The Liverpool Care Pathway and its discontents

As fall-outs between pro-life campaigners go, this one has yet to surface, but it could turn for the worse. The tension is over whether or not the Liverpool Care Pathway (LCP) is being used as a form of euthanasia.

In June Dr Patrick Pullicino, a neurologist, claimed that the Pathway was an "assisted death pathway". According to the doctor, patients are being placed on the LCP without clear evidence that they are close to death, while the sensationalised Daily Mail headline ran: “Top doctor's chilling claim: The NHS kills off 130,000 elderly patients every year” - where 130,000 is the total number of patients who are put on the LCP out of the 450,000 that are terminally ill. In other words, the majority of people who are close to death are not put on the Pathway.

Then in September the Catholic Archbishop of Southwark called for an inquiry into the care of terminally ill patients on the LCP. Writing to the Secretary of State for Health following a number of disturbing reports, he said: “It does seem to me that a thorough and urgent investigation needs to take place, examining the evidence on which the criticisms that have been made of the LCP rest, so that conclusions can be reached as to whether any corrective action is needed.” The Department of Health has just responded, saying there would not be another review.

Meanwhile Dr Peter Saunders, the director of Christian Medical Fellowship and the campaigns director of Care Not Killing, is an outspoken supporter of the LCP, as long as it’s properly administered, and writes about the matter on his personal blog.

Thus slight differences of opinion seem to be floating around in the pro-life end of life camp. Dr Pullicino, who according to the US online newspaper National Catholic Reporter is a Catholic, claims that the “determination [of the medics] in the LCP leads to a self-fulfilling prophecy. The personal views of the physician or other medical team members of perceived quality of life or low likelihood of a good outcome are probably central in putting a patient on the LCP.”

But only terminally ill patients very close to death can be put on the LCP, which was developed as part of the hospice movement in the UK. Since then it has spread into other settings where dying people are looked after, such as in hospitals, care homes and in people’s own homes. According to Dr Saunders: “Before a patient can be placed on the pathway the multi-professional team caring for them have to agree that all reversible causes for their condition have been considered and that they are in fact imminently dying”, adding that “the assessment then makes suggestions for palliative care options to consider and whether non-essential treatments and medications should be discontinued”.

The goal of the properly administered pathway is to help coordinate the work of all carers so the wishes and needs of the patient are directed towards a good and relatively pain free end of life. Furthermore, checks need to be carried out as regularly as every four hours to asses whether the previous diagnoses can still be upheld.

An evaluation of the LCP and its implementation is crucial to maintain trust in this methodology of end of life care. However, such evaluations have taken place leading to 22 of the most well known health care organisations in the UK, such as Macmillan Cancer Support, the Royal College of General Practitioners, the Nuffield Trust, Sue Ryder care and Age UK among others, lending their support to a statement reaffirming a properly administered LCP.

Whatever differences may exist amongst pro-life end of life campaigners, they need to be resolved quickly so as not to distract from the ongoing work to fight the liberalisation of assisted dying regulations.