Thirty years ago, a nurse observed the care given to 50 dying patients across four large hospitals. She documented poor oral hygiene, lack of assistance with eating, unquenched thirst, and increasing isolation of patients towards the time of death.1

Then as now, most people in England died in hospital. To improve care for some of the hundreds of thousands of people in hospital during their final hours and days of life, end of life care pathways were introduced.2 The Liverpool care pathway is the most widely used integrated care pathway, but others have been developed.3 However, the Liverpool care pathway has recently received sustained media criticism in the UK,4 resulting in two ongoing reviews by the Department of Health and the NHS National End of Life Care Programme.5 6

In February, in conjunction with Channel 4’s Dispatches, the BMJ emailed 3021 UK hospital doctors for an anonymous online survey of their views on the Liverpool care pathway. Out of 647 respondents (response rate 21%), 563 doctors had used the pathway in clinical practice, and these 563 were enrolled in the full survey. They comprised 185 palliative medicine consultants (roughly 40% of the UK total), 168 doctors in training or career grade posts in palliative medicine, and 210 doctors in other specialties but with some experience in palliative medicine. The response rate is …