ABSTRACT
The Liverpool Integrated Care Pathway for the Dying Patient lists four criteria. The patient is: bedbound, semi-comatose, no longer able to take tablets and able to take only sips of fluid. In addition to two of these criteria applying, the clinical team need to agree that there is no realistic reversible cause for the patient's deteriorating health. Importantly, such reversible causes might include: metabolic complications, for example hypercalcaemia, the effect of potentially steroid-responsive raised intracranial pressure and inappropriate drug therapy. The attempt to prolong life is such a valued and welcomed goal for so much of healthcare that it is unsurprising that many professionals are inclined to pursue life prolongation, at times uncritically. For the majority of people approaching the end of life, it is skilled nursing care that makes the greatest contribution to physical comfort. Transdermal analgesics such as fentanyl and buprenorphine are difficult to titrate against variable pain and are therefore less suitable in late-stage disease.
