The Liverpool Care Pathway


The Liverpool Care Pathway (LCP) was introduced in the 1990’s and was intended to allow patients with a terminal illness to die with dignity. Concerns were expressed in relation to Patients being subjected to invasive testing and treatment that offered no chance of preventing death and in addition causing unnecessary pain and suffering by needlessly prolonging life.

The LCP has been controversial as several families have reported that there loved ones have been placed on the pathway without there consent, whilst others have complained that the LCP has hastened death in relatives who were not dying imminently. In addition to this, critics have argued that it would be impossible for a doctor to predict when death would be imminent and therefore to place a patient on the pathway in itself makes death imminent.

The LCP makes it clear that even though legal consent is not required before a patient can be put on the pathway, if the plan is considered it should always be discussed with the family or carer. If it is possible to discuss this with the actual patient then this should be done. The recommendation confirms that where there is a family member or carer who is named as the patient’s main contact then there should never be an occasion where that contact is not informed that a diagnosis has been made that a patient is dying.

Whilst withdrawal of fluids and nutrition should never be a routine option, it can be used if it is felt to be in the best interests of the patients and judged on a case by case basis.

Although there is criticism in relation to the LCP, it has also been praised by doctors due to its aim to make life for those who are imminently dying as comfortable as it can possibly be instead of continuing to use artificial efforts to prolong life.

An article which was recently published in the British Medical Journal put forward the argument that the LCP had transformed end of life care and offered a good death, when it was implemented properly.

The Department of Health have confirmed that the LCP is supported by more than 20 leading organisations including Marie Curie Cancer Care and Age UK as a way to help meet the care and dignity needs for those where death is imminent. They have also confirmed that the LCP can only work if where possible each patient is consulted in relation to the pathway or if not possible the family or carer is involved in all aspects of decision making.

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