Care for the dying

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

Stirling