Catholic Online Forum

The British government has opened an independent inquiry into allegations that an end-of-life protocol is operating as a euthanasia pathway.

It said the inquiry would investigate complaints raised by families who say that relatives have died after they were placed, without their knowledge, on the Liverpool Care Pathway.

The framework, intended for people in their final hours of life, often involves sedation and withdrawal of life-prolonging treatment, which under British law includes food and fluids.

A Nov. 27 statement by the Catholic Communications Network said that Archbishop Peter Smith of Southwark, chairman of the English and Welsh bishops' Department for Christian Responsibility and Citizenship, welcomed the review.

It said the archbishop had passed on "specific concerns raised with him by some clinicians" and had called for such an inquiry in a Sept. 27 letter to the government.

Bishop Mark Davies of Shrewsbury also issued a Nov. 27 statement praising the intervention of Fiona Bruce, the member of Parliament for Congleton, within his diocese.

The framework, intended for people in their final hours of life, often involves sedation and withdrawal of life-prolonging treatment, which under British law includes food and fluids.

...removing food and fluids IS murder.

Therein lies the problem

Not so. The problem is allegedly that end-of-life protocols are not being followed and that euthanasia is being performed.

The framework, intended for people in their final hours of life, often involves sedation and withdrawal of life-prolonging treatment, which under British law includes food and fluids.

Sick children are being discharged from NHS hospitals to die at home or in hospices on controversial ‘death pathways’.

Until now, end of life regime the Liverpool Care Pathway was thought to have involved only elderly and terminally-ill adults.

But the Mail can reveal the practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies.

One doctor has admitted starving and dehydrating ten babies to death in the neonatal unit of one hospital alone.

Writing in a leading medical journal, the physician revealed the process can take an average of ten days during which a baby becomes ‘smaller and shrunken’.

The LCP – on which 130,000 elderly and terminally-ill adult patients die each year – is now the subject of an independent inquiry ordered by ministers.

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I'm confused by this statement if they literally mean "final hours of life".

The Liverpool Care Pathway for the Dying Patient (LCP) is a UK care pathway covering palliative care options for patients in the final days or hours of life. It has been developed to help doctors and nurses provide quality end-of-life care. It has also been presented in the media as a way for hospitals to kill off the terminally ill and the old.

The Liverpool Care Pathway was developed by Royal Liverpool University Hospital and Liverpool's Marie Curie Hospice in the late 1990s, to translate into a hospital environment best-practice experience in the care of dying patients that had developed in the hospice setting. According to the National Mortality Statistics 2004, only 16% of cancer deaths and fewer than 5% of non-cancer deaths occur in a hospice.[1]

The pathway was developed to provide the same level of nursing expertise at the end of life as during other treatments, regardless of the patient's chosen environment. The pathway document is reviewed annually by a multidisciplinary steering group to incorporate new evidence and family and caregiver feedback.

In 2012, it was revealed that just over half of the total of NHS trusts have received or are due to receive financial rewards to hit targets associated with the use of the care pathway.[2] These payments are made under a system known as “Commissioning for Quality and Innovation” (CQUIN), with local NHS commissioners paying trusts for meeting targets to “reward excellence” in care.

Controversy

The LCP has continued to be controversial. It has been claimed that elderly patients were admitted to hospital for emergency treatment and put on the LCP without documented proof that the patient wanted it, or could not recover from their health problem; 48 year old Norfolk man Andrew Flanagan was revived by his family and went home for a further five weeks after doctors put him on the LCP.[29] The Royal College of Physicians found that up to half of families were not informed of clinicians’ decision to put a relative on the pathway.[30]

Writing in the Daily Mail, Patrick Pullicino has claimed that doctors' use of the the LCP protocol has turned it into the equivalent of euthanasia of the elderly.[31] In a letter to The Daily Telegraph, six doctors belonging to the Medical Ethics Alliance[30] called on LCP to provide evidence that the pathway is "safe and effective, or even required", arguing that, in the elderly, natural death is more often painless, provision of fluids is the main way of easing thirst, and "no one should be deprived of consciousness except for the gravest reason."

David Jones, director of the Oxford-based Anscombe Bioethics Centre, said the principles that underpinned the Liverpool Care Pathway "are fully in accordance with Catholic moral theology and with a Catholic understanding of a good death."

In recent months, it has been severely criticized by bereaved families and some doctors, who claim that it is being used to hasten the deaths of terminally ill and elderly patients who are not imminently dying. At present, the abuses are the focus of a government inquiry.

But Jones, who since 2009 has served on the National LCP Reference Group, working with palliative care professionals who have designed the protocol, said it was not the pathway that was flawed but the way it was sometimes implemented.

Val,

There is a world of difference between a patient decling the offer of nourishment and that nourishment being withdrawn (presumably without the patient's consent or even knowledge).

Almost half of dying patients placed on the controversial Liverpool Care Pathway are never told that life-saving treatment has been withdrawn, a national audit has found.

The study suggests that in total, around 57,000 patients a year are dying in NHS hospitals without being told that efforts to keep them alive have been stopped.

It also reveals that thousands of dying patients have been left to suffer in pain, with no attempt to keep them comfortable while drugs were administered.

Jeremy Hunt, the Health Secretary, last night described the disclosures from records held by 178 NHS hospitals as "totally unacceptable".

Val,

There is a world of difference between a patient decling the offer of nourishment and that nourishment being withdrawn (presumably without the patient's consent or even knowledge)...

Daniel,

You just don't get it, do you? You've no idea what's being discussed here. (Perhaps because you've not seen anything remotely like it - "McMedicine" - Ugh!)

And as for Logic, that is a subject you really don't want to discuss with me.

It would appear that the framework in some cases actually kills people that would otherwise live for far longer than the "final hours" it takes to kill them with "mercy"...

NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds, a senior consultant claimed yesterday.

Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly.

He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country.

It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent.

There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP.

Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’.

He cited ‘pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients’ as factors.

Professor Pullicino revealed he had personally intervened to take a patient off the LCP who went on to be successfully treated.

He said this showed that claims they had hours or days left are ‘palpably false’.

In the example he revealed a 71-year-old who was admitted to hospital suffering from pneumonia and epilepsy was put on the LCP by a covering doctor on a weekend shift.

Professor Pullicino said he had returned to work after a weekend to find the patient unresponsive and his family upset because they had not agreed to place him on the LCP.

‘I removed the patient from the LCP despite significant resistance,’ he said.

‘His seizures came under control and four weeks later he was discharged home to his family,’ he said.

Professor Pullicino, a consultant neurologist for East Kent Hospitals and Professor of Clinical Neurosciences at the University of Kent, was speaking to the Royal Society of Medicine in London.

Senior Catholic doctors have said that a bishops’ conference report about the Liverpool Care Pathway (LCP) “borders on the disingenuous” adding that it “goes to extreme lengths to align support for the LCP with Catholic teaching”.

In response to the report, issued by a department of the Bishops’ Conference of England and Wales, Professor Patrick Pullicino, Dr Anthony Cole and Dr Philip Howard said in a joint statement: “The sufferings of patients who have been put on the LCP and their relatives is the first thing the Church should be reacting to in order to understand the great depth of anguish that this pathway has caused and the reasons for this.”

Professor Jones said that so far he had not “seen evidence to substantiate the claim that the LCP is structurally unsound or that it is inherently unethical”. But he continued: “It is clear that the LCP has frequently been badly implemented, and I hope that the Neuberger committee can identify practical ways to ensure that the LCP is implemented properly.”

In response to direct criticisms of the report’s tone and conclusion, he said: “My main emphasis was that the committee should review the evidence for itself, including the evidence from individual cases where they would be able to consider evidence that is not in the public realm.”

Professor Jones said: “As a matter of principle, I have no interest as such either in supporting or in attacking the LCP, my fundamental interest is in upholding Catholic teaching on the Gospel of life and examining the evidence of best practice in end-of-life care in that light.”

In his report Professor Jones argues that it is essential that the inquiry investigate allegations made about the LCP while listening to the pathway’s supporters.

He writes: “The most fundamental and troubling allegation against the Liverpool Care Pathway is that, in practice, it is an ‘assisted dying pathway’, that is, a framework for euthanasia by omission … this claim has been repeated in national newspapers and other media and is the basis of considerable anxiety among patients and relatives.”

He later continues in the report: “The allegation, then, is that the LCP both causes death and is intended to cause death.”

Professor Jones concludes by urging the inquiry to “undertake for itself a systematic review of the scientific literature in order to reach secure conclusions”.

“This submission has not considered in detail particular cases in which it is alleged that patients have been harmed by the misuse of the LCP. The review is urged to examine such cases in relation to whether patients supported by the LCP have been harmed, whether any such harm is due to the use of the LCP, and what corrections are needed in the light of these examples.”