WESTMINSTER, July 16, 2013 ( – The notorious Liverpool Care Pathway, the “end of life protocol” that has been denounced by many as a form of passive euthanasia, “should be phased out” by the autumn, a parliamentary review has concluded. Instead, the one-size-fits-all approach of the LCP will be replaced with “a personalised care plan backed up by condition-specific good practice guidance and a named senior clinician responsible for its implementation,” they said. 

The review, titled “More care, less pathway: A review of the Liverpool care Pathway,” which was made public yesterday, highlighted complaints of inappropriate or inadequate care and management of symptoms, and lack of involvement and communication with loved ones.

However, one of the authors said that what they uncovered were abuses that went far beyond the complaints that originally led to the review.


“What we have also exposed in this review is a range of far wider, fundamental problems with care for the dying – a lack of care and compassion, unavailability of suitably trained staff, no access to proper palliative care advice outside of nine to five Monday to Friday,” said Lady Neuberger, who headed the review.

The LCP has been widely criticized for allowing for withdrawal of water and nourishment, and “continuous deep sedation,” if it is in the “best interests” of patients who are judged to be incurable. However, many families and doctors alleged that patients were being routinely put on the LCP, often without any discussion with family members, even though they were not suffering from any terminal illness. One eminent physician famously claimed that as many as 130,000 people were effectively euthansized while on the LCP.

Doctors had repeatedly warned legislators that the fundamental premise of the LCP was flawed, and that it is not scientifically possible to predict when death will occur. Such doctors took risks with their careers to warn the public that the LCP is effectively operating as a “euthanasia pathway,” pointing out that once put on the LCP, death usually follows within 29 hours – whether the patient was suffering from a terminal illness or not. 

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Norman Lamb, the Care and Support Minister who called the review, had said earlier this year that he was “personally horrified” by accounts of suffering related to him by bereaved relatives. 

He told a Private Member's Meeting on the House of Commons this week that the “review heard that when the Liverpool Care Pathway is operated by well-trained, well-resourced and sensitive clinical teams, it works well,” he said. “However, it also heard too many examples of poor practice and poor quality care, with families and carers not being properly involved and supported. This has to change.” 

“[T]here have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable,” said Lamb. 

He also told Parliament that he is “writing to the General Medical Council and the Nursing and Midwifery Council to highlight both the need for effective guidance on supporting nutrition, hydration and sedation for the dying.” 

“However, it is clear that we need to take action immediately.” 

Lamb has asked all hospitals to “undertake a clinical review,” of every patient currently being cared for under the LCP or similar plans, “to ensure that the care they are receiving is appropriate”. 

Fiona Bruce, the Conservative MP for Congleton, Cheshire, who was also part of the review, said that she is among the growing number of bereaved relatives concerned about its application amid allegations that it is being used to hasten death. Both of Bruce’s parents were on the Pathway, but her father survived after she insisted he be removed from the plan. Bruce told parliamentary colleagues she was forced to rescue her 83-year-old father from the LCP after he was admitted to a hospital for an unidentified illness that left him “weak and frail”. 

She said after a few days she had asked a nurse in the corridor how her father was doing and “almost casually” the nurse replied, “Oh, he’s not very well at all. He has not long to live. We are putting him on the Liverpool Care Pathway.” There was “no discussion, no explanation, no consultation” between the family and the hospital staff – “just an announcement, a statement of fact, almost in passing.” Mrs. Bruce said she suffered “terrible guilt” after she watched her mother die an “agonising” and prolonged death of LCP-imposed dehydration following brain surgery two years earlier. The hospital in that case also never consulted the family. 

Peter Smith, the Catholic Archbishop of Southwark and Chair of the Bishops’ Conference Department of Christian Responsibility and Citizenship, responded to the report, saying, “It was in response to concerns raised by Catholics and by others about end of life care in England and Wales that I called for an enquiry into the use of the Liverpool Care Pathway (LCP).” 

“It is clear that the committee has taken its responsibilities very seriously and has listened to patients, relatives, doctors and nurses. The committee has sought to protect the positive aspects of the LCP while proposing a new more flexible and personalised framework of ‘end of life care plans’. This report and its recommendations are worthy of careful consideration.” 

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Palliative care association reluctantly reviews UK death pathway; pro-lifers skeptical