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End-of-life judgements shouldn't be made by one doctor, says new guidance End-of-life judgments shouldn't be made by one doctor, says new guidance
(35 minutes later)
Judgements on when patients are reaching the end of their lives should be taken by a number of health experts rather than relying on the medical opinion of just one doctor, according to new guidance from health officials. Judgments on when patients are reaching the end of their lives should be taken by a number of health experts rather than relying on the medical opinion of just one doctor, according to new guidance from health officials.
The draft guidelines from the National Institute for Health and Care Excellence (Nice) follow the abolition of the controversial Liverpool Care Pathway – a regime that recommended the withdrawal of treatment, food and water from some sedated patients in their final hours or days – which was phased out last year after a government-commissioned review found serious failings in how it was being implemented.The draft guidelines from the National Institute for Health and Care Excellence (Nice) follow the abolition of the controversial Liverpool Care Pathway – a regime that recommended the withdrawal of treatment, food and water from some sedated patients in their final hours or days – which was phased out last year after a government-commissioned review found serious failings in how it was being implemented.
Nice said its guidelines address concerns that fluids were being withheld under the pathway, and its recommendations include that people in their last days of life should be encouraged to drink if they wish to and are able to, and receive assisted hydration if appropriate, but this be reduced or stopped if there is any sign of harm or no sign of benefit.Nice said its guidelines address concerns that fluids were being withheld under the pathway, and its recommendations include that people in their last days of life should be encouraged to drink if they wish to and are able to, and receive assisted hydration if appropriate, but this be reduced or stopped if there is any sign of harm or no sign of benefit.
They also emphasise the importance of recognising when patients actually have a chance of recovery in light of cases where elderly patients were being left to die when the ir condition might have improved.They also emphasise the importance of recognising when patients actually have a chance of recovery in light of cases where elderly patients were being left to die when the ir condition might have improved.
Nice said around half a million people die each year in England and while around three quarters of deaths are expected, recognising when death is imminent can be challenging.Nice said around half a million people die each year in England and while around three quarters of deaths are expected, recognising when death is imminent can be challenging.
It said the new guidelines aim to help doctors and nurses identify when someone is entering their final few days of life and places the individual and their loved ones at the heart of decisions about their care.It said the new guidelines aim to help doctors and nurses identify when someone is entering their final few days of life and places the individual and their loved ones at the heart of decisions about their care.
The chief executive of Nice, Sir Andrew Dillon, said: “Recognising when we are close to death and helping us to remain comfortable is difficult for everyone involved.The chief executive of Nice, Sir Andrew Dillon, said: “Recognising when we are close to death and helping us to remain comfortable is difficult for everyone involved.
“The Liverpool Care Pathway was originally devised to help doctors and nurses provide quality end-of-life care. While it helped many to pass away with dignity, it became clear over time that it wasn’t always used in the way it was intended.“The Liverpool Care Pathway was originally devised to help doctors and nurses provide quality end-of-life care. While it helped many to pass away with dignity, it became clear over time that it wasn’t always used in the way it was intended.
“Some families, for example, felt that elderly relatives were placed on to the pathway without their knowledge or consent. Following a review, the pathway is no longer used.“Some families, for example, felt that elderly relatives were placed on to the pathway without their knowledge or consent. Following a review, the pathway is no longer used.
“Earlier this year, the parliamentary and health service ombudsman said that end-of-life care could be improved for up to 335,000 people every year in England. The guidelines we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care.”“Earlier this year, the parliamentary and health service ombudsman said that end-of-life care could be improved for up to 335,000 people every year in England. The guidelines we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care.”
The draft guidance is open for consultation until 9 September.The draft guidance is open for consultation until 9 September.