Charon QC

LIVERPOOL CARE PATHWAY DEBATED BY MP’s IN WESTMINSTER HALL:  ‘EUTHANASIA BY THE BACK DOOR’?
Asons Solicitors

A debate on the Liverpool care Pathway took place on the 8/1/2013 introduced by conservative MP Mr Glynn Davies a supporter of the Pathway who said that it is ‘certainly not and must never be any form of euthanasia by the back door’

The Liverpool Care Pathway (LCP) is a standard model of palliative care for patients, including children, in the last days of their life and was meant to ease the suffering of the dying by guiding a humane, dignified and pain free. The aim of the pathway was to bring into hospitals etc. the standard of palliative care being offered in hospices so that wherever a person dies they can expect to receive quality and dignified care. In a hospital environment the mind-set is to save the Patient and death is seen as failure culminating in what was thought to be overaggressive treatment of the dying.  The LCP is recommended as a best practice model most recently by the Department of Health and 130,000 of the 450,000 who die in hospital have been subject to the LCP. The Pathway has however been hit by controversial media coverage and Instead it is being labelled by some as potentially an ‘assisted death pathway’  after it has been reported that thousands of Patients have died prematurely after being placed on the Pathway. Why the controversy?

THE CONS

• As a supposed incentive for clinicians to use the pathway and provide this quality of care financial incentives reported to be in the region of £30M have been offered to hospitals to use the pathway. There is increasing concern that this incentive instead of promoting quality care is actually being abused and resulting in patients being placed on the LCP unnecessarily for ‘perverse bonuses’
• Patients are also being placed on the LPC without their or their families’ knowledge or consent. The audit carried out last year by The Royal College of Physicians and Marie Curie Pallative care institute found: 44% of patients who were conscious were not consulted before being placed on the pathway. A 1/3 of families were not consulted before the decision was taken
• It is alleged that Hospitals are placing patients on LPC without a proper understanding of it and without training their staff
• The LPC provides a check list to guide medics through the care of the dying. It is alleged by some that this is being utilised as a tick box exercise. In some instances this has led to abrupt withdrawal of feeding and hydration leading to allegations that patients have been ‘put to their death’. The LPC does provide a blanket policy for the withdrawal of artificial nutrition and hydration. It is however deemed as treatment as are antibiotics and can be withdrawn where it is in the best interest of the patient.
• Dr Bee We President of the Association for Pallative Care said some hospitals appeared to be treating the Pathway as ‘just another thing to be done’ rather than something to be handled with extreme care.
• Despite being placed on the Pathway some Patients have known to survive after questions were raised by the family over the standard of care being offered. ‘Predictions’ that someone is going to die imminently are frequently known to be wrong.
• It is alleged that the LCP entails increasing doses of sedatives and narcotics making improvement in the underlying illness being difficult to detect.
• It is also reported that the pathway is actually being used as a euphemism for dying. Patients and families are informed that there is to be a move to the Pathway instead of actually advising that the patient is actually dying.
• The media coverage has worried Patients and families so much that some are even refusing hospital care worrying what might happen to them

THE PRO’s 

Experts in palliative care have hit back at the criticism. They say that the pathway provides

• a dignified death freeing the patients from the paraphernalia of feeding tubes etc. It also prevents patients from being neglected.
• They also report that good quality palliative care actually extends the life of patients.
• It is misguided that the PCP precludes the use of clinically assisted nutrition and hydration. Infact the LCP prompts clinicians to consider the need for this and to tailor decisions in the best interest of the patients which may not have taken place in the absence of the pathway
• The guidelines promote good record keeping which was often lacking in these situations.

Professor Irene Higginson of Kings College London added ‘We have to bottom out what the concerns are that people have. What we don’t really know is whether it is the way that the LPC is being used and the environment that it is in or whether it is something within the LCP which has confused people or made the use it in a not work well’ .

Is the Pathway a victim of sensationalised press coverage or has it simply failed in what it set out to do?  Have you have been affected by the LPC either positively or negatively? We would like to hear what you have got to say.  Please e mail us with your views  

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For Further Information :

see: For record of Parlimentary debate 8.1.13 ( Page reference 35WH to 58WH)

see: For further Information on the pathway from The Marie Curie Institute for Pallative Care

Asons Solicitors specialise in clinical negligence claims, so if you feel that you or a family member may have been the victim of Clinical negligence please contact our team on Tel 0844 840 8013 and they will be more than happy to assist you.