Wednesday, 21 November 2012

Liverpool Care Pathway – The Open Door

The Telegraph recently published a petition letter by Dr. Natalie Silvey.

Dr. Silvey wrote and distributed the letter with the help of two colleagues and distributed it via Twitter when they found they were not, initially, getting the response they expected.

Dr. Silvey was moved to pen the letter and start the petition because the recent LCP controversy had caused “a lot of distress among families of patients and doctors”.

She said: “We wanted to highlight exactly what the pathway is and how it should be used.”

The letter states the LCP “is used to care for patients, not to hasten their death”.

The LCP “is used to care for patients, not to hasten their death”.

Here follows a letter published in the British Medical Journal.

We see here evidence clear and simple of the Liverpool Care pathway not at all being used quite in that manner that its apologists contend that it is used.

These are people with very clear opinions of what the Liverpool Care Pathway is and what it may open the door to.

This is BMJ -

Liverpool care pathway

Liverpool care pathway is a half baked compromise

BMJ 2012; 345 doi: (Published 13 November 2012)
Cite this as: BMJ 2012;345:e7629

Although the Liverpool care pathway (LCP) seems to be the palliative care version of very slow active euthanasia by very slow lethal injection,1 in practice it is a half baked compromise. An old friend of mine recently died on a LCP regimen. She was already sedated with midazolam to the point of unresponsiveness when I was called to visit her and was told that she was unlikely to last more than 48 hours. I was therefore unable to say a final farewell, as I very much wanted to.
She had a progressive neurological condition with unimpaired intellect, so opiates were not therapeutically indicated. Only after she had remained alive but unconscious for another week was morphine added to her infusion. It was obviously added not to relieve pain but to further suppress respiration. The acute condition that led to her final admission was treatable, and she could have lived for several months afterwards, but the hospital respected her refusal of treatment. The doctors were obviously sympathetic to her clear and documented desire for an early release from her torment, hence the LCP, but they were also afraid to assist nature efficiently, as I believe the LCP is supposed to do. She was presumably unaware of her last days but we, her friends, were very aware of them, and this caused us needlessly prolonged distress.
If palliative care teams will the end, as they evidently did in this case, why do they not also will the means? Can someone please explain to me how the LCP, designed to cause death in a day or two by suppressing protective reflexes, is morally different from infusing a larger dose of sedatives designed to bring about the same end and for the same reasons in an hour or two?


Cite this as: BMJ 2012;345:e7629


  • Competing interests: CB is a former committee member of the (former) Voluntary Euthanasia Society—now Dignity in Dying. He is also a director of the Secular Medical Forum.


Liverpool care pathway: doctors speak out

One doctor who is angry at the way the subject has been presented is Anjali Mullick, consultant in palliative medicine at St Joseph’s Hospice and Newham University Hospital, London.
Mullick says: “Contrary to some of the recent press, it [the pathway] is not prescriptive about either treatments that should be withheld or interventions or medications that should be administered. The clinical needs of the individual are paramount.”
Mullick says she has seen the tool work well in both the hospice and the hospital setting.
“In my practice, I have never seen it being used as a tool to hasten death, which is being implied in some press reports. The tool is absolutely in line with professional guidance and our legal framework and in no way aims to hasten death.
"I have never seen it being used as a tool to hasten death, which is being implied in some press reports."

No comments:

Post a Comment