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The big question: do criticisms of the Liverpool Care Pathway detract from the benefits it brings to patients?

A doctor is calling for greater supervision of the Liverpool Care Pathway after claiming that many older people were having their treatment withheld too early.

This has sparked more than 20 organisations, including the Royal College of Nursing and Marie Curie Cancer Care, to sign a consensus statement to rectify “misconceptions and often inaccurate information” about the LCP.

The statement says the pathway should not “hasten or delay death”, but ensure the right type of care is available in the last days or hours of life “when all of the possible reversible causes for their condition have been considered”.

Will newspaper claims that the LCP has become “an assisted death pathway” detract from the protocol’s aim of providing a dignified death?

Add your comments and they could be published in the magazine.

Readers' comments (5)

  • How does the LCP 'delay' death?

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  • michael stone

    'The statement says the pathway should not “hasten or delay death”'

    No, it doesn't say that. See (from the other contemporary piece) what I've just posted about what the consensus statement actually does say:

    There is also something unhelpful in the consensus statement:

    The Liverpool Care Pathway does not: … Hasten or delay death,

    You can regard that as being a flawed statement on logical grounds (compared to what alternative ? How do you prove it ?) or, as I do, as being generally unhelpful in that it does not in any way advance the argument regarding behaviour around death.

    Two of the more fundamental problems re ‘the rules for dying’ are the issues around patient consent, and the complication introduced by section 4(5) of the MCA (you can see 4(5), shown next, as alternatively saying ‘assisted suicide is illegal’):

    4(5) Where the determination relates to life-sustaining treatment he must not, in considering whether the treatment is in the best interests of the person concerned, be motivated by a desire to bring about his death.

    So, it would have progressed the understanding, if the consensus statement had actually said, instead of the wording it uses, this:

    The purpose of the Liverpool Care Pathway is not to: … Hasten or delay death,

    Think about this – it isn’t hard. General anaesthesia has a known risk of death associated with it, but it is still perfectly legal because it is necessary for operations. Very large morphine doses might in fact ‘speed death’ but if they are given for the purpose of pain/distress relief, then they appear to be legal (see ‘motivated’ in 4(5) above).

    You don’t need to illogically claim that the LCP has no effect on when a patient dies – you only need to properly get either patient consent for the treatments, or else to correctly work through the intricacies of the Mental Capacity Act’s Section 4 test.

    As the GMC so plainly pointed out in ‘Treatment and care towards the end of life’ in section 14(c),

    ‘The patient weighs up the potential benefits, burdens and risks of the various options as well as any non-clinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which. They also have the right to accept or refuse an option for a reason that may seem irrational to the doctor or for no reason at all.’

    ‘The patient weighs up the potential benefits, burdens and risks of the various options’ – as that meerkat on TV says, ‘simples’ !

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  • ‘The patient weighs up the potential benefits, burdens and risks of the various options’ – as that meerkat on TV says, ‘simples’ !

    Shouldn't that read "The patient weighs up the potential benefits, burdens and risks of the various options based on limited or incomplete information, under paucity of medico-legal comeback relating to decisions of veracity of over beneficence, not less pucuniary interests over non-malfeasance. Notwithstanding.


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  • Anonymous | 10-Oct-2012 3:16 pm

    The GMC described te legal principle correctly - as you say, there seems to be divergence in practice.

    But uncertainty in outcomes, is still something that in theory should be described to the patient, and the patient is the person who considers the uncertainties - nobody seems very keen on describing uncertianties, however.

    Patients can only be told, what is knowable - telling them what is knowable, is adequate. Not telling patients what you know, probably isn't legally correct, often.

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  • See the latest headline news !

    Use of the LCP is fast becoming unacceptable to the majority of the general public.

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