Jeremy Hunt is playing politics with end-of-life care

http://www.guardian.co.uk/commentisfree/2012/nov/06/jeremy-hunt-end-of-life-care

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The health secretary, Jeremy Hunt, has ridden into the storm surrounding end-of-life care like a knight in shining armour. He wants a revamp of the NHS constitution to defend patients from their doctors, forcing the medical profession to speak to relatives before implementing the Liverpool Care Pathway (the LCP), which is widely used as a treatment tool in the last hours of the life of a dying patient. Hailed as a "victory for families" by the Daily Mail, the changes will no doubt win some political points. But overall they are about as useful as offering a hedgehog a protective coat of spikes – it promises nothing that patients do not already have.

Hunt's determination that patients' families should have a right to be involved in the care of their relatives is already enshrined within the LCP – excluding families is anathema to its very ethos. If this is not sufficient protection for patients (and I agree it may not be), then the General Medical Council document Duties of a Doctor certainly does not lack teeth, and makes clear a doctor's obligations to families. Moreover, where a patient lacks capacity there is the Medical Capacity Act, which again lays out the duty to involve families. The Mail states that, under the changes, doctors will be "legally obliged to seek patients' consent before placing them on the LCP", but this is meaningless: they are already obliged to seek consent for every treatment they instigate.

As a GP, I have closely followed the sustained attack on the LCP – initially with horror, then with deep sadness and distress. It has been like watching the humiliation of an old friend. This is not because of some blind loyalty to the LCP itself, or an inability to accept that doctors can be criticised, but because, like the vast majority of healthcare professionals involved in end-of-life care, it is something I am deeply passionate about.

Ensuring that those at the end of their life achieve a good death is one of the greatest challenges in medicine. Many times when I have driven to the house of a dying patient, or even more so to the children's hospice, every bone in my body has wanted to turn around and go home. It would be easier – the conversations and decisions you have to make are difficult and emotionally draining – but they are one of the most rewarding things I do.

The LCP is not a ghoulish "death pathway" with sinister undertones, but a compassionate, carefully written document which helps doctors, patients and their families to make the right decisions near the end of life. It ensures that nothing is forgotten – like pressure areas, mouth care or the spiritual needs of the patient – and it encourages regular review. It is not an exact science, and clearly there have been serious problems in some cases. I am as disturbed as anybody when I hear that families have felt excluded from conversations concerning their loved ones. However, the sustained media campaign against the LCP has accused it of crimes it just has not committed.

Time and again the charge is made that the LCP has been instigated without the involvement of families. But enshrined within the very fabric of the LCP is the involvement of relatives. Where relatives have felt excluded, we need to ask why doctors were not using the LCP properly, not to attack the pathway itself. Another common accusation is that families have to "defy doctors" by giving their relatives a drink – and yet the LCP states that patients will "be supported to eat and drink for as long as possible". Artificial fluid and food via drips or a naso-gastric tube may be appropriately stopped, but we need to challenge the impression that end-of-life care in any way involves stopping a conscious patient from eating or drinking. Where this has happened it is not the LCP as I know it.

The gravest charge of all against the LCP, that "NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds", is the most distressing, as it is a charge against every hospital doctor involved in end-of-life care, and its sinister overtones profoundly undermine the doctor-patient relationship at a time when patients are at their most vulnerable.

The defendant in this alleged crime is "NHS doctors", which is sufficiently vague as to make it impossible to counter. When doctors do try to rally some defence, they are accused of arrogance. Indeed, on hearing that I was writing this article, one colleague told me I was "brave" (I think he meant "foolish"). I cannot stop the Daily Mail writing 21 negative articles about the LCP in the month of October without a single column giving a differing view, nor can I prevent the Daily Telegraph from throwing its broadsheet might behind this powerfully destructive campaign, but I can stand up for what I believe in – which is the very best, person-centred palliative care.

For what would critics like doctors to do instead? Insist that every patient be forced to continue with all active treatment until the bitter end? Refuse to stop blood tests, drips and needles in a patient who clearly has only hours to live? Decline the opportunity to receive treatment to relieve suffering in a patient dying in pain and distress in case they get sued? Well, I already know that neither of the newspapers behind the campaign want that. The hypocrisy of their campaign is illustrated by this interesting detail: during the height of their attack on the LCP in October, and without making any reference to it, both the Mail and the Telegraph published the story of Prue Leith. She related the tragic story of her brother's painful death and how he endured agony because doctors were (wrongly, in my opinion) reluctant to prescribe sufficient painkillers. Leith was rightly angered by the way her brother died, and argued eloquently that: "There should be a hospital protocol that if the patient and the next of kin want to end the misery, and two doctors agree the patient will be dead in a month anyway, they can increase the dose of drugs to the level sufficient to alleviate the pain, even at the risk of death."

A protocol to alleviate suffering for dying patients? Now there's a good thought! Come to think of it, I think the Marie Curie Institute might have had that idea already – it's called the Liverpool Care Pathway.