Liverpool Care Pathway - A Private Controversy?

Dr. Richard Hain of the Department of Child Health, Cardiff Children's Hospital appeared on BBC's The Big Questions.

This is Dr. Richard Hain on The Big Questions -

I need to be clear, I do paediatric palliative care and we don’t use the Liverpool Care Pathway in children. 

This is the Mail Online -

The LCP for children has been developed in the North West, where the LCP itself was pioneered in the 1990s. It involves the discharge to home or to a hospice of children who are given a document detailing their ‘end of life’ care.

One seen by the Mail, called ‘Liverpool Pathway for the Dying Child’ is issued by the Royal Liverpool Children’s NHS Trust in conjunction with the flagship children’s hospital Alder Hey. It includes tick boxes, filled out by hospital doctors, on medicines, nutrients and fluids to be stopped.  

The LCP was devised by the Marie Curie Palliative Care Institute in Liverpool for care of dying adult patients more than a decade ago. It has since been developed, with paediatric staff at Alder Hey Hospital, to cover children. Parents have to agree to their child going on the death pathway, often being told by doctors it is in the child’s ‘best interests’ because their survival is ‘futile’. 

Bernadette Lloyd, a hospice paediatric nurse, has written to the Cabinet Office and the Department of Health to criticise the use of death pathways for children. 

'‘I have also seen children die in terrible thirst because fluids are withdrawn from them until they die'

She said: ‘The parents feel coerced, at a very traumatic time, into agreeing that this is correct for their child whom they are told by doctors has only has a few days to live. It is very difficult to predict death. I have seen a “reasonable” number of children recover after being taken off the pathway. 

‘I have also seen children die in terrible thirst because fluids are withdrawn from them until they die. 

‘I witnessed a 14 year-old boy with cancer die with his tongue stuck to the roof of his mouth when doctors refused to give him liquids by tube. His death was agonising for him, and for us nurses to watch. This is euthanasia by the backdoor.’

Dr. Hain defended the use of the Liverpool Care Pathway for the Dying Patient and yet he was wont to stress without prompt that he does not use the protocol with children. Either this protocol does what its protagonists and propagandists say it does or it does not.

Was Dr. Hain's statement a PR response, an acknowledgement of the current sensitivity in the public eye to the use of the Liverpool Care Pathway for the Dying Patient and the outcry that has courted controversy for it that moved him to speak up? Or does he acknowledge the controversy privately and court doubts?

He responded to Dr. Philip Howard's question with a look of wistful silence.

The unanswered question:

Dr. Philip Howard –
One of the problems about the Liverpool Care Pathway is that a decision is made and then, very often, observations are stopped, nursing observations are stopped, simple blood tests are stopped and further interventions are usually stopped – with the exception of oxygen, interestingly enough; that’s continued in 45% of cases. But most other interventions are stopped and very rarely started. When… How can the patient be properly reviewed if you don’t have basic nurse observations, basic blood tests and so on? After three days, em… three quarters of the patients have died, but of those that are still alive, according to the audit that was done of 7,000 patients two years ago, only 20% were reassessed.

Dr. Hain?