Tuesday 23 October 2012

Liverpool Care Pathway – By Word Of Mouth


Stephen Nolan discusses the Liverpool Care Pathway on Radio Five Live -
Scroll forward to 1 hour 6 mins where the LCP is discussed by patients' families and 'medical professionals'. This goes on for 25 mins (to 1 hour 31 mins) when the news starts. Then you need to scroll forward to 2 hours 51 mins where its discussed to the programme close.




Duration: 3 hours

First broadcast:

Saturday 
20 October 2012




International goalkeeper Jason Brown says he's aware of racism between team mates.
Christopher Jefferies, wrongly accused of murdering Joanna Yates, tells his story.
A nurse defends a controversial way of looking after people in their last days of life, known as the Liverpool Care Pathway.


Full transcription:

Stephen Nolan
You might not have heard of the Liverpool Care Pathway but you might want to listen quite closely to what we’re about to say. If you’re in hospital and approaching the end of your life, then the chances are you’ll be put on the Liverpool Care Pathway. It means you will not receive further treatment. Food and fluids may be withdrawn and you’ll be sedated. It’s supposed to mean a more comfortable and easier death for people who just won’t get better and it’s recommended by the Department of Health. Lots of people aren’t happy with it, though. They say it’s the equivalent of putting old people down at the end of their lives. Seventy-nine year old diabetic Mary Cooper collapsed with low blood sugar. She died in hospital eight weeks later after being put on the Liverpool Care Pathway. Her husband Roy and daughter Maxine say they didn’t realise she was being prepared for death.

Roy -
I miss her terrible. But I can’t get over how she went. I didn’t… I’d been telling her all the weeks previous, we got your bed, you’re coming home. And… When she died, I’m sure she thought… (sobs) You’ve been kidding me on all this while, but her bed was here. And she couldn’t come home. (voice shakes)

Maxine –
I think they should take you into a room where you can sit down and they discuss it and tell you exactly, stage by stage, what is going to happen.

Stephen Nolan
Well, obviously, if you’ve experience of this yourself or if you’ve been on the Liverpool Care Pathway as a relative of someone who’s been dying, 0500909693. Maybe you’re a doctor, work in a hospice, relative of a person who’s been placed on the pathway, 0500909693. let’s speak to Marion Hebbourne. Her 85 year old aunt, Olive, was put on the Care Pathway.
Hello to you Marion.

Marion Hebbourne
Hello.

Stephen Nolan
Thankyou for talking to us tonight. Tell us your story, then. What happened?

Marion Hebbourne
Emm… my aunt was taken in from her care home with a broken humerus which is the bone in the shoulder.  Emm… she was quite unwell because, obviously, if she’d suffered a lot of pain. Emm… she deteriorated because, basically, she wasn’t taking fluids. Emm… they put tubes into her Emm… and said that they thought that, you know, with medication and that she would be okay to be returned to the home. I wanted her into a home nearer me so that I could spend more time with her as I was sort of 70 miles away from the hospital. Emm… and that was more or less arranged; we’d found a home and she was going to go. I was going to a family wedding on the Friday so I went to the hospital which was Chelsea and Westminster on the Thursday to see her. Emm… she was very drowsy. Emm… didn’t have a lot of conversation so she actually knew I was there. Emm… I went off to the wedding leaving a contact phone number in case I was needed. I don’t use a mobile very often, but I’d taken a mobile with me just in case, notified the hospital that I wanted to be called if there was any change in her. . Emm… they didn’t call. Saturday, I rang twice at the end of the day to see how she was and said I intended coming up on the Sunday, but if there was any cause for concern I would come on the Saturday. I left my home here around sort of elevenish and made my way up to London to pick up a cousin to go and visit my aunt and, unbeknown to me, they’d phoned at just after twelve to say they wanted to speak to me urgently. Emm… when we got to the hospital. Emm… we’d just got past the nursing station and we were asked to stop and that the senior nurse wanted to speak to us, would we go into the relatives room. And when we went into the relatives room they told us that my aunt had died. I’d not been called or anything like that. And… and, obviously, you know, I was very shocked, along with my cousin.

Stephen Nolan
And you then found out that she’d been on this pathway.

Marion Hebbourne
Well, she just said, the nurse just said to me, well you knew that she was on the Liverpool Path Plan. And I said, no, what is that? I mean, I might be naïve, I know all about it now because I’ve actually taken the time to download it from the internet and read it…

Stephen Nolan
And how did they describe the pathway to you?

Marion Hebbourne
Emm… they described it as a pathway that… Emm… they didn’t think my aunt would make a return to health and that they would remove… the tubes and everything had been removed. And that she would die peacefully. I have no means of knowing whether she died peacefully because I wasn’t present. I mean, when the time of death was given to me it was after eleven and, in any case, they didn’t phone until twelve so, even if I’d been here, I wouldn’t have been able to get to the hospital to see her…

Stephen Nolan
And you do feel very angry that your aunt was put on this pathway without your knowledge, without your permission, without her permission.

Marion Hebbourne
Well, totally, because, at the end of the day, if you actually read the rules and regulations of this path plan, it is designed by the Marie Curie, Emm… cancer people, and it has been agreed that this can be used in hospitals, but it does state very clearly, and it has strict guidelines, that it has to be discussed with relatives and, if possible, Emm… the patient.

Stephen Nolan
Well, the hospital concerned, Chelsea and Westminster Hospital, issued a statement apologising for the failings in the way the staff communicated. They said they’re very sorry for the distress caused. They say they’ve revised their procedures following an investigation. And the statement goes on to say – Instead of a single tick-box for staff to confirm that relatives have been involved in discussions about end of life care, staff now have to specify what was discussed, when, and with whom. Eh, let’s speak to  Sarah tonight. Hello to you, Sarah…

Sarah
Hello.

Stephen Nolan
It’s not your real name. You’re an NHS nurse from Surrey and you work with elderly people, is that right?

Sarah
That’s right, yeah.

Stephen Nolan
Can you tell me about this pathway and if you’ve any concerns about how it’s being communicated to people?

Sarah
No, I think… I think that, you know, the lady you’ve just spoken to is correct, the relatives should be informed, it’s certainly what happens, certainly on my ward. You wouldn’t put someone on the Liverpool Care Pathway without asking… well, telling the relatives or, you know, Emm… talking to the relatives before hand.

Stephen Nolan
What is it, Sarah, literally…?

Sarah
…so at least that relative knows that, you know, that the patient is dying.

Stephen Nolan
Tell it to me Sarah, what actually is it?

Sarah
It’s Emm… it is Emm… a pathway for people who, at the end of their life. I know there’s been a lot of bad press about it, which is quite distressing for nurses like me who really genuinely care their patients. It’s certainly not euthanasia. Euthanasia, in my opinion, is something where you end life prematurely. The Liverpool Care Pathway is a pathway to give best care to someone who is dying anyway. No-one can say someone is going to die within three days, but the idea is that, you know, you think that patient may have just three days or less to live, and usually it’s less than that to be honest…

Stephen Nolan
And what happens to the patient if they’re on it?

Sarah
Well… Emm… they don’t, they tend not to be, have given any more medication. Usually, fluids are taken down, intravenous and subcutaneous fluids are taken down if they’re up already, but not necessarily, that’s another myth, they can have intravenous or subcutaneous fluids and be on the pathway. And then, the best case scenario for me is – well, not the best case, but what happens is they have four drugs written up and these are the drugs that are very important at the end of life. These are Morphine for pain, Medazolam for agitation, glycoperonium which is to reduce secretions – you don’t get that horrible death rattle which my dad had when he died – and an anti-sickness medication. And those four medications are prescribed. They can go in a pump or they can be given subcutaneously (But… but…) with an injection into the skin.

Stephen Nolan
But food and fluids are withdrawn.

Sarah
No, no, that’s another myth of it. Food and fluids are not withdrawn. If they can take food and fluids, they can have food and fluids. No-one’s going to ever stop a patient having food and fluids. The thing is, these people are usually dying and they’re not in a position to have food or fluids.

Stephen Nolan
Does this precipitate death?

Sarah
No, they’re dying anyway. They are dying anyway. The idea is to make them as comfortable as possible because it is the fear of rela…, of patients dying in pain which is the biggest fear of relatives. And if they got all these medications written up, they should not dye in pain. But even though these medications are written up does not necessarily mean a patient has them. I’ve had people on the LCP that have never had any morphine, that have never had any of those four drugs. But the fact of the matter is they’re there if you need them to give to the patient. But just because… in your statement earlier, you said that the patients are sedated, and that is untrue. Why would you sedate somebody who didn’t need sedating?

Stephen Nolan
So, on the pathway, people are… they don’t have food or fluid withdrawn.

Sarah
No, they don’t have food or fluid withdrawn. If you can eat or drink, if they could take a little bit of a drink then they would have a little bit of a drink. If they could eat a little bit… but because they’re dying, the chances are that they’re not capable of eating or drinking (Yeah, but then, if…) if they’re not withdrawn…

Stephen Nolan
Yeah, but what I, what I don’t understand is, even if they’re not capable, Sarah, there are ways to, to medically facilitate that. You can pump food and fluids into someone even if they’re not capable themselves of doing it for themselves.

Sarah
Yeah, well right. Usually… no, a gastric tube would be withdrawn from that point of view, yeah. That would. But they wouldn’t be stopped. Just because someone’s got a gastric tube doesn’t mean they couldn’t eat a little bit. It just means they’re liable to choke if they do eat. But you wouldn’t stop them eating, you would say okay well give them something to eat like a little bit of ice cream or something to make it comfortable for them but you wouldn’t withdraw it.

Stephen Nolan
Let’s speak to Richard tonight. Hello, Richard.

Richard
Good evening.
  
Stephen Nolan
Thankyou for calling us, Richard, what would you like to say?

Richard
Well, I’m actually a registrar in elderly medicine and I actually qualified about seven years ago and seven years ago, it was… the pathway was … in transition in its use in the NHS. I really just wanted to allay the fears that people have about the pathway. I mean, the vast majority of my practice, as I said, I work in elderly medicine. And in the vast majority of my practice, a lot of the discussions take place with the patient’s family and in reality the vast majority of the patient’s families actually suggest it first and formost. And the pathway’s come about because as doctors and medical professionals generally we tended to over-treat the patients in the last days of their life and we didn’t look at it from a holistic point of view. We didn’t really consider the patient’s dignity, the patient comfort, especially in what sort of conditions that are really, really palliative, It doesn’t necessarily have to be cancer; it could be things like heart failure or … response following massive cardiac events for example. But in reality, we changed the way we treat patients even though we should have given more consideration to actually how they’re feeling, dignity, comfort and well-being. And the pathway is there to ensure that, as medics, we are aware that this is a situation that we’re not going to cure in some… and that it’s… events our minds should be focussed that, if we’re not going to cure them, then maybe we should be allowing people to die with dignity and comfort.

Stephen Nolan
So, allowing people to die… eh, I’m not, I’m not judging here, Richard, because I’m not a professional, but it… allowing people to die… Does that mean allowing them to die quicker than in what they might otherwise do? Because you’re not fighting to keep them alive as long as possible because they’re going to die, anyway. Is that what this means?

Richard
No. Emm… I think, I think the big thing used to be is that when the… When the pathway’s used it’s in conditions that are terminal  …  and in conditions that, generally, aren’t reversible. The other thing that needs to be said about the pathway is that the pathway is not a final step. After discussions with the family, patients can be taken off the pathway, and I’ve had patients myself who have kind of rallied and actually maintained as well, and we’ve had patients taken off the pathway because they responded.    A lot of the time, it is very much assessing it on a day by day if not even sort of like every two hourly or three hourly basis. The whole point of the pathway is that no active treatment is actually given to speed up any kind of natural process. There’s no medication given to speed up treatment. Before, … the pathway, really
Would’ve gone off the medication whether or not somebody’s in pain, whether or not somebody’s having seizures, whether or not somebody’s vomiting and whether or not somebody’s agitated. And that’s where medication was actually given, to alleviate any of those symptoms. All the medication would have been given, to alleviate symptoms and not hasten anything that may be ongoing. For somebody who does have terminal cancer we will not give them medication to speed up the passage away from the said cancer.

Stephen Nolan
Richard, thankyou. This is Sandy in Derbyshire. Hello, Sandy

Sandy
Good evening.

Stephen Nolan
What do you think Sandy?

Sandy
Well, I’m very concerned from the experience I had earlier this year. I was visiting an 80+ year old friend in a nursing home, she’d had a partial leg amputation and was having some drugs to help her but she wasn’t seriously drugged, she was fully compos mentis and on my 3rd visit to this lady she said she didn’t like the effect morphine was having on her because she said it’s not relieving any pain or distress, it’s causing a lot of mental distress, it stops her from communicating with people and it gives her terrible nightmares. So I tried to forward her wishes to her family and to the medics so that her wishes would be respected and she was fully compos mentis. Within 2 days she was transferred to an acute hospital for a surgical opinion which was that they were not going to operate. They kept her in and I was told by this lady’s next of kin, the family, which I think was only one person, and the medics have agreed that she should now start a very high dose of morphine and then let nature take its course. I said “well, that’s not a natural course, when she’s been opiated, and it’s not what she wants.” Anyway, I thought it was undiplomatic to argue and I went to visit this patient in the acute hospital, and she was very highly opiated, distressed, struggling to speak, she wasn’t drinking oral fluids, all her fluids were going into a needle in her vein, and every volume of fluid was containing morphine. She knew she was gradually being put down because her mind was being overwhelmed. The next time I visited she was in a side room, the needles were then in her chest which was like hitting her with a sledge hammer, and after about 6 days she was transferred back to the nursing home to die. That lady knew she was being put down and it took 8 to 9 days for her to lose her life through the use of morphine, entirely against her wishes, but at some stage in this opiation the patient loses authority to give or withhold consent. So she knew that she was just being put down the out shoot and this was definitely putting her down, but really, if a vet is going to put a dog down they give them an anaesthetic and the dog’s gone in minutes. I can’t believe that this is happening and it’s very offensive to me.

Stephen Nolan
Stay there Sandy. Sarah, you’re an NHS nurse, you work with elderly people, and you help put people on this pathway. What would you say to Sandy tonight? Does that sound acceptable, what happened to her friend?

Sarah
Well, I couldn’t comment ‘cause I wouldn’t know all the details of that.

Stephen Nolan
But if there is a patient who doesn’t want it, who expressly…

Sarah
If she was compos mentis, and I don’t understand how she could be put on high doses of morphine without her being aware of it and perhaps she was just too…because sometimes patients are just too in awe of doctors and they agree to things they don’t particularly want anyway. But it does sound wrong and my opinion…well the people that I’ve looked after haven’t been on really high doses of morphine.

Stephen Nolan
Here’s an email into the programme from John, says “Stephen, in September 2011 my 80 year old Mum was put on this without any discussion with the family and not with my mother, we were not told, we were not asked. She was drugged to sleep and her drip was taken away. As far as I’m concerned, she died of dehydration. She went into hospital with the effects of radiotherapy and a chest infection, we had no idea she was gravely ill. With all the hoo-ha with switching off life support for some patients and yet this system kicks in on one person’s say so.” Here’s Philip in Watford. Hello Philip.

Philip
Hello

Stephen Nolan
Tell me about your Mum Philip.

Philip
Well, my mother had had a brain haemorrhage and had been in an awake coma for 3 years and was eventually transferred to a hospital, had been in a nursing home. We were asked if we could put her on this Liverpool Pathway, and my brothers were aware and I made a kind of a decision, it seemed that she was looking as though she was about to die and so we agreed to go down that route. After about a week I came back to the hospital and… well, it was nearer to 10 days, and she was just in a side ward and I said “What happened” and they said “well, she’s still on this pathway” and I’m thinking that she’s not being fed or anything. And what happens is that they remove the tubes and they remove all the apparatus, but of course my mother in a coma wasn’t able to eat or drink, and so that meant all her fluids, everything, had been removed. And so effectively 10 days later she was starving and dehydrating, and so we immediately asked the hospital to start putting fluids in her because effectively she was being starved to death. She rallied, as a result of that, and went back to the nursing home, but it was like a horrendous period for us. We weren’t sure what was going on and the doctors were trying to explain but of course, we’re not medics, but it was just unbelievable that she was put through that and when I looked into her eyes I could see that she knew that something was up, and although she hadn’t spoken to me for 3 years, I knew my mother well enough to know that this wasn’t right, so we said “Stop, put tubes back in, feed her, I don’t care what’s going on…”

Stephen Nolan
So they had removed the tubes Philip without your permission?

Philip
Well, they had told us that going on the Liverpool Pathway meant that they would stop medicating and stop all of that stuff. I didn’t realise that meant also feeding her. Because she could only be fed through a peg, which was tubes, I didn’t realise that when they said we are going to remove all the medication and stuff, that meant we are also going to remove all her feeding.

Stephen Nolan
Does that mean…that doesn’t mean starving someone to death does it?

Philip
Well, she hadn’t had anything put in her body for 10 days, so no food, no fluids at all. So effectively she was off fluids and she was off any nourishment of any sort.

Stephen Nolan
Really interesting this actually. Philip, listen to this email which has just come in to me from Paula. It says “The nurse on the programme does not reflect my experience. No food or water was given to my friend’s mother for 3 and a half days until I went in and asked the staff to give her water which they then did. We thought the treatment under the Liverpool Pathway was inhumane. It seemed to be for the convenience of the staff who could just leave her presumably to die” says Paula

Philip
Yeah well, I mean, to some degree they explained it, but what they don’t explain is what that really means, and what it really means is layman’s terms is if you are a relative of a friend who’s on tubes to be fed, then they’ll be removed as well, and so consequently 10 days after my mother was put on this we immediately said “look, put fluids back into her body, if she’s dying, let her die, but don’t let her dehydrate and starve” and so they did and she recovered well enough to go back to the nursing home.

Stephen Nolan
Stay there Philip. Phyllis in Manchester. Hello Phyllis.

Phyllis
Hi Stephen

Stephen Nolan
You’re a nurse are you?

Phyllis
No, I’m a psychologist actually. You know me well.

Stephen Nolan
Ok

Phyllis
Erm I think there are a number of issues here. First of all, I absolutely agree with what Sarah and Richard have said about the correct use of the Pathway. Obviously I can’t comment on individual cases that we’re hearing about but it seems that there are a number of issues, one of which is communication. The Pathway was developed as a way of ensuring that people who were definitely terminally ill, in the last few days, probably 2 or 3, of their lives, were kept comfortable, had access to any medications needed so that the nurses didn’t have to go running for a doctor because somebody was in pain, things were written up. But the idea of it is that it is only to be used when people had come to a stage in their lives when there really wasn’t anything that could be done to reverse what was happening…

Stephen Nolan
Yeah, but what I would like to understand with this and Sarah, maybe you can help me tonight, is that we’re talking here about people that are in the last few days of their lives, dying peacefully and humanely. But if fluids are withdrawn, can you not feel that? Can you not feel the thirst?

Sarah
Not necessarily. Not necessarily that they can’t. But I think the common thing is that the psychologist said, that I just said to you, the problem is that all these people that have got problems with the LCP is lack of communication. Like I said before, you know…

Stephen Nolan
Yeah but that’s one side of it. But I do want to come back to…

Sarah
They don’t have to be withdrawn. They tend to be withdrawn but they don’t have to be, and I have had relatives who cannot cope psychologically that their parents, or the patient, has no fluids and we have kept fluids up. Sometimes it is purely to alleviate the distress of the relatives.

Stephen Nolan
I understand that Sarah, and that’s for the relatives, but I’m very interested tonight, on behalf of the patient. You say not necessarily but presumable that means.. “not necessarily” is not an emphatic no

Sarah
No, and I’m not going to say no because it would be untrue for me to say so.

Stephen Nolan
Ok, so if fluids are withdrawn from someone over the last 3 or 4 days of their lives, does that not mean that they die in pain? In terms of they die with… dying with thirst must be a horrible way to die.

Sarah
Patients are all individuals so different patients will cope with... have different feelings and different situations so if you thought someone was in pain, needed fluids, you would give them fluids, you would encourage it but…

Stephen Nolan
Why are the fluids withdrawn in the first place?

Sarah
Because they don’t need them. If someone’s dying, they don’t want to eat or drink, it’s a natural process.

Stephen Nolan
But what harm would the fluids do, giving someone a drink?

Phyllis
They might drown. If they are overloaded with fluid it will go into their lungs

Stephen Nolan
Well not overloaded, but why is an adequate number of fluids not given to a patient?

Phyllis
Can I ask you a question very quickly? How do you know that you are thirsty?

Stephen Nolan
‘Cause you feel it.

Phyllis
Where do you feel it?

Stephen Nolan
In your brain.

Phyllis
Do you, or do you feel it in your mouth?

Stephen Nolan
What’s your point?

Phyllis
One of the things that the good care does when people have fluids withdrawn is they ensure really good mouth care to ensure that the person doesn’t feel that their mouth is dry. (Pause) Sarah will agree with that.

Sarah
Mmm.

Stephen Nolan
Ok. It’s really interesting stuff tonight. Thankyou very much for talking to us.

*** Programme breaks for other news ***


Stephen Nolan
We’re going to leave the last 9 minutes of the programme tonight to calls about one of the stories we brought to you about 11 o’clock tonight. It’s the Liverpool Pathway, this is a way in which care professionals ensure or try to ensure that people have as humane a death as possible and there’s been some disagreement on the programme tonight as to what actually happens, some people saying that fluids and food are taken away, others saying that all the medicines are put in place so that over the last 2 or 3 days of someone’s life that they are definitely being given the most humane death possible. Lisa’s in Cumbria. Hello to you Lisa.

Lisa
Hi

Stephen Nolan
What’s your experience of this Lisa?

Lisa
I think...I’ve worked in care for a long time and recently my mother-in-law passed away and I think that sometimes the families don’t see things the same as the medical professionals do in that I think the families want people to be kept alive as long as possible but medical professionals want the end of days to be as peaceful as they can be.

Stephen Nolan
Isn’t it a medical professional’s obligation to keep someone alive for as long as possible?

Lisa
I think it depends I think on whether they are having a quality of life, and I think if somebody’s just in the bed, and they can’t move, you know, they can’t speak, they can’t respond, they can’t take the fluid in without it being detrimental to them, you know, trying to force them, it’s not a quality of life.

Stephen Nolan
Lisa have you experienced and cared for people using the Liverpool Pathway?

Lisa
Yes I have.

Stephen Nolan
So what is it? What does it do? What do you do Lisa with the patient, what is it?

Lisa
It’s basically making them be as comfortable and as pain-free as possible and recently my mother-in-law passed away, my partner feels that she was starved to death. But basically what it was is that she couldn’t intake any food or fluids because she’d lost the swallowing reflex and it was going into her lungs which causes infection. If they kept doing that, it would have…if they’d given her intravenous fluids it would have maybe prolonged her life, but there would have been no quality of life because she was just lying in the bed.

Stephen Nolan
I’m sorry that I have such a primitive knowledge of this Lisa, but I asked this question earlier on. If as a patient you’re there and you’re dying, and food and liquids are being withheld from you, do you experience the sensation of hunger and thirst?

Lisa
I don’t know if you experience it because you’re… they’re basically out of it, you know they’re not responsive in the same way that anybody else is.

Stephen Nolan
Lisa thankyou. Ann’s in West Sussex. Hello Ann.

Ann
Good evening, or good night!

Stephen Nolan
Hello there

Ann
Yes, I had a very bad experience with a close friend who was a cancer patient, and still is, had a morphine patch on a Saturday and I was with her for the whole of the day until 7 o’clock that evening. The following morning she was very nauseous and quite ill, and her partner called the local hospice for pain relief and somebody came from the hospice, pronounced that she was dying and that she only had maximum of 2 days to live. Her partner was very upset, called me and asked could I speak with them because he just couldn’t speak any more and I asked them what they were going to do for her in the hospice, you know, what treatment they were going to give her that she couldn’t have at home and I was told that she wasn’t a doctor and that was up to the doctor, which made me wonder how she could pronounce that she was dying in the first place. So she really didn’t like being questioned and I said, well whatever you do, do not put her on morphine because she obviously has a bad reaction to it and I’d seen a friend of mine who was seriously ill with cancer die within 2 days of going on morphine. When she arrived at the hospice the first thing they did was to put the morphine pump next to her and her partner suggested that that wasn’t what she wanted, and from then on she was being encouraged to have this pump, and that it would all be over. She went in on the Sunday morning, I went in on Sunday evening to see her and she was quite alert and fairly bright; by the following day they had not given her any food or drink, her partner thought it was a bit odd and they told him that she wouldn’t want anything any more. Her vital statistics were not fatal, there was no pulse, they didn’t wash her, there was nothing provided to her apart from injections that put her to sleep. When I went to see her the following day at about 3 o’clock she looked like a corpse in the bed, her breathing was very shallow and I couldn’t believe the deterioration in her. By then her partner had got very panicky and said he was really concerned because she hadn’t got any fluids and she hadn’t been offered anything and he’d asked the medical staff if they could put her on a drip and they’d all said no. So I took one look at her and I thought this wasn’t the girl I was out having lunch with on the Saturday and it’s only Monday and, you know, there’s something radically wrong here. So the Chaplain came to see her and I said well we really need to see whoever is in charge here because she’ll meet your Boss at bit sooner than we planned. So at that stage we went up to the foyer, found the doctor in charge and asked her if she could come and see her with the intention of putting her on a drip and her reply was that they didn’t do that, that she’d had enough of him and that she really wasn’t prepared to discuss it any further and she walked off. So we were left in a really distressed state because the girl obviously had gone downhill very seriously and we knew that she needed to have some fluid otherwise she wasn’t going to survive. At that point we made the decision to take her home from the hospice, but she was in such a weakened state that we knew we wouldn’t get medical approval to take her out. So I went down, sat her up in the bed and she flopped over like a doll.

Stephen Nolan
Just because we’ve only got a minute left, what ended up happening?

Ann
We actually kidnapped her out of there, took her to a private clinic, had her on a drip for 4 hours…

Stephen Nolan
Kidnapped her out of there?!

Ann
Yes, we took her in the wheelchair, put her in the car and took her out, and that’s a year ago, and she’s still alive today.

Stephen Nolan
She’s still alive?!

Ann
She’s still alive. But she was never asked, never mentioned the Liverpool Pathway, we didn’t even know it existed, there was no mouth care, nothing.

Stephen Nolan
It’s an extraordinary story.

Ann
She was taken off all fluid, all food, her medication was taken away from her and that night when we got her home and we went to get her medication we couldn’t find it in her belongings. It’s murder by the back door. Euthanasia has regulations and it’s governed by good practice

Stephen Nolan
Obviously when we’re talking about the Liverpool Care Pathway there are many, many dedicated, seasoned experts in the health profession who advocate it as a humane way to endure the last few days of your life.

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