Pressure from the British media has forced an investigation into the controversial Liverpool Care Pathway by National Health Service and the Association of Palliative Medicine.
The medical establishment appears very reluctant to question the LCP. Only a few days ago 22 organisations signed a consensus statement supporting it. It quoted the Parliamentary Under Secretary of State for Health, Earl Howe:
“The Liverpool Care Pathway has sometimes been accused of being a way of withholding treatment, including hydration and nutrition. That is not the case. It is used to prevent dying patients from having the distress of receiving treatment or tests that are not beneficial and that may in fact cause harm rather than good.”
But the campaign by the Daily Mail and the Telegraph has been relentless. “When well over 100,000 are dying on the LCP each year, the suspicion inevitably arises that the pathway is being used to hasten death and free up beds,” said the Daily Mail in an editorial.
Neurologist Patrick Pullicino contends that the LCP has made euthanasia a “standard way of dying on the NHS”. He and his supporters were scathing about the consensus statement:
“It is self-evident that stopping fluids whilst giving narcotics and sedatives hastens death… The median time to death on the Liverpool Care Pathway is now 29 hours. Statistics show that even patients with terminal cancer and a poor prognosis may survive months or more if not put on the LCP.”
The investigation coordinated by the NHS will examine poor experiences under the LCP, which everyone acknowledges do happen. The NHS will talk to family members of people who have died on the pathway, investigate complaints and speak with clinicians. “Poor experiences must be explored, acknowledged and learnt from,” says Professor Mayur Lakhani, Chair of the Dying Matters Coalition.
Will the investigation result in a thorough revision of the LCP? Even though the medical establishment admits that there are problems, it may not admit that they are due to the basic framework. The Consultant Nurses in Palliative Care Reference Group is already interpreting criticisms as dangerous and offensive. “Counter-productive comments”, it says, are “deeply offensive to public servants who abide by clear codes of conduct and the law”.
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