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 74.

    If a prisoner was denied food and water, even for a day, it would be called, at the very least, inhumane if not torture. It would certainly breach their human rights. Why are doctors allowed to do this sort of thing without prosecution?

  • rate this

    Comment number 73.

    The way BBC and the Daily Mail have reported this story, it is clear that most people have the wrong idea about the LCP. As a doctor I can say that LCP is only applied when patients are within days or hours of dying. They are unable to eat or drink naturally. Only intrusive treatment is withdrawn; patients are kept comfortable and allowed to die naturally and peaceful. Is this wrong?

  • rate this

    Comment number 72.


    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,......

    I did not remark its just your opinion, humans in general, which still doesn't mean we are superior, unless you count might as right.

  • rate this

    Comment number 71.

    You can't consent on behalf of another adult. Therefore families cannot make the decision to start a pathway.

    You can't demand treatment that the medical team do not believe to be indicated. Therefore families cannot block the decision.

    This changes nothing. We already talk to families about these things in order to help them understand their relatives' illness and limit their distress.

  • rate this

    Comment number 70.

    //63. Joyanblu
    If the patient knew they were hungry or thirsty it would be cruel to deny them but those on LCP aren't aware of it,//

    Having had recent experience of this when a friend died, I feel obliged to contradict, our friend had a stroke with a very poor prognosis, she chose to follow LCP and was aware right until the end, her body shut down, we cared for her with as much love as we could.

  • rate this

    Comment number 69.

    It's important to understand the physiology of the dying process to appreciate the value of the Liverpool care pathway. "Withholding" food may sound cruel, but a part of dying is the loss of appetite, and in actual fact feeding can cause distress itself.

    As for the comments suggesting doctors are using it an 'back door' euthanasia, that's absurd, it's an entirely caring decision to use the LCP

  • rate this

    Comment number 68.

    My mother died in hospital last year.She was denied water to drink over the last two days of her life,despite pleading for it and being obviously distressed. Nursing staff said they couldn't go against the instructions of the doctor who was on leave for two days.She died at the end of the two days, aged 97 - the memory of that time will never leave me. It was cruelty.

  • rate this

    Comment number 67.

    I've worked as a nurse in the NHS for two years and this is the first time I've heard of a NHS constitution. The government has made zero effort to get this initiative to the front line. As for the critics who think the LCP is 'inhumane', forcing food and fluid down someone's throat when they are dying is far worse.

  • rate this

    Comment number 66.

    Euthansia is an active process of hastening death; the LCP allows the withdrawal of treatment for those patients in whom death is expected. For them not all aspects of modern medicine are appropriate and the LCP makes that explicit. It is not a license to double dose opiates so that death comes swiftly. Family understanding and involvement are crucial and it should be a team decision

  • rate this

    Comment number 65.

    Doctors are like any other person doing a job day in day out. Under pressure and from time to time get it wrong. Why should the doctor have to work with the burden of making that let them die decision. Family know the person and their values on life and death. What ever way it goes the accountants have to be kept well away from this one

  • rate this

    Comment number 64.

    These laws should only be applied alongside laws allowing assisted suicide.

  • rate this

    Comment number 63.

    If the patient knew they were hungry or thirsty it would be cruel to deny them but those on LCP aren't aware of it, they're unconscious and already dying...a process that can take days. It is not care for the patient to want it to go on, it is selfish love and not wanting to let them go. We all die and it's part of life

  • rate this

    Comment number 62.

    It needs to be the right of the patient as to when they want to die and should be the last right of the patient, the decision should be make when the patient is in sound mind with a legal witness and doctor present. Look at the Netherlands their system works, they don't torture their patients or have a pathway that does just that! This can be done a whole lot better than it currently is.

  • rate this

    Comment number 61.

    I am old. I do NOT want end of life treatment to get tougher, I want quite the opposite. I want to make it easier for health professionals to allow me to die as quickly as possible when my time comes.

  • rate this

    Comment number 60.

    LCP is fine in many circumstances, perhaps most, but the idea that the medics can impose it without very strict checks on patients wishes/family is worrying.

    Bit it of a daft argument given that women havent been equal to men for very long - does that mean the historical perspective = the right one? Some animals do have forms of 'art' and develope and use simple tools.

  • rate this

    Comment number 59.

    More meddling from politicians, who as a group seem to know little and whose main aim is to feather their own nests. These elected but otherwise generally ignorant individuals should maybe in some areas listen to the professionals, rather than ignore them.

  • rate this

    Comment number 58.

    It is symptomatic of this selfish generation to want to murder their own parents and kin - sow the wind and reap the whirlwind. why not just curse God and die

  • rate this

    Comment number 57.

    My dear Mum had teminal cancer, she was put on the LCP and passed away so peacefully, I didn't even realise she had gone. For this I will always be grateful.

    It was not a case of withdrawing food or drink, Mum decided herself she did not want/could not, eat or drink. Keeping Mum's mouth moist was all she wanted and she was comfortable.

  • rate this

    Comment number 56.

    Thank goodness that at last people who actually know what they're talking about our commenting - QuinsFanDoc, Appolonia etc. And I absolutely agree with Joyanblu - it's an incredibly emotional time when someone is dying and the chances of all family members agreeing on the best way forward is remote.

  • rate this

    Comment number 55.

    My mum died 16 months ago we went into hospital and although the staff did their best they said there was no more they could we expected her to pass within days but it was 2 weeks very distressing for the family but more for my mum who would have not wanted it this way. Plus remember we have no win no fee lawyers who only make it worse with no medical staff who want to leave themselves open


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