Saturday, 23 June 2012

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.


Rita said...

Thanks for this Joe.

I've been thinking along these lines myself. When my late mother-in-law was put onto it a few years back we made it clear we were Catholics from the outset. They HAD to take our beliefs into consideration and actually I think were glad that we showed some sense of order and direction and made sure they were not in the driving seat.

The Liverpool Care Pathway is not great if you read it. However it needs educated Catholics to stop behaving like scalded cats, to own up to the reality that it exists and manupilate it so that is works for us on our terms.


The problem is that you are looking at this problem through the eyes of a medical professional and not through the eyes of a Catholic.

The Catholic Church is the one true church. It is the line in the sand which not be crossed. You seem to be crossing that line.

Joe said...

Ora pro nobis:

Strictly speaking, I am not a medical professional though I do have hospital chaplaincy experience; and, strictly speaking, I am a Catholic, and a Catholic who has had more than typical opportunities in terms of intellectual formation in matters to do with the Catholic faith.

I stand by my point that those who wish to attack the Liverpool Care Pathway should do so from a better informed point of view than simply one headlining that it is opposed to Catholic teaching - the question is much more involved than that, both from the point of view of what is and is not compatible with Catholic teaching and from the point of view of what the Liverpool Care Pathway actually is and is not.


Thank you for your observation.
I do think the Pathway can be used in a way that is compatible with Catholic teaching - but Catholic patients and relatives need to ask firmly that it be used in that way, or something else can all too easily happen. This seems to me to be the real question for Catholics in relation to the LCP.


In much the same way that it is a sin to give to organisations like CAFOD it is also a sin to be a Catholic who engages in the LCP.

Try having this conversation with Paul Priest (OTSOTA) on twitter and see how far you get. You obviously do not agree with Humanae Vitae or Evangelium Vitae and therefore you are a liberal who dissents from Catholic teaching.

I do not think we need to say any more than that.

Joe said...

There are currently something like 1400 posts on this blog. If you can find the ones that dissent from Humanae Vitae and Evangelium Vitae, I will remove them.

Joe said...

I have since 27th June received three further comments to this post, the last just a couple of days ago. After some thought, I decided not to publish them.

This is not because I am unhappy to publish comments that disagree with my point of view. It is because, despite a considerable effort on my part, I have not been able to find anything in the documentation about the Liverpool Care Pathway that supported the claims made about the Pathway in those comments.

It is quite possible that the care experienced by a patient, particularly in a busy hospital, involves actions that are, according to Catholic teaching, unethical, and not inappropriate to express concern about that. But to attribute those actions to the LCP as such, which is what the three comments concerned did, is inaccurate.

I do not consider it helpful to propagate that inaccuracy further, which is why I decided against publishing the comments concerned.