Bytheway...Hospitalreallyisnoplacetodie

I THINK it’s fair to say that hospitals are not good places for those dying from chronic disease — too often we read of inadequate treatment and the unnecessary suffering of these patients, which is both unsettling and puzzling. After all, this is not high-tech medical care, nor are the failures in care due to lack of understanding.

Instead, the problem centres around deficiencies in the so-called ‘soft side’ of medical and nursing treatment: essentially, kindness and compassion.

These are things that are difficult to teach and where standards are difficult to measure — and which have suffered in the current culture with its emphasis on protocols, tick-box mentality, completing the paperwork and so on.

Thus it was that the Liverpool Care Pathway (a set of guidelines that was intended to assist those professionals engaged in the giving of palliative care) ended up being so misused — with dying patients being refused even a sip of water, in some instances — that it ended up having to be abandoned.

Blind adherence to the pathway became an end in itself, thereby missing the point entirely.

When it first emerged many decades ago, the hospice movement led the way in how it should be done, with doctors and nurses trained in the care of the dying based upon apprenticeship and experience: young professionals learned by the example set by their senior colleagues.

There is no reason at all why this shouldn’t also be what happens in hospitals, yet somehow we have deviated from the four pillars of medical ethics in the care of dying patients. These are: autonomy — if someone is thirsty, give them a drink and allow them to govern what is happening to them; beneficence — be kind, be gentle, be understanding and ease pain; non-maleficence — do nothing harmful, help settle tumultuous emotions, do not sit in judgment; and, finally, justice — be fair, do everything to ease the journey and the suffering, within what is laid down by law.

The word hospice originally referred to a place of rest for a weary traveller, often a traveller who was ill or dying.

Any of us who care for the dying must take care to remember that and adhere to these four key principles. It’s no less than what we’d want for ourselves or our loved ones, too.