Liverpool care pathway

[stella1w]

Posting here for traffic, not debate,
distraught friend just told her mum, demented, at home with 24 hour care has been put on liverpool care pathway. She spoke to the gp about palliative care thinking it would mean a nursing home and was not consulted about lcp. Gp is refused to let her mum have sedatives or water and my friend is v v v upset and feels this is like euthanasia. She doesn,t seem to know what to do or if she has any rights to stop it. It could take four weeks.
I said if she had doubts she should ask for lcp to be postponed until the children had been consulted and undertood and consented.
What can she do?

Is dementia her only affliction?

Is there another condition that means the digestive system cannot handle any fluids?

Is she lucid or aware of anything?

From what I understand of the LCP the family don't have to give consent but this GP's actions seem a bit OTT.

I don,t know the full detaild of her medical condition. Daughter says her carers were finding it difficult to eat but that she would eat when her daughter encouraged her. She is still mobile and gets agitated without sedatives which gp has just banned.

In a hospital environment we generally don't put people on the LCP unless they are expected to die within the next 72 hours. The LCP does not deny people water or food if they are capable of eating and drinking. If she is concerned that the GP is euthanising her mother then she should get her into hospital where she can be fully assessed as to the appropriate level of support or palliation.

Obviously I don't know the details, but the Minister in charge of such things(health minister maybe) was on the TV last week saying that if patients were able to take food and drink then they should definitely not be prevented from having it, LCP or no LCP.

If this lady's only problem is her dementia and she can take nourishment then your friend must be extremely distress by the course of action the GP is insisting on.

I don't really have any knowledge, but maybe she could urgently contact her MP, or the health authority perhaps? - hopefully someone who knows more will be along shortly.

My Dad died of advanced alzheimers a year ago, he had a stroke and had trouble swallowing for the last 3 weeks of his life, we had a 'no medical intervention' agreement, but he was certainly not denied water or food and was able to enjoy things like jelly, yogurts etc up to the day he died.

I am so sorry for your friend, - this is a horrible thing to be happening to her family

It is absolutely impossible for ANYONE on this forum to comment - we have no idea of what this ladies physical state is - she could be in renal failure, have end stage cardiac failure -there could be a dozens of reasons why she is deemed to be appropriate for end of life care.

And despite all the hysteria peddalled by the daily wail, the LCP does NOT advocate witholding food and fluids. Instead it recognises that in the last stages of life, a patient may be unable to take food and fluids - at which point it would be unsafe to continue administering them. Akin to pouring a bowl of soup into somebodies lungs with the net effect of drowning them. The daily shite actually published a 'retraction' of their wildly misleading crap last week - albeit tagged on to the end of a made up piece of crap about the LCP.

Your friend needs to seek a second opinion. She should call the out of hours GP cover now. If her mum is NOT at the end of life, she needs to be in hospital.

This doesn't sound right at all. The LCP is meant to ensure the last days of someone's life are as comfortable as possible. I've not seen it used very often but when I have it seems to consist almost entirely of sips of fluids and sedation so I'm not sure what the GP's up to here.
If I was your friend I would go back to the regime of her mum had in place before the LCP was started and get the GP to explain very clearly why they felt that the LCP the best plan. I would then get a second opinion and maybe have a chat to social work and the district nurses or any other agencies that are involved.

What Piecesofmyheart said, that's very sensible and avoids any harm coming from going straight back to the old regime if she can't swallow.

I think it's worth pointing out that dementia is a terminal illness and it can be entirely reasonable to be put on the LCP with no other diagnosis.

I'd agree that a second opinion is appropriate, if only to help your friend come to terms with what is happening, and there is a difference of opinion with the current GP, but don't necessarily think anything is "wrong".

I agree with piecesofmyheart and itchywoolyjumper that your friend needs a second opinion and maybe someone with her when she asks about her mothers care.
When you are distraught and emotional its hard to take it all in, misunderstandings can easily occur

From personal experience the LCP is there to ease the passing of a terminally ill patient, not all meds are withdrawn but may be given all thee time by a small pump.
We were kept informed at all times

www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/pdfs/lcpv12newdocuments/LCP%20Relative%20Carer%20Information%20Leaflet%20-%20Nov%2009.pdf

Erm, some of the LCP drugs (used as required) ARE sedatives. And noone can stop her eating and drinking if she is capable of it and wants to. But forcing people to eat and drink against their wishes is cruel too.

The LCP is designed to give people a comfortable death. Why on earth would someone prefer a nursing home to a comfortable death at home?

And all of what pieces said.

So basically, if what she/you says is true, this bears absolutely no resemblance to the LCP.

piecesofmyheart is spot on.

The LCP can, and should, make somebodies days peaceful, comfortable and as dignified as possible. But if your friend doesn't believe this is what is needed for her relative at the moment then she needs to seek a second opinion.

Oh FGS, "pathway to death" - do you have any concept of what the LCP actually means?

1. Stopping "routine" blood tests - cruel and unkind to continue them
2. Stopping unnecessary and unhelpful drugs eg anti cholesterol medication - irrelevant, unhelpful, may have unwanted side effects
3. Stopping routine use of INTRAVENOUS fluids - nothing at all to do with stopping people from eating or drinking for as long as they want to or are able to
4. Prescribing medications that are commonly needed in palliative situations in advance, on an as required basis, so you don't have to wait for an overworked and busy Dr to be able to attend and prescribe them
5. Making sure the person is comfortable - not in pain, on a comfortable mattress etc.

It does NOT include anything to hasten death.

All of this is what I would hope all kind, decent people would want for people who are ALREADY dying.

I just cannot understand the hysteria

OOps forgot too add that group offers lots of help there and one of their members Rita Pal is a doc, so you should be able to get a bit of help there if you need it ~~

But it doesn't deny them water, it simply doesn't force them to have it when they don't want to which is very different.

Can't understand the hysteria over the LCP. No idea why it is linked in anyone's mind to euthanasia. Everything I have read about it from reliable sources makes sound sense.

Your friend needs to get a second opinion if she doesn't believe the patient is at end of life, and ask someone to explain what the LCP actually is, rather than panic needlessly. You can ind a pdf leaflet nline explaining everything very clearly.

Further professional info about the LCP for anyone who wants to read more. includes a link to the concensus statement made by 22 voluntary, medical and stautory organisations in September 2012 in support of the LCP.

www.rcn.org.uk/newsevents/news/article/uk/rcn_signs_statement_on_liverpool_care_pathway

Cheryl - would you like to outline the effect of excessive fluid intake on an already weakened and compromised circulatory system ?

I think you have invented your own version of the LCP, Cheryl. Because what you are describing has absolutely zero to do with the actual LCP. But hey, why let the actual facts get in the way of a good dose of hysteria?

CherylAmber do you know anything about the LCP?

I doubt it going by your posts.

Oh and just because the church says so, doesn't mean it true you know Cheryl

Lenglogs www.nhs.uk/chq/pages/899.aspx?categoryid=68&subcategoryid=156 :/