Liverpool Care Pathway – A Problem With The Concept

The tenets of the Pathway clearly have not even been adhered to. In the words of Dr. Silvey who has condemned this abuse of the LCP in practice -

"It is unacceptable."

 It is arguable that, in the words of Dr. Bee Wee, - 

“Instead of simply defending the concept [of the LCP], 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.” 

The problem with the concept may not be in the application of the concept, but in the concept itself. Can a blanket 'Pathway' ever be a substitute for real individualised care tailored to the individual?

This is from Gateway, a funeral Services company blog -

When should a patient be placed on The Liverpool Care Pathway. – Taken from Nursing Times 2005.

Recognising that a patient has entered the dying phase can be difficult.  A team approach to diagnosis should be used, as this unites the care given and avoids giving conflicting information to the family.

A diagnosis of dying is made when the multi professional team agree the patient is dying and two of the following may apply:

- The patient is bed bound

- The patient is semi-comatosed

- The patient is only able to take sips of fluid

- The patient is no longer able to take tablets

So what is happening?

In practice, the Liverpool Care Pathway has turned into something quite different. In some cases it has been used properly as it was intended, but with numerous others it has become, a back door form of euthanasia.

Over the past week, families have been saying that they believe their loved ones were wrongly put on the Liverpool Care Pathway by hospitals when they were not in fact close to death, fuelling the suspicion that it is used to hasten deaths to save the NHS money and free up beds.

The growing fears of patients’ relatives and doctors has highlighted the fact that the Pathway is being applied to patients without their families’ knowledge and when they still have a chance of recovery. The regime, which involves the withdrawal of food and fluids as well as medical treatment, is designed to be used on patients who are dying. Doctors try to ease their suffering in their final hours instead of trying to save them. Yet critics say it is impossible to predict accurately when a patient may die and that the Pathway instead becomes a ‘self-fulfilling prophecy’ that hastens their death.

One of its ten ‘key messages’ is that it ‘neither hastens nor postpones death’. But, on the contrary, many examples have emerged where it has, indeed, been used to hasten death.

Terminally ill patients have been heavily sedated and deprived of essential nutrients and fluids in order to make them die more quickly.

How has this situation been allowed to develop?

It would seem that the Liverpool Care Pathway has not lived up to expectations. When people are put on it, they are said to be dying.  But they may not be dying at all — not,  until, they are put on the ‘pathway’, where it would seem they die as a result of being on it, through starvation or dehydration.

Families, who may be in a state of shock having heard of their relatives’ condition, are in a vulnerable state and may not be able to understand what the doctors or nurses are saying regarding the next stage in the care of their relative.

It is imperative that families should be consulted, every step of the way, during the care of a dying relative and it has emerged today that the government, will ensure that families and carers will be fully involved before the decision is made to start end-of life-treatment.

If you have a relative or friend who is coming to the end of their life, whether that is in hospital, in a nursing home, or in their own home, make sure you are fully informed of what steps are beings taken to alleviate their pain in the final days and hours.