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Time for a healthy debate about how it's best to die

By Kent and Sussex Courier  |  Posted: February 22, 2013

FINAL CHOICES: Planning is important if we are to provide good care for patients who are near the end of life

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EVERYONE knows the great strides that medical science has made in recent decades.

Illnesses that used to be very dangerous are now safely and easily managed and some that used to be lethal can now be cured.

When nothing more can be done, it's not easy for patients or doctors to accept and it's often a difficult thing to talk about.

But conversations and planning are terribly important if we are to provide good care for patients who are near the end of life.

There must not be a conspiracy of silence between patients, their families, and the doctors and nurses treating them. This only leads to some intensely distressing experiences for people, with loved ones dying in pain or with less dignity than they would have liked.

Telling people they are terminally ill gives them the chance to decide where they want to spend their last days and what care they want, in discussion with those closest to them.

If they have a heart attack, do they want to be resuscitated or would they rather slip quietly away? Do they want to stay at home, with medication on hand to manage their pain when needed? Or would they rather go to a hospice or hospital?

Part of this planning is the Liverpool Care Pathway. This has been much in the news recently with appalling allegations that it is being used as an excuse to deny people food, water and medication to hasten their death. This, if true, is abhorrent. It is absolutely right that the Government has set up an independent inquiry to look into these claims.

But in principle, the LCP is a really important development in healthcare. Developed by the Marie Curie Palliative Care Institute in Liverpool, it's about making sure that everyone recognises when the focus of a patient's care should move away from treating to prolong life, and towards relieving suffering and allowing a dignified death.

Few of us these days experience death until it is someone very close to us, when we are likely to be acutely distressed.

The LCP encourages discussion by doctors and nurses with those closest to the patient, so they understand what will happen.

For instance, it is natural for people to stop wanting to eat or drink as the end of life draws near.

The aim of the pathway is to make people's last days as peaceful and pleasant as possible, in the way that hospices have often achieved but which has not always happened elsewhere.

Please let us know at West Kent Clinical Commissioning Group about any experience of local end of life care – good or bad – that you would like to share. This will help us improve services in the future.

You can e-mail westkent.ccg@nhs.net or write to me, Dr Bob Bowes, at West Kent CCG, Wharf House, Medway Wharf Road, Tonbridge, TN9 1RE

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