Is the Liverpool Plan just another name for euthanasia

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.

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.

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

strongly recommended

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

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,

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

ethel I agree with Iam4 so I will respond to that. It sounds to me that you know nothing at all about the complexity of serious ill health, modern nursing and medical care and despite all the helpful an informative answers here your mind remains closed.

One reason the LCP came into being was that many older people did not recognise that they were dying. It was a way of getting to know their wishes, and a way of checking on the care the dying person received.
Nothing wrong with your way, ethel, but it does not sound as if you particularly cared for your gran, saying everyone ran to her bidding. You make her sound quite cantankerous.
My husband would not have fitted your plan. He was only 65.

For the record, I agree with iam64 as well.

Also, I did not think the LCP existed any more, because of all the controversy.

Yes I have! I really think this is an honest enquiry and is not unreasonable from someone who may be relatively unfamiliar with the topic. I suppose you only really learn about it when directly confronted. LCP must seem scary to some

Have you read any of ethel's other threads, jane10?
I agree with iam64

etheltbags the LCP is just formalising the steps that need to be taken to ensure as painfree and comfortable a slipping away as possible. I'm sure that up until the steps were clarified in the LCP various ad hoc approaches were in place. These may or may not have been very good and depended on the people doing the caring. Sadly not all deaths are peaceful or pain free. Iam64 I don't think ethel is winding us up. Why would you think so?

good morning etheltbags1 - good to see you're winding us all up again

Why on earth do we need an end of life plan.
Cannot the staff just care for someone in a kind and compassionate way while being aware that they are dying and being aware of the patients last wishes. It is just common sense, do we get vacuous nurses saying, 'oh dear she is not going to die as shes not on the Liverpool plan'.
If you have a very ill person aged 80+ and the doctors know they are unlikely to recover then they should be treated with respect and perhaps given a little indulgence perhaps let them eat a special treat etc and just let them slip gently away.
My gran was in this situation and we nursed her at home and nothing special changed, she demanded what she wanted, everyone ran to her bidding and one day she just fell asleep, no nurses or doctors had been for a couple of weeks but she died just as she probably wanted.

great to hear she was able to make her own decision and that they respected her wishes not to share with relatives. Close relatives, especially adult children- often cannot understand that the patient's wishes are paramount and the only ones that count if compus mentis.

My lovely mum was put on the LCP without our knowledge she made the choice herself with her Doctors and insisted we where not told at the time.The care mum received was second to none and she was treated with dignity and respect she even helped herself to her favourite tipple a couple of times during those sad last few days.

I cant see any positive experiences at the end of life, someone you love is going. It has to be sad and hard for those left no matter how easy/painfree/peaceful they staff can make it. I agree with many though that being in hospital is no place to be dying, much better at home or in a special peaceful place that they love.

Indeed Iam64- heart warming. Sounds to me that in most cases LP is used with dignity and care, and with the patients' best interest at heart. When the time comes, who'd want to keep going a few more days or weeks of agony and total loss of dignity.

It's good to see so many positive experiences of end of life care. A close friend who knew he was dying, chose the LP . He died at home, with excellent care that relieved his pain and with his family around him. My mum in law received wonderful end of life care in a local nursing home.

I was with my cousin during his last days in a hospice. The staff informed us that they were going to stop giving his medication for heart and other conditions but he was kept on a morphine pump for pain relief which was added to before they moved him for any procedure. We did not press him to take food but if he expressed an interest we gave a little soup and ice cream, at no point did the hospice suggest we did not offer food.

When my mother got to 101 and became 'out of it' she was given water or her lips moistened but was not capable of eating. She became distressed when handled (very gently by lovely care staff) and was given a sedative and also a morphine patch to alleviate any pain. 4 days later my sister went in to find her dressed, in her chair, eating porridge and saying "I think I've been a bit poorly". The next day she was again 'out of it' and died peacefully a week later. We had been asked about end of life care a few months previously but cannot remember whether LCP was mentioned or not. Never-the-less the care was wonderful.

My mother who was 98 when she died was very frail at the end of her life. It was very obvious that she was dying. Our GP asked if I would like her to go onto the 'Liverpool Pathway'. I knew about this after my friend's father had been in the same situation so didn't hesitate to agree. It is essentially end of life care but every comfort is given and I felt sure that my mum would have preferred to go this way. She was made comfortable, hydrated and we stayed with her until the end. It just seemed to me to be more humane than battling with drugs etc when end of life has come and the strength to carry on isn't there.

I guess if you are really very ill you would lose your appetite. I am sure they would give her drinks if she was thirsty. I should certainly hope so.

I think it falls on a fine line etheltbags1 and whether or not it drops to the euthanasia side depends on how it is carried out and the involvement of the patient or the person representing them. I must admit it causes me worries but I have a feeling that is more because of the way some hospitals administered it at one point by comparison to how it was dealt with in the hospice movement where, I believe, it started.

I have nursed on a number of terminally ill patients with and without the LCP and managed and supervised nursing staff applying it- its far better with I feel. Everyone knows what is happening, patients and NOKs are fully consulted and involved and the patient is given the best possible care at all stages of their sadly deteriorating condition. Its crucial to get End of Life care right and there has to be structured and fully auditable way of doing that s that all staff involved follow the plan. The other thing is of course that a great deal of knowledge has been gained since the implementation of this plan and EOL care has improved dramatically. If it were me when the time comes I would rather have it than not. I do hope your Aunt has a peaceful and dignified end and that your friend is comforted by the good care she receives.