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Doctors to launch investigation into Liverpool CarePathwayDoctors are to investigate public concerns over the use of the controversial LiverpoolCare Pathway, which has been used without family members knowledge.

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By Rebecca Smith, Medical Editor11:27AM BST 24 Oct 2012

44 CommentsThe technique is supposed to alleviate suffering in the final hours ordays of a persons life and can involve the removal of tubes artificiallyproviding food and fluid.Families have come forward saying their loved ones were placed on thepathway without their knowledge and argued they were not dying.

A group of senior doctors said this week that decisions that patients aredying are based on no evidence and are often little better thanguesswork.They said that once patients were on the pathway with food and fluidswithdrawn, the prediction of imminent death became a self-fulfillingprophecy.Related Articles

Death pathway under renewed attack from doctors 22 Oct 2012Family doctors asked to identify patients likely to die 17 Oct 2012Family 'not told' grandmother was put on 'death pathway' 16 Oct 2012Patients before profits 24 Oct 2012TV chef's anger over mother's 'end-of-life' pathway 31 Oct 2012Care Pathway must not be 'agenda-driven' 31 Oct 2012

Dr Bee Wee, president of the Association for Palliative Medicine, hassaid rather than simply defend the pathway, it is right that experts stand-back and look at the issues raised.The association intend to conduct research into these concerns and how

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care of the dying can be improved.Dr Wee, a consultant and Oxford academic, wrote: There are somevery real anxieties amongst the public and some professionals about thiswhole concept.Instead of simply defending the concept, or reiterating that if only itwere used properly, it would be OK, it might be more helpful to standback a bit, identify and explore the concerns properly, and find ways ofaddressing those concerns and improve practice.The APM intends to undertake such a piece of work about integratedcare pathways for the last days of life, in collaboration with a number ofnational organisations.Discussions are taking place about the details of the proposal, who elseis involved.The Association signed up to signed a consensus agreement lastmonth saying that the pathway was a framework for good practice andwas not used to hasten death along with the Royal Colleges of GeneralPractitioners, Physicians, and Nursing and the National Council forPalliative Care.

Should the Liverpool Care Pathway be banned?

But a coalition of senior doctors, lawyers and pro-life groups is arguingthat it is flawed. The coalition is led by Prof Patrick Pullicino, aneurologist who has warned that it has made euthanasia a standardway of dying on the NHS.A statement from the group said: It is self-evident that stopping fluidswhilst giving narcotics and sedatives hastens death.It added: The median time to death on the Liverpool Care Pathway is

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now 29 hours. Statistics show that even patients with terminal cancerand a poor prognosis may survive months or more if not put on theLCP.The group said that diagnoses of impending death were at best aneducated guess. An actual misdiagnosis of impending death couldresult in a wrongful death, its statement says.The Liverpool Care Pathway was rolled out across the cou ntry from2004 but within five years doctors began publicly to air theirdissatisfaction.Earlier this month, Peter Tulloch made a complaint to police ofattempted murder after his mother Jean, 83, was isolated anddisconnected from food and fluid in an Edinburgh hospital even thoughshe was not imminently dying.He demanded that her sustenance be restored and it began again after30 hours. She died two weeks later.The Department of Health has contined to back the pathway, saying in astatement that it fully supported its proper use.

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