We have recently been emailed a copy of Professor Jones submission to the Liverpool Care Pathway Review which is entitled, “Submission to the Review of the Liverpool Care Pathway (LCP) on behalf of the Department of Christian Responsibility and Citizenship of the Catholic Bishops’ Conference of England and Wales.”
As practising Catholic physicians who have been personally involved with criticism of the LCP, We were rather taken aback by the content of the submission. We have been through the submission in detail, and we would like to highlight three main areas of concern and comment further on two of them.
Our main concerns about Professor Jones’ submission are:
1. Without apparently directly involving Catholic physicians in this report, he makes several clinical medical conclusions based on a superficial review of the literature alone. As a result, in an area of very difficult clinical decision making, he has almost completely sidestepped important and fundamental issues that make the LCP highly problematical
2. He has not included any information from the public cases in which the LCP has been blamed for causing death or suffering, however well documented. The sufferings of patients who have been put on the LCP and their relatives, is the first thing the Church should be reacting to in order to understand the great depth of anguish that this pathway has caused and the reasons for this. This is a major gap in his critique.
3. The feeling that comes across in this review is that Professor Jones is a supporter of the LCP and that no available evidence is going to change this. He goes to extreme lengths to align support for the LCP with Catholic teaching and this at times borders on the disingenuous.
From the medical academic point of view,
He supports the idea of withdrawal of fluid and sedative management in “dying” patients, without showing he understands how this conflicts with the physiology of thirst and the respiratory and central nervous system depressant effects of opiates and benzodiazepines.
He fails to highlight the pivotal place of the diagnosis that a patient is “dying” in the LCP. He accepts the term “dying patient” with only superficial discussion. He mentions that if the diagnosis of “dying” is wrong, then reduction of fluids could be fatal. He does not see the potential for this to bring about a “self-fulfilling prophesy” in someone diagnosed as “dying” in the LCP, although he says that there is some concern for those “who live longer than expected”.
He is very critical of the views of Catholic physicians who have reported on the LCP and fails to do justice to what they put forward.
From the bioethical point of view,
He repeatedly refers to the need to accept death and not flee from the “inevitable”, which is not the way physicians looking after sick patients view the course of disease. To focus on the acceptance of death as a “major good” of healthcare, again detracts from the focus of looking after the sick patient and tends to deter criticism of the LCP.
If the Archbishop and Bishops would like to understand Catholic Physicians’ views about the LCP, we would respectfully suggest that they should ask these physicians directly.