‘Tickbox’ care consigns patients to early death

An end-of-life care scheme used widely in UK hospitals is sentencing some patients to a premature death, leading doctors have warned.

Under the scheme, patients who are diagnosed as close to death can have food and fluids withdrawn and be put on continuous sedation until they die.

But this can mask signs of improvement in a patient’s condition, the doctors warned in a letter to The Daily Telegraph.

“As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients”, they wrote.

“Syringe drivers are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong.”

The scheme, called the Liverpool Care Pathway, has been rolled out across hundreds of care homes, hospitals and hospices across the country.

The decision to place a patient on the pathway has to be agreed upon by the whole medical team treating them.

Doctors are then recommended to withdraw intravenous drips and other invasive procedures. Food and drink continues to be offered depending on the patient’s condition.

Dr Peter Hargreaves, consultant in Palliative Medicine at St Luke’s cancer centre in Guildford and a co-signatory to the letter, says that while the desire to stop dying people being “overtreated” is laudable, he is increasingly concerned about the pathway’s use.

“It is supposed to let people die with dignity”, he said, “but it can become a self-fulfilling prophecy.

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.”

Other signatories included Professor Peter Millard, Emeritus Professor of Geriatrics at the University of London, Dr Anthony Cole, Chairman of the Medical Ethics Alliance and Dr David Hill, a Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons.

The letter said: “Just as, in the financial world, so-called algorithmic banking has caused problems by blindly following a computer model, so a similar tick-box approach to the management of death is causing a national crisis in care.”

Related Resources