Liverpool Care Pathway – The Prophesies of Ezekiel?

Here is Ezekiel Emanuel quoted in Wikipedia -

Without overstating it (and without fully defending it) not only is there a consensus about the need for a conception of the good, there may even be a consensus about the particular conception of the good that should inform policies on these nonconstitutional political issues. Communitarians endorse civic republicanism and a growing number of liberals endorse some version of deliberative democracy. Both envision a need for citizens who are independent and responsible and for public forums that present citizens with opportunities to enter into public deliberations on social policies.
This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason. Clearly, more needs to be done to elucidate what specific health care services are basic; however, the overlap between liberalism and communitarianism points to a way of introducing the good back into medical ethics and devising a principled way of distinguishing basic from discretionary health care services ^[59]

The Wikipedia article attacks critics of Emanuel and provides source quotes in his defence.

Emanuel claims he has been quoted out of context.The fact is that Emanuel is an advocate of what he calls "communitarianism." 

The above quote originates from 'Where Civic Republicanism and Deliberative Democracy Meet' published by The Hastings Center.

The individual doctor has always responded by treating the individual patient before them, traditionally, according to the Hippocratic Oath. Emanuel is asking that doctors do otherwise, according to the concept of 'the good' whereby the physician is asked to respond to the socially agreed demands of the category instead of the individual demands of the patient.

The patient is categorised and responded to accordingly rather than responded to according to the medical demands of an individual patient. The protocol of the category is easier to respond to; it is 'less fuss', less time-consuming and with evidenceable outcomes. 

A protocol pertaining to category removes responsibility and releases the medical practitioner from tiresome, time-consuming responsive diagnosis. The physician's time is more efficiently and economically spent.

Dr. Emanuel has described as "an absolute outrage" (abc News) his critic's misinterpretation of what he considers a 'philosophical treatise'.

However, Dr. Emanuel is the health-policy adviser at the White House’s Office of Management and Budget. This Presidential Office determines what is affordable within the budgetary constraints and what is not.

In other words, where it may become necessary to ration care.

Dr. Emanuel says:

civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. 

it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed.

it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. 

services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.

This is a case of a philosophical discussion quoted out of the context in which it is written, says Dr. Emanuel. But the ideas have been floated for dissemination and discussion. They are 'out there'. 

Here, reported in these pages -

Liverpool Care Pathway – A Blanket Policy Of Extermination

Baroness Warnock 

has said that elderly people suffering from dementia are “wasting people’s lives” and “wasting the resources of the National Health Service” and should be allowed to die. These are the words of a well-respected commentator on medical ethics.

Lady Warnock’s comments were published in an interview with the magazine of the Church of Scotland, Life and Work, and have been condemned by dementia charities.

Jacques Attali
is a leading French intellectual and former President of the European Bank for reconstruction and development.
He has said, "As soon as he goes beyond 60-65 years of age man lives beyond his capacity to produce, and he costs society a lot of money...euthanasia will be one of the essential instruments of our future societies."

Martin Amis 
says euthanasia is 'an evolutionary inevitability'Martin Amis says the 'primitive' Christian notion of the 'sanctity of life' is holding back debate on assisted suicide.

BMA: Let patients die 'to save cash'
Published on Saturday 25 June 2011 13:55THE leader of Scotland's doctors has questioned whether society can afford to pay thousands of pounds to keep terminally-ill people alive for weeks or months when health service budgets are under unprecedented strain. 

Elderly are helped to die to clear beds, claims doctor

Mark Macaskill and Jon Ungoed-Thomas

2^nd April 2000

THE callous treatment of the elderly in NHS hospitals has been exposed by a doctor who claims patients are denied life-saving treatment, are grossly neglected and are given drugs which hasten death.  Rita Pal, 28, a junior doctor, was so disturbed by her experiences that she is leaving the profession. This week she will submit a dossier to the General Medical Council (GMC) detailing the cases of abuse that she saw.

The Liverpool Care Pathway has become the blanket policy of extermination, slipped in under the radar, a wolf in sheep's clothing, by which this agenda may be achieved.

Liverpool care Pathway – A Moral Dilemna

Surely, these are lines from the screenplays of Soylent Green and Logan's Run? Again, do we tread this path, take these careless steps and stumble blindly into the abyss?

And with the introduction of LCP, killing has become a ‘legal’ therapy!


Such Wellsian prophesies of Orwellian foreboding are plentiful. A peculiar parallel that I remember from  my school-days exists in C S Lewis' science-fiction trilogy  - 

'Out of the Silent Planet'; 'Voyage to Venus'; and 'That Hideous Strength'

Lewis' brilliant mind envisioned the sinister National Institute of Coordinated Experiments, or NICE. Now, that is at once Orwellian Newspeak, for 'nice' it isn't, but it is also Wellsian in its prophetic anticipation of the modern-day NICE - The National Institute for Health and Clinical Excellence!

The Liverpool Care Pathway: a decision taken with purposeful intent to terminate a life.