Tuesday, 26 March 2013

Liverpool Care Pathway - Unconstitutional And Inappropriate

The Liverpool Care Pathway is being used without knowledge and, where there is knowledge, without permission or consent. Can this be right?

Both Mr. Hunt and Mr. Lamb have gone on record as saying that it should not be used without knowledge. Would they not agree, then, that it should not be used without permission...?

The Mental Health Act permits compulsory medical treatment under certain circumstances.

In the matter of communicable (contagious) diseases/infections, compulsory medical treatment may also be permitted. 

Neither is the case here.

In the matter of enacting other medical procedures, a consent form is procured and presented to the patient to sign. Why is this not so in the case of the LCP? 

LCP literature states that it is a ‘framework for best practice’. This means that the issue of consenting to the LCP is not relevant as consent is only applicable to a medical treatment.

The LCP is not a 'medical treatment'; it is a framework, a care pathway.

Here, Gordon D. Rubenfeld, MD MSc, discusses Principles and practice of withdrawing life-sustaining treatments -

It is stated here that -
5) Withdrawal of life-sustaining treatment is a medical procedure.

The LCP does involve withdrawal of life-sustaining treatments.

It may provide for the withdrawal of nutrition and fluids, for instance; it may involve withholding and/or withdrawing life sustaining treatments such as artificial hydration and feeding, oxygen, ventilation, dialysis; not attempting resuscitation in the event of cardiac arrest.

The withdrawal of life-sustaining treatment is a medical procedure and part of this medical procedure is the novel prescribed treatment with medications specific to the pathway.

The LCP is both medical procedure and treatment; it is both compulsory medical treatment and compulsory medical non-treatment.

The LCP, therefore, being compatible with Section 2a of the NHS Constitution (the Health Act 2009 requires NHS to have regard to the constitution) is not being used appropriately.

Section 2a states: “You have the right to accept or refuse treatment that is offered to you" and "be given information about your proposed treatment in advance, including any significant risks and any alternative treatments which may be available."

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