"The Liverpool Care Pathway (LCP) is a scheme that is intended to improve the quality of care in the final hours or days of a patient's life, and to ensure a peaceful and comfortable death. It aims to guide doctors, nurses and other health workers looking after someone who is dying on issues such as the appropriate time to remove tubes providing food and fluid, or when to stop medication.
However, its use for some has become controversial, with relatives reportedly claiming it has been used without consent, and some saying it is used inappropriately.
This criticism and the media emphasis on the supposed controversy is puzzling, as the LCP has been standard practice in most hospitals for a number of years. The LCP has also received recognition on both a national and international level as an example of good practice.
As a GP put it in the British Medical Journal, the LCP 'has transformed end of life care from an undignified, painful experience into a peaceful, dignified death at home'"
(NHS Choices, UK)
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The database is continually being updated by a team of authors. We take a pragmatic approach to authoring: we look out for topical issues, keep track of the journals and update material in response to user feedback.
We use a range of knowledge sources, including clinical experience, knowledge taken from literature reviews, original research articles and guidelines published by national and international bodies. In many cases references are made to sources of information; we are committed to making GPnotebook fully referenced in the near future. As a team we review each other's work but we also rely in the feedback from experts in primary care and the various clinical specialities to keep us on the right track.
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(Oxbridge Solutions Ltd., UK)
"Of the modes of persuasion furnished by the spoken word there are three kinds. The first kind depends on the personal character of the speaker [ethos]; the second on putting the audience into a certain frame of mind [pathos]; the third on the proof, or apparent proof, provided by the words of the speech itself [logos]. Persuasion is achieved by the speaker's personal character when the speech is so spoken as to make us think him credible."
(Aristotle 1356a 2,3, translation by W. Rhys Roberts)
Aristotle, Book I - Chapter 2 : Aristotle's Rhetoric (hypertextual resource compiled by Lee Honeycutt)
"The judgment by the war crimes tribunal at Nuremberg laid down 10 standards to which physicians must conform when carrying out experiments on human subjects in a new code that is now accepted worldwide.
This judgment established a new standard of ethical medical behavior for the post World War II human rights era. Amongst other requirements, this document enunciates the requirement of voluntary informed consent of the human subject. The principle of voluntary informed consent protects the right of the individual to control his own body.
This code also recognizes that the risk must be weighed against the expected benefit, and that unnecessary pain and suffering must be avoided.
This code recognizes that doctors should avoid actions that injure human patients.
The principles established by this code for medical practice now have been extened into general codes of medical ethics."
(Circumcision Reference Library, 7 December 1996)
"On the 22nd July 1942, 75 prisoners from our transport that came from Lublin were called, summoned to the chief of the camp. We stood before the camp office, and present Kogel, Mandel and one person which I later recognized Dr. Fischer. We were afterwards sent back to the block and we were told to wait for further instructions. On the 25th of July, all the women from the transport of Lublin were summoned by Mendel, who told us that we were not allowed to work outside of the camp. Also, five women from the transport that came from Warsaw were summoned with us at the same time. We were not allowed to work outside the camp. The next day 75 women were summoned again and we had to stand before the hospital in the camp. Present were Schiedlauski, Oberhauser, Rosenthal, Kogel and the man in when I recognized afterwards Dr. Fischer."
(Vladislava Karolewska, 1946)
fig.1 Herta Oberheuser, physician on trial for having conducted medical experiments on concentration camp prisoners. Nuremberg Medical Trial, Germany, August 1947. NARA
Fig.2 Vladislava Karolewska, a victim of medical experiments, who appeared as a prosecution witness at the Doctors Trial. Nuremberg Medical Trial, Germany, December 22, 1946. NARA