Liverpool Care Pathway

Some Catholic commentators are happy to lash out at the Liverpool Care Pathway, or at Catholic bishops who they do not feel oppose it when they should. Their comment can be ill-informed both with regard to the content of Catholic teaching in its application to a moral evaluation of the Liverpool Care Pathway and with regard to the nature of the Liverpool Care Pathway itself.

A refreshingly clear and accurate account can be found at Christian Medical Comment: here.

My own sense is that, if it is used properly with a patient who is coming to the end of their life, the Liverpool Care Pathway expects a very high level of health care staff attention to the patient. It expects a multi-disciplinary meeting when a decision is made to use the pathway with a patient, it expects a four hourly review of the patient's condition with escalation to the multi-disciplinary team if signs of changed prognosis are seen, it expects full multi-disciplinary team review at 3 days if it has not occurred before then. On a typical busy ward in an NHS hospital, the main challenge to effective use of the pathway is likely to be lack of sufficient staff resources.

Another challenge may be the layout of the forms adopted by a particular hospital trust for use in planning and recording a patient's care under the pathway. The pathway itself, for example, does not mandate removal of aided nutrition and hydration, but raises the question of its continuance or removal as a question to be considered by the multi-disciplinary team. However, a hospital's paper work might allow a team deciding to remove such nutrition and hydration to just "tick the box", whereas a team deciding not to remove it would have to complete the "exception report" at the back of the pack to justify their decision. In this respect, and in others, the paper work, not the Liverpool Care Pathway itself, might create default options in favour of certain courses of action rather than others. Such default options would run counter to the principle of assessment of needs of the individual patient in their individual situation which seems to me to be of the essence of the assessment process of the Liverpool Care Pathway.

If I recall correctly, the Liverpool Care Pathway also expects the multi-disciplinary team to consider provision for the spiritual and pastoral care of the patient. Perhaps this is an aspect of care under the pathway to which Catholics should draw more attention.

In his post Peter Saunders refers to the risk that some who are opposed to euthansia will have their public credibility undermined if they undiscriminatingly label deaths of patients on the Liverpool Care Pathway as euthanasia. I think this is an important point.

Peter Saunders ends his post thus:

In good hands the LCP is a great clinical tool. But in the wrong hands, or used for the wrong patient, any tool can do more harm than good.