BMJ  2008;336:905 (26 April), doi:10.1136/bmj.39556.400370.80

Letters

Continuous deep sedation

Dutch research reflects problems with the Liverpool care pathway

The first 150 words of the full text of this article appear below.

The Liverpool care pathway (LCP) is the UK’s main clinical pathway of continuous deep sedation and is promoted for roll out across the NHS.¹ Rietjens et al’s study highlights some serious weaknesses in its design.²

The eligibility criteria do not ensure that only people who are about to die are allowed on to the pathway. They allow people who are thought to be dying, are bed bound, and are unable to take tablets on to the pathway. In chronic diseases such as dementia, dying can take years, but such patients may be eligible. Reitjens et al’s paper shows that GPs often put patients on to such a pathway without palliative care advice. A pathway for general use should minimise opportunities for early or inappropriate use.

Murray et al are concerned that sedation is being used as an inexpensive alternative to assessment and specialist treatment.³ The LCP recommends sedatives and opiates . . . [Full text of this article]

¹ Memorial Hospital, London SE18 3RZ

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