From: The Catholic Herald,
Baroness Neuberger is chair of an inquiry into the LCP (Photo: PA)
Senior Catholic doctors have said that a bishops’ conference report about the Liverpool Care Pathway (LCP) “borders on the disingenuous” adding that it “goes to extreme lengths to align support for the LCP with Catholic teaching”.
In response to the report, issued by a department of the Bishops’ Conference of England and Wales, Professor Patrick Pullicino, Dr Anthony Cole and Dr Philip Howard said in a joint statement: “The sufferings of patients who have been put on the LCP and their relatives is the first thing the Church should be reacting to in order to understand the great depth of anguish that this pathway has caused and the reasons for this.”
An independent inquiry into the LCP, chaired by Baroness Neuberger, a crossbench peer, was announced by the Department of Health in February, following mounting criticism from families of patients who were placed on the pathway.
The bishops’ Department of Christian Responsibility and Citizenship commissioned Professor David Albert Jones to write their report, which has been submitted to the independent inquiry.
In their joint statement, Professor Pullicino and colleagues wrote: “The feeling that comes across in this review is that Professor Jones is a supporter of the LCP.” They added that in their opinion Professor Jones “goes to extreme lengths to align support for the LCP with Catholic teaching and this at times borders on the disingenuous”.
They conclude: “If the archbishop would like to understand Catholic physicians’ views about the LCP, we would respectfully suggest that they should ask these physicians directly.”
But Professor Jones has defended the report, emphasising that Catholic doctors have mixed views on the LCP controversy. He said: “There is a diversity of opinion about the LCP among Catholic doctors, with some very critical and others firmly supporting its use. Positive appreciation of the good use of the LCP is especially noticeable among Catholic doctors who work in palliative care.”
Professor Jones said that so far he had not “seen evidence to substantiate the claim that the LCP is structurally unsound or that it is inherently unethical”. But he continued: “It is clear that the LCP has frequently been badly implemented, and I hope that the Neuberger committee can identify practical ways to ensure that the LCP is implemented properly.”
In response to direct criticisms of the report’s tone and conclusion, he said: “My main emphasis was that the committee should review the evidence for itself, including the evidence from individual cases where they would be able to consider evidence that is not in the public realm.”
Professor Jones said: “As a matter of principle, I have no interest as such either in supporting or in attacking the LCP, my fundamental interest is in upholding Catholic teaching on the Gospel of life and examining the evidence of best practice in end-of-life care in that light.”
In his report Professor Jones argues that it is essential that the inquiry investigate allegations made about the LCP while listening to the pathway’s supporters.
He continues: “One repeated concern is that the reporting of the Liverpool Care Pathway in the media… has been unbalanced, frequently misleading and at times factually inaccurate… There is also concern that weight is being given to the medical views of ‘experts’ some of whom are not practising medicine or have little direct experience of the implementation of the LCP.” Professor Jones also outlines the allegations that have been made against the LCP.
He writes: “The most fundamental and troubling allegation against the Liverpool Care Pathway is that, in practice, it is an ‘assisted dying pathway’, that is, a framework for euthanasia by omission … this claim has been repeated in national newspapers and other media and is the basis of considerable anxiety among patients and relatives.”
He later continues in the report: “The allegation, then, is that the LCP both causes death and is intended to cause death.”
Professor Jones concludes by urging the inquiry to “undertake for itself a systematic review of the scientific literature in order to reach secure conclusions”.
“This submission has not considered in detail particular cases in which it is alleged that patients have been harmed by the misuse of the LCP. The review is urged to examine such cases in relation to whether patients supported by the LCP have been harmed, whether any such harm is due to the use of the LCP, and what corrections are needed in the light of these examples.”
My observation: Why are there so many questions surrounding the LCP. Too many sad stories related. All programmes I’ve listened to support the allegation that when placed onto the LCP, patients have little time left. No hope of survival. That indeed, the LCP is rather ‘an ‘assisted dying pathway’…’
Much investigation necessary here methinks!
As a Catholic doctor who frequently has to supervise the last hour’s care of incurably sick patients, I feel qualified to comment on this.
There is nothing wrong per se with the LCP as written. It contains very sage and common-sense advice for doctors and nurses dealing with these tragic situations, and indeed, it was partly created in order to educate them in the best modern informed practice in terminal care, of which I remember receiving little training myself. In this area, I have been essentially self-taught.
Where there is a problem is in that in the prevailing culture of death, the LCP may be seen and used as a means of turning the care of the dying into a mere shortcut process, that can be mentally sidelined. “Oh, they’re on the LCP, so I can forget about them and, as a bonus, the bed should be free by the morning…”. That is a big temptation, especially in hard-pressed hospitals (ie all of them).
I think the LCP brand name has been irretrievably damaged in the minds of patients and relatives in the UK. The sound practices from within it must continue to be taught right down at medical and nursing school level, but care of the dying must remain an individualised compassionate process, with as much involvement of the patient and relatives as possible, and as much explanation as necessary.
This is how I manage care of the dying, and I have never had a complaint from the bereaved.