Liverpool care pathway: doctors have always aimed to ease distress in dying

Some years ago I was working as a junior doctor in a busy teaching hospital in northwest England. I was part of a team in a regional renal unit. We had many patients with end stage renal failure. On regular dialysis many had no hope of recovery; some had unsuccessful renal transplants, and many were too unwell to be considered for a transplant.

After years of itching, twitching, failed fistulas, infections, nausea, oedema, and breathlessness, some patients would reach the inevitable end stage. The senior registrar with whom I worked was a former army officer. We worked in a rigid regime of discipline and protocol, and I remember wondering aloud to the consultant if I had joined the armed forces. This approach to the management of the patients, however, was effective and efficient. Nothing was missed, and all data were recorded in rigid fashion. I was taught a discipline to carry with me throughout my working life.

You might think that this obsessive approach would leave little room for compassion. Quite the opposite. Once all criteria pointed to the end of life, as all options had failed, a further set of rules applied. The family was summoned, nurses were called in, and this commanding officer would become …