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 34.

    The pathway programme is euthanasia and families will be pressured into accepting it.One cannot take BBC reporting on this issue seriously as the have campaigned long and hard for euthanasia and have steadfastly avoided their charter to educate and inform on the subject.However,many oppose involuntary euthanasia and are not going to be wrongly dismissed by HYS pundits as misinformed spiritualists

  • rate this

    Comment number 33.

    Mulvanik (22) - I couldn't agree more. A few years ago I watched a much loved uncle who was cancer-riddled, blind, deaf, incontinent and never, ever going to recover being kept alive by the NHS because they could. My aunt, not in the best of health herself, took the "doctor knows best line" and allowed them to get away with it. The inhumanity of what happened will haunt me for ever.

  • rate this

    Comment number 32.

    Patients families should have the right to know if a treatment is going to be withdrawn. The path way in my opinion is a form of torture for patients as to denigrate their position at their most vulnerable. Palliative care is a legal way of euthanasia and progressing the patient to the end. I would like to see the Liverpool care pathway banned from practice and a more humane process introduced.

  • rate this

    Comment number 31.

    @greatjohnbill: I know, if only doctors would get back to the teachings of that well-known Jew/Christian Hippocrates. Medicine has been led astray by these Greek polytheists, with their oaths.

    Ultimately these decisions should have little to do with families: it should be down to highly trained doctors and nurses, not distraught families without the facts.

    We need to sort out euthanasia as well

  • rate this

    Comment number 30.

    "a decision to withdraw food or water is taken"

    But we prosecute people for assisting suicide and the courts to date have refused the right to die to numerous desperate litigants.

    But it's allegedly OK to wilfully starve people to death without their consent.


  • rate this

    Comment number 29.


    The reason we are not put down like pets is because we view ourselves as superior, not inferior, to them.

    That is just in our opinion, when you think of the chaos and misery that humans cause to each other and animals its not a foregone conclusion.

  • rate this

    Comment number 28.

    My father who was terminally ill was left to basically starve after he developed fluid in his stomach and was to unwell to eat, it was extremely painful for my family to watch him die an undignified death despite the senior doctor informing us that there was no chance of him recovering. It is time we stopped treating the end of someone's suffering on the same level as murder.

  • rate this

    Comment number 27.

    @13.Timothy Lewis

    The reason we are not put down like pets is because we view ourselves as superior, not inferior, to them.

    A pet is more 'disposable' than a human who has greater rights. The current law protects the status of human life.

  • rate this

    Comment number 26.

    I would rather be 'put to sleep' not denied food and water. However, my wish to go or not should be put first if I am conscious and able to speak.

    I assume I would rather go but it is possible that I might prefer to live in agony than die and miss what is happening.

  • rate this

    Comment number 25.

    When my dad died 7 years ago we were told there was no hope for him. They stopped feeding him and giving him water while the nurse that usually took care of him was on leave, she came back from leave and went balistic at them stopping his water.

    I think when there's no hope the family should be allowed to decide as there's no way my father would have wanted to lay the way he was in hospital.

  • rate this

    Comment number 24.

    "17.Tamar This is not about euthanasia"

    It is though, my Gran had all food and water withdrawn and lived for 8 days afterwards.

    It's is euthanasia by the back door.

    However it's cowardly because patients are MADE to suffer on whilst being killed, rather than simply cleanly euthanised, like we would do to any pet (in fact anyone putting a pet on the LCP would rightly be prosecuted for it).

  • rate this

    Comment number 23.

    Hospitals have not been getting away with it for far too long. What has happened is non medical staff have been allowed to compromise ethics in a bid to balance budgets. Also the medical ethics underpinned for years by Judeo Christian ethics have been compromised by doctors from other faith or no faith traditions.

  • rate this

    Comment number 22.

    The needs of the patient should come before the needs of the family. If you've ever seen someone battle a long illness then come to what everyone agrees is the end of their life, it is frustrating to see them suffer because the NHS is so concerned about litigation their instinct is to prolong life when to live is nothing more than to be unconscious to everything but pain.

  • rate this

    Comment number 21.

    I'm not one normally in favour of all this human-rights nonsense, but what's happened here is a complete dismissal of the wishes of both patient and family by, of all bodies, the BMA, which sanctioned such a disgraceful practice. Dignity in Dying campaigners want to see the law changed to reflect patients' wishes, not the ideals of doctors who want to play God with them.

  • rate this

    Comment number 20.

    The lack of understanding about the LCP is so frustrating! Patients are not being 'denied' food and water. Dying patients generally cannot swallow! To force feed someone who cannot swallow is torture and them will likely end up getting pneumonia.
    The LCP is designed to help patients who are going to die, die without pain. How on earth is that a bad thing?

  • rate this

    Comment number 19.

    I'm a doctor in elderly care and have regularly made use of the Liverpool Care Pathway of the Dying Patient. I am disappointed by the misrepresentation of the LCP. We do not kill patients. We recognise when they are approaching death and keep them comfortable. The evidence is that fluid hydration does not relieve thirst, good mouth care does. LCP = Symptom relief and good quality care at the end.

  • rate this

    Comment number 18.

    Who decides whether you live or die, certainly not any Government Scheme. Is it so impossible for doctors, to consult relatives as to the realistic condition of their loved ones, and seek professional advice from, say three doctors as to the final decision. Or can anyone realisticly give this decision. Difficult.

  • rate this

    Comment number 17.

    This is not about euthanasia - this is about Care Pathway. Can anyone on HYS have the courage to think about circumstances other than their own?

  • rate this

    Comment number 16.

    Just because a person is terminally ill does not mean that at the end of their life, they should be starved, and deprived of water, just because no one has the balls to give them a red button for a self-administered lethal injection, as for kids it's an impossible dilemma that I am not qualified to comment on, but just because there kids should not mean they suffer through starvation and thirst.

  • rate this

    Comment number 15.

    Under the Mental Capacity Act (2005), an Independent Mental Capacity Advocate (IMCA) is legally obliged to be consulted (for patients without relatives) for such serious medical treatment decisions eg. LCP. This has been law since 2007, yet these mandatory consultations are often missed (through ignorance of existing legislation).....only media articles like this seem to be progressing things.


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