Lord Carlile says doctors who put patients on the end-of-life pathway without their consent should be struck off
One of Britain’s leading legal experts has said that the controversial Liverpool Care Pathway should be abolished and replaced with a new end-of-life framework.
Lord Carlile of Berriew also suggested that doctors who placed patients on potentially lethal end-of-life regimes without their consent should be struck off the medical register.
The Liberal Democrat peer said reforms to the system must begin with dropping the term “Liverpool Care Pathway”.
“It does no good for Liverpool, it does no good for care and as pathways go it is nearer to the River Styx than the Mersey,” he said in a reference to the torrent that in Greek mythology separated the earth from Hell.
He said that following the independent inquiry under the chairmanship of Baroness Neuberger, who will report to the Government in the summer, the “best elements” of the LCP “could be part of a much-improved end-of-life strategy”.
But he told a meeting in the House of Lords that “whatever is put in its place, and I have every confidence in Julia Neuberger, it cannot be the Liverpool Care Pathway”.
He said that best practice would also have to be applied consistently if a replacement to the LCP was to have the confidence of the public.
Lord Carlile also expressed shock at the large number of families who have complained that relatives had not given their consent when they were placed on the pathway, which often involves heavy use of sedatives and narcotics and the withdrawal of food and fluids, resulting in death in an average of 29 hours.
He suggested that the situation warranted the intervention of the General Medical Council, the regulatory body of the medical profession.
“I spent about 10 years, as an MP, as a lay member of the GMC,” he said. “If a surgeon decided not to tell a sentient patient that in order to save his or her life he was going to have to remove a leg he would be struck off the register for serious professional misconduct.
“The Liverpool Care Pathway is being provided without the consent of either its sentient patients or – where they are not fully sentient or do not have full (mental) capacity – their relatives.”
He added that he also believed that patients should never be placed on an end-of-life pathway by doctors who did not know them.
Lord Carlile is one of the most highly-respected barristers in Britain and was sought for his legal expertise when he was appointed by Tony Blair as the independent reviewer of terrorism legislation in 2001.
The son of a Lancashire GP, he has taken an interest in end-of-life issues that recently led him to co-chair the anti-euthanasia group Living and Dying Well.
His comments in the Lords, expressed in public for the first time, contrast starkly with the insistence of Government Ministers that the LCP is “good medicine” and an effective framework for the treatment of patients in their final days and hours.
The Government insists that any abuses stem from the misapplication of the pathway and consequently the Neuberger inquiry’s terms of reference will focus solely “on the use of the LCP model rather than on re-evaluating the model itself”.
Lord Carlile’s remarks came during a meeting arranged by Baroness Knight of Collingtree to give peers the chance to hear from doctors convinced that the LCP is flawed, rather than misused, and that the inquiry does not go far enough.
These include Prof Patrick Pullicino, a consultant neurologist with East Kent University Hospitals NHS Trust, and a Catholic, who told the meeting the LCP was “dangerous” because it was founded on the “irremediable flaw” that doctors were able to predict when a patient might die when there was no objective way of making such a diagnosis.
The meeting was held just days before Auxiliary Bishop Tom Williams of Liverpool, chairman of the healthcare reference group of the Bishops’ Conference of England and Wales, said in a letter to The Tablet that Catholics applying the LCP well in palliative care were “doing the Lord’s work”.