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 54.

    They don't seem to be aware that you can already act on the behalf of he patient with "lasting power of attorney health and welfare" which can be organized by a solicitor, registered and made legally binding that you have to be consulted.
    Is this reinventing the wheel?

  • rate this

    Comment number 53.

    Both my parents who died last year were on the LCP at the end of their lives and they were neither starved nor denied water. The care afforded to them by their care teams were second to none, and when they died they slipped away in no pain. Why would we want to prolong their lives when there is not hope. the most compassionate thing to do is allow then to die in dignity surrounded by their family.

  • rate this

    Comment number 52.

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

    Is not the next of kin involved in any decision that will basicaly allow your loved one to die? I would have expected this to be basic hospital policy and the patients human right.

  • rate this

    Comment number 51.

    Starve you to death is the right thing? Really? If you did that to an animal, you would have the RSPCA on your back. What do you do to a suffering animal? Use lethal injection...

  • rate this

    Comment number 50.

    The ignorance and lack of knowledge about the LCP from some of these comments is quite frightening! In order to be put on a care path way patients must be comatose, unable to swallow anything and clearly in the final stages of life - to advocate force feeding them or sticking tubes in them at this point would be cruel! The LCP is just about keeping them pain free and comfortable!

  • rate this

    Comment number 49.

    43:LCPs are used in young pts who are dying. your mothers story is not the LCP. Most 93 year olds take meds, usually secondary prevention meds, and you need to give them to about 20-30 people to prevent an event. They don't keep people alive. They do cause a lot of side effects and a large number of hospital admissions. and people do die suddenly. especially at 93. life is a terminal illness.

  • rate this

    Comment number 48.

    The minister is incorrect. It is "completely wrong" that relatives always be consulted.

    What if the doctors know of my wishes? If my wishes are known it is NOT up to my relatives, it is up to me.

  • rate this

    Comment number 47.

    My biggest fear for when I am old is that someone would stop me from having water to drink. I drink masses every day and always have, and am just a thirsty person, so if someone deprived me of water I'd be very distressed, in fact in a panic. How can depriving someone of food and water be ' easing their discomfort' ??

  • rate this

    Comment number 46.

    My nan was put on pathway 18 months ago, the family were informed of what would happen and as she had been refusing food herself we felt it was the right thing rather than them force feeding her. At no point did I ever see any suffering,and it seemed she had decided herself it was time to go. 6 days later my nan got herself out of bed and said the "que was too long". She's still with us.

  • rate this

    Comment number 45.

    As a retired nurse with 40 years experience and involved in hundreds of deaths . Families very rarely if ever agree, son says yes, daughter says no, patient hasn't expressed a wish either way, aruments and fall outs and ill feeling with recrimination lasting years results. Responisbility has to be taken by someone and supported and prefereably taken by those who understand the process intimately

  • rate this

    Comment number 44.

    Communication and Care: sadly it is both of these which appear to be lacking.

    Doctors & nurses have lost the ability to talk to patients & their relatives.

    As for care- there is too much anecdotal evidence which shows that patient care has deteriorated. Nurses dont seem to have the time or inclination and there is a perception that nursing is not about this basic care.

  • rate this

    Comment number 43.

    My mother was admitted to a leading Birmingham Hospital from her Nursing Home where the A & E dept successfully dealt with her. She was discharged 2 days later having had all her medication withdrawn.By the time it was restored by her Dr it was too late. My mother aged 93 was not terminally ill. So is this another type of Pathway that is applied to elderly but not terminally ill patients.

  • rate this

    Comment number 42.

    It's simply bonkers how we have to starve each other to death to get around the right-to-die law.

    Britain will always be light years behind Europe, I don't want to live in this country anymore.

  • rate this

    Comment number 41.

    further to my last:
    3 - people who are dying often have heart failure - giving IV fluids would be difficult and painful, and end up worsening pulmonary oedema - slowly drowning them. those that can swallow drink. they don't die of thirst. they die of multi organ failure.
    4 - death is inevitable and horrible. anything that can be done to make lifes only inevitable event better must be good.

  • rate this

    Comment number 40.

    Having been involved with a number of LCPs I would like to point out the following:
    1 - families are nearly always consulted before the decision is made, on occassion this is impossible and clinical need overrides this
    2 - people aren't denied food or fluids. theyre generally semi-comatose. one of the four criteria for starting the LCP is that the pt cannot swallow

  • rate this

    Comment number 39.

    No No no -you have all got it all wrong.!!! The LCP is in NO WAY assisted suicide, murder, putting one of of their misery or anything else you can think of calling it. It is merely a tool used to ensure a person is at their most comfortable when they are dying.Would you rather someone died in agony? Do none of you realise that people die and no-one is immortal? This is just an aid in that process.

  • rate this

    Comment number 38.

    My advance directive forbids treatment in some circumstances -- e.g if it appears I may have attempted to commit suicide or if forced feeding would be involved.
    Doctors should reduce pain, not prolong it. If that means shortening my life: so be it.
    Life isn't sacred, or all our troops would be potential murderers.

  • rate this

    Comment number 37.


    Well it's not just my opinion, animals have never been given equal status and right to humans in any society in human history.

    Humans are capable of much more than "chaos and misery": art, literature, scientific advancement, space exploration, music, universal human rights, health care and more.

    I'd say 1000s of years of human history support my opinion.

  • rate this

    Comment number 36.

    If ever Im in that situation I would rather be given a leathal injection than be die of dehydration, that it just cruel. Trouble is the powers that be seem to be under the impression that they know best ! and we know they dont !

  • rate this

    Comment number 35.

    "22. MULVANK NHS is so concerned about litigation their instinct is to prolong life"

    IMO that IS the point of the LCP it is "litigation free euthanasia" with concern being given to the hospital having no legal come back rather than the most humane way to end a persons life.


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