There is a fundamental fallacy that people here who are 'against' the LCP always fall into - and that is that there is some kind of choice in the situation when somebody reachest the end of their life. It is not the case that it is simply, go on the LCP and die, or not and live, because these patients are dying. They will die anyway, whether we care for them or not, whether we give them pain reief or not, whether we carry on medications that in many cases produce side effects that outweigh the benefits anyway. We cannot control death, in our society we are conditioned to belief that death is somehow unnatural, always intrinsically wrong and therefore other people can be held accountable, when that simply isn't the case. The LCP began life as an audit tool, a way in which the hospitals could see whether the patients that die (and there will always be patients that die) have been cared for in the way that minimises their suffering. And that is exactly what it is. When it is implemented properly (patients being allowed fluid/food if they want it), being given adequate pain relief etc, it is the kindest thing to do.
Yes, there will be some people who appear to get better once on the LCP, and detractors often site that as evidence it is being used incorrectly. However, people can be taken on and off the LCP, and secondly, often people improve because they have been placed on it, usually due to stopping many of their medications, as well as the psychological effects of not being poked and prodded.
And as for the accusations that there is a financial element to putting patients n the LCP - well, I find it hard to even dignify that with a response. Think about what you are saying - that the doctors and nurses who go to work everyday to look after the sick, who spent years training - are deliberately 'bumping off' patients for a financial gain that they will never see? And also, the above about targets for 35% of patients who die should be on the LCP is not necessarily a terrible thing, it is saying a certain percentage of patients who die anyway, not somehow increasing the number of deaths. The majority of patients who die do not die of a sudden, acute 'attack of death', it is a more drawn out process and ultimately the most loving thing to do, the most dignified thing is to treat that person as someone who is leaving their life, not having their final moments spent being poked getting cannulas in or being pumped with fluids.
A final note about DNARs, like a PP post, only 1% of CPR attempts are successful. The simple fact for this is that the patient is dead. You cannot and will not successfully bring someone back to life when the patient has died, especially when they have underlying pathology (which can include advanced dementia without necessarily requiring other pathology). Have you ever seen CPR being done? It is brutal Very occasionally you may get some electrical activity in the heart, but that person is not alive, and goes on to officially 'die' 12, 24, 48 hours later. That is not patient centred care. Who wants that. The best treatment is not always life-sustaining. We have to put our misconceptions about death aside and talk about dying. It will happen. The LCP is simply a way of trying to make sure it happens in the most peaceful way possible.