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Bishop welcomes reports that care pathway will be phased out

By on Saturday, 13 July 2013

Bishop Philip Egan (Mazur/catholicnews.org.uk)

Bishop Philip Egan (Mazur/catholicnews.org.uk)

An English bishop has welcomed reports that a controversial end-of-life protocol will be phased out.

In a statement issued today, Bishop Philip Egan of Portsmouth said: “On Monday July 15, the Review of the Liverpool Care Pathway (LCP) led by Baroness Neuberger will be published. News reports this morning suggest that this Review will recommend that the use of the LCP be phased out from our NHS hospitals over the coming months. If this is so, I welcome this news.

“I expressed my own concerns about the LCP in a pastoral teaching message on December 8 2012. I acknowledged the honourable intentions of the LCP: the dignified care of the dying, the alleviation of suffering and pain, and the cessation of invasive treatments and unnecessary procedures.

“But I was especially concerned about its day-to-day implementation in our busy hospitals, where the pressure to save money and to utilise beds might lead to a perception that death was being hastened. Moreover, the media at the time were full of reports about patients being placed on the LCP inappropriately and families not being consulted.

“I also expressed my reservations about the LCP itself: that doctors are asked to make a definitive judgment that a patient is about to die and that feeding and hydration can be summarily withdrawn.

“The LCP has been used widely in the NHS these last years, but as I have found from the many letters written to me, not least from Catholic doctors and nurses, it has been a controversial methodology, despite its noble intentions.

“Clearly, we need a good system of end-of-life care. It is my hope and prayer that the positive aspects of the LCP model will be incorporated into whatever new arrangements are developed.

“Life from conception to natural death is God’s gift. It is sacred. Let us pray to the Lord Jesus for all doctors, nurses and health-care professionals, and ask him to bless and guide the wonderful work they do. And let us pray for those who will die today, and for ourselves too, that we will receive from the compassionate Heart of Jesus the grace of a happy death and merit at the last to hear those thrilling words from the Saviour: ‘Today, you will be with me Paradise’ (Lk 23:43).”

  • http://twitter.com/JamesCallender3 James Callender

    Sick and tired of the equivocal mutterings of the English bishops.
    “it has been a controversial methodology, despite its noble intentions.”
    Sorry, but there was nothing noble about the LCP. Are these bishops really Catholic?

  • paulpriest

    Simple question: If Bishop Egan was so desperately concerned over the LCP

    Why did he permit his name to be added by default to the deposition to the Neuberger review by Prof David Albert Jones – for the Bishops Conference – saying the exact opposite???

  • NatOns

    ‘Clearly, we need a good system of end-of-life care. It is my hope and prayer that the positive aspects of the LCP model will be incorporated into whatever new arrangements are developed.’

    Indeed so, and that need cries out to heaven among us as if life’s blood spilt on the ground .. and that regardless of age. To let a child die in wanton neglect is not accidental manslaughter it is wilful murder – the premeditated and intentional killing of one human being by another, so too the deliberate starving to death of a confused, helpless old man or woman.

    Yet before some unwise and careless moralists fly off to the opposite but equally willed demand that artificial life be imposed upon a corpse for as long as medically possible or, more rationally yet equally false, that life be clung to as if mortal life alone were all in all, a careful pause for consideration must be engaged. Refusing a thirsty body water even in the throws of death is to do wrong, so too to drag a dying soul from death bed to healthcare death bed, and back again, for the sake of intrusive medical intervention merely to prolong the process of dying; yes, both are sinful, however well intentioned the action. Nonetheless, meeting the needs of the soul in dying physically .. making a happy death, in both corporeal and spiritual sense .. is not a mere lifestyle option or religious blessing, it is a basic, reasonable and sensible human act of mercy and charity and justice: how this is achieved, it seems, remains beyond the wit of man (or at least a very large body of medical practitioners, too eager to see all or any suffering ended as quickly as possible within the law, or at least as unseen, or too terrified of reputation-destroying legal dispute).

    The archbishop is speaking the truth in expressing reservations about the LCP, yet he is not entirely forthright in setting out what it is to meet a Happy Death in the Catholic Faith (a contradiction to many an existentialism-fed humanist mind) even within the modern, intrusively life-prolonging, and at times utterly soul destroying care system

    http://stcatherinenyc.org/2013/02/03/cooperating-grace-happy-death/

    ‘These needs of dying persons at such a “decisive phase” of their lives should affect the way in which healthcare professionals administer palliative care. The dying person should be made as comfortable as possible in order to be able to attend to such personal and spiritual needs without the distraction and disruption of excessive pain. On the other hand, the dying person should, as far as possible, be left conscious and able to actively engage in the important work of making peace with God and others and of consciously receiving the grace of God in the sacraments of Penance, Anointing of the Sick, and the Eucharist as Viaticum.’

    Erm, yep! That simple, really. Hardly beyond the wit or will of intelligently applied science – or self-sacrificing priesthood.

  • $20596475

    Sensible comments from the Bishop. I think we need to wait to see what is actually recommended and especially what is proposed to replace the LCP model. My own hope is that we retain the best intentions and practice, but improve the training and supervision.

  • bluesuede

    I guess it depends on which way the wind is blowing.

  • bluesuede

    Let’s face it, the dark clouds of the culture of death have been gathering power all over the world and are increasing every day.
    It is inevitable that since democratic governments make laws against the will of the people, as we’ve seen already more encroaching surveillance against privacy, redefinition of marriage, abortion, Plan B pill, euthanasia, loss of religious rights, clergy cooperating with evil etc., that we will be overcome–eventually. Despite what little we can do to stop it. If they’re questioning the LCP, it may be because they’ve already developed another plan to be make killing more efficient.

    It is good to continue to defend our rights and the rights of the most vulnerable, but even better, at the same time, prepare ourselves to become its victims and prepare for a good death….ultimately.

  • Fr F Marsden

    James, I suggest that you read the actual protocols of the LCP which can be found on-line. There are about 17 checks to be carried out on the patient every 6-8 hours. There is full provision for spiritual care from a minister of religion. If the dying patient’s condition improves they are to be taken off the pathway immediately. Full consultation with family is advised. Many of the problems came about because the LCP was abused, or not followed properly by staff poorly trained in it. It was only supposed to be used in the last 2-3 days of life, to make the patient comfortable when medical treatment no longer is working. We had a parishioner aged 94 who was kept on it for 14 days without food or water and, I suspect, starved and dehydrated to death, despite attempts to get her taken off it. But this was a gross abuse of the LCP. Many people were put on it who shouldn’t have been.

    A programme developed in a cancer hospice, specialising in care for the dying, may not transpose well to a busy general hospital. Apart from the question about how certain the prognosis of death can be, and the danger of its becoming a self-fulfilling prognosis, most of the other provisions in the LCP are very good. It was its abuse which caused most of the problems

  • paulpriest

    Sorry Father but it was never its misuse or abuse which was the problem – it was its use – the safeguards are not safe!!!
    They also directly contravene Catholic teaching all over the place…

  • paulpriest

    sigh! obviously you haven’t spent much time on here – will deal with other issues later as I’m at work but I have written quite a bit on the LCP on my blog onthesideoftheangels.blogspot.com but I also made a youtube video Liverpool Care Pathway: Catholics speah out against it

  • paulpriest

    Sorry Father but you are being somewhat [inadvertently?] misleading in your appeal to the 17 ‘so-called’ monitoring checks in that it implies these are diagnostic tests rather than prognostic. They are simply checking the progress towards death – not potentially providing determinant factors for reversal of the procedure.

    Once the 72hr prognosis is determined all diagnostic tests are withdrawn – including one of the most crucial – opiate toxicity levels – a person who is not dying but is simply a victim of morphine poisoning – cannot be rescued because the testing is withdrawn and symptoms mirror accelerating towards death [even the myoclonic jerks can be suppressed by sedation and the vomiting prevented by the anti-nausea [and desiccating] meds]

  • http://twitter.com/JamesCallender3 James Callender

    Very true PP. The LCP directly contradicts Catholic teaching and it pains me to hear priests and others try to defend this nonsense. Really I am in despair at such nonsense. It is a mortal sin (euthanasia), I have seen it with my own eyes (to my own uncle in hospital) and my wife works in a nursing home. I don’t need people to tell me rubbish about the care pathway. It is part of the all encompassing culture of death prevalent in the UK.

  • http://twitter.com/JamesCallender3 James Callender

    Canon law out-trumps Bishops conferences which are mainly Vatican 2 talking shops. Even a candidate for confirmation would know from his/her basic cathecism that euthanasia is a mortal sin. We don’t need “Catholic advisors” to try to argue otherwise.

  • Fr Francis Marsden

    Paul, I went back to the protocols from the Liverpool Marie Curie Centre – reproduced below.

    The problem areas, as has often been stated, are No 1 – Can you be sure a patient is dying? (cf Prof Pullicino). Having been at hundreds of bedsides of dying patients I would say, usually, yes, although there are sometimes surprises. Many of the LCP problems have been when people who are not dying are put on it (back-door euthanasia).

    Items 6 and 7 can be interpreted in line with Catholic moral theology. However, the big problem in the UK was the Government redefining artificial nutrition and hydration as medical treatment rather than as a basic human right -opening the way to patients being starved / dehydrated to death. This issue pre-dates the LCP issue.

    As to opiate toxicity – in my experience the local coroner has been ordering a lot more post mortems in the last couple of years – delaying funerals. Death by morphine poisoning could well lead to a prosecution. Many medical staff are very careful not to give overdoses – they don’t want to end up in the dock.

    You don’t strengthen your case against the LCP by overstating it.

    From the Liverpool Marie Curie website:

    Ten key elements of care for the dying patient:
    1. Recognition that the patient is dying
    2. Communication with the patient (where possible) and always with family and loved ones
    3. Spiritual care
    4. Anticipatory prescribing for symptoms of pain, respiratory
    tract secretions, agitation, nausea and vomiting, dyspnoea
    5. Review of clinical interventions should be in the patient’s
    best interests
    6. Hydration review, including the need for commencement or
    cessation
    7. Nutritional review, including commencement or cessation
    8. Full discussion of the care plan with the patient and relative
    or carer
    9. Regular reassessment of the patient
    10. Dignified and respectful care after death

    How often should the patient be reviewed when supported by the LCP?

    The patient should be reviewed as often as needed as each patient and their relatives and carers have individual needs.
    However, irrespective of clinical need, the patient in an in-patient unit (e.g. a hospital) should be reviewed at least 4 hourly, and at home each time the doctor or nurse visits.

    In addition to these regular 4 hourly assessments as outlined above, a full Multi-disciplinary team review of the plan of care should occur when:

    the patient appears to have an improved conscious level, functional ability, oral intake, mobility, or ability to
    perform self-care

    and / or concerns are expressed regarding the management plan by either the patient, the relative or carer or healthcare
    worker

    and / or it is 3 days since the last full multi-disciplinary assessment. As above, this assessment and the subsequent outcome should be communicated to the patient where possible and deemed appropriate but always to the relative or
    carer.

    What if the patient improves? Can the LCP be discontinued?

    Yes, the LCP can be discontinued following a review of the patient’s condition by the multi-disciplinary team and in
    consultation with the patient, where possible and always with the relative or carer. The views of all concerned must be
    listened to, considered and documented. (GMC 2010)

    Does the LCP recommend stopping or not
    commencing clinically assisted (artificial) nutrition or hydration?

    No, the LCP does not preclude the use of clinically
    assisted nutrition or hydration (CANH). Indeed the LCP prompts clinicians to consider the need for CANH. All clinical decisions must be made in the patient’s best interest and tailored to the patient’s individual needs. The GMC guidance provides specific information regarding this issue. (GMC 2010)

    Each patient is an individual with individual needs. Some patients will have a drip continued, some will have a drip discontinued or indeed commenced.

    These best interest clinical decisions should be made by the senior doctor ultimately responsible for the patient’s care at that moment in time supported by the multi-disciplinary team, and reviewed regularly.

    All decisions leading to a change in care delivery should be communicated to the patient where possible and deemed appropriate but always to the relative or carer. The views of all
    concerned must be listened to, considered and documented and all significant conversations should be supported by an appropriate written information leaflet.

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