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Is the Liverpool Care Pathway badly maligned?

Claim that thousands of patients are being killed appears sensational

By on Thursday, 28 June 2012

There was an article in the Daily Mail last week, picked up by the Telegraph and The Catholic Herald, with the headline: “Top doctor’s chilling claim: the NHS kills off 130,000 elderly patients every year.”

Apparently Professor Patrick Pullicino, a consultant neurologist for East Kent Hospitals and Professor of Clinical neurosciences at Kent University, stated in an address to the Royal Society of Medicine: “The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway. Very likely many elderly patients who could live substantially longer are being killed by the LCP. Patients are frequently put on the pathway without a proper analysis of their condition. Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically.”

For those not familiar with the LCP it is a response to a patient perceived to be dying developed in a Liverpool hospice that involves heavy sedation, coupled with withdrawal of food and fluids. Professor Pullicino went on to comment that “This determination in the LCP leads to a self-fulfilling prophecy. The personal views of the physician or other medical team members of perceived quality of life or low likelihood of a good outcome are probably central in putting a patient on the LCP. If we accept the LCP we accept that euthanasia is part of the standard way of dying as it is now associated with 29% of NHS deaths.” It seems the Daily Mail then calculated the figure of 130,000 being “killed off.”

I would have been inclined to believe all this, having read anecdotal evidence in the past of the hazards of the LCP, though I wondered why, if it were true, it did not dominate the next day’s headlines and news stories. Then I read BioEdge, an online commentary on bioethics, which pointed out that the article was full of general speculations such as the phrase “very likely”, the words “probably” and “if” and “associated with”. It was opinion rather than fact, which the Mail, in its sensationalist fashion, managed to turn into an emotion-grabbing story. (BioEdge thinks the Mail has taken up the discarded mantle of the late News of the World; I think that’s going too far.)

Dr Peter Saunders, head of the Christian Medical Fellowship and a strong opponent of euthanasia, commented: “The overwhelming majority of people on the LCP are experiencing much better care at the end of life than they would have had if it had not been chosen.” It would be interesting to know the medical reasons why people are being put on it, though; and the statement also implies that a minority of people might be experiencing worse care ie inappropriate measures that are deliberately ending their life too soon.

Yet Dr Philip Howard, an NHS doctor from Surrey, is pessimistic about the benefits of the LCP; he feels it means large-scale euthanasia by stealth and that the practice would gradually make it irrelevant whether euthanasia should be legalised. He commented: “It is a decision with an end in view. The patient is dying. Why? Because we say they are dying. Why? Because we have decided.”

Yesterday on the radio I heard that in the near future local councils will have to ditch all their other commitments (apart from emptying the bins), such as the maintenance of local roads and providing public libraries, in order to pay for the end of life care of their elderly local residents. It strikes me that wheeling out the LCP alongside the wheelie bins will look like an increasingly attractive option to our health and social services. This is my opinion rather than fact, obviously.

  • Jason Clifford

    Both of my parents were subject to the type of care proposed by the LCP – heavy sedation via large doses of morphine and no food or drink. The intention is to prevent pain and suffering on the part of the patient – and on the part of those close to them and those caring for them.

    The problem with this is that reducing pain in this way robs the patient of awareness during the most important part of their life. They are unable to use this time to be reconciled with others.

    Instead they are reduced to a state of bare existence and starved to death.

    I did not know any better when my mother died. I did however when my father was dying and the hospice he was in started this path with him. Because I caught it early on I was able to take him out of the normal routine for long enough that he was sufficiently aware as to be able to tell me that he did not want his awareness stolen from him. We took him home and cared for him there with help from the excellent community nurses and Macmillan nurses.

    Suffering is not something to be avoided at all costs. We must not forget that suffering, when joined to that of Christ in His passion, has a vital salvific element. It’s hard to watch someone you love suffer – your own suffering is can also be joined to that of your loved one and Christ.

  • MCarroll

    Catholics should read this list of reasons why they should not engage with any aspect of LCP. 

    There is very little information out there for Catholics so this is a good starting point.

    http://catholicgadfly.blogspot.co.uk/p/cbcew-liverpool-care-pathway-guidelines.html

  • paulpriest

    Yes the Liverpool care Pathway is back-door euthanasia.
    Despite Prof David Albert Jones claiming it is only euthanising when the guidelines are abused there is absolutely no need to abuse the higly arbitrary and discretionary statements and still accelerate or even actuate a patient’s death.
    I have been repeatedly dismissed over the years for my desperate appeals against Conference’s endorsement of the LCP [and let's make it clear - even though the 'official' endorsement was removed from the final 'BCEW end-of life pastoral care document it was present in the preliminary draft and not countered in the final one ; nor has the LCP been anything but promoted far and wide across the country by Catholic charities, commentators, professional lay representatives/academics and even repeatedly by Archbishop Smith] I was personally publicly denounced by members of Catholic Voices for my position ; they claimed , and I quote: “There is absolutely nothing wrong with the new guidelines of LCP v 12″

    The CDF and repeated Papal directives [Evangelium Vitae, pastoral care for those in PVS, etc]  teach that
    nutrition and hydration are forms of natural care and not removable
    clinical treatment 

    Yet the Liverpool Care Pathway v.12  states they may be removed when ‘it is
    no longer tolerable’ or ‘in the patient’s best interests’

    The Liverpool Care Pathway has a 72hr prognosis-limit as the determinant for sedating opiate provision for analgesia rather
    than a needs-based pain-alleviation system – people are put to sleep; never to wake up again.

    [Note that
    the terminally ill with non-cancer diagnoses are more likely to have their
    lives unnecessarily shortened by opiates (Gomes 2011, Trescott 2008)

    AND
    that Pius XII's allocutio to anaesthetists Feb '57 spoke of the
    deprivation of consciousness for unnecessary, non-grave reasons as 'a
    deplorable practice'..'repugnant to Christian sentiments' and ultimately
    evil!]}

    Dr Peter Saunders is – plainly and simply – wrong; and it is deeply saddening to say this.

    The daily mail may have hyperbolically overplayed their hand with wild speculation and fantasist false induction – but it is very simply the case that at present the LCP is directly in contravention of Catholic moral teaching and we should in no way be either supporting or endorsing it.

    It is accelerating the deaths of many, murdering the few, and denying virtually all the chance to come to the end of their natural life in analgesic consciousness where they can die with the dignity of saying goodbye to their loved ones.

    It’s barbaric – it’s euthanasia – it’s a grave evil.

  • stevhep

    I work as a nurse mostly specialising in care of the elderly. In my experience the LCP does not mandate the heavy use of opiates or sedatives. It permits it if it is clinically indicated. That is a person for whom inevitable death is imminent is experiencing distressing symptoms of pain, agitation or nausea. Such medications can be delivered via a subcutaneous syringe driver and if insufficient can be topped up by further injections. The insufficiency is measured by the presence of symptoms of pain, agitation or nausea which may require the background driver to have it’s potency increased. The protocol is that the LCP should be embarked upon with regard to the expressed wishes of the patient, either in the past or currently and in consultation with the next of kin and with an exploration of the persons spiritual belief’s and values so far as they can be ascertained. Furthermore people can be, and in my experience have been, taken of the LCP if there are measurable signs of improvement or recovery.

    The LCP presents itself to me as an improvement on what preceded it, i.e, haphazard arrangements made on an ad hoc basis often by junior physicians with no real experience of care of the dying. The biggest danger presents itself through the withdrawal of artificial hydration although there is no barrier to oral intake of fluid except that presented by the patients level of consciousness or ability or desire to swallow. The Charter for Health Care Workers http://www.wf-f.org/healthcarecharter.html issued from Rome has this-

    “The administration of food and liquids, even artificially, is part of the normal treatment always due to the patient when this is not burdensome for him: their undue suspension could be real and properly so-called euthanasia.”

    Which leaves open the meaning of the word “burdensome” in this case. It think the intent is to close of the withdrawal of such treatment in illnesses like Persistent Vegetative Syndrome rather than to forbid it bearing in mind this principle from the Charter
    “21. For the doctors and their assistants it is not a question of deciding the life or death of an individual. It is simply a question of being a doctor, that is, of posing the question and then deciding according to one’s expertise and one’s conscience regarding a respectful care of the living and the dying of the patient entrusted to him. This responsibility does not always and in all cases involve recourse to every means. It might also require the renunciation of certain means to make way for a serene and Christian acceptance of death which is inherent in life. It might also mean respect for the wishes of the patient who refuses the use of such means” 

  • JByrne24

    Perhaps an insight can be found within two of the statements made. 

    Professor Patrick Pullicino:  “Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically.”         And

    Doctor Saunders: “..people on the LCP are experiencing much better care at the end of life than they would have had if it had not been chosen.”

    Saunders’ assumption that the “end of life” has always been reached, when LCP is “activated”, no doubt often ensures that it has been.
    Prof Pullicino’s statement denies the possibility of knowing that this point has been reached. But if food and all drink is denied to the person then death results.
    The death can then (wrongly) be interpreted as a correct  prediction that it was only a few days away, when it is more probably, and simply, the result of the application of the LCP.

    This is only a cruel form of euthanasia. Our society is deliberately deceiving itself by denying euthanasia and allowing high-flown moralisers to preach about the sanctity of life etc,  while simultaneously allowing a cruel, and partly hidden form of it to take place under another label – and equally effectively. 

    My mother was subjected to this, and I agree with some of Jason Clifford’s comments. My father died suddenly from a heart attack (his first known) – I have my fingers crossed, although I will, if needs be, seriously consider going abroad for a planned death.

  • Joseph Sowerby

    In reply to stevhep:

    This, too, is how I understand the Liverpool Care Pathway and the teaching of the Catholic Church. I certainly have the sense that, if the assessments expected by the pathway are carried out properly, levels of pain relief, for example, should be matched to the patient’s need. Withdrawal of aided nutrition/hydration should not be immediately equated with “application of the Liverpool Care Pathway”. A thought I do have is that an effective use of the LCP needs quite a high level of patient/relative engagement with the processes involved - if it becomes an exclusively clinician-led assessment then the nature of the pathway in terms of patient experience might change significantly, giving rise to some of the concerns that others have.
     
    But a blanket statement that the LCP is in contravention of Catholic moral teaching is not accurate, and is somewhat ill-informed. I believe it is quite possible for the pathway to be used in a way that is compatible with Catholic teaching.

  • theroadmaster

    There is a fine line between heavy sedation to relieve pain, and an overdose of morphine with the hidden intention of causing death, and to thus curtail any chance of end of life care.  Life is widely viewed in strictly utilitarian terms, and a person’s worth seems to decrease with the gravity of illness and level of economic unproductivity.   This mindset unfortunately characterizes the attitude of much of western society towards care for those who have fallen prey to life-threatening diseases or conditions, The populist view regards the autonomy of the individual as being superior to objective, holistic medicine.  In that light, the words of the esteemed neurologist, 
    Professor Patrick Pullicino, give rise for concern, as he would be considered a sober-minded professional who is not prone to sensationalism.  Possibly an independent investigative committee of recognized experts from the medical profession should review the effectiveness of the LCP, in terms of the best ethically-based practices in medicine.

  • http://twitter.com/terryprest terry

    The debate about the Liverpool Pathway is not simply a debate or difference of opinion  between Professor Pullicino and Professor Saunders.

     
    It would seem that other distinguished Professors and consultants support the viewpoint of Professor Pullicino such as  Peter Millard, Emeritus Professor of Geriatrics at the University of London, and Dr Peter Hargreaves, palliative care consultant at St Luke’s Cancer Centre in Guildford,

  • S J H S

    I have studied the LCP a lot with the help of an anaesthetist. My husband was put on it.
    I believe that where proffessionals are not giving the whole and honest truth, one must ask why. 
    1 A possible side effect of valium family drugs is to raise breathing rate, therefore,  haveing administered the former, why are you now pressuring to give diamorphine to try and lower the breathing rate, inferring it would make the patient more comfortable.
    2.If my husband could not swallow as alleged, why were some nurses giving him a little drink. ( because they had some grain of compassion),Why was he keen to suck juice off a spoon. I believe it is standard practice to say Nil By mouth, when in fact the patient is hungry and thirsty. In fact I just believed them at first, then I was forbidden to give him any more sips of drink.Lying about whether someone can swallow or not does not engender trust.
    3. The death rattle does not hurt and is natural so why do nurses make such a fuss about it?
    4.The are drugs are all pre-prescribed, on the paper work you explain why the drug is not given, rather than the reverse, and in nursing homes, the   are stocked for each person  in advance.. 
    5. The LCP is the governments plan for everyone, and it is, I believe, so highly politicised that anyone who questions it is in danger of losing their job.

  • Lewispbuckingham

     Dear SJHS ;Having been with my mother as she died, peacefully as it happened, with no valium or other drugs I may share with you that I do not envy your experience.
     It is true that valium may heighten breathing and cause a paradoxical exitement in a patient.This can only happen if the dose is relatively too high and the patient is unable to excrete the drug because of liver or kidney problems.The opioids can help the anxiety caused by such a paradoxical reaction from a drug that usually dissolves anxiety in a patient.
     My experience is in animals only, but they often mimic the drug reactions of man.
    These problems of excretion of drugs often occur at the time of terminal disease as the circulation fails.Sometimes the patient feels thirst, in my mother’s case she was in a state of general organ failure and the administration of fluids would have over hydrated her, filled up her lungs and she would have drowned.Her kidneys had failed and she could not remove excess fluid from her body.
     The death rattle, or as I prefer to think of it, the last gasp, is a desperate appeal by the most primative part of the brain, after the mind is at rest, to call on the body to wake up.
     It is most distressing to watch and any nurse that has seen it before wants to reassure those that have seen it for the first time that it is normal and part of the patient’s passing.
     My comments now are general in nature, I am not across the LCP protocol.
     One of the problems with high schedule drugs such as morphine is that the drug book just has to balance or all hell breaks loose.This could explain the prior ordering of drugs and the signing off for each patient over a particular time period.It’s not best practice and if this protocol encourages it then it needs rectification.
     The use of morphine for the terminally ill is almost a mantra in the medical profession.
     Despite this there are many opioids which have far fewer side effects, such as nausea, flushing and catastrophic clouding of consciousness which at least fifteen years ago were not used in Australia.
     My Italian neighbour, a wonderful man, dying of the respiratory form of mesothelioma, insisted they not cloud his mind till the pain was too great and he had many wonderful conversations in his last week, surrounded by friends.He showed the way.
    The situation here is since vastly improved and excellent pallation has been given to many of my friends.
     If the problem is political then that is the place you must enter if there is to be change for the good.
    It starts with building good hospitals and developing a gold standard for pallation in them.All the politicians and the influence makers go there for treatment and if needed pallation.
     If this were to happen then your experience may not have been in vain.

  • Liberty123

    My mother was also subjected to this clandestine method of euthanasia. There was no diagnosis, no discussion with relatives, and she had a condition that could have been reversed with the right care – something I have only discovered since her death. She was deprived of fluids, nutrition and insulin over a period of 48 hours until I intervened and gave her fluids and then asked for IV fluids. She had been experiencing fluctuating levels of consciousness with moments of total lucidity – associated with delirium and common in the hospitalised elderly but only terminal, I understand , if it is not treated. She recovered enough to ask me to speak out for her. Two weeks later she developed an infection. Again the family were lied to and she was given antibiotics she was allergic to while unknown to us her notes read  “I see no point in treating a potential sepsis – NOT FOR ACCELERATION.” When her arms started swelling and turning red we were told it was just her age. She died five days later. Withholding fluids can cause renal failure and weakens the immune system. The LCP was intended to be benign but it has been hi-jacked to further a very different agenda that is nothing to do with bringing comfort to the dying but has a lot to do with helping NHS Trusts survive financially. If you look you will find many stories like mine.

  • MCarroll

     In that case how is it that priests are now beginning to say it is against Church teaching?

  • Pauline G

     Francis Phillips states:

    “For those not familiar with the LCP it is a response to a patient
    perceived to be dying developed in a Liverpool hospice that involves
    heavy sedation, coupled with withdrawal of food and fluids.”

    Is this so?

    According to a document which I found online, publsihed by the Marie Curie Palliative Care Institute:

    “The LCP does not recommend the use of continuous deep sedation”

    and

    “The LCP does not preclude the use of artifcial hydration”.

    I do not in any way condone the use of the LCP as a cover for the intentional hastening of death and there is ample anecdotal evidence that it has been and is so used. There is also clear evidence that continuous deep sedation, for example, whether ostensibly within the LCP protocol or not, is far more widely used than could ever be clinically justified.  This is clearly very wrong and must be vigorously challenged.

    Nevertheless, we should also acknowledge, as Peter Saunders does, that the LCP, applied properly (that is without any ethical compromise), has had a positive impact on the quality of end of life care for many people.

    Misrepresention of the protocol hardly helps to foster credible and productive debate and may cause great concern and distress to many families whose loved ones have benefitted from the LCP without any justification whatsoever. That is more than unfortunate.

  • Judith

    In my limited experience of relative’s deaths (where I haven’t been the immediate family) – there seems to be no/limited discussion with the immediate family, a routine withdrawal of hydration and nutrition and fairly routine sedation. There doesn’t seem to be any discussion around the fact that if hydration is withdrwan deat will always occur within 3 – 4 days. Even a healthy peson will die within 3- 4 days if they are not given water or food. in my limited experience heavy sedation has been given without any discussion, robbing relatives of any chance to discuss hwo their relative would like to die.

    The argument is that a heavily sedated death is less distressing for everyone. I ahve told my family that as far as possible I would like to have a natural death with minimal medication.

  • Lomond Handley

    I have had occasion to witness the witholding of nourishment for an elderly patient last September at the Royal Surrey County Hospital in Guildford, where a 93 year old stroke patient was put on one of these  ‘Pathway’ projects, in order to end her life.
     
    Mrs Marjorie Joan Clarke of Haslemere, a dear family friend whom I’d known for approximately 50 years, was admitted to the Royal Surrey County Hospital a few days beforehand where she was diagnosed as having suffered a stroke and she died some days later.
     
    When I visited her in the hospital after her admission, I was horrified to see this ‘pathway’ plan, printed up in her medical notes and this included the instruction ‘no nourishment’.
     
    I was unable to do anything to change this, as I was not a relative and it appears that those who were not her relatives, but who had her power of attorney were in agreement with the hospital’s policy.

  • Daniel_colquhoun

    my dad was put on the program and having cared for him from his first diagnosis till the day he died at home on 14 06 12 i feel i let him down terribly by allowing him to be put on this program my dad had terminal small cell lung cancer and never been on this cancer journey before i can honestly that after all advice from doctor and nurses involved i thought i was doing the right thing for dad at the time but realize what a terrible mistake i made if i new then what i know now i would never have allowed it you see dad had the cancer for 14 months and never had any sort of pain relieve apart from paracetamol until 4 days before he died i know my dad was dying and he was getting worse on a daily basis but he was still able to get up out of bed and go to the toilet with a little help from myself he was confused as the cancer had spread to his brain so they said although no scan was ever done he never soiled or wet himself or needed oxygen at any time during his illness he died 3 days later due to this program my dad should have been allowed to die in his time not on there time i feel they robbed me and my brother of saying a proper goodbye to dad   its a horrible way to treat any human being in my opinion and i feel so guilty for letting it happen 

  • StopUnlawfulKillinginHospitals

    they did this to my dad and it wasn’t his last hours and days. Doctors at North Middlesex Hospital , London N18 were also neglecting his palliative treatment to make him more ill than he was.

    Complaints and shouts to get him off this went ignored. Was still fine on Tuesday, eating drinking, sitting up in chair but doped up. Wednesday was heavily sedated to make him bed bound. Thursday was killed.

    Lethal injection by Doctors at Oncology Ward, North Middlesex hospital. My dad didn’t sign up for any form of Euthanasia, but went into hospital for a simple drainage of the lung.

    The medical team which was meant to ensure that we was to receive palliative treatment, included contract doctors, a MacMillan Nurse ( of the hospital) and they decided to kill him off before his time was due. His illness didn’t kill him, but the cocktail of DiaMorphine, Cyclizine, Hyoscine Hydrobromide, Midazolam. ( killing cocktail).

  • Caramorrissey

    may  i add that the  liverpool care  pathway  does not just put the elderly to  death  my mother  was  put on the  pathway  without our consent or my mothers she was just 59 years of age . the hospital  denied mum was on the pathway altho  they  removed fluids and food 4 days before her death ….

  • Caramorrissey

    hiya to  all  i have made a  group on facebook  called LIVERPOOL CARE OR DEATH  PATHWAY  would be nice to  hear  your  stories on this there  i hope  that  with  enough people  we may  be able to  stop  this hapening  to  someone elses loved one .. lets  take this to  the top 

  • johnny

    dr. peter saunders is hiding the truth,by pretending to be a strong opponent of euthanasia its a load of rubbish  he is already doing backdoor euthanasia on the so called liverpool care pathway more like a death pathway and he knows it, the british public should demand a referendum and this will prove right from wrong,  to virtually starve a patient to death backed  up  by syringe driven morpine, 24hrs a day  is worse than what adolf hitler did in the 2nd world war. whoever gives the tick box orders should be executed themselves on the liverpool death pathway.

  • moneymad

    how can this liverpool care pathway be allowed to continue with all these professionals speaking out to the national newspapers surley they must know what they are talking about they work in the profession of helping patients to survive young or old and infirm, lets not use hitlerism to save money not lives. i am disgusted with the british governement it stinks.

  • will

    In my direct experience LIVERPOOL CARE PATHWAY (LCP)   is indeed stealth.  The daughter and family carers were misled and lied to many times while the not born in Britain consultant locum waited for their permanent job which they now have.  Only by fighting for the medical records for 9 months could the family find out the name of the consultant and read so many inaccuries and unsubstantiated points including that the family agreed when they did not.  The death was an economy for the hospital.  The details were like Hitchcock film.  Like the carriages going to the concentration camps in WW2.  We witnessed a lot of cover up.  The nurses, mostly agency, have moved and the matron as well.  Nursing staff know when a patient cannot consent.  The instruction is move the patient from the general ward to an isolated one and the family is told to COMFORT and then the family requests are utterly and mechanically ignored.  The most disgusting point is that it is not -in our case – for the ‘best interest’ of the patient – who I believe would have lived on.  The majority of people do not know that the power lies between the doctor and the patient which is fine if the patient ‘understands’ and ‘consents’.  The opposite is a barbaric practice of not writing down LCP details.  Getting signatures of consent from family should be continually on the media news until every voter understands their ignorance and that consultants are being allowed to practice in such a way which is not checked or is public knowledge.  All OK’d by you not knowing our Acts of Parliament.  Look around!  We are selling it abroad too!  But not in France, Germany and Spain, I believe.  Here, it is not debated and it is being ALLOWED to be used, not supervised and not documented.  It happened to our family and in my own country of England in a NHS central London hospital.  Not one person I know had heard of it, us included, until after the death of our loved one.  But within 1 month when I mentioned THE MANNER of death, 3 complete strangers said the same had happened to their loved one and they had never heard of the LCP.  These relatives will remain in shock for their lifetimes, like us.   The CEO does not answer letters.  The head of Department said the LCP was not practiced in his Department.  It was.  Whats more the Asian ward consultant at weekend prepared a DO NOT RESCUSITATE form without consulting the family who were 1 metre from the patient’s bed 24 x7.  (a pro life signed document had some months previous been sent to the medical records).   The name LIVERPOOL CARE PATHWAY was not mentioned at all by any staff at all.  It was the most awful happening I have seen in my life and it should never happen to anyone else IN THE CASE WHEN A PATIENT DOES NOT HAVE CAPACITY TO CONSENT.   The law needs adjusting as the family desires or any power of attorney is not valid in a hospital.  But at home, it is!  IS THERE AN ORGANISATION MAKING THE PRIME MINISTER AND THE QUEEN AND THEIR CITIZENS AWARE our LOVED ones are being killed off in this manner, right now, – IN FRONT OF OUR NOSES?  In WW2 ‘the people’ also said they did not know the murders were going on in the camps.  If our Government wants to economise they will soon have white vans going around the nursing homes with white coated ‘anybodies’ aiming syringes of morphine which take 33 hours til death – and cheaper than medical intervention.  IT IS already happening and allowed in the way I have described in only about 5% detail.  Write to the PM and Queen – no less – Get up and do something about our country hidden tactics which now you have read this, ‘you’ are allowing.  fin

  • Donald

    i believe this LCP was applied to my 28 year old son who died last sunday 22nd july at 3-30am in hospital having been diagnosed with pancreatic cancer in late april.
    on thursday i was having conversations with him, he had been admitted to hospital again on tuesday after contracting a bladder infection, after just having overcome a lung infection.
    on friday he could not speak and was not breathing properly and was being given diamorphine to -ease his pain.- he was not offered any food or drink, his clinical records disappeared from outside his room.and his 2 sisters, his brother, mother and i were with him almost constantly. at no time did any one tell us or suggest that he was on this path. he could not answer for himself and so he died not knowing that his loving family and friends were with him.
    i believe he was stolen from us.

  • concerned

    to joseph sowerby, how can the lazarus pathway be compatible with the catholic faith when the pope is screaming for catholics to wake up on this back door euthanasia, its plain simple murder, you have professors and top doctors criticising saying how wrong it is, i myself have seen two relatives butchered on it, and quite clearly from all the petitions and relatives seeking solicitors it should be banned instantly.  

  • concerned

    to stevhep, with you working and you administering this back door money saving lazarus pathway, its  obvious you will say its a good way to kill a patient because thats all it does, did you not read numerous daily newspapers,  professor pullicino a consultant neurologist says its equivalent to euthanasia, and its an assisted death pathway rather than a care pathway.also peter millard emeritus professor of geriatrics at the university of london, and dr. peter hargreaves a pallative care consultant at st lukes cancer centre in guildford surrey, warned of back door euthanasia without a proper analysis of there condition predicting death  in a time frame of 4 to days is not scientifficaly possible, 450,ooo, deaths a year in hostpitals out of this amount  29%  were on the liverpool pathway, 130,000 deaths ,note the care missing,  in the l c p. also complaining were 6 top doctors, all in the same field of work like you  stevhep, its a disgrace to the british governement.                      

  • Paulanderson002

    are you a professional person eg priest ect.. im very sad and failed my mum on the above matter i tried very hard to save her but failed

  • Paulanderson002@aol.com

    please dont feel guillty i no what you mean they did the same sneaky triks to me our problam is we trusted the doctors why would we ever to think theid kill our loved ones we need to find a find a way of stopping this

  • Paulanderson002@aol.com

    if theres anything i can do to help you stop ths contact me paulanderson002@aol.com   iv had a very bad excperience and want this to end

  • Paulanderson002@aol.com

    o gosh i dont no how you managed to go thru this 2times iv been there 1 with my mum it drove me mad i wish i could stop this

  • Paulanderson002@aol.com

    you sound very green ,i can assure  you the lcp is misused , and twisted in every possible fashion it can be .the only reason doctors no there dying is because there gion to kill them

  • Johnny Meehan

    thats a load of bollocks how come they starve them to death and at the same time put them on a 24 hr syringe driven morphine driver to see them murdered by the back door , if you starve a person who is healthy they will die on this barbarick, hospice contraption its death by starvation and poisoning its a fact, ask dr pullcino and six top doctors who work   in hospitals, not down the pit. 

  • Karen

    My husband was put on the Liverpool Care Pathway when he had
    lost his swallow reflex. Offering him food and water would have made him choke.
    He did not have the full dose he was prescribed of either morphine or anti
    agitation drug. He died at home with me and my 15 years old daughter – earlier
    in the day the district nurses had called in.  As his body failed he
    became more agitated – he wanted to speak but as he could not swallow he could
    not speak. Hr struggled for every painful, noisy breath until his body finally
    gave up. I was upset at his suffering and was later told by a MacMillan nurse
    that as the body fails it releases adrenaline to try and overcome the physical
    problems and this causes the restlessness and agitation.
    When he started on the LCP his body was already closing down. I would have
    liked him to have more anti-agitation drug to calm him and make the end less
    traumatic for all of us.

  • x nurse

    to karen, which hospital do you practice this barbarick is back door murder,you dont need to worry   karen if his body was not closing down the lack of iv fluids and food would soon close the  the bodies  organs down  the starvation of the l c p is the main cause of death, on the death certificate it should read dehydration but it will not for money saving issues, i will say a prayer for you.

  • Bev

    They are doing the same to my mother and after reading this I’m going into the hospice and asking for her to come home

  • Helen

    did you get your mother home?  my mother is on lcp and shes wasting away in front of us its barbaric, it wasnt fully expalined to us about removing fluids and foods,  6 days ago my mother was sitting up eating her dinner by herself, now she is all bones and cant communicate  with us but is very restless like agitated when the morphine and med drug where said to help her have a peacefull  time, which is all un true please can  anyone out there help us  

  • watchman

    when you are tricked onto the no turning back cruel uncaring liverpool  pathway very few survive only those taken of it early before the damage has been done with. the starvation and lethal drugs given so called to give dignity  when did starvation and poisonous drugs give you dignity they just kill you before your time is up.

  • John

    Yesterday on the radio I heard that in the near future local councils will have to ditch all their other commitments (apart from emptying the bins), such as the maintenance of local roads and providing public libraries, in order to pay for the end of life care of their elderly local residents. It strikes me that wheeling out the LCP alongside the wheelie bins will look like an increasingly attractive option to our health and social services. This is my opinion rather than fact.

    The above statement is the criteria of the LCP.

    The LCP is murder my father was killed in this way last year he had dementia.We were not asked or consulted, one day he was able to talk to us the next he was unconscious and starved of food and liquids. I begged them to feed him and give him liquids but they refused. We were unable to feed him ourselves because he did not respond because he was drugged. Docors are now playing God they do not have the right. The day before they started this process we were granted continuing care. I believe this was done for financial reasons.

    We have the nerve to criticise the Nazis are our doctors any better than  Dr Mengele.

  • Liberty123

    I had the same experience as John. On the day I confronted doctors about withdrawing food and fluids from my mother without a diagnosis and when she was still communicating with her family and expressing her desire to get better (Her notes read after her death showed she had a treatable and not a terminal condition which was never mentioned to the family) I was also told my mother was eligible for continuing care. My mother died two weeks later from an infection and was denied life-saving treatment. Who pays for continuing care? Is is the hospital or from a more general budget? Why are hospitals mentioning continuing care as an option at the point they have decided to end a life.

  • colette

    liverpool pathways is euthanasia and if u say its not if it happens to som1 close to u that u care about u will soon see what we have,  every human should be aloud to die naturally don’t agree at all i might not be a doctor but this is not wright there killing people that’s what there doing who gives them the wrights to put som1 on pathway ,the doctors may think well whats there ability to live well it doesnt really matter as long as there not getting murdered ,this has got to stop,

  • follyscorner

    In August 2005, my partner, just 63 years
    old, elected for a day surgery biopsy on a neck mass that began development in
    March 2005. At no time had she been judged as terminally ill.
    As opposed to
    accompanying me home that day the Consultant surgeon came to tell me that my
    Partner suffered respiratory collapse, following surgery, in the recovery room.
    An emergency Tracheostomy was performed and she was made stable in ICU.

    I next saw her consciously 4 days later on
    the nursing ward where she then told me, “I have been through hell”. Because
    she expressed a wish to seek legal redress when we returned home I took
    photographs of her condition that no one has ever seen. I have over 300 ward
    medical notes now condemning the NHS Trust’s treatment.

    A week later, the biopsy result, on 1st
    September ’05, was Tongue cancer and a discharge plan for home was made for 4th
    Sept with a referral for further out patient appointments.

    But, no one, to this day, can comprehend that
    on the 16th Sept, just a fortnight following a supposed cancer
    diagnosis, my Partner passed away.

    On 19th the hospital rang me to
    primarily inform me to collect the death certificate. The caller then proceeded
    to tell me, “Whilst I have you on the phone I can confirm that death will be
    recorded as LUNG cancer”? I questioned “can
    you explain why LUNG cancer when only a fortnight ago the surgeon
    diagnosed TONGUE cancer”? He replied, “For the purposes of death
    registration I have to state where the cancer originated”. Being a layman,
    but no idiot, I didn’t argue but knew something was untoward. He then added, “As you are only a partner you will not be
    able to request a post mortem”. I still didn’t contest the information as
    alarm bells were ringing 90 to the dozen.
    The day following the funeral I tried
    to engage a solicitor but to no avail. Every firm stated that any compensation is
    based on a 5 years survival rate of which Lung cancer has a poor prognosis and
    the cost of litigation would be cost prohibitive.

    I was finally advised to apply for her
    medical notes and, if I still felt that explanations were needed, to proceed
    with the NHS complaints procedure. On the issue of being denied a post mortem
    the Trust immediately responded with, “the information provided to you was
    made by a Coroner’s Officer who is beyond the remit of any NHS complaint”.
    When the NHS is supposed to investigate and respond to a complaint within 25
    days it took the Trust 6 months. The Trust vehemently contended that my Partner
    died of an aggressive form of Lung cancer. But, with no past medical history
    of any cancer it remains incomprehensible that she died within 3 weeks of a day
    surgery procedure?

    It took a further 3 years and 2 Independent

    Reviews, by the Healthcare Commission, for their clinical experts to conclude that
    none of the CT scans or chest X-rays showed any definite evidence pointing
    towards lung cancer? Only once the Health Ombudsman began her investigation did
    I become aware of the surreptitious use of a Morphine syringe with Midazolam
    and Cyclizine. AKA the LCP

    I obtained a private independent medical
    report upholding that no cancer existed and that medical notes reveal a number
    of occasions of missed Pulmonary Embolisms. Throughout the NHS investigation
    and expert reviews, delays, deceit and corruption are rife deliberately
    designed to expire the 3 years limitation period to bring litigation. I now
    have one of the UK’s top Barristers prepared to conclude my case if I can engage a
    solicitor to instruct him as he does not take direct instructions from clients.

    With regard to the initial denial of my right to
    a post mortem the Trust finally responded 4 years later stating that I was
    indeed entitled to request a PM. Whilst they offer a superficial and worthless
    apology for incorrect information they rubbed salt into the wound by adding, “please
    be assured that this example will be used by the legal department for
    educational purposes”.

  • http://twitter.com/DaveWMac DaveW. Mac

    YES and I have been warning people about it for months in my video http://youtu.be/gapbPxMgP3Q

  • David Sender

     Say a person gets a pension of £5756 per year and receives say £100
    medication per month = £1200 per year, the total maybe £6956 per year,
    if has attendance allowance = £51.85 per week = £2696 per year, if has a
    carer with a allowance £58.45 per week = £3039 per year, grand total =
    £12691, multiply that by 130,000 deaths by LCP then annual savings =
    £1,649,830,000 compound that by each year that those people would have
    lived longer, the government has saved a lot of moneyRead more: http://www.ncregister.com/site/article/u.k.-death-pathway#ixzz2BCkCkN5A

  • DawnBreaking

    Both my parents have died on this pathway.  My mother died five years ago and my father,only 2 weeks ago.  I stayed with them in the last days and hours of their lives as dedicated doctors and nurses battled to ease their suffering and keep them comfortable as they slipped away from this life. My father would have died in screaming agony if it was not for these amazing people.  I was able to assist in giving food and drink to my mother and father for as long as they were capable of taking it. In the days before he was placed on the pathway my father ate less and less until he was unable to take anything more than spoons ful of  yoghurt or ice cream which the nurses were keen to provide as long as he could swallow. This was not only to provide some nourishment but was considered as a way of boosting the morale and maintaining some quality of life for of the terminally ill person. When my father was no longer able to swallow even sips of liquid taken through a straw he was given a subcutaneous drip for hydration.  This resulted in his lungs filling up with mucous that he didn’t have the energy to cough up so the hydration was taken down to help his breathing. His sedation was increased in line with increases in agitation and anxiety, to make him more comfortable in his final hours.
    I have found these articles extremely distressing and I wonder if they are written by people who actually care about the dying or by those who see extreme agony, confusion, breathlessness and emotional distress as necessary payment for our sins in this life –  in the way that the labour pain suffered by women used to be seen by some in the Church as necessary to pay for the “sins of Eve”. Perhaps you are academics who rarely, if ever, set foot inside a paliiative care unit.  Perhaps you do not consider your own mortality, failing to understand that my Dad’s story could be your story one day.
    In his last days my father asked to see his priest, a request passed on personally by me.  The priest never came and some unknown priest was sent to minister to my father.

  • x nurse

    to dr. saunders you stand against euthanasia so you say, so why not stand against the liverpool uncaring money saving back door murder which is euthanasia itself, the proof is there to be seen professors and loads of doctors say it is a barbarick act to starve backed up with morpine, midazolem and injected killer drugs also without  nourishment and water it is lethal cocktail and puts the patient into an induced coma followed by death shame on the british government for allowing it to happen.. 

  • Codelou7

    my mum was put on the pathway for 17 days and died a horrible death and this is with me everyday she was a slow eater and was not good at taking tablets she wanted a drink but wasnt aloud to this day i blame myself for my mums death it was cruel and as made me ill 

  • http://www.facebook.com/people/Kevin-James/100002177166941 Kevin James

    Lets be clear about this. Patients are being actively killed by the withdrawal of all food and fluids. so they starve and die of dehydration within days. the heavy sedation to silence them and ease the death and pain. The active withdrawal of food and fluids from babies is also used as  a way of ending their lives. This is murder active murder and violence upon the person, a vulnerable defenceless person such as disabled, elderly or baby.

    I am not a defender or supporter of the catholic church because of your own bad practices and standards of care and regarding vulnerable and young. But if by Almighty God you are under Him somehow you know this is euthanasia and murder. 

    You despair me on all accounts.

  • true roman catholic

    hi daniel sorry to hear about your dad the same thing happened with my wife, i myself feel i have let her down by not  staying with her but was not possible i had a sick son at home, i did have her taken off it twice but they kept telling me she would drown if they gave her water, and choke if they gave her food so i did not want to be responsable for killing her i have since heard they get paid money to put a patient on this barbaric treatment i am gutted, i know exactly how you feel,one patient whom relatives wrote on google , doctors told them it had spread to  his brain they got a solicitor and got from the hospital thousands of pounds for there wrongdoing, iam not saying this was the case with your father but you never know i dont trust them anymore  

  • true roman catholic

    i think you are living in cloud cuckoo land a catholic will never want to be involved in  taking a persons live deliberately, no way we leave that to god almighty, the creator of  heaven and earth. i am very sorry joe..

  • true roman catholic

    thanks paul for your kind words you just have got to accept it but its so hard,thanks again.johnny.

  • watchman

    you talk a load of tripe steve, you  try not to have a drink or any nutrients for a   couple of days plus morphine i think you would feel on top of world, or more like an induced coma and  if you recover pigs will fly, and thats more bonus for you, its nothing less than cold blooded murder.and a disgrace to the british governement it has to be stopped and will be or the citizens of this country will be up in arms.