more exchanges between health care, spiritual care and social care. The LCP is a pretty good prop for improper activities.

  3. Great piece. I have been thinking about what has sparked all this madness too… And a part of me wonders if it at all stems from the push to privatise NHS services. If you are withdrawing active treatment you are no longer paying for investigations/medications etc and ultimately the private companies. Like I said just a thought….

    …I have found that despite all the media as long as we remain open about our aims relatives/patients are still receptive to the LCP.

  4. Thank you for so clearly expressing the need to spend time and speak with honesty to patients and family throughout the treatment journey.

  5. Wonderful post and interesting insight. What really annoys me about the whole furore is the only people to suffer will be those too scared to reach out and accept help because they believe they are going to be left to die. Obviously there are instances where communication between the medical/nursing team and the patient’s family/carers has broken down and where the LCP has been implemented in an area where staff are not adequately confident in using it but these are the issues that need to be tackled and not any more legislation. The media hype has only served to intensify people’s fear of death, a subject we don’t talk about enough.
    *Steps off soapbox*

  6. Thanks for this excellent read Kate, and I agree with your point about involving the palliative care team early. I’m just not sure if you mean to have the palliative doctor in at the diagnostic and treatment planning discussion? If so, what would this achieve when patient and family are thinking ‘cure me’. The Daily Mail has had it out for our professions for some time and front page headlines such as ‘death pathway’ are unacceptable in fact disgraceful. We must keep communicating the benefits of the LCP.

    • i will tell you were the histeria came from it came from whistleblowers working in the same field of work and i am sorry for kate granger like i was sorry for my wife starved to death and poisoned with morphine and midazolam in suppose to be small doses not the case induced into a coma, obviously kate will support it because if she did not she would feel guilty from putting patients on it as professor glasser stated its corrupt medicine especially paying doctors large amounts of money to put patients on it, i may add i think it is a mistake and a disgrace.

      • Re. concerned on January 22, 2013 at 3:36 am

        Dear Mr Concerned,
        You can’t even put your name to this ill-thought out & semi-literate comment – how cowardly…

  7. Thank you for a great piece. I as a HCP can’t believe what has happened to the LCP in the press, it is completely ridiculous. We as a team work closely with our palliative care collegues and have recently started bringing them into our various clinics to talk to patients about their prognosis and advance care planning, as Kate says it has to start early and hopefully we will be able to do that. Lets get rid of this horrible myth created by vicious vindictive journalists!

    • Christine, you talk a load of rubbish it was the press conveying letters from very respectable people in the n h s in other words whistleblowers I am so sorry if I have upset you.

  8. Why do you only post comments from those who agree with you Kate? It’s your blog etc, but it is a sign of someone who doesn’t like to be seen as others see them…and can’t take on a debate…..shame really.

    • I post all the comments I receive Jessie (unless outrightly abusive). If you look at my first blogpost there are numerous people commenting with different views to mine. If you have an alternative view please voice it & I will publish it.

  9. ive read this report and i feel no different,the lcp is basically legalised murder,to withdraw fluids must be agonising pain. recently i was with a person who was dying and she was needing fluids and lots of them up to 24 hours before she fell unconscious and sadly passed away. I dont agree with the lcp and i will cammpaign to get this stopped.

    • The LCP is not murder! People are identified as dying before implementation of the LCP. Sometimes health professionals can get it wrong and sometimes patients show signs of recovery…these patients are then removed from the LCP and treatment reinstated. Doctors and nurses are not in the habit of killing their patients (barring one or two aberrations who are then arrested and prosecuted!)

    • to Julia, since you wrote your letter 2012 they have stopped the Liverpool care pathway too many errors involved with patients put on it that should never have been subject to this so called care I hope it now satisfies you. and well done with your petition against it.

  10. I agree about early involvement of pall care. I am a physician but was lucky enough to do 6months of my training with an excellent pall care team (something I would recommend to all trainees). It certainly isn’t an issue to have pall care involved early in the discussion even at the communication of diagnosis. I regularly have a cancer support nurse with me when I break bad news about a lung cancer diagnosis and openly talk of the role of pall care at that stage (unfortunately we don’t have the facility to have a pall care professional with us at that time). The hospital I last worked in has set up a service whereby pall care are involved at the consent stage for bone marrow transplant. They have audited the process and both the patients and haematology staff feel more supported. As Kate says when the transplant doesn’t achieve the aims of cure the patient is already comfortable with the team and when it does the team have been an extra support along the way. I have great respect for Kate’s attitude and writing – I would challenge the Daily Mail to publish her piece alongside some of their rhetoric!!

  11. Hello Kate, I found your blog yesterday and find what you have to say very interesting however I am sorry to hear about your illness.
    I run the charity Post Pals (www.postpals.co.uk) helping make seriously ill children and teenagers smile by the sending of happy post. We recently had Sapphire join, she is 13 and also has terminal cancer (Sarcoma too). I wondered if any of your readers would be willing to send her a cheerful Christmas card? They can read about her here http://www.postpals.co.uk/pals-page/sapphire-b/

    Thank you,

  12. Hi, I just saw your interview on newsnight, I really appreciated it. As a pall care doctor this stuff in the media seems so cruel given all the suffering we see so frequently and you put the case brilliantly for good care, we still have a long way to go in hospitals but I hear on the grapevine that you are helping people in the general public think more clearly about what they would really want for themselves. Thank you.

  13. Well written Kate on a personal level as my sister died in a hospice. We found the communication and help offered beyond anything we had experienced in the local hospital. My sister was very happy in the hospice so happy she went back there to die with no fear. It meant a lot to all of us.

  14. Hi Kate, I read the your book today, it’s unbelievable how brave and strong you are! Honestly when you ended the story and stopped treatment-I cried.
    I put myself in those scenarios and struggled to survive-well done

    I know we did not get on very well during my job in elderly medicine if you remember when you were working with Dr phelan
    I always say I did not like working with you but I would like my mum to be treated by you-as a appreciation of your commitment and your abilities.
    Best of luck through your journey.
    GP Crofton Surgery

  15. I have great respect for our local hospice, and the work they do there – a friend died in the hospice, and they did everything they could to make sure he had a good last few weeks and a good death. He had an aggressive head/neck tumour, and right from his initial surgery Cancer Care nurses were involved, improving his quality of life. In the six months that he lived after diagnosis, he saw his triplets born, and had a chance to spend Christmas at home with them, and had a death without pain.
    The hospice works closely with the hospital trust in whose grounds it is situated where the main Cancer Centre is located. The ambulance service can get people admitted direct to the hospice if they are “on the books”, saving an unnecessary trip to A&E then transfer across town. The important thing I think is their attitude that there’s never “nothing we can do” – they will always be able to do something.

  16. Very well written, thanks for exploring the issue from your rather unique perspective.

    I find it interesting to contrast adult palliative care with children’s palliative care. Admittedly, all my experience in paediatric oncology and palliative care has been abroad, but in a system very similar to ours. With children, it’s totally acceptable, even expected, for palliative care to be involved whilst treatment is still with the aim of cure. Palliative care and curative intervention work alongside each other. And when all curative options are exhausted, when the LCP is appropriate for children it is fully anticipated and usually supported. There are fewer secrets and things unsaid when it comes to the care of dying children.
    Perhaps children can keep going for much longer before they get to LCP-stage, allowing families longer to accept what is happening, but I think the differences between adult and children’s palliative care are due to more than just this.

    On a separate note, following the media spotlight on the LCP, my NHS Trust looked into it and have decided they aren’t sure if they fully support the LCP as it’s “paternalistic” and can be problematic. Perhaps they have identified shortcomings that other trusts have been aware of all along and found ways of dealing with, or perhaps they want to do things differently. Time will tell.

  17. Some interesting comments about how the media has created the furore. I wonder if your viewpoints are still the same in light of such reports as 50% of deaths in the Mid Staffs scandal were allegedly on the LCP? Or what about the 14 year old cancer victim who died with his tongue stuck to the roof of his mouht. Or how about the Doctor who’s distressing report of obvserving his 10th case of a baby put on this pathway because it was severly disabled. If these reports are true, this is not care or dignity in death. This is abuse even possibly murder. I’m all for people dying with their dignity intact and properly cared for.

    I have only recently become aware of the LCP due to all the media hype but my step-father died a couple of years ago. He was drugged unconcious with no water and no nutrition or fluids. When I look back I am now certain he was put on the LCP and without consultation with him or any family member. They literally finished him off. Most upsetting.

  18. very well written willow, sorry to hear how bad your step father was ill treated when a person like you who speaks the truth very few have any harsh words against your complaint,its like you say the mid staffs hospital was a clear example of what is going on in our hospitals with this 30 million pound bribary to put patients who are not seriously ill on it, but still have the will to live, not all but a vast amount, the british governement have gone crazy like adolf hitler was in world war 2 ,its mass execution.

  19. Thank you Kate for your words of truth and openness – as a palliative care professional, this message needs to be constantly repeated as there is so much denial and avoidance of the subject of death and dying – sure its hard, but openness helps to dispell some of the fear.

    • now kate grainger you have kept quiet since the extermination care pathway was scrapped was the independent enquiry wrong, iam afraid not to starve and poison any living being is cold blooded murder and you know it non of this I want it myself to cover up how come they did not put you on it to make more bribary money, you are just a cover up to hide your sins , your judgement day will come don’t you worry, the truth is out from the freedom of rights you are sad people who support the T 4 hitler treatment out of site out of mind , it should have been called, the easy way out is death.

      • Nice man … Not … Perhaps you should question maybe why Dr Granger has been quiet ????? Maybe struggling with symptoms if terminal cancer ??? Physically … Emotionally ???

        Tactless troll … Enough said .

      • John Meehan. You are a despicable and evil minded Troll with a shrivelled soul. I realise that a robust reply may give you the oxygen you need to feel like you exist in the world, but I can’t sit by and let your comments on such a compassionate and heartfelt blog entry from an extraordinary, brave woman such as Dr Kate Granger go past without some come back. There is probably nothing in the world that will make you feel any remorse for your horrible words, so all I can say is that I feel sorry for you. Sorry that you obviously have absolutely nothing good in your life, or any personal yardstick to measure just how vile your comments are. You are the one that will be judged – but I’ve got a hunch the judgement won’t come from any God (if that’s what you believe in), I think it will come when you’re lying on your own lonely death bed. Surrounded by no-body. With no-one to mourn your passing. Whereas Dr Kate Granger will die with dignity, surrounded and supported by love, leaving a legacy of compassion and awareness for us all to benefit from. Crawl back under your stone. Kate, ignore this troll for that’s what he is. Nothing.

      • John Meehan – you are an uneducated, offensive, naive troll. Kate you are brilliant and are achieving so much, it was inspirational to listen to you speak at asit 2013. There are always people like John who seek pleasure in hurting others, and don’t want to or cannot understand the situations they try to involve themselves in. Best wishes.

      • What a cruel man you are John Meehan. You should be ashamed.
        Everyone is entitled to their opinion on end of life care. I happen to be in complete agreement with Dr Kate but that is irrelevant. A personal attack on someone simply because you don’t share their views demonstrates your own short fallings. You too will face judgement!

      • John Meenan:-
        There are so many things wrong with your post here it’s difficult to know where to start. But let’s have a go anyway.
        Firstly, please learn how to spell properly. While the meaning of what you write is clear enough, the spelling and punctuation errors do nothing to make you seem rational. Quite the opposite.
        Next, your rant (for that’s what it is) just exposes your fundamental lack of knowledge about the subject being discussed. Instead of ranting and foaming at the mouth like a Daily Mail reader/commenter perhaps you should look at the evidence first?
        Next, congratulations on invoking Godwin’s Law so quickly and succinctly. Google it if you don’t know what that is (which I suspect you don’t).
        Next, some of the language used suggests that you might be a Christian or of some other religious persuasion such as a Muslim. Knowing many people from several different religions I can tell you that they would all be ashamed to be associated with someone who spews such bile and hatred as you have in those few short sentences.
        Finally, your entire comment shows such a gross disrespect for the author and her awful situation that it beggars belief. You should be thoroughly ashamed of yourself. If you are in any way religious, you might consider praying to whichever mythical sky fairy you believe in for forgiveness and redemption. Better still, do something that actually might have a positive effect for humanity – maybe support a cancer charity.
        Unbelievably appalled by you. Sort yourself out.

      • John Meehan, shame on you and your horrible, disgusting comments. Im sure karma is keeping a close eye on you after what you have written!

      • I have been following Kate Granger for about a year now, first her blog and then on Twitter. Unlike many of her other followers, I am not a medical professional. I choose to follow her story because she is someone who I find to be an amazing example of strength through adversity, dignity and courage. She has raised a huge amount of money for charity, demonstrates an exemplary work ethic and is clearly someone who is generous to both friends and strangers. I have nothing but respect and compassion for this woman and cannot understand why anyone would attack her personality. I do not believe that the man in question has the emotional intelligence to realise that it is abhorrent to exercise a freedom of speech on a woman who is facing a nightmare situation and yet still strives to better the world a better place. He cannot possibly have read much of her material or been keeping up with her tweets/campaigns. There must be some comfort in the knowledge that this man has no insight of Kate Granger because if he did then he could NEVER have written his atrocious comments.

        People can differ in opinion without resorting to low blows. I learned that in Primary school, perhaps the man in question should re-enrole?

  20. Mr Meehan is personal and inappropriate in his comments and although he is entitled to his own views, to express them in such a way is socially unacceptable. I suggest Mr Meehan only publishes comments that he would be happy giving face to face and I suggest the comment above is inappropriate for both publishing or sharing with anyone.

    • to cathy cooke, I don’t find john meehans comments inappropriate if you had lost two loved ones on this Liverpool care pathway, would you take it lying down he is doing what any man or woman would do standing by what he thinks was done wrongly to two relatives one his wife, with two professors of medicine saying its a bad treatment and he has been assisting with petitions which have helped to get the Liverpool pathway scrapped, its just sad that kate grainger supported it and obviously he deplored it and every right to he does not wish any harm to kate but it is unfortunate and I congratulate him on his support of his two lost loved ones

  21. Thank you for posting this Kate. My Dad was put on the LCP but only lived for 8 hours after the team decision was made with my Mum’s full involvement. This was done within an intensive care setting after long-term treatment for cancer. The intensive care staff had to switch ‘hats’ from people who every day save lives to allowing my Dad to have a comfortable passage across the bridge (as we like to say.) Their care, treatment and attitude towards my Dad and our family was nothing short of excellent and fitting. We remain ever grateful that Dad had a positive passing (if that makes any sense!).

  22. John Meenhan you should be ashamed of yourself. End of life care and treatment is a complex and emotive subject but just because some see it differently from you is no excuse to rant like you have done. I am sorry to say I have not had the pleasure of meeting Kate Granger but I have no doubt that the world has been a better place for her existence. I very much doubt the same can be said for you.

      • marieke, which hospital are you at don’t preach rubbish because you get paid being there, your soul is an arsehole. its you who needs the salvation you may soon be out of a job its scrapped.

    • to peter, why should he be ashamed of himself he is still in mourning from the loss of his wife, and blames the Liverpool care pathway treatment a source of which put his wife to sleep before her time this has not just happened to him but god knows how many others, no shame in supporting your dead wife. okay peter perkins.

  23. Emma Norton I couldn’t have put it better myself. What a despicable man.
    Kate your are a true inspiration who’s legacy will live on. I follow you on twitter and I am thinking of you & your dignified struggle everyday.

  24. You’re a piece of work, troll Mr Meehan, aren’t you? And illiterate to boot.

    My mother had a living will, stating she did not want to be kept alive and be cared for by others if she had a serious illness from which she would not recover.

    Unfortunately, she spent the last seven years of her life in a nursing home after suffering a series of strokes and vascular dementia, and for much of that time it was a living death. She also had epilepsy and atrial fibrillation, MRSA and double incontinence.

    She was, finally, put on the Liverpool Care Pathway in April 2013 when she could no longer walk, talk, turn over in bed, eat, drink or understand anything that was going on. And not a moment too soon. It was a blessing.

    Speaking for myself, as someone who underwent cancer treatment last year, including a mastectomy, five sessions of chemo (I was too ill to have the sixth) and 15 of radiotherapy, I shall book myself onto the LCP or take a trip to Switzerland when I think it’s appropriate.

    Mr Meehan, you’re an arse and you can’t string two sentences together. Get stuffed.

    • hi LizC you say your mother was put on a living will, every other patient may not want a living will or go on the Liverpool care pathway its just a tick box method and in one sentence say you will book yourself on the pathway and then say or I will take a trip to Switzerland, make your mind up is the care pathway good or bad, I think its you whos the arse. ,

  25. Kate, a wonderful piece. I am a
    Matron and today is my first day back at work since the death of my amazing mum. She died in my hospital and I have never been prouder. We talked, she talked,

    • (and I obviously pressed something too early) the care team talked, and none of this happened in isolation. She made her wishes clear and we know that we were able to support these. Sometimes it is hard to talk and it doesn’t matter if you cry while you are doing it. I think her ” good ” death will make my grief more bearable. Keep talking people.

    • to mr haran, would you be interested to know they have scrapped your Christian hospice movement the Liverpool lazarus pathway along with the royal Liverpool hospital why was it scrapped was it too good to use, I will tell you why it had far to many faults so were does the problem lie?

  26. Just to add to what everyone is saying: Kate, you are making such a difference to so many people, and your courage and grace are beyond inspiring. I think about what you are going through every day, and I hope that you can feel the love and support of the many people whose lives you have changed for the better. Thank you.

  27. Oh, dear. Some newspapers, especially one that is known as the daily fail, lead their poor readers up to garden path and way beyond…
    My mum had a ‘managed death’ in 2001, before the LCP came into widespread use. She spent her last 18 months in an excellent nursing home in Scotland, where she was cared for as an individual, not a ‘client’, or a number. She had rapid onset vascular dementia, combined with chronic diverticulitis, occasional GI blockages and bleeds, etc.. Her heart and lungs were strong, as were her major organs – one doctor we consulted described her as having multi-system failure. 2 years before she died, as her next of kin, I consented to no further invasive or aggressive hospital treatment.
    She was given a prognosis of months rather than years by the geriatricians, but she improved so much in the nursing home – by and large she was happy there. I don’t know how the nurses coped, but they managed somehow.
    This fear of withdrawal of fluids is nonsense – my mother took three days to die after her final GI bleed, her pain was well controlled, we gave her sips of water on a rota, along with keeping her mouth moist. She enjoyed Coca Cola, so we shook it up until the bubbles had gone, and gave her sips of that.
    She slipped away very peacefully when I’d left to get some things for her, take care of the dog, etc.. The nurses told me that often happens – people often wait to die until their loved one is out of the room.
    She had a smile on her face. She was at peace at last. Nobody wants to die, but a well managed death, whatever you call it, if preferable to, e.g. the chaos of A&E.

  28. I find Mr Meehans comments shocking & obviously has never experienced death . As an experienced nurse it fills me with horror to think that these ignorant people want to take medication away which settles patients & ensures their death is pain free & dignified .
    People don’t always die in their sleep like the movies ! Some people can have many symptoms which without medication would be extremely distressing – we simply cannot allow this to happen .

    • I am sorry to tell you lynn but food and water are taken away when put on the Liverpool back door pathway and replaced with a syringe driver with morphine , midazolam and others, so they are put to sleep forever we simply cannot allow that to happen either.

      • Concerned – from your comments I get the feeling you might be someone who doesnt work in the medical profession. Therefore before you try and criticize other peoples opinions I think you should look to increase your understanding of end of life requirements of the human body, and just anatomy and physiology in general.

  29. I am sorry to say when you get two doctors and numerous nurses saying the Liverpool care pathway is another name for euthanasia ie drs Patrick pallacino a professor in this field of work, dr glazier a cancer specialist who says it is the most corrupt medicine in british history, and its not the media its the whistleblowers wrighting to the media complaining that Its dangerous practice,adding to this they have now scrapped abolished the Liverpool so called care pathway, who his telling the truth also being paid by coquins to put patients on it is bribary so I am 100% sure this pathway is wrong and agree with john wholeheartedly even if he cant spell or misses a full stop out.

  30. if all these readers on the subject of the Liverpool care pathway put pen to paper and ask Fiona bruce who is a ministry of parliament and she would explain how her relatives were abused on this pathway and now have had a re-think and stopped it I support ex-nurse, Fiona bruce, and john.

      • okay jo, I will show you how small minded you are from this letter, it was announced by MP norman lamb, the Liverpool care pathway was abolished following a government commissioned review heard that patients were drugged and deprived of fluids plus the mortality rate has risen over the last few years, junior doctors made life and death decisions beyond their competence ie after hours and weekends, and there must never again be a tick box exercise when dealing with a persons life, the n m c said it was looking at reports at standards of conduct performance and ethics of nurses following a report into the mid Staffordshire hospital, the independent review made 44 recommendations and the phasing out of the Liverpool care pathway over a period of six to twelve months, it also says that there must be no incentive payments to hospitals to put patients on the l c p it could speed up the patients demise, so I am not that very narrow minded at all, I am just sticking up for the death of my loved ones. okay.

  31. very well edited john, you should have been a professor of medicine you would have saved millions of lives by now its as well your not an atheist, when they die they are going nowere but in hellfire like maggielotty. father forgive them for they know not what they do.

    • when a patients are ill with cancer it is at times curable,with radio theraphy and chemo theraphy lets not give people the idea that it is not but to put them on the l c p and not give treatment is deplorable it may save money but very wrong, that’s what has been happening with a large amount of patients, in the telegraph, not the mail,it gives names of learned professors, doctors, nurses, lawyers, amongst others who criticise the Liverpool care pathway. here are the list for your future reference if needed. professor mark glaser senior oncologist and cancer specialist, dr. Philip howard, dr. Miriam Stoppard ,elsepeth chowharay alert,baroness knight of Collingswood,anen bishop of southwark, dr.rita paul,dioscese of shrewsbury, Wesley smith, u s bioethicist, Jacqueline laing barrister,graeme archer the daily telegraph journalist, professor carol j gill researcher, dr. liz miller, doctors association, terry prachet, alex schahden,criticised abuse of the l c p, dr. laura de rooy consultation neonatologist at st. georges hospital London,erick kodish dutch protocol similar to the dutch method, berny Lloyed hospice paediatric nurse, Teresa Lynch, medical ethics, carol jones health visitor,nurse, plus many hundreds of relatives, who have lost loved ones, on the pathway all the names on this list speak against the Liverpool pathway. who have I missed?.

      • I can name 100 times more doctors, nurses and Professors that supported the correct use of the LCP…..Do I win something?

        Also, regarding above comments, LCP was not a treatment, it was a holistic management plan. You cannot compare it to chemo or radiotherapy. Its strategies were designed to help manage the awful symptoms that a patient will have in the last few days and hours of life.
        As sad as it seems, in my experience, and maybe I was just fortunate to work in a well staffed hospital, patients were managed on the LCP when all other available treatments had been exhausted.
        The reason that trusts (not individual doctors duh!) would get money for managing a patient on the LCP was because 10000s of specialists in the area decided that this was a framework for the best most dignified death, not to make money.
        I understand that some people where not managed properly while the LCP was in place, but I cannot begin to imagine being a poor F1, on a first night shift and a patient has taken an awful turn for the worst. Expected deterioration, no guidance on correct doasge of medications to relieve pain and secretions – is this too much? Is this too little? My senior is stuck in A&E with another incredibly poorly patient. I’m glad I’m not an F1 now. Without the guidance of the LCP there will be much suffering to patient’s and relatives. The death rattle is the worst sound I have ever heard – many patients and relatives were grateful for the LCP guided use of glycopyrronium! I hope that any F1 in the future on their first night shift, looking after me, has a sneaky copy of the advised LCP doses in their back pocket.

        The problem wasn’t with the management strategies outlined in the LCP, it was with the awfully poor staffing levels, and extra man power that is required to look after a patient who is at the very end of their life.
        But hey, it’s easier to throw a load of LCP paperwork in the bin than train more nurses, right….?

  32. There are multiple cures for cancer that the media suppresses because cancer is worth billions to the government every year. The completely natural cures work better than chemo and have no side affects. The world needs to know about these cures!! The soursop fruit cures cancer. cannabis oil cures cancer. Urine therapy cures cancer. There is evidence that sodium bicarbonate cures cancer. PLEASE EVERYBODY, LOOK INTO THIS!!!

    • Funny ho this kind of drivel never comes from people with actual cancer. Or even better: people with cancer that was PROVED to be cured by the above mentioned quackery. I wish the Thatcher doctrine could apply to people like this and that it would be illegal to give them even the oxygen of publicity.

  33. to kate grainger, I must tell you love I feel I was very harsh in what I wrote and looking back I wish I had not said the words that I said, so please accept my sincere apologies, it was due to the anger of the loss of my wife of 52yrs, I am not prepared to go into detail but I still say she was murdered by the n h s hospital, and may I wish you the very best in your traumatic illness, and keep up your good work with your charity, love john.x

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