He was referring to the Liverpool Care Pathway (LCP), which Marie Curie describe as “an integrated care pathway that is used at the bedside to drive up sustained quality of the dying in the last hours and days of life”. Circumstances dependent, the LCP can involve withdrawing artificial hydration and nutrition. Speaking at the Royal Society of Medicine in London, Prof Pullicino said “If we accept the Liverpool Care Pathway we accept that euthanasia is part of the standard way of dying as it is now associated with 29 per cent of NHS deaths.”
Research rather than anecdote is needed to test his claims. However, we must be careful not to equate potential misuse of the LCP with the LCP itself. The fact that the LCP is or may be misused does not mean that the LCP itself is in any way sinister.
The primary purpose of the LCP is not to hasten death, but to alleviate potentially distressing symptoms in the last hours of life. Without being overly graphic, there are medical reasons why you don’t want a dying body to digest artificial hydration and nutrition. The theory of the LCP is that treatment may be withdrawn, but in order to make the process of dying better, not to hasten death. A palliative care doctor has told me that using a care pathway for any purpose in medical care does not mean that healthcare professionals stop using their professional judgement “the pathway is simply that – a pathway, or prompt, if you like – which is there to ensure the best possible care at the end of life.”
Two weeks ago, the Daily Mail carried another story, which highlighted that some dying patients are being resuscitated against their wishes at the end of life. Cardiopulmonary resuscitation (CPR) in most instances, much like the LCP, is a legitimate medical practice. Its use doesn’t indicate that the NHS officiously strives to keep people alive against their wishes, in much the same way that the use of the LCP does not indicate that the NHS culturally strives to hasten death. But, like any legitimate medical practice, it can be misused. What both these stories indicate is that there are appropriate and inappropriate uses for these practices, and the key to differentiating between the two is whether it is in the patient’s best interests to use them. Essential to determining best interest is, where possible, finding out what a patient’s wishes are for their care and treatment at the end of life.
This is not to say that improvements cannot be made in the delivery of end-of-life care and the use of the LCP. As an exchange in the House of Lords this week highlights, any medical tool is only as effective as those implementing it, and there is a need to ensure effective training in its use (specifically to ensure effective communication between healthcare professionals and patients and their loved ones). But, when it comes to this issue, we should be careful not to oversimplify and sensationalise.