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 154.

    "47. yorkshirelass2

    My biggest fear for when I am old is that someone would stop me from having water to drink. ... 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' ??"

    The discomfort of thirst would be eased by morphine.

  • rate this

    Comment number 153.

    suzymoo wrote "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.... 6 days later my nan got herself out of bed and said the "queue was too long". She's still with us."

    What a wonderful opening to a movie -- go write it!!!

  • rate this

    Comment number 152.

    People need to remember that the Liverpool Care Pathway is only used for patients for whom there are no other options. My Grandad was put on it because he had septicemia and had been unresponsive to antibiotics for 48 hours. We were kept informed and we felt that putting him on the LCP was the only human option available to us, although I did seriously have to think about the ethics of it.

  • rate this

    Comment number 151.

    //9. AlanP
    Any sort of method or intention of ending any one's life, in any conditions, is pure simple murder. I hate when people and the Government try to invent new terms and absurd explanations to compensate the guilt and justify this attitude.//

    Spoken by someone who is completely clueless!

  • rate this

    Comment number 150.

    My mother was put on the LCP when she was clearly dying and showed no sign of recovering (she was 99 years old). The process was clearly explained to me and all tubes etc were withdrawn making her more comfortable. She was fed if awake, but hardly took anything, and was given water and her mouth kept moist. It eased her last hours and she died with dignity as she would have wanted.

  • rate this

    Comment number 149.

    i firmly believe that once you reach a certain old age hospitals dont do as much for you as they would for a younger person. you see the doctor when youre diagnosed then but never see him/her until near the end. youre never given any info unless you ask for it. this was the my experience re my mother. we are told they are doing everything they can but are they really?

  • rate this

    Comment number 148.

    135 Ian. Retired after 40yrs as nurse. Point was training should be acknowledged just like you'd trust a pilot to fly a plane in difficult circumstances. A lot of criticism against medics/nurses on here and we can only do our best...and even to ourselves that sometimes isn't enough. Most of us, including me still care but people now expect perfection 110% of the time and it just can't happen.

  • rate this

    Comment number 147.

    If you with hold food and water, knowing that your action will cause someone to die. Isn't that murder??? I work in health care and I could not participate in any such action, any care giver that did would be taking a huge risk.

  • rate this

    Comment number 146.

    On the one hand it bothers me that humans don't get a dignified death at the right time, something we all agree is best for our pets, BUT:

    the medical profession insists the worst symptoms of a hangover are due to severe dehydration - if you've ever had a stormer of a hangover, imagine that getting worse and worse, as how you'll spend your final 3 or 4 days.

    So IMO CAN'T be right to deny fluids.

  • rate this

    Comment number 145.

    KEY LCP (v12) Messages include: LCP:
    1. Is only as good as the people who are using It
    3. Good communication is pivotal to success
    4. neither hastens nor postpones death
    6. does not recommend the use of continuous deep sedation
    7. does not preclude the use of artificial hydration
    8. supports continual reassessment
    9. Reflect, Audit, Measure & Learn
    10. Stop, Think, Assess & Change

  • rate this

    Comment number 144.

    "132. AW
    .... patients can be taken off the LCP if improving. "

    How can patients possibly "improve" when water is withheld?

    "The LCP does not mean that patients cannot eat and drink, if they want to they can. But most patients are at a stage when they are barely conscious/ unconscious."

    They would be, as heavy and increasing doses of morphine are part of the routine.

  • rate this

    Comment number 143.


    The advice that relatives are consulted normally means that they are informed of the decision and given an explanation of why it has been made. Normally this is accepted and understood by the family and they are much happier for it. Occasionally, family struggle to hear this decision, which is entirely understandable, but the doctors must make the decision in the patients interest

  • rate this

    Comment number 142.

    Anyone with concerns about LCP (and anyone else who hasn't come across it) should read Jennifer Worth's excellent book 'In the Midst of Life'.

    LCP is an important step towards de-medicalising the natural process of death - a welcome reversal of practice after 50 or so years of what has sometimes been genuine abuse of the dying. It is time we stopped being afraid of death.

  • rate this

    Comment number 141.

    Health workers sometimes have difficult decisions to make at the end of life. An extra dose of painkiller is often administered to help terminally ill people on their way. In most cases relatives are grateful & relieved the suffering is over.

    However, some relatives will consider claims for medical negligence & compensation. Greed is often the motivator.

    These guidelines do not help.

  • rate this

    Comment number 140.

    I wouldn't like to have to make the decision to pull the plug on somebody, it must be a horrible feeling, but I can see it being totally necessary under certain conditions. What happens if you don't have any relatives and sombody in authority makes the decision to terminate your life, is that state-sanctioned murder?

  • rate this

    Comment number 139.

    I have heard constantly of things being done to people "as their care", I have not once heard of those practitioners asking the patient and consulting them on their care as always used to be the standard treatment. It is not up to professionals or family to decide wether treatment should be resusitation or or just comforting, it THE PATIENT's Choice, and THEIRS ONLY.

  • rate this

    Comment number 138.

    Relatives should be informed of the family member being put on the LCP, as the family should make the choice not the doctors or nurses as the person under their care may not want to die only the family knows what the person wants as they have known them over the years the doctors and nurse only know them as long as they are in the hospital.

  • rate this

    Comment number 137.

    LCP is an excellent aid to help guide medical staff in relieving suffering in the dying phase. It has benefited many patients and families since it was introduced. It is always good practice to communicate decisions such as this with relatives. From my experience every effort is made to do so. I hope patients will not suffer as a consequence of all this unecessary publicity around the pathway.

  • rate this

    Comment number 136.

    Why should the relatives be consulted at all? Surely, the medical staff are best placed to assess the condition of the patient. I, for one, would rather have my suffering ended by somebody able to make an objective assessment, rather than prolonged by a tearful relative.

  • rate this

    Comment number 135.

    joyanblu... hope your not in the profession. What you seem to say is agree with everything we do or do not use us. Fantastic attitude.


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