Published on: July 25, 2013

By Dr Wendy Pattemore –

It is with concern that we watch the demise of the LCP – Liverpool Care Pathway. More than a decade ago it was hailed as the tool to ensure the dignified death of those who were clearly dying. It was to bring clear communication and expectations for the patient and family alike and to prevent futile and invasive procedures being carried out in a persons final precious days or hours.
The risk, as with all protocols slavishly followed, was that the principles and care behind the document would be forgotten in the rush to fill in the paperwork. This seems to have occurred and has led to distressed families and patients alike – and probably distressed carers.
What started as a caring model to raise the quality of care in the dying has been reduced to a ‘tick box procedure’. There is no doubt that when implemented by caring and well educated and resourced staff  the LCP works well, allowing a “peaceful and dignified death”.
So what now? The LCP has been splattered with mud that will not come off. People have been hurt and disillusioned. I do not believe that the LCP in its current form will survive. But does that mean that all it stood for and attempted to achieve is to be thrown away as well?
Certainly not! The thinking use of the principles embodied in the LCP must be continued. Some guidelines for the Care of the Dying need to be in place. Certainly there needs to be the educational support and caring investment in the guidelines that can only come from people that truly believe in the principals of a ‘good death’.
Every ‘protocol’ that is produced runs these risks. This is one reason that I prefer “guidelines” rather than “protocols”. Guidelines can and should be adapted to the individual situation. The very name suggests that it should be used in a thinking manner.
The work done by the proponents of the LCP remains sound. We now need to take the knowledge that has come – both the good and bad outcomes of using the LCP – and create a guideline for our own situations. One that takes into account the cultural needs of the people it serves, one that understands the restrictions on carers and medical systems that it seeks to aid.
So that we may be able to facilitate that last experience of life – dying – in dignity and comfort.