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 94.

    Suggestion to those who 'know' how others should live/die...shut up and get on with your you do so, I don't really care.

  • rate this

    Comment number 93.

    Food/fluid should not be withheld as part of the LCP, The problem usually arises when the patient's swallow has been deemed unsafe; normally a drip would be put up or naso-gastric feeding started, but at the end of life these can cause unnecessary distress. Let them have access to food/fluid if they want it - if it goes down the wrong way resulting in distress then a drip/tube may be appropriate.

  • rate this

    Comment number 92.


    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?
    The prisoner's not terminally ill. I think you're knocking down a straw man.

  • rate this

    Comment number 91.

    How many people have never heard of LCP? Why not? Health Trusts should be forced to publish full details of their LCP procedures in all media. It's not a secret is it?

    Iit should be a legal requirement that the patient is told they will be put on LCP - the patient and their representative must both sign a document agreeing to this specific procedure before it starts and they can stop it anytime

  • rate this

    Comment number 90.

    This seems like another example of the media creating a storm over something, without getting the full grasps of the fact, fuelled by some Baroness passing on hear say that is probably clouded by grief and emotion.
    It is far crueller to force feed a dying person than to slowly withdraw fluids and foods. This furore will increase the suffering of those dying in hospitals.

  • rate this

    Comment number 89.

    I'm reminded there's a tale, of a very ill Yorkshireman who one day felt a little better.

    "Could I 'ave one o' them sandwiches?" he asked his wife, who was making them.

    "Get on wi' dyin' thee. These are for t' funeral" came the stern reply...

  • rate this

    Comment number 88.

    @75 adriansmith: If LCP was applied inappropriately these 2 cases then yes it should be investigated but in all the instances I have seen it applied it was to allow a natural death. We should not throw the baby out with the bath water purely based on alleged or perceived misuse. I would welcome a review but perhaps not change practice based on perception and allegations alone.

  • rate this

    Comment number 87.

    There are a lot of comments on here from people who don't understand this, and are mispercieving the LCP as cruel. Judging by the way this is being reported, politicians and journalists don't understand it either.

    Paliative care doctors developed this, they are the experts, leave them to it

  • rate this

    Comment number 86.

    There is misunderstanding around hospitals getting "paid" to put people on the LCP. They have a financial target to make sure that people who do die are on the LCP - ie to make sure that people who are dying have been recognised as dying and treated appropriately, without unnecessary painful tests and on have robust analgesia. They're not paid to kill people - there are also mortality targets!

  • rate this

    Comment number 85.

    Consulting the relatives on hand is the good practice of most hospitals. But turning it into law? The words "have to be consulted" leaves hanging in the air what happens if the views of the relatives are perverse, they disagree with each other, are estranged and hate the dying person or scattered half way around the world. Not sure this has been thought through.

  • rate this

    Comment number 84.

    As a doctor who has experienced putting patients on the LCP, I can assure you that it is not so demonic as the media and the comments below have made it out to be. First and foremost, it is done with the patient's comfort in mind.more often than not, doctors can recognise when a patient is dying and do everything they can to alleviate suffering. Families are always consulted if available.

  • rate this

    Comment number 83.

    Oh come on people. Gov't stay out of my isn't that what you would really like to see happen????

  • rate this

    Comment number 82.

    Giving someone food and fluids when their organs are failing causes nausea and pain. When patients are on the LCP they get regular mouth care to moisten the mouth to alleviate dry mouth, why do the critics think healthcare professionals haven't thought of this issue already? the LCP came into fruition from extensive evidence based practice, we know what we are doing thank you very much.

  • rate this

    Comment number 81.

    We will never know how many health workers play God - it's a sign of the times - CARE of the elderly is just an expression.

  • rate this

    Comment number 80.

    What about the poor old soul (& there are plenty of them)who hasn't seen their families for years, left alone and lonely & then the vultures arrive to be there at the death, literally? Are they the ones to be deciding...they'd probably want it to happen even quicker to get the money..& be the first ones to kick up and sue &believe me it happens. How many kids actually want the responsibility?

  • rate this

    Comment number 79.

    @73 No this isn't wrong - but is the way it really happens?

    I suspect not universally

  • rate this

    Comment number 78.

    The key issue is not having decisions taken out of your hands by others behing your back.
    Personally, it all sounds like a money-saving racket to me when hospitals get financial 'rewards' for using LPC, and I respect those on here who say they found it helpful but have on more than one occasion interrupted arbitrary close down tactics. This makes people scared to trust doctors and nurses.

  • rate this

    Comment number 77.

    The problem with any occupation, is that it can attract people for entirely the wrong reasons.

    One that involves being near to a lot of suffering people may draw those who enjoy, or who at least are unaffected by, contemplating suffering in others.

    It's not possible to see into hearts and minds with certainty, so some will slip through.

    Hardly the ones to trust with these powers.

  • rate this

    Comment number 76.

    Ethically this sounds very worrying. It is very easy how something like this could get used inappropriately. It also sounds like a fallacious ethical contrivance, in fact more like a legal contrivance. In other words letting someone dehydrate and starve, rather than someone taking direct action which could kill them such as administering a drug. Contrived to avoid legal responsibility .

  • rate this

    Comment number 75.

    Joyanblu can that be proven as I know of at least two cases where the patients were aware of it and managed to communicate that to a next of kin! Both these cases are currently under legal scrutiny and rightly so. Hence my last couple of posts here. Families are being kept in the dark and taken advantage of due to a lack of knowledge and understanding given the situation they are in. Its shocking.


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