Care for the dy­ing

The Daily Telegraph - - Letters To The Editor -

SIR – I, with Dr K Nes­bitt (Let­ters, May 3), am dis­mayed by the at­ti­tude of some physi­cians to­wards the care of the dy­ing pa­tient, fol­low­ing the demise of the Liver­pool Care Path­way.

This was an ideal pro­to­col used in the man­age­ment of pa­tients, both in hos­pi­tal and at home. Un­for­tu­nately, the LCP was ap­plied in­cor­rectly on many oc­ca­sions and is no longer em­ployed. The care of the dy­ing pa­tient is now fre­quently sub­op­ti­mal.

My 96-year-old un­cle died re­cently in a univer­sity teach­ing hos­pi­tal in Eng­land. When I saw him five days af­ter ad­mis­sion, I found that he had re­ten­tion of urine; pres­sure dam­age to the skin over­ly­ing his sacrum; to­tally in­ad­e­quate pain re­lief, with at­tempts be­ing made to ad­min­is­ter oral mor­phine in spite of his be­ing un­able to swal­low safely; and con­tin­u­a­tion of his usual med­i­ca­tion, which had be­come ut­terly in­ap­pro­pri­ate.

He was beg­ging to be killed. No thought had been given to his be­ing re­ferred to the hos­pi­tal pal­lia­tive care team, and I was told that even if he were to be re­ferred he would prob­a­bly not be seen for sev­eral days. Af­ter dis­cus­sion, he was seen by a pal­lia­tive care con­sul­tant in a few hours, and he died in com­fort, later that day, fol­low­ing sig­nif­i­cant changes to his med­i­cal and nurs­ing man­age­ment.

My con­cern is that such ap­palling care pro­vides am­mu­ni­tion for the “as­sisted sui­cide” and euthana­sia lobby, which I op­pose pro­foundly.

Dr Richard Len­ton


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