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Feature Palliative Care

Liverpool care pathway: doctors speak out

BMJ 2012; 345 doi: (Published 14 November 2012) Cite this as: BMJ 2012;345:e7644
  1. Adrian O’Dowd, freelance journalist
  1. 1Kent
  1. adrianodowd{at}

Adrian O’Dowd assesses the professional reaction to media criticism of a pathway used to guide end of life care

The row over the controversial Liverpool care pathway continues, with more doctors and palliative care specialists speaking out over its use in UK hospitals and hospices. As the BMJ has reported,1 2 there has been mounting public and media hostility towards the protocol for the care of dying patients.

The strength of feeling was apparent in a letter sent to the Daily Telegraph last week (6 November), signed by 1300 doctors who said they supported the pathway.3

The letter said the pathway was used to “care for patients, not to hasten their death,” and added: “The decision to begin the care pathway is made in partnership with the patient and their carers . . .

“All of the health-care professionals who have signed this letter have been involved in the care of dying patients; many of us have also cared for friends or relatives during the final days of their lives. This is how we would wish to be cared for at the end of our lives and our patients deserve to be offered nothing less.”

One doctor who is angry at the way the subject has been presented is Anjali Mullick, consultant in palliative medicine at St Joseph’s Hospice and Newham University Hospital, London.

Mullick says: “Contrary to some of the recent press, it [the pathway] is not prescriptive about either treatments that should be withheld or interventions or medications that should be administered. The clinical needs of the individual are paramount.”

Mullick says she has seen the tool work well in both the hospice and the hospital setting.

“In my practice, I have never seen it being used as a tool to hasten death, which is being …

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