Doctors to launch investigation into Liverpool Care Pathway

Doctors are to investigate whether the controversial Liverpool Care Pathway, which is supposed to alleviate suffering, is actually being used to deliberately hasten death.

Hundreds of elderly people are being neglected in NHS hospitals

11:27AM BST 24 Oct 2012

Palliative care doctors are preparing to open an investigation in concerns that the Liverpool Care Pathway is being used to deliberately hasten the death of elderly and terminally-ill patients.

The Association for Palliative Medicine, representing over 1,000 doctors working in hospices and specialist palliative care units throughout the country, is going to carry out research to see if the LCP is operating as a “euthanasia pathway”.

The pathway is supposed to be used to alleviate suffering in the final hours or days of person’s life and often involves heavy sedation and the removal of feeding tubes providing food and fluid.

The investigation comes after senior doctors declared that prognoses that patients are dying had no evidence base and were often little better than “guesswork”.

But they said that once patients were put on the LCP and their food and fluids were removed the prediction of imminent death became a “self-fulfilling prophecy”.

The impending inquiry was revealed by Dr Bee Wee, the Oxford-based president of the APM, in her blog.

She acknowledged that there are “some controversies about the strength of the evidence-base” supporting the use of the LCP and also “some very real anxieties amongst the public and some professionals” about the way it was used.

She said that instead of “simply defending the concept or reiterating that if only it were used properly it would be OK … it might be more helpful to stand back a bit, identify and explore the concerns properly, and find ways of addressing those concerns and improve practice”.

Should the Liverpool Care Pathway be banned?

The APM intends to officially announce the inquiry, which will be carried out with other organisations, at a later date.

The decision to launch an investigation comes as a “consensus agreement” of professional associations and organisations in support of the LCP was attacked by a coalition of senior doctors, lawyers and pro-life groups.

They challenged the assertion made by 22 medical organisations, brought together by the Government, that the LCP was a “framework for good practice” and that it was not used “to hasten death”.

The consensus statement had been signed by such eminent groups as the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Nursing and the National Council for Palliative Care – and issued by the Department of Health.

But in their response, the group opposing the LCP – led by Professor Patrick Pullicino, the neurologist of East Kent Hospitals who in June warned that the LCP had made euthanasia a “standard way of dying on the NHS” – argued that the pathway remained fatally flawed.

“It is self evident that stopping fluids whilst giving narcotics and sedatives hastens death,” the group said a statement.

The group also pointed out that the latest LCP audit showed that just 16 per cent of patients had fluids continued on the pathway and none had fluids started.

“The median time to death on the Liverpool Care Pathway is now 29 hours,” the group said. “Statistics show that even patients with terminal cancer and a poor prognosis may survive months or more if not put on the LCP.”

They added: “The fact is that there is no scientific evidence to support the diagnosis of impending death and there are no published criteria that allow this diagnosis to be made in an evidence-based manner.

“This is even more true of non-cancer conditions. This diagnosis is a prediction, which is at best an educated guess. Predictions have been shown to be often in serious error.

“There is no evidence that the diagnosis of impending death can be improved by using ‘the most senior doctor available’, and an actual misdiagnosis of impending death could result in a wrongful death.”

They continued: “The LCP is more than a framework. It is a pathway that takes the patient in the direction of the outcome presumed by the diagnosis of impending death.”

But the Department of Health has so far stood by the LCP, saying in a statement that it “fully supported its proper use”.

The LCP was rolled out across the country from 2004 but within five years doctors began to publicly air their dissatisfaction with the process.

But public concern over the LCP erupted this month when Peter Tulloch made a complaint of attempted murder to police after he discovered his mother Jean, 83, had been isolated and disconnected from her food and fluid by doctors in a hospital in Edinburgh even though she was not imminently dying.

He demanded that her sustenance was restored and it began again after 30 hours but she died two weeks later.