Inquiry suggests British-run hospitals stop using end-of-life protocol

Manchester, England

A British official indicated the government will abandon a controversial end-of-life protocol following an anti-euthanasia campaign spearheaded by concerned Catholic physicians.

An independent inquiry into the Liverpool Care Pathway has recommended that the protocol be abolished and replaced by "individualized care plans" after evidence of abuse and suffering was discovered.

"This is not civilized. It is a national disgrace," Norman Lamb, Britain's care services minister, said in comments Monday reported by the London-based Daily Mail newspaper.

The pathway was designed to make the final hours of dying patients as peaceful and dignified as possible.

But the report, "More Care, Less Pathway," said the protocol's "tick-box" approach to end-of-life care allowed medical professionals to base clinical judgments not on patient needs but on whether the criteria set out by the framework had been met.

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The foreword to the report, signed by all eight members of the review team, said many people reported positive experiences with use of the pathway.

"Clinicians themselves expressed their own views that in their own last hours they would prefer to be treated under an approach such as the LCP, and we found that many relatives of people dying while being treated under the LCP had felt that their loved ones had had good deaths," it said.

"It would seem that when the LCP is operated by well-trained, well-resourced and sensitive clinical teams, it works well," the report said.

However, it said that reports of "uncaring, rushed, and ignorant" treatment abound and that "many families suspected that deaths had been hastened by the premature, or over-prescription of strong pain-killing drugs or sedatives and reported that these had sometimes been administered without discussion or consultation."

The inquiry, set up by the government in November and led by Baroness Julia Neuberger, a rabbi, found that the drugs often served as a "chemical cosh" to keep patients quiet while they were dehydrated.

It found numerous examples of patients dying of thirst, with one patient sucking desperately on a wet sponge used to moisten his mouth. The review team also heard stories of nurses shouting at families who intervened to give their relatives a drink.

When one family pleaded with a nurse to give a patient a drink they were told "to soak a paper towel from the dispenser in the toilet and let her suck it."

Some patients took up to 16 days to die after they were wrongly diagnosed as dying and placed on the pathway. Others suffered such irreversible damage from being placed on the pathway that doctors felt they could not remove them, the inquiry found.

The Neuberger Report, published Monday, made 44 recommendations, including the phasing out of the pathway from Britain's state-funded National Health Service within the next 12 months.

It underlined the rule that medical professionals would be guilty of "professional misconduct" if, in the future, they refused a patient food and fluid, and demanded better policing and funding of end-of-life care. It also called for the end to financial incentives rewarding hospital trusts for meeting targets of patient deaths on the pathway.

The report was issued almost exactly a year after Dr. Patrick Pullicino, a Catholic neurologist from Kent, England, became the first senior medical professional to raise alarm about the pathway when he told a medical conference in London that the protocol had made euthanasia "a standard way of dying" in National Health Service hospitals.

Since 2008, the pathway has been rolled out across the country using financial incentives, and an estimated 130,000 people die on it each year, most within about 30 hours.

In an email to Catholic News Service on Monday, Pullicino welcomed the report but he said that "the risk of death in patients who were not at risk of dying but could be killed by the pathway was not highlighted."

"The fact that there are well-documented cases of patients being taken off the pathway and surviving over a year shows that this is a real issue," he said.

"One of the principal selling points of the LCP was that it provides dignity in dying," he said. "There was clearly a failure to provide dignity in a significant proportion of patients."

In a telephone interview Monday with CNS, Pullicino added he was also concerned that the flaws in the pathway would create similar problems in more than a dozen countries to which it has been exported, such as Italy and Australia.

The Catholic Bishops' Conference of England and Wales has been supportive of the pathway, and it defended the protocol in a submission to the Neuberger inquiry earlier this year. Its submission suggested that the inquiry investigate whether "misreporting has had a detrimental effect on the ability to deliver end-of-life care," as doctors grew increasingly wary about using the pathway.

However, the chairman of the department, Archbishop Peter Smith of Southwark, said in a statement Tuesday that he welcomed both the report and the response of the government.

"The (Neuberger) committee has sought to protect the positive aspects of the LCP while proposing a new more flexible and personalized framework of 'end-of-life care plans,' " Smith said. "This report and its recommendations are worthy of careful consideration."

He added: "From a Catholic perspective, the key issue is that, whatever pathway, plan or framework is adopted, it must be implemented ethically, with care for the patient always as the first priority."


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