Liverpool Care Pathway: Relatives 'must be informed'

Elderly man's hands There will be a 12-week consultation on the proposed changes to the NHS constitution

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Relatives of terminally-ill patients would have to be consulted before a decision to withdraw food or water is taken, under new government proposals.

It comes after some patients were placed on the Liverpool Care Pathway - designed to relieve suffering - without their relatives' knowledge.

The government wants to ensure families are told of life and death decisions.

The instruction will be included in a number of proposed changes to the NHS Constitution to be unveiled on Monday.

The Liverpool Care Pathway was developed at the Royal Liverpool University Hospital and the city's Marie Curie hospice to relieve suffering in dying patients, setting out principles for their treatment in their final days and hours.

Supporters say it can make the end of a patient's life as comfortable as possible and the method is also widely backed by doctors and many health charities.

However, critics argue it can be inhumane.

The government has now said that the rules needed to be stricter, meaning relatives of patients are always consulted before the technique is applied.

'New right'

A Department of Health (DoH) spokesman said the proposed changes would set out a "new right" under the NHS Constitution, which was established by the Health Act 2009, but he stopped short of describing the move as a "legal requirement".

However, the spokesman added: "Anybody providing NHS services is required by law to take account of it [the NHS constitution] in their decisions and actions."

Some reports suggested health trusts that failed to involve patients and families in decisions could be sued, while doctors could face being struck off.

The DoH spokesman said it was unlikely policy had been developed on this as the proposal was still at an early stage.

Health Secretary Jeremy Hunt will launch a 12-week consultation on the proposed changes to the constitution - the formal statement of patients' rights - on Monday.

Health minister Norman Lamb said this week that it was "completely wrong" for terminally-ill patients to be put on a "pathway" to death without relatives being consulted.

Mr Lamb has called a meeting of doctors and patients to discuss worries about the pathway.

Meanwhile, Conservative peer Baroness Knight called for an inquiry into claims some people might have survived had they not received this treatment.


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  • rate this

    Comment number 454.

    Everyone should make a Living Will directing their physicians about end of life treatment. It is cruel to prolong life and suffering. My late father, a well loved and trusted family GP, did not hesitate to increase the dose of morphine when death was inevitable.

  • rate this

    Comment number 453.

    So many people not listening, keen to spread tales of horror fueled by their own ignorance.

    The LCP is not used to kill, it's used on the imminently dying
    The LCP is not used for financial gain or bed unblocking
    The LCP is not used to deny people drink IF THEY ARE ABLE to take it
    Using the LCP does not condemn people to death who would otherwise have survived

  • rate this

    Comment number 452.

    I would like to challenge the idea that dying is an illness that needs managing by doctors. The time before death, which we call dying can be a time for soul work, putting things in order, saying what we need to say, atoneing if we feel we need to. Its the journey of the soul to god to anyone of faith. Stopping this process is officious meddling. Not everyone is afraid of dying in their own time.

  • rate this

    Comment number 451.

    My father was not admitted to hospital to die. He was in hospital for tests. How do you get selected for this 'pathway' to death? He never applied for it. His family never applied for it. If we had been informed we would told them they were making a 'grave' mistake. I'm seething about this.

  • Comment number 450.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 449.

    People should be allowed to do die if they want to. As a healthy person, I am free to overdose on painkillers, jump off a bridge, stick my head in an oven or slit my wrists open. If I become incapacitated, I expect the same freedom of choice without the government or some individual imposing their will on me.

  • rate this

    Comment number 448.

    A lot of people on this forum have no concept of what end of life care is and the moderator should carefully consider whether the inflammatory pseudoscientific hokum they espouse is palatable for public consumption.

    There is no debate, there is poor communication and it is this alone which needs to be addressed.

    Alas the right wing love a band wagon to jump onto.

  • rate this

    Comment number 447.

    Reply to Richard. I have to challenge 'it is the disease process that kills'not LCP. My husband had terminal cancer, managed hiw own medication at a dose above the pain threshold because he wanted a few more weeks. He was killed in a hospice by an acute fatal overdose of opiates followed by an overdose of a sedative 4 times the GP prescribed dose.An inquest is to follow..

  • rate this

    Comment number 446.

    Marcus, you are so wrong.

  • rate this

    Comment number 445.

    The last time I looked it up, food and water is one of the most fundamental rights within the Human Rights acts.

    Depriving someone of food and water is deprivation of their human rights.

    While many will not agree, painkillers dosed max is probably the best way to go. Swiftly and painlessly with the dignity that befits a human being KNOWING there is no alternative, except a painfully slow exit.

  • rate this

    Comment number 444.

    As Doctors we will always endeavour to involve relatives in end of life decisions. However this is not always possible and the decision is made to withdraw futile and often distressing treatment and focus on symptom control, in lieu if this. The disease process is what kills the patient not the LCP.

    The new rules will lead to a culture of fear, and patients will suffer not benefit because of it.

  • rate this

    Comment number 443.

    I by no means agree with prolonging the suffering of someone who is close to death, and has accepted their imminent end; but this is really the start of something much more serious. Look at what's being said about the 'burden of the elderly' and 'unproductive citizens', look at what's being done with the NHS, pensions and austerity. This is about killing off the unfit, and it's only the beginning.

  • rate this

    Comment number 442.

    In life we make dozens of decisions every day, as we approach death i cant see why we should be prevented from excersizing choice. Unless a person no longer has mental capacity i cannot see why it should be left to a doctor to decide whether we eat,drink or are sedated. . Death isnt always traumatic, suffering isnt always meaningless. Sometimes a person will chose to live in pain over death.

  • rate this

    Comment number 441.

    How can you be certain someone is dying? Stop playing God.

  • rate this

    Comment number 440.

    435: Graham, I agree and I have always tried to explain the process to families and answer questions fully. Consequently I have never had any relatives express concern about the LCP - the obvious anger on this site has shocked and saddened me.

    Communication is key: the LCP is a good thing but understanding the process is critical so it is not mistaken for neglect or hastening death

  • rate this

    Comment number 439.

    I don`t care what you doctors think .It was you who ended my mothers life .May God forgive you.

  • rate this

    Comment number 438.

    I'm appalled and disgusted that the pathway exists at all. The LCP is, in my opinion diametrically in opposition to the tenets of the Hippocratic Oath which Doctors used to take - or at least take seriously. Denial of food and water is a hideous way to die without any "dignity" or "peace", and I can only presume is applied to patients for the sake of convenience.

  • rate this

    Comment number 437.

    Last year, three days before I started my medical degree I witnessed my grandfather pass away in hospital, In the end he was in great pain and uncommunicative. Unfortunately, despite mine and my mother's requests for treatment to be stopped in order for him to die in dignity no senior staff were available to approve this. LCP would have spared him this.
    LCP IS NOT EUTHANASIA, it is dignity.

  • rate this

    Comment number 436.

    What about Life support no need to withhold the support.

  • rate this

    Comment number 435.

    429. Chris
    This is not about the benefits or evils of this treatment, you say there are misconceptions about this treatment.
    Is it too difficult to explain this to relatives?


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