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Liverpool Care Pathway replacement ‘is not only wrong it is dangerous’ says professor

Professor Patrick Pullicino

A senior Catholic doctor has severely criticised new NHS guidance replacing the Liverpool Care Pathway (LCP), saying it has the potential to hasten patients’ deaths.

Professor Patrick Pullicino, who had previously called for the reform of the LCP in 2012, said the new guidance on end-of-life care, released last week, was even more dangerous.

The guidance, published by the National Institute of Health and Care Excellence (Nice), asks that staff identify a list of signs which suggest a patient is entering their last days.

But Professor Pullicino, a clinical neuroscientist at the University of Kent, said these signs did not provide enough evidence on which to base treatment and called for “good quality compassionate care” instead.

He told the Catholic Herald: “The section on hydration contains some very worrying language. It says that ‘death is unlikely to be hastened by not having clinically assisted hydration’. This is completely untrue.

“Everybody knows that if you don’t give someone water, they will die. This document is not only wrong, it is dangerous.”

In the late 1990s the LCP was created for the care of terminally ill cancer patients.

Subsequent to this the scope of the LCP was extended to include not just cancer patients but rather all dying patients.

Six years ago, researchers said that forecasting death is an inexact science and therefore attributing the symptoms to death could be cutting lives short.

Signs of death under the LCP could point to other medical problems or an experience of side effects of strong pain-killing drugs according to academics.

Three years after this, Professor Pullicino echoed these criticisms of the pathway and this was presented in the national media.

According to the Daily Mail a Department of Health spokesman responded to his original accusations and said: “The Liverpool Care Pathway is not euthanasia.”

The neurologist is believed to have intervened in the case of a 71-year-old man and took him off the LCP to be treated successfully.

Criticism around this time led to a review, which was chaired by Baroness Julia Neuberger.

She said more research was needed to establish whether it is possible to predict death with any degree of accuracy.

The review led to a rebranding of the LCP, as opposed to a complete removal, in which every patient would receive individual end-of-life care plans.

In a recent Daily Telegraph column the professor expressed fears that features of the LCP that made the pathway dangerous have been added to even more lethal errors in the new guidelines.

He wrote: “The reality is that LCP was in operation for so long that it has changed accepted practice in the NHS and even after it was removed, similar practices continued under different names.”