Letters Liverpool care pathway

Liverpool care pathway is a half baked compromise

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7629 (Published 13 November 2012) Cite this as: BMJ 2012;345:e7629
  1. Colin Brewer, research director1
  1. 1Stapleford Centre, London SW1W 9NP, UK
  1. brewerismo{at}gmail.com

Although the Liverpool care pathway (LCP) seems to be the palliative care version of very slow active euthanasia by very slow lethal injection,1 in practice it is a half baked compromise. An old friend of mine recently died on a LCP regimen. She was already sedated with midazolam to the point of unresponsiveness when I was called to visit her and was told that she was unlikely to last more than 48 hours. I was therefore unable to say a final farewell, as I very much wanted to.

She had a progressive neurological condition with unimpaired intellect, so opiates were not therapeutically indicated. Only after she had remained alive but unconscious for another week was morphine added to her infusion. It was obviously added not to relieve pain but to further suppress respiration. The acute condition that led to her final admission was treatable, and she could have lived for several months afterwards, but the hospital respected her refusal of treatment. The doctors were obviously sympathetic to her clear and documented desire for an early release from her torment, hence the LCP, but they were also afraid to assist nature efficiently, as I believe the LCP is supposed to do. She was presumably unaware of her last days but we, her friends, were very aware of them, and this caused us needlessly prolonged distress.

If palliative care teams will the end, as they evidently did in this case, why do they not also will the means? Can someone please explain to me how the LCP, designed to cause death in a day or two by suppressing protective reflexes, is morally different from infusing a larger dose of sedatives designed to bring about the same end and for the same reasons in an hour or two?


Cite this as: BMJ 2012;345:e7629


  • Competing interests: CB is a former committee member of the (former) Voluntary Euthanasia Society—now Dignity in Dying. He is also a director of the Secular Medical Forum.