A group of health care experts in the UK has expressed concern over the end-of-life care received by many in the British National Health Service system.
In an effort to reduce unnecessary procedures as patients’ lives come to an end, much of the NHS has adopted the “Liverpool Pathway Care” approach, which ends the administration of medication and fluids and substitutes sedation at the end of a patient’s life to make their passing more comfortable.
Certainly this is appropriate in some situations, and no one disputes that, but doctors are concerned that the LPC is being used too broadly and without individual consideration for each patient.
Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance.
When a decision has been made to place a patient on the pathway doctors are then recommended to consider removing medication or invasive procedures, such as intravenous drips, which are no longer of benefit.
If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention.
Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition.
He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die.
He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in.
“It is supposed to let people die with dignity but it can become a self-fulfilling prophecy.
“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”
He added: “What they are trying to do is stop people being overtreated as they are dying.
“It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.”
He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition.
Almost twice as many patients in Britain die under heavy sedation than in Belgium or the Netherlands – an indication of how often this plan is being used.
The LPC is a good example of how an idea with a laudable goal can lead to terrible consequences when it’s institutionalized and decisions are made by those detached from each patients’ situation.
If patients were given control over their care by being able to take their health care dollars elsewhere, or insisted on more personalized care for themeslves or their family members, it may help to solve the problem, but it would also conflict with the idea of “free” care under the NHS.