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
    -1

    Comment number 174.

    163 Lagerlord re 152 . Cases much different, Endocarditis and septicaemia can't be compared in any way at all. Your comment is both irrational and insensitive to Adam who was there and saw what was happening to his relative. This was not a like for like situation and I daresay you're own state of general health might be different to his grandfathers to start with.You did the right thing Adam

  • rate this
    -1

    Comment number 173.

    Many of these comments imply there is a lack of trust in healthcare professionals.eg 149.

    Every day patients die in hospital because of medical negligence etc and the NHS pays out millions every year in compensation

    Trust them? Of course not

  • rate this
    +3

    Comment number 172.

    163. Lagerlord

    To clarify, my Grandad was 85 years old and very frail. He was admitted to hospital with infected leg ulcers (which he has suffered from for over 10 years). After 48 hours on antibiotics the doctors advised us that his condition was unlikely to improve and that the LCP was the only option and we took their advice. He died very peacefully 3 days latter surrounded by his family.

  • rate this
    +8

    Comment number 171.

    It's your own business, not your relatives'.

  • rate this
    +4

    Comment number 170.

    While this is an emotional issue, LCP is the best option available. Doctors have developed increasingly invasive means to prolong life - but this often means prolonging or increasing suffering. LCP often means a withdrawal of artificial nutrition when death is believed to be imminent (this can change and LCP stopped). Importantly, it focuses healthcare on comfort, pain relief and spiritual needs.

  • rate this
    +4

    Comment number 169.

    I think like a lot of people here my concern isn't that this exists, but whether it's deployed on people who aren't ready to die, nobody should have to phone the police to beg for water!

    Don't let's turn this into a US-style debate about pro-life at all costs vs. euthenasia.

    In my experience hospitals take a lax attitude to food and fluids for the elderly anyway, which DOES cause real suffering.

  • rate this
    +3

    Comment number 168.

    My mother died 13 months ago from a brain tumor. I attended her bedside every day in her last month and at no point was i ever told that my mother had been put on the LCP. I discovered this after all foods had been removed. Hospitals and doctors have a conflict of interest and too much power and this should not be allowed. I now have a lasting fear that they hastened, not managed, her death.

  • rate this
    0

    Comment number 167.

    I work as a district nurse and the first part of the LCP is that medical and nursing staff jointly identify that the patient is dying. Next, it is discussed with family members , if available, the intended plan of care and the rationale for the pathway. It appalls me that some people think this is 'murder'!!

  • rate this
    -1

    Comment number 166.

    @108 no it isn't. If a person is not consulted its murder. not assisted suicide, Murder, If you allow the killing of someone in this state, you open the door for other things, killing the mentally retarded for example.
    This ridicules idea atm is that if someones life wont be good, we should end it. It's shallow and backward, assuming you don't believe in an afterlife

  • rate this
    +2

    Comment number 165.

    Who are these people who keep thinking they can decide other people's life and death issues! It is not up to them to tell us we should welcome death like they do! It is not the "nanny" state, it is for individual patients to decide if they with care to prolong life, or just wish to die. To deny them this choice is to steal their LIBERTY and is anti-Libertarian. Many different views - whose choice?

  • rate this
    +5

    Comment number 164.

    More sensible for Govt to debate that everyone makes a living will (say age 50) so patients have their own choice that many are arguing about on here then no matter what the relatives thought the Docs/Nurses would have written authoristaion & relatives would have evidence if needed to say they'd acted against the interests of the patients. Individual self responsibility and choice

  • rate this
    +1

    Comment number 163.

    152. Adam – “unresponsive to antibiotics for 48 hours.”
    Much as I think the government should butt out of political healthcare, 48 hour on AB’s is no real time, sorry.

    I had endocarditus, takes a good 10 days or so for any real result…

  • rate this
    +4

    Comment number 162.

    Dignity is not being starved and dehydrated.

  • rate this
    0

    Comment number 161.

    The LCP does NOT mean withdrawing food and water. The dying can eat anything they like, often little because loss of appetite is a near death sign; force/NG feeding is considered inhumane LCP or not. Furthermore families are already consulted. This shameful misrepresentation of the LCP + the law change forces families to feel they are signing a death warrant. Millions will be hurt by this.

  • rate this
    +1

    Comment number 160.

    I have on dozens of occasions had somebody refuse food/fluid, however the same people have held my hand and looked into my eyes as they pass, when the time comes you won't be interested in a cup of tea and a scone, the personal interaction is what one seeks, to know that somebody cares right there and then. Not to force feed !!!!! To hold a hand and care !!!!!!!!!

  • rate this
    0

    Comment number 159.

    I always thought this was the case, unless a DNR had been signed.

  • rate this
    0

    Comment number 158.

    As I understand the LCP was developed at the Marie Curie HOSPICE Liverpool! Yes folks a "HOSPICE"! ALL of their patients are terminally Ill. I have seen patients die in avoidable pain because their nurses (mostly Irish Catholics in 1970s) didn't want to be the one who gave the last painkilling injection. The Church's view was focussed on "intent". Why did you give it -to relieve pain or kill? QED

  • rate this
    0

    Comment number 157.

    At last, the real truth is coming out about the NHS treatment of the terminally ill. Ignoring force feeding and other discomforting measures, hospitals and even more so, Nursing Homes do not put up drips, so patients become emaciated and die more quickly. Perhaps someone can explain to me how painless it is to starve to death?

  • rate this
    +1

    Comment number 156.

    To Pm03ds - you did not read the reports of someone phoning the police begging them to get him something to drink before he died of dehydration? LCP would be fine as long as the medical staff followed all rules, such as pain killers as it is not a pleasant death if one is conscious. The problem is as the medical staff in hospitals cannot be trusted to do anything according to good guildlines.

  • rate this
    +5

    Comment number 155.

    My great-aunt was put in hospital at the end of her life & they told us she was "refusing food" - in fact she was so confused as to why she was in hospital she didn't understand she had to open the covered plates and eat & drink quickly.

    The lack of care caused definite suffering, this issue of denying food & fluids goes beyond the LCP, God help you if your family don't live near & visit 2 x day.

 

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