Archbishop’s response to the review of the Liverpool Care Pathway

Following the publication of the Review of the Liverpool Care Pathway, The Most Rev Peter Smith, Archbishop of Southwark and Chair of the Bishops’ Conference Department of Christian Responsibility and Citizenship, has made the following response:

“The Catholic Church has a long tradition of care for the dying combining acknowledgement of death with care for vulnerable patients. It was in response to concerns raised by Catholics and by others about end of life care in England and Wales that I called for an enquiry into the use of the Liverpool Care Pathway (LCP).”

“I welcome the report of Baroness Neuberger into the implementation of the LCP and the initial response to that report from the government. It is clear that the committee has taken its responsibilities very seriously and has listened to patients, relatives, doctors and nurses. The committee has sought to protect the positive aspects of the LCP while proposing a new more flexible and personalised framework of ‘end of life care plans’. This report and its recommendations are worthy of careful consideration.”

“From a Catholic perspective, the key issue is that, whatever pathway, plan or framework is adopted, it must be implemented ethically, with care for the patient always as the first priority.”

Related

More Care, Less Pathway A review on gov.uk of the Liverpool Care Pathway

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Catholic Medical Association UK statement on the Liverpool Care Pathway

Catholic Medical Association (UK)

 

NEWS RELEASE

FOR IMMEDIATE RELEASE: TUES 16 JULY 2013

 

The CMA(UK) notes with huge sadness the deep anxieties about poor care which the Neuberger inquiry  into  the Liverpool  Care Pathway  has identified. Patients who are coming towards the end of their lives require the best possible care and excellent symptom control as well as careful review of their treatments to assure that they are appropriate.

 As Catholic Clinicians and Healthcare Professionals we support the need for high quality, personalised care for people at the end of their life, which enables them to die with dignity, free from pain and thirst.

It is vital for our society to get end of life care right.  We recognise that the Liverpool Care Pathway was well intentioned but as the Neuberger report has identified there have been problems with implementation where poor care has happened, or the pathway has failed. This has unacceptably harmed patients and their relatives at a time when the priority should be to give good quality care.

 Consistent standards and compassion are needed

As work progresses towards phasing out the Liverpool Care Pathway, care towards the end of life in the UK remains too much of a patchwork and we call on Government to ensure that consistent high quality standards driven by best possible evidence, strong clinical practice, motivated by compassion and love for the human person are put at the centre of the care of patients approaching death whether in hospital, hospice or the community.

Tick box and formulaic approaches to the care of the dying are not acceptable. Any Care Pathway which is not underpinned by training, commitment, resourcing and effective clinical practice will be likely to fail. It is vital that support of those who are dying is based more clearly upon individual assessment of need which is regularly repeated and where treatment and care is shaped and adjusted accordingly.

The elements of good care towards the end of life

 Good care towards the end of life is not so much about death, rather it is about how someone lives in their last months, weeks and days.

 Patients who are coming towards the end of their lives require the best possible care and excellent symptom control as well as careful review of their treatments to assure that they are appropriate. The CMA therefore strongly supports the principles and good practice of palliative care.

The true outcome of care is comfort, dignity and living as well  as possible while people die. As well as that, preparation for and acceptance of death  is important for many.

In many ways “End of Life Care” is a misnomer which prompts people to think that the outcome of care is death.  “Palliative Care towards the end of life” is a better term than “End of Life Care” which would focus minds better upon living well until someone dies, with the excellent palliative care that it necessarily entails.

Our clinical experience and practice convinces us that the emphasis in end of life care must be placed upon needs of those who are dying rather than decisions based solely around prognosis.

Deprivation of consciousness (inappropriately sedating people) is a serious issue that is contrary to Catholic teaching and which deprives people of time with their loved ones as they die.

The CMA is committed to delivering best possible care

As work progresses towards a better way  of supporting people who  are coming towards the end of their lives, the CMA wishes to express its deep  commitment towards the best possible care in all clinical situations, from those dealing with the whole of people’s lives to those where patients are possibly approaching death.

We attempt to work with all systems of Health Care to improve the delivery of care using the Catholic Christian model for (the) excellence of care according to the inviolable nature of the dignity of the human person. We feel that Catholic insights on the dignity of the person, providing care from compassion tailored to the individual, and ensuring people can spend their last weeks and months in dignity are insights the healthcare system needs to re-learn.

 

Useful  Questions for Relatives and Families and Carers to ask

Relatives, families and carers of patients should be seen as partners in care at end of life.  While we work to improve care towards the  end of life care, we suggest  the following questions that  patients and their families may  find helpful  as they  discuss their loved ones care with  doctors and nurses to  ensure that  care is appropriate .

·         Are you sure that death is imminent?

·         Can the patient give consent to the treatment proposed?

·         Will the treatment reduce consciousness?

·         What effects will the treatment have, including the combined effects of the drugs proposed, and their effectiveness in reducing severely troublesome symptoms?

·         Will you assure that the patient will not experience thirst and can fluids be given by mouth or another way?

·         Will death be hastened by what is proposed?

Soundbite 1

“The CMA works towards the best possible care in all clinical situations, from those dealing with the whole of people’s lives to those where patients are possibly approaching death. We attempt to work with all systems of Health Care to improve the delivery of care using the Catholic Christian model for the excellence of care according to the inviolable nature of the dignity of the human person.”

 

Note for Editors: About the Catholic Medical  Association

The CMA exists to support Catholic Health Care Professionals and students of those professions in their daily working lives. It does this by mutual  support,  meetings and education as well  as working nationally and internationally with all systems of Health Care to improve the delivery of care using the Catholic Christian model for the excellence of care according to the inviolable nature of the dignity of the human person. We also publish  the Catholic Medical  Quarterly.

www.catholicmedicalassociation.org.uk