The report on the Liverpool Care Pathway echoed concerns raised by Catholic physicians and by Bishop Philip Egan of Portsmouth, who said doctors were being asked "to make a definitive judgment that a patient is about to die and that feeding and hydration can be summarily withdrawn".

The LCP is also used in New Zealand hospitals with Ministry of Health funding.

"This is not civilised. It is a national disgrace," said the Minister for Care and Support, Norman Lamb, after learning of "too many examples of poor practice and poor quality care, with families and carers not being properly involved and supported".

He said the LCP would be phased out and replaced by individual care plans for the dying.

The report — titled More Care, Less Pathway — said the protocol's "tick-box" approach to end-of-life care allowed medical professionals to base clinical judgments not on patient needs but on whether criteria set out by the framework had been met.

"It would seem that when the LCP is operated by well-trained, well-resourced and sensitive clinical teams, it works well," the report said.

However, reports of "uncaring, rushed, and ignorant" treatment abounded and "many families suspected that deaths had been hastened by the premature, or over-prescription of strong pain-killing drugs or sedatives and reported that these had sometimes been administered without discussion or consultation".

"There was a feeling that the drugs were being used as a ‘chemical cosh' which diminished the patient's desire or ability to accept food or drink."

The report emphasised that medical professionals would be guilty of professional misconduct if they refused a patient food and fluid, and demanded better policing and funding of end-of-life care.

Numerous examples were cited of patients dying of thirst. The review team also heard stories of nurses shouting at families who intervened to give their relatives a drink.

Some patients took up to 16 days to die after they were wrongly diagnosed as dying and placed on the pathway.

Sources:

National Catholic Reporter

Independent Catholic News

Daily Mail

More Care, Less Pathway

Image: The Guardian

"Its intentions are benign," he writes, "yet as a pastor, my own experience, together with anecdotal evidence, suggests that what should be supported dying becomes blurred with assisted dying."

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"I seem to recollect that a few years ago the approach was criticised by some eminent doctors in the national press but after a couple of articles and a little disquiet the debate simmered down and we as practising clinicians continued to use what is considered the framework for best practice when delivering end of life care."

"So what has happened in those few years?" she asks "The LCP itself has not really changed. Perhaps the document has been developed a little but the fundamental principles of care remain the same. Maybe it is society's expectations that have changed."

Granger says that the irresponsible handling by some of the media has left clinicians in a difficult and worrying place. "As a doctor I would hope that the relationship I have with my patients and their families is based on a solid foundation of trust; a trust that I am there solely to act in their best interests and to care for them. As a patient myself I trust my own GP and Oncologist implicitly. But when the press and sometimes the politicians start to undermine this trust then we are left in an extremely worrying and dark situation."

The Liverpool Care Pathway "is an integrated care pathway that is used at the bedside to drive up sustained quality of the dying in the last hours and days of life."

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Kate Granger is a medical doctor who has terminal cancer. The treatment has been arduous and unsuccessful so Kate took the decision to stop it and, returned to her job as a hospital registrar at Pinderfields Hospital, Wakefield. UL

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drkategranger A doctor & terminally ill cancer patient musing about life & death

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The inquiry will focus on the Liverpool Care Pathway, designed to ease the suffering of patients in their last hours or days of life.

The pathway often involves sedation and the withdrawal of life-prolonging drugs, nutrition and hydration.

Critics say people are being put on it without their relatives being informed, and that the pathway is being used to hasten the deaths of patients who are not imminently dying.

When Norman Lamb, Britain's Care and Support Minister, announced the review, he said consider whether payments to hospitals for meeting targets on their use of the pathway might have led to "bad decisions or practice".

The Daily Telegraph has revealed that six out of 10 National Health Service hospital trusts had received payments totalling $NZ23 million or more for attaining these goals. In some hospitals more than half of all dying patients were put on the pathway

Department of Health officials have insisted that the payments are to ensure that patients are "treated with dignity" as they die — and many doctors argue that the widespread adoption of the Liverpool Care Pathway has led to improved care for the dying.

"It is clear that everyone wants their loved ones' final hours of life to be as pain-free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim," Mr Lamb said.

"However as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable."

The Catholic Communications Network said Archbishop Peter Smith of Southwark, chairman of the English and Welsh bishops' Department for Christian Responsibility and Citizenship, welcomed the review.

It said Archbishop Smith had passed on "specific concerns raised with him by some clinicians" and had called for such an inquiry in a letter to the government in September.

Sources:

Catholic News Service

The Telegraph

Image: The Spectator

Tony Nicklinson, paralysed from the neck down after a stroke seven years ago, died of natural causes a week after three High Court judges ruled that Parliament should decide whether euthanasia should be allowed.

The media battle has included numerous opinion polls conducted with the aim of demonstrating widespread support, especially among the young, for euthanasia and assisted suicide.

Euthanasia campaigners are also using celebrity endorsements to curry support, with actors, singers, novelists, comedians, philosophers and even war veterans agreeing to serve as patrons of the Dignity in Dying group. They include Sir Patrick Stewart, the Star Trek actor, and Sir Terry Pratchett, the science fiction writer.

Catholic News Service reports that some Catholic doctors in recent months have taken huge risks with their careers to argue that a system designed to care for people in their final hours can be operated as a euthanasia pathway.

The Liverpool Care Pathway allows medical staff to decide if a patient is dying, then to sedate the patient with opiates and to remove artificial food and fluids, which under British law are classed as "treatment". Audits have revealed that patients take an average of 29 hours to die.

Dr Philip Howard, a Catholic who works in a health service hospital in Surrey, said it is extremely difficult to predict when a patient will die, especially if the disease is noncancerous. The short life expectancy on the Liverpool Care Pathway "suggests that in some cases (or perhaps many), the pathway is either causing or significantly contributing to death," he said.

The government insists, however, that the pathway "is not euthanasia". A Department of Health statement described the pathway as an "established and respected tool" that enjoys "overwhelming support from clinicians at home and abroad".

Source:

Catholic News Service

Image: The Telegraph

Pullicino was reported as saying doctors had turned the use of the Liverpool Care Pathway into the equivalent of euthanasia of the elderly. The Liverpool Care Pathway, which was created at the Marie Curie Hospice in Liverpool in the 1990s, is used in New Zealand with Ministry of Health funding.

"It is alarmist to say that patients ‘are being killed' by The Liverpool Care Pathway (LCP). It is incorrect to say, as reported, that it brings about the death of patients in the sense of causing their death. For persons who are dying the LCP is designed to provide caregivers with a set of standards that define quality care," Kleinsman said.

"It arose out of the hospice care system and has been developed as a way of ensuring excellence in, and consistency of, care. The overwhelming majority of people are able to experience better care at the end of life than they would have previously. It provides a mechanism for accountability and a means to standardise care across the country."

"It is a mistake to equate the introduction of LCP with euthanasia. Of course, like any tool, it is only as good as those who are using it. We do need to maintain vigilance to make sure that patients are receiving the level of care that accords with their human dignity," said Kleinsman.

Source

• The Nathaniel Centre
• Image: Bedfordnow.co.uk

Professor Patrick Pullicino said doctors had turned the use of the Liverpool Care Pathway into the equivalent of euthanasia of the elderly.

Professor Pullicino, a consultant neurologist for East Kent Hospitals and Professor of Clinical Neurosciences at the University of Kent, was speaking to the Royal Society of Medicine in London.

The Liverpool Care Pathway, which was created at the Marie Curie Hospice in Liverpool in the 1990s, is used in New Zealand with Ministry of Health funding.

It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

The pathway can include withdrawal of treatment — including the provision of water and nourishment by tube — and on average brings a patient to death in 33 hours.

Professor Pullicino claimed there was often a lack of clear evidence for initiating the LCP programme.

Far too often, he said, elderly patients who could live longer were placed on the LCP and it had now become an "assisted death pathway rather than a care pathway".

He cited "pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients" as factors.

Professor Pullicino revealed he had personally intervened to take a patient off the LCP who went on to be successfully treated.

"Very likely many elderly patients who could live substantially longer are being killed by the LCP. Patients are frequently put on the pathway without a proper analysis of their condition.

"Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically."

Sources

• Christian Post
• Daily Mail
• National Liverpool Care Pathway (NZ)
• MacDoctor
• Image: Mark Hillary