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

Drug trials must not abuse peoples’ rights, European Bishops tell EU

Drugs trials necessary but must respect the vulnerable

Drugs trials are necessary before drugs come to market, but those conducting them have ethical duties to obtain consent and respect the rights of those from developing countries, says a statement on behalf of all Catholic Churches in the European Union.

COMECE, the Commission of the Bishops’ Conferences of the European Union, issued the statement through its Bioethics committee in response to the EU Proposal for “A Regulation on clinical trials on medicinal products for human use’ which aims at re-launching clinical research within the EU while at the same time ensuring protection to participants as well as the reliability of the acquired data. The European Commission proposed regulation which will be submitted to a vote of the European Parliament next 29 May

The statement on Ethical assessment of clinical trials on medicinal products: Respect and protection of vulnerable persons and populations  was released by COMECE this week in English and French.

Importance of consent

“Many people who are unable to give consent as well as people from less-developed countries often participate in clinical trials.” The COMECE statement asks how we can better protect them and vulnerable populations against abuse in the process.

The COMECE bioethics team conclude that  EU proposal could go further in the protection of the people concerned. A spokesperson said:

“The COMECE Secretariat welcomes this proposal for a Regulation as it goes in the right direction. The COMECE Reflection Group on Bioethics has monitored the issue from the launch of the public consultation by the European Commission and publishes today its Opinion on this proposal for a Regulation. ”

Key ethical concerns and principles

The COMECE team underlined some principles which they feel should be implemented in the proposed EU Regulation :

Volunteering

“The appreciation of the value of voluntary participation in research projects for the good of the community:  granting financial incentives to any person agreeing to take part in some medical research therefore raises ethical issues.”

Protecting those particularly vulnerable

“A key ethical consideration for research carried out on human subjects is that of respecting and protecting particularly vulnerable people and populations who could be unduly used as easily-exploitable objects for experiments.”

Benefits for the population concerned, especially in developing countries

“Clinical research with a disadvantaged or vulnerable population or community is justified only if it responds to its health needs and priorities and if it is likely that such a population or community will benefit from the results of the research.”

Security of the participants to tests

“The subject of research may agree to become involved in a research protocol that does not fully respond to the individual’s own interests but will do so for the good of others, in the “medical interest of the community” and consequently for the “common good”, insofar as the patient’s physical or psychological integrity is not endangered.” This underlines the importance of full and informed consent.

Benefits to the person incapable of consent

“Trial medicinal products should not be given to persons who are not capable of giving their consent except in cases where the same results cannot be obtained by resorting to persons capable of giving their consent and if the foreseeable benefits/predictable risks ratio is to their advantage.”

Ethics of testing in emergency situations

As for clinical trials in emergency situations, “the only acceptable research is specific research on individuals placed in such a situation that one may have good grounds for anticipating a direct benefit with regard to their condition and that would present a minimal risk and only impose a minimal burden. It is also important to give a sufficiently precise definition of the terms “minimal risk” and “minimal burden”. ”

The full statement on Ethical assessment of clinical trials on medicinal products: Respect and protection of vulnerable persons and populations is available in English and French