We must talk about death says fan of the Liverpool Care Pathway

Care Plan
Care Plan

It has been called a “death pathway” and a “scandal” in the national media but the Liverpool Care Pathway is intended to improve quality of care in the final hours of a patient’s life.

“It has been misinterpreted in the press but I am a real fan of it,” said Jane Stokes, End of Life Care Co-ordinator at Brighton and Sussex University Hospitals.

The pathway aims to guide doctors and other health workers looking after someone who is dying on issues such as the appropriate time to remove tubes providing food and fluid or when to stop medication.

However, its use has become controversial with relatives claiming it has been used without their consent.

Speaking at a Central Sussex Independent Patients’ Forum meeting in Burgess Hill last Thursday, Ms Stokes said: “There is a lot of misunderstanding around the Liverpool Care Pathway. If a dying patient can’t manage a fluid drip and it is going into their tissues and lungs or they can no longer swallow, it is kinder to withdraw fluids but part of the Liverpool Care Pathway is to keep the mouth moist and that is good, compassionate nursing.

“We need to go back up stream and start talking about dying so that our wishes and preferences are known. A cubicle in a hospital A&E is not the place to start doing that. It’s a shock for relatives to be told their mother is dying when they have been told previously by a doctor that she is ‘very unwell’.

“If we can plan ahead and make our wishes known, fewer people would die in hospital. I would like ‘dead’ and ‘dying’ to be in every doctor’s vocabulary instead of euphemisms.

“If a doctor asks: ‘If you become really unwell, where would you like to be cared for?’ the obvious answer is ‘hospital’ when what the doctor really means is: ‘where and how would you like to be cared for when you are dying’?”

The NHS has produced a guide to ‘Advance Care Planning’ which is a voluntary process and involves patients talking openly with health carers about where they would like to die or whether they would like specific treatments witheld. You can, for example, give another person legal authority when you are no longer able to make your own decisions through cognitive impairment.

Ms Stokes said: “Some people don’t mind what happens to them when they die but others do care and as compassionate carers we want to look at their notes and follow their wishes.”

You can find out more at: www.dyingmatters.org/overview/resources