Feature Liverpool Care Pathway

Inquiry launched into newspaper story about babies on “death pathway”

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1273 (Published 01 March 2013) Cite this as: BMJ 2013;346:f1273
  1. Sophie Arie, freelance journalist
  1. 1London, UK
  1. sophiearie{at}fmail.co.uk

Sophie Arie examines how misunderstanding led to a children’s hospital becoming embroiled in media outcry about the Liverpool care pathway

In November 2012, amid a long campaign to expose misuse of the Liverpool care pathway (LCP), the Daily Mail newspaper ran a front page story entitled “Now sick babies go on death pathway.”1

The story claimed that NHS hospitals were discharging sick children and babies to hospices or their homes, where food and fluid were withdrawn until they died.

Several complaints over major inaccuracies were made at the time, including by the BMJ. The Press Complaints Commission has since received 10 more complaints and recently launched an inquiry into the story.

The centre piece was a doctor’s anonymous testimony—billed as “doctor admits starving and dehydrating ten babies to death in neonatal unit.” But that testimony—which was first published in the BMJ2—came from a physician practising in another country, although the location was not disclosed to protect the families involved.

The article went on to allege incorrectly that Alder Hey children’s hospital in Liverpool was discharging patients “for LCP end of life care,” based on a document the newspaper had obtained with tick boxes for doctors on medicines, nutrients, and food to be stopped.

A photo of the hospital was juxtaposed with general criticisms not related to Alder Hey saying that parents were being coerced into allowing their children to be put on a care pathway, that sometimes they recovered when taken off, and that there were big questions to be answered. The article also referred to the ongoing government review of the pathway and allegations that hospitals were receiving financial incentives for putting patients on the pathway.

Alder Hey hospital was horrified when it saw the story.

“We have an end of care plan for children who are inevitably going to die,” Professor Ian Lewis, the hospital’s medical director, told the BMJ. “But it is not the LCP and it is not all the other things implied.”

Unlike the LCP, Alder Hey’s pathway is not used for large numbers of patients (only 28 since 2006) and it has not involved withdrawing food and fluids, says Lewis. Alder Hey has not placed patients on its pathway without informing the patient or their family, and families whose children have died have expressed gratitude to the hospital for its expertise.

“Our children’s pathway includes a detailed review of all medical intervention, including medicines and artificial nutrition,” the medical director says. “These could be withdrawn if thought to be of harm. But if that is uncertain it is continued.”

Dissatisfaction with response

The hospital wrote to the Daily Mail’s editor protesting that the article was factually wrong and its attempts to explain the difference between its pathway for children and the LCP had been ignored. The editor in chief of the BMJ, Fiona Godlee, also complained in writing that the story was highly misleading. Her point that the main testimony in the story was not from an NHS doctor was published on the newspaper’s letters page.

But the Daily Mail did not remove the story from its website or correct or clarify it. A version was also published by the Daily Telegraph, and both stories have inspired scores of emotional responses from readers, many of whom expressed disgust that NHS doctors were using distressing methods to kill sick babies who might have survived.

The Daily Mail told the BMJ it could not comment on the story because a Press Complaints Commission inquiry is underway.

But a letter sent last year in response to Alder Hey’s complaint defended the story.

In the paper’s view, the anonymous doctor’s testimony was still valid as an insight into what happens when food and fluids are withdrawn. “It is not apparent that this [the location of the doctor] makes any difference since the pathway clearly is being practised in this country,” the newspaper said in letter to Alder Hey.

In the same letter, the paper insisted that Alder Hey had developed its pathway for dying children in collaboration with the same experts at Marie Curie Palliative Care Institute in Liverpool who developed the LCP. “It is not clear on what basis you are insisting that this is not a development of the LCP to cover children,” the Daily Mail argued.

Fundamentally, the hospital believes, media campaigning about the LCP has turned the word “pathway” into a dirty word. The message is that all pathways are a form of “euthanasia by the back door.”

“Parents are being told something sinister is being done. This isn’t representative of the care that is provided at Alder Hey,” said Louise Shepherd, chief executive of Alder Hey hospital.

Alder Hey thinks that parents of children in its care may have been panicked unnecessarily.

“The term ‘pathway’ has become so misunderstood,” says Lewis. “It’s a complex clinical medical process being reported very hysterically. There’s a need for a wider debate around care pathways in general. People need to understand what they are.”

Notes

Cite this as: BMJ 2013;346:f1273

Footnotes

  • Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References