THE Liverpool Care Pathway (LCP), the guidance that informs
end-of-life care in the NHS, has been defended by the Christian
Medical Fellowship (CMF). It nevertheless warns that "there is
always potential for misuse and abuse."
The Health Minister, Norman Lamb, announced in November that a
review of the framework would be conducted, after newspapers
published reports from families who said that their relatives had
been placed on the pathway without their consent, or that the
pathway had hastened their death.
"There have been too many cases where patients were put on the
pathway without a proper explanation or their families' being
involved," Mr Lamb said.
A national audit of 7058 deaths, which occurred between April
and June 2011, conducted by the Marie Curie Palliative Care
Institute Liverpool and the Royal College of Physicians, found that
in 44 per cent of cases where conscious patients were placed on the
pathway, there was no record that the decision had been discussed
The LCP was developed during the late 1990s at the Royal
Liverpool University Hospital, in conjunction with the Marie Curie
Palliative Care Institute, and is recommended as best practice in
end-of-life care by the Department of Health. It guides the reviews
of care of patients in the last hours or days of life, including
the administration of sedative drugs and the cessation of food and
drink. Latest figures suggest that about 130,000 people a year die
on the LCP.
On Tuesday, the CMF published nine points for the review of the
LCP, to "iron out the abuses". These include discussions with
relatives or carers before patients are placed on the pathway, and
a suggestion that it be made "absolutely clear" that no one should
be placed on it who was not dying in "at most, two or three
The chief executive of the CMF, Dr Peter Saunders, said: "The
Liverpool Care Pathway is a useful clinical tool that has helped
many thousands of people experience better care in the last hours
or days of life, but, like any tool, it must be used with the
proper indications and by properly trained staff."
In November, Philip Fletcher, the chairman of the Church of
England's Mission and Public Affairs Council, cited concerns about
the LCP in a response to proposals by Lord Falconer to introduce a
Bill to legalise assisted suicide this year.
"The current disquiet at whether the Liverpool Care Pathway and
'Do not attempt resuscitation' protocols are consistently applied
in a correct manner indicate that even carefully and reputedly
well-monitored practices can be prone to lapses, and perhaps even
deliberate circumvention," he said. "There is nothing to cause us
to believe that a law permitting assisted suicide would not
encounter similar problems."
In December, Professor David Jones, the director of the Anscombe
Bioethics Centre, an Oxford-based Roman Catholic institute, said
that the main principles of the LCP were "fully in accordance with
Catholic moral theology, and with a Catholic understanding of a
good death", but that there were "a number of pressures that might
subvert the proper implementation" of it. These included "the
subjective character of judgements about how soon someone is going
to die", and the "influence of managerial pressures".
In September, the heads of 22 organisations, including Age UK,
Macmillan Cancer Support, and Marie Curie Cancer Care, signed a
statement supporting the "appropriate use" of LCP.
The Health Secretary, Jeremy Hunt, said on Monday that the LCP
was a "fantastic step forward . . . and we need to be unabashed
about that because it's basically designed to bring hospice-style
care to terminally ill people in hospitals".