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 Promoting
the advancement and development of Palliative Medicine |
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The Association for Palliative Medicine of Great Britain and Ireland (APM) is an association of doctors who work in hospices and specialist palliative care units in hospitals. Formed in 1986, it now has approximately 1000 members from all over the UK and Ireland, and includes doctors based overseas. If you are an APM member and would like to use the site, please click on `Register` and fill in your details. If you are not yet a member and wish to join the APM, please contact Sabine Tuck at the address below. For trainees, the APM Trainees` Committee (informally known as The Doyle Club committee) represents palliative medicine registrars across the UK. The aim is to information gather and network on matters pertaining to training and facilitate organisation of twice yearly APM Trainee study days, which rotate through the various deaneries in the UK and Ireland. All doctors training in palliative medicine who are members of the APM are automatically members of `APM Trainees` (Doyle Club) . The APM Trainees` Committee itself consists of 14 members who co-ordinate activities and represent trainees on other APM committees such as the executive committee, the SAC, ethics committee, science committee and others. We also have a rep in each region/deanery and hope that this means that there is a clear structure for registrars to get help or advice should they need it, as well as for the committee to get regional information. This site is best viewed using MS IE 5.0 or greater at screen resolution 1024 x 768 public non-members pages link below for more resources. Contact us at our registered offices: Association for Palliative Medicine of Great Britain and Ireland 76 Botley Road, Park Gate, Southampton SO31 1BA tel: 01489 565665 email: sabine [dot] tuck [AT] palliative-medicine [dot] org The Association for Palliative Medicine is a company limited by guarantee registered in England and Wales with company number 3164340 The Liverpool Care Pathway Professor Millard, Peter Hargreaves and others’ concerns over the use of the Liverpool Care Pathway, recently published in the Daily Telegraph, do not represent the view of the overwhelming majority of physicians who specialise in palliative care. Although forecasting death is an inexact science, clinical decisions regarding end of life care are no longer made in isolation, and palliative care hospital support teams are available throughout the country to support other specialities in this work. These teams include physicians who also practise in the local hospice or palliative care unit. Clinical decisions on the prescription of analgesics, sedatives and fluids must be made on an individual patient basis. Modern practice in evidence-based palliative medicine no longer requires that we administer toxic or life threatening doses of analgesics or sedatives to obtain adequate relief of pain and other symptoms. Treatment with subcutaneous or intravenous fluids is occasionally indicated when dehydration causes distressing symptoms, but is futile in patients where poor oral intake is part of a general deterioration that is inevitable in a terminal illness. It is potentially harmful if administered to patients with heart failure leading to congestion of the lungs. The Liverpool Care Pathway is not a one-way street and, when further deterioration does not occur, it is common practice to take the patient off the Pathway and re-institute previous treatment. The use of sedative medication titrated against patient needs is common in the final hours, simply because delirium with agitation is common as dying patients slip into a coma that precedes death. This treatment of distress, using drugs and doses appropriate to the patient, is not the same as the practice of continuous deep sedation until death that has been described as an alternative to euthanasia in the Netherlands. The care pathway approach is now commonly used to aid the work of many specialities throughout the health service; it does not replace clinical judgement, but acts as a prompt to assist clinical teams ensure that every patient gets adequate attention to every aspect of their care. Clinical pathways are useful in auditing practice and developing services. It is possible to misuse any clinical tool, but our experience of working with colleagues in hospitals and the community is that, with adequate training and support, it is used appropriately. The Association for Palliative Medicine is an organisation of over a thousand doctors working in palliative care and we strongly support the Department of Health’s End of Life Care Strategy, which includes the promotion of the Liverpool Care Pathway together with the resources required to educate doctors and nurses in its proper use. It represents one of the most powerful tools we have to foster the principles of palliative care in hospital and community where the majority of NHS patients die. Dr Bill Noble President, Association for Palliative Medicine of Great Britain and Ireland |
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