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Jeremy Hunt orders an inquiry into the Liverpool Care Pathway, and says patients and relatives must be consulted. But will the doctors pay any attention?

There is too much evidence that the LCP is being used by some doctors as euthanasia by the back door, and that they are wilfully failing to consult: the Health Secretary will be ignored

By on Friday, 9 November 2012

Palliative care specialists say doctors must be 'trained appropriately' before they adopt the Liverpool Care Pathway (Photo: PA)

Palliative care specialists say doctors must be 'trained appropriately' before they adopt the Liverpool Care Pathway (Photo: PA)

A discussion conducted on the Today programme last week, about the so-called Liverpool Care Pathway, has left me distinctly uncertain, not about whether or not the LCP is being used by some practitioners as a sort of euthanasia by the back door (since it looks to me as though it clearly is), but about how exactly we are to confront it. Some of its defenders are undoubtedly decent and compassionate people. The LCP is intended, so they say, to ease the last hours of dying patients to save them the suffering caused by invasive treatment. One defender, on the Today programme, claimed, with every appearance of sincerity, that they are simply doing what the hospice movement does: this is the introduction of real palliative care into the geriatric mainstream.

Its critics say that it is a way of hastening patients’ deaths: and the evidence really does seem to be that this is often the case. Typically, it involves most patients being sedated and then being denied nutrition and fluids by tube. There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. About 29 per cent – 130,000 – are of patients who are on the Liverpool Care Pathway (LCP). According to Professor Patrick Pullicino, far too often elderly patients who could live longer are placed on the LCP which has now become, he says, an “assisted death pathway” rather than a “care pathway”. He cited pressure on beds and difficulty in nursing confused or difficult to manage elderly patients as factors. He has also recounted how he has personally intervened to take patients off the LCP who later went on to be successfully treated.

Now, another ingredient has been introduced into the mix: a financial incentive for hospitals to get as many elderly patients as possible on to the LCP. In some cases, it is claimed, hospitals have been set targets that between a third and two-thirds of all deaths should be on the pathway. It is also alleged that at least £30 million of taxpayers’ money has been given to hospitals over the last three years to achieve this objective. Professor Pullicino comments: “Given the fact that the diagnosis of impending death is such a subjective one, putting a financial incentive into the mix is really not a good idea and it could sway the decision-making process.”

There can be little doubt that some patients have not in fact been dying at all when they were put on the LCP and that they have then been starved and dehydrated to death as a result. We know, because of those who somehow escape, usually as a result of their relatives’ horrified intervention (that is also how we know how often old people are put on the death list without consultation). Consider the story of 82-year-old Patricia Greenwood, who was put on the Liverpool Care Pathway by doctors in Blackpool, who removed all her feeding tubes and drips. Then her family, who had not been consulted, gave her water, which effected the beginning of a remarkable recovery. Now she is planning to go on a world cruise.

The excellent Melanie Phillips recently wrote a piece questioning the LCP. She had received many letters, containing alarming accounts of what had happened to elderly relatives. “One woman, for example, wrote that her father suffered a severe stroke caused by a blood clot in his brain. ‘All fluids were removed from him and we were told he was in the final phase of his life,’ she wrote.

“‘All we were told was that there was no hope for him; it was a matter of time before he died. Eight days later, he opened his eyes and proved everyone wrong by pulling round. Two years on from this he is back at home, although in a wheelchair and with some loss of speech.’

“Another woman’s 85-year-old mother was admitted to hospital with an infected gall bladder. The following day doctors told her, to her shock, that her mother was gravely ill and had no chance of survival.

“The doctors, who included three consultants, told her that if she did not agree to the Pathway she would be adding to her mother’s distress and misery. She signed the form – only to be horrified subsequently to find her mother highly disorientated, agitated and distressed from lack of fluids and treatment.

“‘I compelled the nursing staff to restore hydration and medications, or take full responsibility for the outcome if they failed to. I also took matters into my own hands by feeding her natural yogurt, soft foods and spooning water into her – something which was to continue until she was released three days later, having been restored to full health, cracking jokes and saying goodbye to those who were unfortunately left probably to suffer the same fate.”

Is Melanie Phillips simply being sensationalist? She has been accused, she says, by more than one doctor of “deliberately sensationalising the issue in order to sell newspapers, and to that cynical end I had set out to terrify dying patients and their relatives”. There are also genuine palliative care specialists who think that some press coverage has been sensationalist, so here, in the interest of fairness and balance (always a priority for this column) is Heather Richardson, of the organisation Help the Hospices, who says that “Recent media coverage around a small number of distressing stories has been sensationalist and at times inaccurate”, and that “it risks causing unnecessary distress to people at one of the most vulnerable times in their lives and may even prevent people from receiving the care that they need.” Maybe she is thinking of apparently sensationalist headlines like “Three thousand doctors putting patients on death lists that single them out to be allowed to die”. On the other hand, read the article: it all looks believable enough to me.

It also has to be said that though Heather Richardson is herself clearly bending over backwards to be fair to the LCP, what she says at greater length doesn’t look as though she is exactly wholly convinced that the medical practitioners who operate the LCP are necessarily entirely competent or even that they are not quite often just blundering around. The give-away passages are in my italics: “Help the Hospices”, she says, “believes that the LCP has played an important role in improving the experience of people who are dying and we support the use of this tool where staff have been trained appropriately in its application.

“We believe everyone should have access to the best possible care at the end of life, whoever they are, whatever their illness and wherever they are dying. The LCP has gone a long way to help achieve this.

“But there is still a long way to go to ensure high quality care is available to all. We urgently need to build on the palliative care training which is currently available to health professionals and in particular to those who are unfamiliar with the LCP.

“It is also important that professionals in palliative care work together and with families and carers to build the evidence base for the LCP and its impact.”

There is now (or so we are told) to be a Health Department inquiry into the LCP, and the Health Secretary, Jeremy Hunt, says he plans to make it a legal right for patients and their families to be informed of end-of-life care decisions, as part of changes to the NHS Constitution. Well, that is something, I suppose. But is it enough? The medical profession has an advanced capacity to carry on doing exactly what it was doing before. Will it really pay any attention to this here today, gone tomorrow politician? I doubt it.

  • watchman

    aidan do you not read tabloid press there are at least four professos and twelve doctors who are whistlblowers from that field of work not just catholics open your eyes man tony blair has a lot to answer for this pathway will go down in history as the crime of the century or pathogate it stinks and eventually it will be euthanized itself mark my word i  am 100% sure it will be halted.  

  • watchman

    as a doctor you talk a load of rubbish but everyone   has a freedom of speech can you tell me if you get a bonus for putting so called dying patients on this none feeding and   pumped into a syringe driven coma, look at all the deaths on it and they all were not dying according to statistics patients are being taken off it by relatives and are still living, some could have been dying  but it seems a guessing game when you hear about patients still alive if taken off this nasty pathway in time lets face it, lets be honest if you dont feed an healthy person and pump  morphine and other drugs,into them no way will that person live with all his organs shutting down by de hydration with thirst, so dont kid yourself doc.it does stop bed blocking by killing a patient. 

  • watchman

    i have had the  experience of seeing three patients on the lazarus uncaring pathway and all three were  put into a morpine induced coma why are four whistleblower professors and  twelve top doctors saying it is involuntary euthianasia and give there names to the media, so i think its you  trying to put the wool over peoples eyes after all you do get a bonus for putting patients on it look at the freedom of information act, paliative care is just a cloak, your only fooling yourself mate. 

  • watchman

    to paulpriest i cannot agree with you more you are spot on, you are  the next prime minister you speak the truth.

  • concerned

    nips obviously you will say there is nothing wrong the death pathway is proven to be back door murder, and you say importantly they do come off it, what 1% its practically impossible to come of it starved dehydrated by poison, they dont show any improvement because the are put on an induced coma, so you are talking load of rubbish i am afraid to  say, my main evidence is top professors just one to mention peter millard emeritus professor  geriatrics at the london university and dr peter hargreaves palliative care consultant at st lukes cancer centre guildford surrey, they say we are moving to a situation with economic factors to save money not lives  on the lcp they are not discussing how to  care for patients the government is rolling out palliative care soley to help patients to die, to halt bed  blocking  also the freedom of information tells us they are being paid to put them on this death pathway and it is very much a bribe to put them on this pathway of no return. its  sad and a barbarick  thing to do and it is not just done to the terminally ill but everyone.god forgive us what is this government thinking about it must be money.

  • concerned

    one word to you carolynnscrim and thats rubbish.

  • concerned

    well written paulpriest i like you speak with integrity.

  • concerned

     i am concerned about lots of patients suppose to be dying in hours days weeks it could be twelve months  but when relatives have taken them off they have not died but still alive i smell a rat, also being paid to put patients on the death pathway is bribary, you should be using palliative care and macmillan nurse to help them live not die, to stop bed blocking and money its a scandel ask the whistleblowers professors and nurses condem  it as back door murder not euthanasia,  i will bet adolf hitler is over the moon saying i showed them how to do it on my t 4 programme, its a disgrace to the british government.

  • concerned

    how can they improve thick head if they have been put on an induced coma do you think you could improve starved and pumped with opiates i very much doubt it, mr 75.

  • concerned

    professor pullicino is a very intelegent doctor he has taken patients of this god forbidden practice and they have lived he is not a roadsweeper.

  • watchman

    if they can put newborn babies on it i am qite sure age does not matter. one palliative care worker states doctors must be trained to use the lcp god i would have thought after this long killing patients they should be trained to do there dirty deeds.its more patients on it and more cash for them. its  corrupt.t

  • John Humphreys4

    When Doctors help patients to live, recommend help, seek help is that not good, but when OCT’s and administrators make decisions to kill to save money is that not MURDER like Helen Sheila Cowley even when family complained and still attended in secret with the help of her New Care Home the family thought was safe.
     

  • John Humphreys4

    How can they call this euthanasia, the Nazis called it the final solution,we call it Genocide in Africa the team responsible for the covering up of Murder is Liverpool Police Family Crime Unit, Liverpool Council Safeguarding and NHS Out of Hospital services Lathom Court with their colleagues the Matrons of the ERT the Government Authority is the Health Ombudsman and the Care Quality Commission.
    If ever they visit run away and take your loved ones outside Liverpool they sent North Wales Police to my home, the Prime Minister did the same to keep me quiet apparently I am going to commit suicide.I was told by Panorama this is what they do to isolate you and make you sound affected, I am all my family are distraught. If you do not believe me call a Solicitor and ask them for help saying you caught NHS nurses killing a family member and watch them run.

  • Johnny Meehan

    nicolas, why are they having an indipendant enquiry now for the fun of it , they are taking patients of this pathway and they go on living whos kidding who  i thought adolf hitler was dead has he left you his notes?.

  • watchman

    yes mr 75, if you neglected your car such as not feeding it with oil and water it would soon overheat and finishe in the car cemetery thats identical what they do on the lazarus pathway no water no food and poisoned to death with morphine , midazolam and other coma induced drugs, it is the same as car crashes i think its you who does not have a clue, more than likely you work in the slaghter houses.

  • watchman

     i am sorry dr but i strongly disagree with you is a syringe driver not a needle emptying morphine into patients vains,24hrs a day   i am sorry to upset you but the proof comes from whistleblowers in your profession saying it is a  cruel  death these professors and doctors who wrote to not one newspaper but three and stating it should be abolished, mp fiona bruce took her father off the l c p and still living today and loads of others suppose to be dying in hours or days  if i gave you everones names  i would run out of ink one 82 yrs old and gone on a world cruise, come on doctor own up and tell the truth a muslem would because they dont believe in euthanasia.

  • godlover

    death is happenig anyway you are so right we are born to eventualy die, but what was dr shipmans ideas kill them of quickly, how you can have the face to write so much rubbish, when you have been whistleblown by your own co-workers if you read papers and listen to the news sure to god you must have seen this scam, patients taken of this idious pathway   most  still. alive and were not dying you were just finishing them off quicker the easy way out for you, remember this you get paid to save life not exterminate it quicker. think about it, also your comments are wors than inflammatory.you encourage murder one of gods commandments thou shalt not kill..

  • watchman

    they already use and abuse the l c p on new born babies its hitlers   T4.  REGIME.

  • concerned

     you say they come off the l c p how is it when i asked a nurse  she told me she had never known anyone to come off unless relatives take them off it. it is the liverpool pathogate of the century.