Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Close

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

End-of-life care pathway 'used to cut costs'

  • 30 Comments

Hospitals may be withholding food and drink from older patients so they die quicker to cut costs and save on bad spaces, leading doctors have warned.

Thousands of terminally ill people are placed on a “care pathway” every year to hasten the ends of their lives.

But in a letter to the Daily Telegraph, six doctors who specialise in older people’s care said hospitals across the UK could be using the practice to ease the pressure on resources.

The Liverpool Care Pathway, which withholds fluids and drugs in a patient’s final days and is used with 29 per cent of hospital patients at the end of their lives, is backed by the Department of Health.

But the six experts told the Daily Telegraph that among older people, natural death was more often free of pain and distress.

The group warned that not all doctors were acquiring the correct consent from patients and are failing to ask about what they wanted while they were still able to decide.

The doctors say that this has led to an increase in patients carrying a card stating that they do not want this “pathway” treatment in the last days of their lives.

One of the letter’s signatories, Gillian Craig, a retired geriatrician and former vice-chairman of the Medical Ethics Alliance, told the newspaper: “If you are cynical about it, as I am, you can see it as a cost-cutting measure, if you don’t want your beds to be filled with old people.”

A DH spokesman said: “People coming to the end of their lives should have a right to high quality, compassionate and dignified care.

“The Liverpool Care Pathway (LCP) is not about saving money. It is an established and respected tool that is recommended by NICE (National Institute for Health and Clinical Excellence) and has overwhelming support from clinicians at home and abroad.

“The decision to use the pathway should involve patients and family members, and a patient’s condition should be closely monitored.

“If, as sometimes happens, a patient improves, they are taken off the LCP and given whatever treatments best suit their new needs.

“To ensure the LCP is used properly, it is important that staff receive the appropriate training and support.”

  • 30 Comments

Readers' comments (30)

  • Tiger Girl

    'The group warned that not all doctors were acquiring the correct consent from patients and are failing to ask about what they wanted while they were still able to decide.

    A DH spokesman said: “People coming to the end of their lives should have a right to high quality, compassionate and dignified care.

    The decision to use the pathway should involve patients and family members, and a patient’s condition should be closely montiored.

    To ensure the LCP is used properly, it is important that staff receive the appropriate training and support.”

    This needs to be used properly, not improperly. Like everything else.

    Unsuitable or offensive? Report this comment

  • 'hospitals MAY be witholding ............

    what a dreadful thing to say, where is the evidence that this is happening, what a terrible accusation to make.

    Unsuitable or offensive? Report this comment

  • I don't for one minute think doctors think about the cost. I agree it is a dreadful thing to say. The LCP is about comfort if a patient can still eat and drink that is fine if not IV fluids can be given following a discusssion with their family.

    Unsuitable or offensive? Report this comment

  • Adam Roxby

    This has created quite a storm on twitter which I have been following. I don't want to give anything away, but this might be featured in the next episode of the Student Nursing Times Podcast so watch this space.

    Unsuitable or offensive? Report this comment

  • Oops I've offered patients on the LCP water before and I think I've seen family members do it too... (luckily most of the patients refuse it, are unconscious or can't swallow anyway). I was told to do whatever to make them comfortable. Better read the paperwork more carefully next time!

    Unsuitable or offensive? Report this comment

  • The letter the doctors wrote suggests sub-cut fluids to ease thirst - how does that work? When they say doctors 'withold drugs' it's not quite like that is it.

    They also suggest that in the elderly a natural death was free of pain and distress - really? how do they know? might it have something to do with the fact that a lot of older people are stoic, or perhaps they can't express their distress or pain, particularly at the end when they may be semi-conscious.

    The card that patients are supposed to carry saying they don't want to go on the LCP - has anyone here ever seen one? If so can you copy and paste it please.

    Very unkind and misleading article which does nothing to help anyone.

    Unsuitable or offensive? Report this comment

  • It seems there is a misconception in the media and among the public of the LCP.

    Unsuitable or offensive? Report this comment

  • Sin to Heal Me ?

    Anonymous | 10-Jul-2012 10:09 am
    Anonymous | 10-Jul-2012 10:13 am

    Yes, quite !

    I read this story in the paper - The Medical Ethics Alliance is a Christian group, with a perspective/agenda it seems.

    There is confusion, in what is being reported of their position - i.v. fluid is quite different from drinking a glass of water, etc - and I am not exactly certain what they did write in their paper.

    However, some people perceive the LCP and similar as 'killing the patient' - it all looks very dubious, legally and ethically, if clinicians start to decide what a patient wants, without getting that instruction from the patient.

    And Adam, will you also place your feedback highlights in this set of postings, if possible - your comments are always interesting.

    Unsuitable or offensive? Report this comment

  • from Anonymous | 10-Jul-2012 10:13 am

    Hi, Sin to Heal Me ? | 10-Jul-2012 10:59 am

    The public obviously needs to be somehow far better informed about end of life care, the LCP and the boundaries between personal choice and clinical decision making. I too have followed it in the national press and reading some of all the hundreds of comments I have discovered that so many different issues have been introduced into all the arguments that it results in total confusion and many do not have a clear understanding of what care their loved ones and others receive, the quality of that care, the skills and clinical judgement involved and limitations of nursing and medicine.

    Unsuitable or offensive? Report this comment

  • There is a section of the LCP which states that patients are assisted to take oral fluids for as long as possible and artificial hydration is to be considered so I don't understand what is going on here.

    Unsuitable or offensive? Report this comment

Show 102050results per page

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.