A group of pro-life physicians and other professionals, as well as the Catholic archbishop of Southwark, and innumerable patient’s families, are now being joined by the UK Health Secretary in calling for a thorough, independent review of the reported abuses of the Liverpool Care Pathway, a controversial end-of-life medical care protocol. A public outcry is growing after news media have revealed that doctors are using the LCP as a method of passive euthanasia, in some cases for financial reasons.
Now it has been announced that the Association of Palliative Medicine (APM) has ordered a review into the concerns, to be organized by the National End of Life Care Programme, an NHS affiliate that has recently defended the use of the LCP. The news comes as a surprise after the calls for a review had been dismissed by public health officials.
Less than a week ago, the Consultant Nurses in Palliative Care Reference Group issued a statement in response to the “negative media coverage” the LCP has received. “We deplore the counter-productive comments made in the media which describe care of the dying as killing,” the group said.
Pro-life observers, however, are skeptical that an internal review will be sufficiently disinterested. John Smeaton, Director of the Society for the Protection of Unborn Children, wrote that his organisation is in doubt “that the review by the APM, which supports the LCP, will address adequately the disturbing claims about the LCP.”
Intended ostensibly to ease suffering of patients in the last hours of their lives, the LCP is coming under more scrutiny, with many cases highlighted in the media in which families have said it was used to dispatch loved ones whose medical condition was not terminal. Some reports have indicated that it is used in some cases to clear beds in resource-stretched public service hospitals. In the many news stories families have said that patients are routinely placed on the LCP without the consent or even knowledge either of the patient or their families.
“The average survival of a patient on the Pathway is just 29 hours. But some patients taken off the Pathway at the insistence of their relatives have lived for several months,” the Mail’s John Stevens wrote.
Most shockingly, the Daily Mail recently revealed that hospitals are being paid for making quotas for patients who die on the pathway. According to a report by the Daily Mail, one hospital was paid £600,000, over the last two years.
Traditional ethicists maintain that when a patient is so close to death that his body can no longer assimilate fluids, the removal of a hydration drip is ethically warranted. But critics maintain the LCP is being used to hasten the death of patients who could otherwise recover by removing food and hydration, defined in Britain as “medical treatment,” and is therefore a means of euthanasia.
Health Secretary Jeremy Hunt told the Daily Mail it is an “unforgivable failure” by some doctors to fail to inform relatives that their loved ones have has been put on the LCP. He said the hospitals accused of abusing the protocol “must carry out detailed investigations.”
Stephen Dorrell, chairman of the Commons health select committee, told the Mail said there are “clearly problems” with the LCP.
“The idea that a person can be cared for at the end of life without the family being involved – that is not high-quality care as anyone would understand it.”
The Department of Health recently bluntly rejected a call for a review of the LCP by the Catholic archbishop of Southwark in early October. In a letter, Archbishop Peter Smith asked the Secretary of State for Health urging him to launch a “thorough and urgent investigation” into the care pathway.
“If the allegations that are being made can be substantiated, there is serious cause for concern either that the LCP is in some way structurally unsound and needs to be modified or that some doctors and nurses are failing to implement the guidelines as intended,” the archbishop wrote.
Smith said even if there were no problems with the LCP, it was in the interests of government and medical associations to carry out the review if only to clear away growing public unease, an outcome that would relieve the anxieties of families and patients at a difficult times in their lives.
A spokesman for the Department of Health, however, told The Catholic Herald there would be no inquiry. “We would expect all trusts to investigate any reports of abuse or clinical failure and to act accordingly,” she said.
“The Liverpool Care Pathway is supported by leading clinicians and charities such as Marie Curie and is NICE [National Institute for Clinical Excellence] recommended. We continue to fully support its proper use as a way of managing a patient’s care with dignity and respect in their last days.”
A defense of the LCP was recently issued by the National End of Life Programme, to which a group of mainly Catholic physicians and professionals has responded, saying that the LCP is not based on sound, science-based medicine and can often result in “wrongful death.”
“The fact is that there is no scientific evidence to support the diagnosis of impending death,” the group said, “and there are no published criteria that allow this diagnosis to be made in an evidence-based manner.”
“This diagnosis is a prediction, which is at best an educated guess. Predictions have been shown to be often in serious error.”
“Good clinical practice has always traditionally involved a close doctor-patient relationship and the management of symptoms in the best interest of the patient, as and when they arise,” the statement continued.
“The LCP is more than a framework. It is a pathway that takes the patient in the direction of the outcome presumed by the diagnosis of impending death. The pathway leads to a suspension of evidence based practice and the normal doctor-patient relationship.”
Among the nine signatories of the statement, issued by the Society for the Protection of Unborn Children earlier this month, are Professor Patrick Pullicino, a professor of Clinical Neurosciences at the University of Kent, Dr. Anthony Cole, chairman of the Medical Ethics Alliance, and Dr. R Hardie, president of the Catholic Medical Association.
Dr. Pullicino made headlines in Britain and abroad earlier this year when he told media that up to 130,000 patients are being killed every year by what he termed the LCP’s “death pathway.”
Dr. Anthony Cole said recently, “The LCP is inherently hazardous and it is also unnecessary. Excellent end of life care can be delivered without referring to the LCP framework. It is time for an inquiry by the Department of Health into how the LCP is actually operating.”