Liverpool care pathway has transformed end of life care, argues doctor

The Liverpool care pathway has transformed end of life care from an undignified, painful experience into a peaceful, dignified death at home, argues a doctor in this week’s BMJ.

His views follow media criticism of the pathway that is designed to help doctors and nurses provide quality care for dying patients. Newspaper reports say doctors are establishing “death lists” of patients to put on the pathway and have accused hospitals of using it to kill terminally ill patients.

But Dr Des Spence, a general practitioner in Glasgow, argues that there is another side to the story.

He describes how, 25 years ago, doctors received no training in end of life care. “In hospitals far from their loved ones, patients were left screaming in pain in the dark and behind unmarked curtains were mass undignified and peace-less deaths,” he writes.

“Patients were admitted to hospital without their consent,” he adds. “Care was disorganised and poor.”

But in recent years, he has seen care transformed by the pathway. Used properly with senior supervision, he says it “offers structure to a peaceful, pain-free, dignified death at home: a good death.”

The “death lists” exist to tackle a taboo, he adds – they facilitate discussion about death with patients and families.

The newspapers are right to insist that this pathway is used with full explanation and the consent of all involved, he says, but argues that “there were no good old days in end of life care and so we need to Liverpool care pathway.”

In an accompanying article, Dr Margaret McCartney reviews the recent Daily Mail coverage of the pathway and describes “the onslaught of scaremongering publicity” as potentially harmful.

“Criticising current procedures and practices can be useful, and newspapers should be free to do this,” she says. “But doing so in a way that scaremongers and alleges that doctors are parties to “killings” is reprehensible and unfair to a highly vulnerable group of people and their families.”