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 194.

    I lost my grandma to cancer 4 days ago and she was on the LCP. It was undetected and only lived 9 days after going into hospital. She didn't eat or drink on her own decision as she didn't want the process to be long drawn and undignified. I think it should ultimately be the patients choice but should be discussed with relatives. I don't believe it is inhumane, it ensures as little pain possible.

  • rate this

    Comment number 193.

    This minister should stick to expense fiddling rather than interfering with dr-patient relationships. The dr has a duty of care to the patient; any discussions with a third party could potentially be a breach of confidentiality. Therefore making it a legal requirement could place the doctor in an impossible situation

  • rate this

    Comment number 192.

    Death is inevitable. The point of the LCP isn't to hasten it, but to ensure it is comfortable.

    You don't die of thirst, and the evidence is that keeping the mouth moist prevents thirst. Persisting with medical interventions when it is futile is cruel and only adds to the suffering of the patient+family. Eg IV fluids accumulate sub cutaneously when given to dying patients.

  • rate this

    Comment number 191.

    As a hospital visitor coming into contact every day with LCP patients and their relatives I can say that it is a very well organised and successful system whereby patients pass away with the minimum of suffering and distress, and with dignity. Medical staff concerned demonstrate a high level of care, and liaise very closely with the relatives. Any notion that it is otherwise is quite erroneous.

  • rate this

    Comment number 190.

    My father-in-law was on the Liverpool pathway and he had a relatively peaceful end, with our consent. I didn't now that the withdrawal of food and water was part of it; he was heavily sedated with morphine and would not probably have needed food or water, but if he had, his care was so good I am sure he would have been given it. He was cared for tenderly by us and the hospital till the end.

  • rate this

    Comment number 189.

    40 years as a nurse. Because we cared we helped people to die with dignity then, the LCP is only a more formalised and documented way of doing it now (so more easily questioned which is a good thing) Death was part of life when I started, now it is almost a crime, someone has to pay or be blamed. Death hasn't altered, attitudes and litigation have though, not necessarily to he patients benefit.

  • rate this

    Comment number 188.

    So we've politicised death now.

    Have they found a way to make money off it yet? Won't be long before they do.

  • rate this

    Comment number 187.

    Your job is to watch people die. Not to research or help them keep going it is to watch them go through a horror show. The money for cure yes they are cures this treatment non sens goes to doctors £60,000+ for GP, the real disease for the NHS is the doctors pay.

  • rate this

    Comment number 186.

    177.Outside the Marginals "I don't think he was on the LCP!"

    My great-aunt was denied food & fluids, she wasn't on the LCP, my point is the NHS has an ABYSMAL track record in this area, having seen it first hand I welcome clearer guidelines + greater emphasis on living wills which should be followed, NOT reliance on family who might not live near enough to visit. Good medics surely welcome this?

  • rate this

    Comment number 185.

    my late grandfather was left alone in a hospital bed with no care or food in his last days. His mind was going but he did not understand why the nurses wouldnt give him a cup of tea. We didnt either, they didnt tell us, but left his care to my mum and her brother. We knew he was going to pass away but they never discussed it.

  • rate this

    Comment number 184.

    Fine if you are lucid. My older brother died of cancer at 66, by the time he was admitted to hospital he was delerious. He didn't respond to me, a voice he knew. There was no point in asking him for his views.

    There was no hope for him so why prolong his misery by trying to keep him alive? He died five days after admission but it was the morphine that finally killed him.

  • rate this

    Comment number 183.

    My dad was placed on the LCP earlier this year two weeks before he died. It was the best thing for him- after three months of aggressive hospital treatment he was finally able to die with dignity in a lovely nursing home. He had dementia and did not understand what was happening to him in hospital which just added to distress for everyone. I am so thankful for the LCP.

  • rate this

    Comment number 182.

    Cont from post 172.

    I did some quick online research at the time and found out that the LCP is endorsed by an anti-euthanasia campaign group which is affiliated with the Church I attend, so I decided not to question the ethical arguments.

    To this day I still think we made the right choice because there was no point in prolonging his suffering.

  • rate this

    Comment number 181.

    Keeping the elderly alive is becoming unaffordable and sensible measures should be adopted without endless box ticking. Personally, I should like to be put down before I become a hopeless vegetable, much as one would a dog or a horse to avoid it suffering. My mother in law has advanced Alzheimers and I am sure would rather not be around if she had knowledge of her state.

  • rate this

    Comment number 180.

    @166 You say enough to allow us to say you have no idea "Mentally Retarded" No such thing !! I'm going to turn this off now as like many of the people who have posted, some peoples comments have been hard to stomach. I work extremely hard and consider myself good at my job ! Whilst I don't like to be so blunt but loved one's often need someone to blame, often because it was them that didn't care !

  • rate this

    Comment number 179.

    Doctors: we can't be bothered to cure them lets kill them instead and hey give us higher wages we need 3 mercedes and 4 homes.

  • rate this

    Comment number 178.

    Whilst having no problem with the LCP I take strong exception to the relatives being involved in the decision making.

    Some members of my family do not share my views on the end of life "journey" and there is no way I would want them overriding my wishes.

    I have already made my views known and they are recorded in my medical records in the form of a living directive.

    It's my life I will decide.

  • rate this

    Comment number 177.

    Just now

    ... nobody should have to phone the police to beg for water! //

    Is this from someone on LCP or has the following got conflated?
    I don't think he was on the LCP!

  • rate this

    Comment number 176.

    "The government wants to ensure families are told of life and death decisions."

    Sorry but I believe that relatives should be CONSULTED in these matters and not just informed of a decision by the powers that be.

    It is also wrong to suggest that a patient would not want to be included with decision making if they are able to.

    Doctors saving money may lead decision the pathway to death.

  • rate this

    Comment number 175.

    This so called Liverpool Care Pathway is just a slippery slope for older people to be subjected to organised Euthanasia in time. It is typical of the general attitude towards older people in this society. They have paid their taxes but that does not matter. They should have representatives who resist this at all costs. What is the cut off age to be ? 50?!


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