Is the Liverpool Care Pathway badly maligned?

There was an article in the Daily Mail last week, picked up by the Telegraph and The Catholic Herald, with the headline: “Top doctor’s chilling claim: the NHS kills off 130,000 elderly patients every year.”

Apparently Professor Patrick Pullicino, a consultant neurologist for East Kent Hospitals and Professor of Clinical neurosciences at Kent University, stated in an address to the Royal Society of Medicine: “The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway. Very likely many elderly patients who could live substantially longer are being killed by the LCP. Patients are frequently put on the pathway without a proper analysis of their condition. Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically.”

For those not familiar with the LCP it is a response to a patient perceived to be dying developed in a Liverpool hospice that involves heavy sedation, coupled with withdrawal of food and fluids. Professor Pullicino went on to comment that “This determination 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. If we accept the LCP we accept that euthanasia is part of the standard way of dying as it is now associated with 29% of NHS deaths.” It seems the Daily Mail then calculated the figure of 130,000 being “killed off.”

I would have been inclined to believe all this, having read anecdotal evidence in the past of the hazards of the LCP, though I wondered why, if it were true, it did not dominate the next day’s headlines and news stories. Then I read BioEdge, an online commentary on bioethics, which pointed out that the article was full of general speculations such as the phrase “very likely”, the words “probably” and “if” and “associated with”. It was opinion rather than fact, which the Mail, in its sensationalist fashion, managed to turn into an emotion-grabbing story. (BioEdge thinks the Mail has taken up the discarded mantle of the late News of the World; I think that’s going too far.)

Dr Peter Saunders, head of the Christian Medical Fellowship and a strong opponent of euthanasia, commented: “The overwhelming majority of people on the LCP are experiencing much better care at the end of life than they would have had if it had not been chosen.” It would be interesting to know the medical reasons why people are being put on it, though; and the statement also implies that a minority of people might be experiencing worse care ie inappropriate measures that are deliberately ending their life too soon.

Yet Dr Philip Howard, an NHS doctor from Surrey, is pessimistic about the benefits of the LCP; he feels it means large-scale euthanasia by stealth and that the practice would gradually make it irrelevant whether euthanasia should be legalised. He commented: “It is a decision with an end in view. The patient is dying. Why? Because we say they are dying. Why? Because we have decided.”

Yesterday on the radio I heard that in the near future local councils will have to ditch all their other commitments (apart from emptying the bins), such as the maintenance of local roads and providing public libraries, in order to pay for the end of life care of their elderly local residents. It strikes me that wheeling out the LCP alongside the wheelie bins will look like an increasingly attractive option to our health and social services. This is my opinion rather than fact, obviously.