LCP

[gfwgfw]

Please

Has anyone have negative/positive views on the controversial Liverpool Care Pathway (LCP)

Graham

[GillD46]

It was designed for Palliative Care, often in a hospice and if used correctly, in the correct environment, can work well. As Medical Director of a hospice, my husband has used it for years.

[Andrea S]

Graham, Unless anyone has experienced this I think it hard to decide whether it is a good or bad thing.

At 92 my Mum was very poorly and there was very little chance of her getting better. It was never discussed that she was on such a plan but all she wanted to do was sleep so she was constantly sponged down and given sips of water but no food. As far as I was concerned she was comfortable and in no pain and whenever she opened her eyes I was there. If that is what it is about in this case it was ok.

The other thing that can occur is Do Not Resuscitate. That was my Sons wishes and it broke my heart every time this appeared on his notes or during
conversation.

I think both things are to give a dignified end.

[Dark Knight]

as with Gill's post
if it is used correctly , then no problem, a friend of mine had this type of care before he passed away from a brain tumour and he and his family were very grateful for the care the hospice took of him during his final few weeks

I sincerely hope this thread does not get hijacked by turning it into a right to die or not debate

[Manoverboard]

What I have read leaves me with mixed emotions ... however in the final analysis I would prefer to die with dignity than to be kept alive just for the sake of it and / or to face the prospect of an extended life without any quality in that life.

ps ... my posting is based on two real life experiences and has nothing whatsoever to do with a euthinasea debate.

[oldbluefox]

Both of my in-laws died in hospital and went on the pathway. I must say the care and attention they received was excellent, they were never in any distress and both of them quietly and peacefully passed away. For them it was a very gentle and dignified end to their lives.

[The Tinker]

Graham - i dont know if this topic is relevant to your recent loss but if it is please read the following and take comfort that what you are asking is a normal way of grieiving. Link Added

The stages of mourning are universal and are experienced by people from all walks of life. Mourning occurs in response to an individual’s own terminal illness or to the death of a valued being, human or animal. There are five stages of normal grief. They were first proposed by Elsabeth Kubler-Ross in her 1969 book “On Death and Dying.”

In our bereavement, we spend different lengths of time working through each step and express each stage more or less intensely. The five stages do not necessarily occur in order. We often move between stages before achieving a more peaceful acceptance of death. Many of us are not afforded the luxury of time required to achieve this final stage of grief. The death of your loved one might inspire you to evaluate your own feelings of mortality. Throughout each stage, a common thread of hope emerges. As long as there is life, there is hope. As long as there is hope, there is life.

Many people do not experience the stages in the order listed below, which is okay. The key to understanding the stages is not to feel like you must go through every one of them, in precise order. Instead, it’s more helpful to look at them as guides in the grieving process — it helps you understand and put into context where you are.

1. Denial and Isolation

The first reaction to learning of terminal illness or death of a cherished loved one is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.

2. Anger

As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us more angry.

Remember, grieving is a personal process that has no time limit, nor one “right” way to do it.

The doctor who diagnosed the illness and was unable to cure the disease might become a convenient target. Health professionals deal with death and dying every day. That does not make them immune to the suffering of their patients or to those who grieve for them.

Do not hesitate to ask your doctor to give you extra time or to explain just once more the details of your loved one’s illness. Arrange a special appointment or ask that he telephone you at the end of his day. Ask for clear answers to your questions regarding medical diagnosis and treatment. Understand the options available to you. Take your time.

3. Bargaining

The normal reaction to feelings of helplessness and vulnerability is often a need to regain control–

If only we had sought medical attention sooner…
If only we got a second opinion from another doctor…
If only we had tried to be a better person toward them…

Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defense to protect us from the painful reality.

4. Depression

Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words. The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell. Sometimes all we really need is a hug.

5. Acceptance

Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.

Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. This is by no means a suggestion that they are aware of their own impending death or such, only that physical decline may be sufficient to produce a similar response. Their behavior implies that it is natural to reach a stage at which social interaction is limited. The dignity and grace shown by our dying loved ones may well be their last gift to us.

Coping with loss is a ultimately a deeply personal and singular experience — nobody can help you go through it more easily or understand all the emotions that you’re going through. But others can be there for you and help comfort you through this process. The best thing you can do is to allow yourself to feel the grief as it comes over you. Resisting it only will prolong the natural process of healing Graham - i dont know if this topic is relevant to your recent bereavement and hope this will help.

[Silver_Shiney]

Very wise words, Tinks, eloquently and sensitively stated.

[gfwgfw]

Tinker

Thank you so much

Graham

[Not so ancient mariner]

If used properly, the LCP works well in the palliative care setting. However, predicting when a patient is about to pass away is not an exact science. The decision to commence a patient on the pathway should not be set in stone, but regularly reviewed in light of any changes in the patient's condition. Patients do sometimes plateau - or even improve, so they should always be taken off the pathway if changes in their condition warrant it.