Press statement from the CMA on the Liverpool Care Pathway.
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?
“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