I AM concerned to hear that the NHS in England has decided to abandon the Liverpool Care Pathway (LCP) in the care of the dying patient and I hope that in Scotland we can take a more considered approach to this ("'Misused' care pathway for dying patients to be abolished", The Herald, July 16).

The LCP has successfully enabled the export of good terminal care out of specialist palliative care units and into hospitals, care homes, and private homes. Although I have not observed this, I have to accept that there may have been occasions when it has been misused (or possibly even abused) but this is a reflection on clinical judgement and not on the LCP itself.

The proposal to have personalised care plans is interesting, but that is exactly what the LCP is. Every question is relevant to the situation where a patient is in the last few days of life, but can be answered in a way which is appropriate to the individual. Contrary to common opinion, there is no obligation to withdraw food, fluids or drugs if these would be of benefit to the patient or if, for example, the patient feels thirsty or wants something to eat. Conversely, a misguided obligation to rehydrate or feed dying patients is almost certain to cause distress and would be to the detriment of many. The LCP is used because a patient is dying. It should never be that the patient is dying because of the LCP.

It is fascinating that in the whole assisted dying debate, the public response is to favour such a policy. However, the reaction to what is perceived as "backdoor euthanasia using the LCP" demonstrates what people actually feel when they think this is happening, and I hope this dissonance does not go unnoticed.

The introduction of the LCP was accompanied by detailed training in its use. Perhaps we need to rehearse that training, or to improve the communication skills of clinicians who are speaking to patients and relatives about this stage of care. But it would be a great pity to throw the baby out with the bathwater, and to lose altogether an instrument which has had a generally positive influence on the quality of terminal care.

Dr Stephen Hutchison,

Consultant Physician in Palliative Medicine, Highland Hospice,

1 Bishops Road,