Letters Liverpool care pathway

Liverpool care pathway is a nice idea—pity about the practice

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1837 (Published 28 March 2013) Cite this as: BMJ 2013;346:f1837
  1. Eugene Breen, psychiatrist1
  1. 1Mater Misericordiae University Hospital, Dublin, Republic of Ireland
  1. breen.eugene{at}gmail.com

The idea of optimal palliation during the final days of life makes good medical sense and should be the end of a continuum of best practice.1 The idea of making someone comfortable and easing suffering sounds good. Relatives like to think their loved ones are at peace.

This is the plan, but who will diagnose “dying” and what internationally accepted criteria will be used? Is there evidence that opiates and sedatives plus or minus no nutrition or fluid are good for anything except to hasten death? The differential diagnosis of “dying” is large and often incorrect. The pathway does not accommodate second thoughts or reassessment of the diagnosis lightly. Before any invasive procedure, a thorough investigation is carried out, and objective data are obtained before starting any treatment.

Thorough assessment of “dying” is needed, especially as the course of treatment being considered (Liverpool care pathway) will definitely confirm the diagnosis. Specialist palliative care doctors acknowledge they cannot diagnose “dying” with certainty, yet junior trainees have become expert at this according to reports.

Is this “euthanasia lite”? It’s not called this, but once the diagnosis of dying is made, by whomever, that is the reality in many cases. There is no quality control or accountability and there are no penalties. You can hear people say “the mother in law doesn’t look too good, I wonder if she is dying? We ought to get her as quickly as possible to that pathway to get her the best accredited care.” This is the problem. It is a free for all and it is euthanasia lite. The fast forwarding of dying saves money, brings closure, and frees up relatives’ time and suffering, but it disrespects patients’ basic rights to life and dignity. It is impossible to control such a programme with any respectable level of professionalism or care for the person involved.


Cite this as: BMJ 2013;346:f1837


  • Competing interests: None declared.