News

Doctors leaders, charities, and hospices back Liverpool Care Pathway

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6654 (Published 03 October 2012) Cite this as: BMJ 2012;345:e6654
  1. Zosia Kmietowicz
  1. 1London

A group of 20 organisations has issued a consensus statement backing the Liverpool Care Pathway for the Dying Patient and reiterating that the care is not about ending life but about delivering excellent end of life care.

Those backing the statement include the Royal College of Physicians, the Royal College of General Practitioners, the British Geriatrics Society, charities, organisations representing care homes, hospitals, social services, and palliative care services.

The statement says “Published misconceptions and often inaccurate information about the Liverpool Care Pathway risk detracting from the substantial benefits it can bring to people who are dying and to their families. In response to this we are publishing this consensus statement to provide clarity about what the Liverpool Care Pathway is—and what it is not.”

The Liverpool Care Pathway was developed in the late 1990s by doctors and palliative care teams working in hospices to help spread elements of hospice care to hospitals, care homes, and people’s own homes.

A discussion of what the pathway is and isn’t took place in the House of Lords on 20 June,1 following, it is believed, the publication of a story that morning in the Daily Mail that suggested thousands of NHS patients were being put on the pathway and dying prematurely because they were difficult to manage and to free up beds.2

Baroness Knight of Collingtree said that a growing number of people believed the pathway had become a tool for euthanasia and asked whether it was consistent with the outcome of parliamentary debates and votes on euthanasia.

In response, Earl Howe, the parliamentary under secretary of state for health, said: “The Liverpool Care Pathway has sometimes been accused of being a way of withholding treatment, including hydration and nutrition. That is not the case. It is used to prevent dying patients from having the distress of receiving treatment or tests that are not beneficial and that may in fact cause harm rather than good.”

He said that the Department of Health supported the use of the pathway, adding, “The Liverpool Care Pathway has sometimes been accused of being a way of withholding treatment, including hydration and nutrition. That is not the case. It is used to prevent dying patients from having the distress of receiving treatment or tests that are not beneficial and that may in fact cause harm rather than good.”

Howe said that the recent national care of the dying audit of hospitals, run by Marie Curie in collaboration with the Royal College of Physicians, found that, in 94% of documented cases, discussions explaining the use of the pathway were held with relatives or carers.

He added, “That audit process gives clinicians an opportunity to feed in their views about how well, or not so well, the pathway is working in practice.”

Anjali Mullick, a consultant in palliative medicine and clinical lead at St Joseph’s Hospice in Hackney, London, said, “As a physician in palliative medicine, I believe that the LCP [Liverpool Care Pathway] provides a useful framework for delivering good quality end of life care if used in the manner intended. On occasion, I have encountered patients, carers, or professionals who have had some misconceptions about the use of the tool, and the consensus statement will hopefully go some way to addressing these.”

Notes

Cite this as: BMJ 2012;345:e6654

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