Letters: Pathway to solace in death

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The Liverpool Care Pathway for the care of the dying (LCP) has come in for ill-informed criticism (report, 9 January).

I am a retired cardiologist with no formal palliative care training. My interest in the LCP began when I was involved in its introduction for the care of patients with terminal heart disease more than 10 years ago in south Manchester. It is a meticulously designed comprehensive management programme which, when used correctly, offers comfort and dignity for the patient and solace for family and friends. The problems being reported have not arisen because of shortcomings in the LCP but as a result of its misuse by medical teams who failed to appreciate that it is not just a tick-box exercise.

One basic tenet of palliative medicine is that treatment for the terminally ill "should neither shorten nor prolong life." Another is that advanced communication skills (which very few other doctors possess) are an integral part of good patient care. The opprobrium heaped on the LCP is a result of non-palliative-care teams failing to follow these principles. Medical teams with palliative care experience do not kill patients and nor do they fail to consistently communicate about the patients' management with them and with their families.

Those who criticise the LCP in hysterical, apocalyptic terms demonstrate a lack of understanding of the working of palliative-care teams in general, and specifically of the LCP. They do the terminally ill and their families a serious disservice; some patients, through the fear generated, have refused to be placed on the LCP, sadly depriving themselves of the opportunity for a peaceful death and leaving their families with bitter memories.

Dr C Ward

Dundee

Free education from the control of the state

You report that the Conservatives are considering introducing for-profit schools in their manifesto in 2015 (10 January). Shouldn't this be welcomed? The state makes up 93 per cent of the education sector, schools are overcrowded and parents have hardly any choice of where they want to send their children to school.

In The Spectator's "Private School Guide" last year, some private schools were providing cheaper and more effective education than many state schools. We need more of this, and introducing profit in education combined with a state-backed education voucher, the cost of private education will fall. New businesses will open schools in areas where there is high demand for education, new ways of teaching will be discovered and supply will be expanded.

This is not possible under the current state monopoly on education. The Government has run out of money, there is little innovation by state-paid bureaucrats and there is no price mechanism working to indicate where there is a lack of supply. This is why we have huge problems in our education system.

We need bold thinking outside of the box, and introducing profit is a step in the right direction.

James Paton

Billericay, Essex

Mali, the West's latest target

Your leading article of 15 January, combined with reports in recent editions, makes an excellent case for invasion of the Islamist regime in Mali: the desecration of historic monuments, forced Islamic dress code, amputations for crime, beheadings and so on. So when are we invading Saudi Arabia?

But no, the Wahhabist state – our great ally – is to be left alone, Mali is the new target. Undoubtedly the existence of large oil deposits and other mineral wealth under the desert sand has no influence at all on yourselves or the rest of the Western media. The current scramble for African riches is to be ignored.

Western imperialism has bought nothing but misery to Africa; the entire continent is treated as a western mineral deposit with some people in the way. The Sahara is no different; the Tuareg and others must be moved out of the way to allow exploration; that is the process being undertaken now.

Chris Miller

Bristol

While I wholeheartedly agree with Owen Jones (14 January) that intervention in Mali by France might have destructive consequences, I consider intervention as necessary to provide peace and stability in the region.

As you have explained, this conflict is the consequence of the Libyan intervention, which was led by France and Britain. Some of Mali's jihadists are former Gaddafi fighters, and although Mali's government is far from being democratic, Britain and France should provide them with support to restore constitutional order and territorial integrity and prevent further spread of terrorism in the region.

Selikhov Rasul

Newcastle upon Tyne

Stop demand for lead in petrol

I found your article on tetraethyl lead (TEL) misguided in its indignation ("Made in Britain, the toxic lead used in fuel sold to world's poorest", 14 January). The environmental, health and safety hazards of producing, handling and using TEL should not be underestimated.

The consequence of banning the last (known) manufacturer from producing it legally, in the appropriate infrastructure, and under the jurisdiction of the health and safety executive in the UK, without ensuring that demand is eliminated, is that it would be produced elsewhere under much less regulation and in far more hazardous circumstances.

The real issue is not that one company is still producing it, but that governments are still approving its use and therefore establishing a market for it. If environmental campaign groups were to turn their attention to encouraging the last few countries and the UN Environment Programme to make sure that all fuels, including aviation fuels, are finally free from TEL, this would be far more effective.

Ronan M Bellabarba

Cupar, Fife

Savile and the 'creepy' label

Christina Jones (letter, 14 January) congratulates herself for being wise before, during and after the event, describing Jimmy Savile as "creepy and repulsive" and claiming never to have watched his programmes. There seems to be no end of such wise and insightful commentators coming out of the woodwork, all of them effectively saying: "I never liked the look of him, and I always knew he was up to no good".

I have no wish to defend Savile's actions, but I find this sort of "thinking" (if I can dignify it with such a word) equally creepy and repulsive. There are any number of people who, either because of birth or choice, do not look conventionally "normal", but who do not deserve to be so lazily pigeon-holed. Remember what happened to Chris Jefferies in the Joanna Yeates murder case; for him, it was enough to have a dodgy comb-over to be labelled a dangerous killer.

Edward Collier

Cheltenham, Gloucestershire

It seems to me that the ultimate blame for the Jimmy Savile affair lies with the legal system itself ("Britain's most prolific sexual predator", 12 January). It is a system that apparently allows the rich to browbeat and bully the less well-known and less well-off. Had this not been the case, it is abundantly clear that Jimmy Savile could have been brought to justice decades ago.

Until the law is changed to make it accessible to all and equal to all, this whole sordid business could happen again.

Peter Smith

Hertford

We don't need gay marriage

I am getting the impression that same-sex civil marriage is regarded as a Good Thing which all gay people want. My partner of many years and I do not agree. As civil partners, we have all the legal protection and benefits of married couples. In reality, same-sex marriage already exists for those couples who wish to take advantage of it.

The only case for creating civil marriage is that civil partnership is somehow second-rate. We find this deeply patronising. It is no more second-rate to marriage than being single, childless, divorced, undersexed, widowed or just plain odd.

I have been used for most of my life to being regarded as second-rate by bigots. Now I will be labelled as second-rate by liberals.

Jon Blanchard

South Croydon, Surrey

How to paint a dull royal portrait

If it is true that the portrait of the Duchess of Cambridge was done largely from photographs, with only a couple of sittings, it is not surprising that it appears so bland.

As a portrait sculptor, I need to get to know my subjects. This can be like a one-sided love affair, but it is only by getting to know the subject that my response to him or her will come through to the portrait, and bring it to life. Without enough sittings there is no feeling and the finished result is flat and "dead".

Sara Neill

Tunbridge Wells, Kent

Quicker houses

In Ross Clark's article on how to "solve the housing crisis" (11 January), one word was conspicuous by its absence: productivity. Walls are being built brick upon brick, roofs tile upon tile – labour-intensive technologies two millennia old. Yet good houses can be constructed faster and more cheaply by using pre-fabricated units. "Pre-fab" became a dirty word after the Second World War, but the use of colour and different textures can result in houses which are a pleasure to live in.

William Robert Haines

Shrewsbury

Off the map

James Moore (8 January) finds it bizarre that people actually like Morrisons of Bradford. He then refers to the supermarket group as "the cheekie Geordie chappies". Morrisons are based in West Yorkshire. The territory of the Geordies lies immediately north and south of the Tyne, further up the map from Bradford and on the right hand side.

Edward Pearce

York

Death in colour

I am not surprised at all that thousands of people still have monochrome TV licences (report, 10 January). I first saw the Visconti film Death In Venice on a black-and-white portable while a student and liked the film immensely. The scenes of the Venice Lido in the mist are particularly evocative. I have seen the film in colour since and can't abide it.

Tom Orchard

Manchester

Undeserving

Many "hard-working families" must depend on Jessops for employment. If they can't find alternative jobs, and become reliant on benefits, will they then become, according to this government, "scroungers"?

Rob Bray

Ardentinny, Argyll

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