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Christian medical group backs LCP — but with provisos

04 January 2013

by Madeleine Davies and Simon Caldwell


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 with them.

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 days".

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".

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