Is the Liverpool Plan just another name for euthanasia

Give her a break everyone! Not everybody has this experience at their fingertips!

An independent review panel strongly recommended in August 2013 that use of the Liverpool Care Pathway be replaced within the next six to 12 months by an end of life care plan for each patient, backed up by condition-specific good practice guidance.

This was because the standard of care bring given was not adequate. I'm surprised that 18+ months down the line this is still operating,

Only a recommendation. Its now discontinued in our area but, as previously stated, if done well by good staff it was very good.

strongly recommended

www.bbc.co.uk/news/uk-england-norfolk-23312195

If the person is clearly dying and 'out of it' then the 'Liverpool Pathway' is what is happening anyway. In her last few days my aunt, who died recently, was comatose, she had no health problems but she was 96 and for a month or so before her death had gradually been declining, not talking, not engaging with people, not eating, drinking little, when she became comatose, she just lay in bed with staff damping her mouth regularly and making sure she wasn't in pain. Death came naturally.

However I find it very difficult to understand how there can be any justification for a woman who is still talking and engaging with people and who does not know they are on the plan, should be on it, even if she is imminently terminally ill. My father was full mentally alert until the moment of death. Even though we had known for his last week that death could happen at any moment nobody at the hospital suggested at any point putting him on the Liverpool Pathway - and it was at the height of it's 'popularity' at the time. He was drinking and eating normally, although he needed to be fed, until only an hour before his death.

I find the touching faith that some people have in the honest rectitude of the NHS and NHS staff, given the stream of stories that have come out of the service of poor and negligent care, particularly for the elderly in recent year, quite incomprehensible. In this case, if I had any right, to I would be politely but firmly insist on finding out the hows and whys of the decision and openly discussing it with the lady involved.

When my father died I don't think he can have been on anything like the LCP because he died in ITU. I wasn't told anything though, so even 27 years later I still don't know what his prognosis was.

"I find the touching faith that some people have in the honest rectitude of the NHS and NHS staff, given the stream of stories that have come out of the service of poor and negligent care, particularly for the elderly in recent year, quite incomprehensible."

When the Andrea West story I linked was originally broadcast, it was mentioned that her husband had been threatened for ordering the second PM, but that comment was clipped out of the late evening repeat. The coroner eventually concluded that the two independent PMs were wrong, and that she had died from cancer not morphine, but it makes you wonder whether he had been threatened too.

Only the bad news about the poor old NHS ever makes it to the public. No one is interested in all the excellent care that the majority of people actually receive. Of course bad care should be identified and rectified but a tiny minority of people are responsible for it. Others are just doing the best they can under sometimes difficult circumstances. We should have a TV programme like 'One born every minute ' based in a care of the elderly unit!

I think the problem is that; yes, there is very good care in the NHS but as Stafford, Morecambe, Colchester and some of the Kent hospitals have shown there is also some systematic and systemic poor care and those most likely to receive the poor care are the vulnerable elderly.

Over the last 15 years I have had responsibility for the care of four different elderly relatives in hospitals 150 miles apart and in all but one case the hospital care they have received has been anything from poor to appalling.

I do not think TV programmes help. What relevance has 'One born every minute' to the appalling care and problems in the maternity unit at Morecambe?

Why is ethel being silenced? Decades ago I received a letter by regular mail sent by my sister from England to Canada. She told me that by the time i received it our mother would have died in a hospital in England. My sister had been given poa for health decisions and my brother for financial decisions. I left immediately and for a week spent most of each day by my mother's side. I was there am and pm and discovered that food and water was left on her bedside table but none of it was brought to her mouth. She told me to get her bananas and yoghurt which i helped her to eat until she was able to do so herself. She was being allowed to starve to death with my brother and sister's permission. Had i not reached her as quickly as possible she would not have lived for another 10 years. This still seems to me to be barbaric , yet over the years of telling others this story i have heard many similar here in Canada and elsewhere. The question is why?

By the stories on here it has worked for some people but not for others. If people have died when it was not their time because they were refused food and liquids then the LCP has not worked as it was meant to and people have been killed.

Amarmai, this article in the Guardian is possibly a reason: "There must be no incentive payments to hospitals to put people on end of life care as occurred with the pathway. This was intended to adopt best practice but has been interpreted as payments to speed up patient's demise."

I share your horror ethel, of people being refused food and liquids when they want them. My mother who died at home refused food and drinks. She slept most of the day, the next morning she woke up and said she would have her cup of tea now. She died peacefully late that night.

There is also the other extreme which is worrying and happens far too often is when people who are dying are revived.

My understanding is that LCP as used by the hospice movement involved keeping the patient comfortable, but not giving painful procedures or aggressive resuscitation. I agree with Faye that it was in danger of being used to stop bed blocking in the NHS.
On the other hand, I have known several cases of very old and sick people who were aggressively resuscitated to live in pain with broken ribs for a few more weeks. My own DF died aged 92 in a hospice on LCP three years ago. He was never denied anything, but slipped away while he was being washed and made comfortable.He had turned down the offer of surgery for his cancer, saying "I've had a good innings". He'd made his own decisions and LCP supported him in this.

Your post sums it up well Faye. Also the failure to ensure basic nursing care, such as ensuring patients are kept hydrated and nourished is not limited to end of life care. Too many elderly patients admitted to our hospitals for minor operations or conditions are left to feed themselves. I have witnessed food and drinks being removed, undrunk and uneaten, despite protests from the patient that they are hungry and thirsty and need help.

My suggestion re a "One born" type of programme was to bring this time of life and the very different and difficult care needs to public attention. Currently I think there is massive unawareness of this time of life. Only people directly involved know what's going on or not. A programme hopefully highlighting the dilemmas and hopefully good professional practice could open up this area and potentially lead to an understanding of the need for increased funding and better staffing levels and training leading to more universal higher standards.

Yes, indeed Jane and I agree.

BUT, how well trained does a person need to be to realise that patients, particularly the elderly, need to eat and drink to stay alive?

And if some staff CBA to help them do this, then all the training in the world won't change this attitude.

I think the really tricky problem is probably in assessing whether or not a person just wants to be let go. My Dad was furious at being resuscitated: he had clearly stated a DNR. As a doctor who worked in end of life care, he knew exactly what he didn't want, nevertheless a young SHO resuscitated him in the middle of the night. He died the next day after demanding champagne and insisting on drinking it despite being fully aware that his swallow reflex had gone. He said goodbye to us and said that he was going to sleep. And he did, forever. A way to go that the LCP hadn't considered!
My mother and MIL just stopped eating and drinking and drifted away. Assessing capacity and clarifying these difficult, vital, potentially final wishes is very difficult . It takes real experience to assess this accurately. I suppose the LCP was a way of trying to standardise this and highlight the key steps needing to be followed but allowing for individual variation.
Staff also would benefit from training in managing bereaved families after the event. We were very lucky to be treated with great kindness and consideration after mother and MIL's demises. Much appreciated. As ever its the little things............

Many people worry about being kept alive with aggressive interventions by well meaning medical staff when they are terminally ill, in pain and with no quality of life.

I like the sound of the LCP.

Do they? I thought all that went out of the window years ago. The only comments I have seen in recent years is from people who fear being dispatched to soon as the result of poor and inadequate care.

If I'm out of date on that one I'm pleased.

I'm not worried about being despatched too soon though.

What about all the 'right to die' lobby? The assisted suicide bill proposal seems to have a lot of support flickety. Can't say I've heard much from people afraid of being despatched against their will.

I understood that LCP had been stopped by NHS last year and should not be implemented.

Indeed Jane10- and recently highlighted again because of the demise (of natural causes) of one of its great supporter, Terry Pratchett.

I feel truly privileged that I live in a country where, if ever I was in a final, painful and undignified end of life situation, or suffering in final stages of a terrible disease like Motor-neurone disease- I would be able to make the choice to die at home, in my own bed or favourite armchair, with or without family and friends, at a time entirely of my own choosing, and professional help. For me, the fear of living too long in terrible conditions is far far greater- and I am NOT alone.

Definitely not alone Granjura
End of Life Care Pathways are used to inform and direct the patient's wishes and where necessary, those of the relatives, on the Older People's unit where I'm currently working.
Resuscitation status is also discussed with the patient and relatives, by the Consultant and documented.
These wishes are followed closely - and if necessarily changed as the patient wishes. They include what level of resuscitation, it is agreed and reviewed regularly.

Well, you wouldn't, they are usually elderly, have dementia and other medical problems, or sedated. The papers almost daily have stories from families about elderly relations who went into hospital ill but functioning and are reduced to a confused non-functioning state and then given up on and sedated and put on a nil by mouth regime as death is imminent.

I think people are very negative about their deaths, always assuming it is going to be nasty, miserable and painful. Yes, for some it is like that but more and more are living to extreme old age, healthy, well and functioning and then dying in their sleep or after a short illness without much suffering.

I have decided quite consciously to make no decisions about how I am to be treated as I near death as I do not yet know when it will be, how old I will be, what health problems I will have, whether I will be in pain, what my mental condition will be, nor how I will feel about it at the time.

I do not like making decisions when the data needed to inform the decision is grossly inadequate. And when the decision is quite literally a matter of life and death, then I want to be sure that I have as much data as possible before I reach any decision.

I would worry about the 'data' available in certain newspapers!