The Liverpool Care Pathway was created to ensure that dying patients are treated properly in NHS hospitals. But it got caught up in centralized care dysfunction, with bureaucrats setting targets and suggestions for payment incentives, etc.. That led to some patients being subjected to check list medicine, in which they are dealt with as category members instead of as individuals — which was not the Pathway authors’ intent.

Bad press followed when non dying patients were put into comas and dehydrated to death, as just one example. Well now, a survey shows that many medical professionals blame the media for reporting the problems instead of the actual cause, e.g., the manner in which the Pathway has been too often misapplied. From the British Medical Journal story:

Overall, 57% (321/563) of the doctors thought that recent negative press coverage had led to the Liverpool care pathway being used less. This rose to 74% (136) for palliative medicine consultants, supporting concerns made by leaders in the specialty. Among those doctors who said there was less use of the pathway, 60% (194) said patients and relatives had asked them not to use it and 80% (258) said staff were apprehensive about relatives’ complaints. One palliative medicine doctor said, “Negative press regarding LCP [the pathway] has caused additional distress for relatives at an already distressing time when their loved one is dying. This has caused a dilemma in judging if discussing the LCP will cause more distress than the benefit of being on the LCP for coordination of care in the dying phase.”

But that’s because many of the horror stories were and are real! That’s not the Pathway’s fault — it was written to ensure the individual needs of each patient were met. But once it became a bureaucratic imperative, the point of individualized care got lost in the memorandum and target document weeds.

Some still have a “blame the messenger” mentality:

One doctor said that this “scare mongering” was “putting end of life care back about twenty years, where dying patients were hidden inside rooms and not seen by a consultant.”

If so, look in the mirror! The bad things happened! That’s the cause of discord, and the reason for the negative stories.

The reports of very serious problems in the implementation and misapplication of the LCP are not scare mongering. The Pathway was not intended to put most dying patients into comas. It was meant to be nuanced and individualized, with care provided based on the exigencies of each case. Again — and please forgive me for being a broken record — that is the fault of the deprofessionalizing of medicine caused by increasing bureaucratization.

(For you younger readers, “broken record” is an archaic reference to a phrase repeating endlessly because of the phonograph needle hitting a scratch in the vinyl record. Today, we would call that a loop.)

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Wesley J. Smith, J.D., Special Consultant to the CBC
Wesley J. Smith, J.D., Special Consultant to the CBC