The Liverpool Care Pathway v Assisted Dying

For information, this is the answer provided by ‘Dignity in Dying’ when I enquired about the difference between shortening someone’s life by putting them on the LCP and actively assisting them to die:

‘Under an assisted dying law, a patient could only have an assisted death if they had made several requests for assisted dying and met all the safeguards. The patient would self-administer the life ending medication. A terminally ill person could start the process of requesting an assisted death when they had a prognosis of 12 months or less to live

This is very different to the Liverpool Care Pathway, which is about managing symptoms when a person is dying – a day or two from death at most. The principle behind the LCP is that treatment, including artificial hydration and nutrition, may be withdrawn to make the process of dying better in the last hours of life. Even though it sounds alarming, dying people may not be able to take in nutrition and fluids and in many cases it would be harmful and result in very distressing symptoms to continue with such treatment. Your email reflects the media coverage that families have not been told about the use of the LCP in some cases. Whilst research shows that poor communication around the LCP is not the norm, the media cases are concerning.

Even if the worst claims about the LCP were true, this would be completely different to the patient-centric, choice based, safeguarded assisted dying process that we propose.

In terms of Dignity in Dying and Compassion in Dying, we are closely monitoring the research and the media reporting around the LCP.

In terms of the government, there is currently an independent review of the Liverpool Care Pathway in progress – members of the public are encouraged to email the review team about their experiences of/views on the LCP at liverpoolcarepathwayreview@dh.gsi.gov.uk. There is more information on the review here: http://www.dh.gov.uk/health/2013/02/liv-care-pathway/.’

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About bmitzi

Medical writer, author, artist. Cancer campaigner. Aiming always to improve health services and bring compassion into health care.
This entry was posted in Campaigns, Compassion in healthcare, palliative care and tagged , , , . Bookmark the permalink.

6 Responses to The Liverpool Care Pathway v Assisted Dying

  1. Mark says:

    Presumably, there is an impartial and independent check of the diagnosis and prognosis, a signed consent form, and a test of the mental capacity to give the latter.
    I know someone who was ‘diagnosed ‘ with ‘terminal HIV infection/AIDS’ about this time of year in 1984…..still here today 🙂
    Shame that v.11 of the LCP (in use from 2003-present day in some areas) didn’t even bother to check the patient whether they could speak English or not until after they’d had their treatment withdrawn/witheld and the syringe drivers had been set up!
    Oh,…and all those missing consent forms…..

  2. bmitzi says:

    Thanks very much for your comments Mark. I would agree with shortening life when death is clearly inevitable and close and a patient is suffering – eg I’d like treble +++ doses of morphine please, because I know just how terrible pain can be. But I had concerns about the LCP (a relative’s family were horrified that they were not allowed to feed him) so thought I’d pose the question to Dignity in Dying for their views. I have heard that withdrawing food and water can cause extreme pain, so my concern is that, even if valid informed consent is obtained from patient./relatives, is adequate pain relief and palliative care ALWAYS provided …? With hospitals shortstaffed, scandals around neglect, own and friends’ experiences to go on – I can’t say I’m confident. I’m hoping the Independent Review will improve the situation, but not holding my breath.

    • Mark says:

      These review submissions are all being pre-screened by people who rely on the liverpool care pathway for a living (one of whom is a ‘risk management’ legal expert)…I don’t think many of the victims families are even going to bother , as the reviewers reject any queries about the actual liverpool care pathway itself..its actually NOT included in the terms of reference for the review panel at all! The drugs that both versions of the lcp uses (midazolam and morphine) were considered as euthenasics by the royal dutch college of pharmacists, when they were looking for a euthenasic for legal voluntary euthenasia in Holland, and were only rejected because they took too long! To do this to people who are in genuine misery and want to die is fine with proper safeguards…but to call this a ‘care pathway’ has allowed many practitioners to simply bury their mistakes (one only has to look at the sheer number of dead patients at Mid Staffs who were ‘back clerked’ as ‘palliative care ‘ cases to prove this.
      I would also add, that there are a hundred advances in pain management that are not available on the NHS…how awful that many people feel their only option is ‘assisted dying’, rather than good pain relief with drugs other than those that risk killing them.

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