Tuesday, 10 July 2012

A newspaper’s letters page is not the right place to discuss clinical decisions.

For the non – clinical among my readers, the Liverpool Care Pathway for the Dying Patient (LCP) is defined by Marie Curie Palliative Care Institute as a means to ‘ensure that all dying patients and their relatives and carers receive a high standard of care in the last hours and days of their life’. Actually – for the clinical among my readers the definition is, of course, the same.

I have some very personal views on life and death, as we all do. But, as a clinician, interim NHS project manager and healthcare commentator, I also have a professional view. And guess what? They are the same.

I was shocked to read in the Daily Telegraph yesterday that six physicians had chosen to write to the letters page to imply that hospitals are applying the Liverpool Care Pathway inappropriately for patients to ease bed availability and financial pressure. They state that there is ‘no scientific way of predicting death’ (no argument there) but continue ‘other considerations may come into reaching such a decision such as the availability of hospital resources.’

I must confess that as I read this on the train – I gasped out loud, much to the concern of fellow travellers. Basically, it would appear that Professor Millard and his colleagues are suggesting that patients’ deaths are being hastened to free up beds. This is a truly shocking and disturbing accusation. Worthy of the Daily Mail even. They must have been very pleased with the column inches the Telegraph awarded them. Not only was their message printed in the letters page, they got front page billing (under Andy Muuray’s Wimbledon defeat of course)

What these physicians have done is wrong on so many levels. They have written as supporters of The Medical Ethics Alliance, a ‘Christian medical organisation’. As if politics and the media wasn’t enough – they bring religion into it!

The long and the short of it is – death, like birth is a very personal subject. Not everyone wants to die at home. Nobody wants to die in pain. Dying ‘with dignity’ (oh how I hate that phrase) means very different things to different people. But of one thing I am absolutely certain. The majority – no – the VAST majority of clinicians truly want to avoid patient suffering. They want to ease the passage to end of life with as much compassion, professionalism and care as is humanly possible. We talk of a ‘good death’ and trust me, there is such a thing as a good death.

I stumbled on to #nurchat on Twitter and quickly noted the outrage and upset that this letter has caused clinicians. If these doctors feel that that patients are in effect being ‘bumped off’ to free up beds (which I sincerely doubt’) – then they should not be writing to a national newspaper – they should be following the appropriate, official complaints procedure. These irresponsible individuals have probably caused great distress among readers who may start to doubt that their relatives have been given appropriate palliative care.

I applaud those who write to the papers in an attempt to change political opinion. Some of the letters in The Times in the lead up to the Health and Social Care Bill were priceless. But when it comes to clinical decision making - the public press is not an appropriate medium.

Professor Millard et al – shame on you.


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