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The banned end-of-life pathway that has never gone away


JULY 15 will be the tenth anniversary of the abolition of the Liverpool Care Pathway (LCP) in every hospital and hospice in the country. The end-of-life-care protocol was scrapped by the Government as a ‘national disgrace’, in the words of Norman Lamb, then Care Services Minister, after a review by Baroness Neuberger found widespread failings and abuses.

More than a thousand families came forward to relay horrendous accounts of poor care under the LCP. These followed prognoses of death, a practice without an evidence base, and clinicians then authorised ‘continuous infusions of strong opioids and sedatives without justification or explanation’, according to Neuberger who referred to this as a ‘chemical cosh’. Food and fluids were simultaneously withdrawn, often without consent, and patients took an average of 36 hours to die from dehydration.

Appalled by her discoveries, Baroness Neuberger singled out deliberate dehydration for specific criticism. ‘There can be no clinical justification for denying a drink to a dying patient who wants one, unless doing so would cause them distress,’ she wrote in More Care, Less Pathway, her final report. ‘The urge to drink when thirsty is very powerful and basic . . . to deny a drink to a thirsty patient is distressing and inhumane.’

She could not have been more emphatic that this was an abuse and must be stopped. Yet last year a report called When End of Life Care Goes Wrong  provided evidence to demonstrate that the practice was still common in the NHS.

The Lords and Commons Family and Child Protection Group, which conducted the study, drew on 17 cases of about 600 to hand. New cases continue to be reported, and one of the most recent involves an 89-year-old Indian grandmother who died this month, 11 days after fluids were withdrawn. The family went to the Court of Protection to halt the actions of the doctors but a judge sitting in secret decided it was not in the patient’s ‘best interests’ to receive continued nutrition and hydration. The Bland judgement of 1993 redefined food and fluid as ‘treatment’ so they could be taken away by Airedale NHS Trust. Neuberger was severely critical of the broad interpretation of this legal precedent to mean that doctors could starve and dehydrate their patients to death whenever they predicted, rightly or wrongly, that death was imminent.

Yet the Court of Protection always seems to side with the doctors who want to kill, and this latest case provides another example of why this sinister institution is Orwellian to the point of having a name which contradicts its actual purpose. It was the same court which in effect sanctioned and covered up the killing of a 19-year-old woman in September. 

Just as in the case of ‘ST’, the court in this latest case denied this family the publicity they sought by imposing restrictions on the identity of the grandmother, the staff ‘treating’ her and even the hospital where she spent her final days. Such tyrannical edicts prevent public scrutiny of matters of life and death, precisely where accountability and transparency are most vital in any normally functioning democratic society.

One member of the family, who may not be named because of the gagging order, said: ‘Our mother would find it unacceptable and morally reprehensible to starve and dehydrate anyone to death like this. We will have to live with the acute trauma from watching this happen to our dear defenceless mother for the rest of our lives.’

He added: ‘Active treatment has been a pretence, they (the hospital) put our mother on end-of-life months ago, well before the starvation started. This is the Liverpool Care Pathway by the back door.’

Sam Ahmedzai, Emeritus Professor of Palliative Medicine at Sheffield University, represented the family by submitting an opinion on appeal where he criticised the hospital’s evidence and unsuccessfully demanded the immediate restoration of assisted hydration.

He said afterwards: ‘Having witnessed at close hand the deaths of hundreds of patients in my 30-year career, this has been one of the most distressing and chilling cases. Dehydrating a person to death is distressing, degrading and inhuman. Having helped to see the infamous Liverpool Care Pathway abolished, I can see the spirit of it lives on today in Britain.’

Amanda Hunter of Together Declaration, which campaigns against end-of-life abuses and assisted the family, said: ‘This remarkable lady and her family were failed by the hospital and failed by the judicial system.’ 

Yet the media still hero-worships the NHS and sympathises with campaigners and celebrities who want to change the law to give doctors more power to kill by assisted suicide and euthanasia.

When such horrendous cases first came to light, they were considered so scandalous they could not be ignored, moving the Government ostensibly to accept all 44 recommendations of More Care, Less Pathway.

What followed after 2014 was a classic establishment stitch-up in which the LCP was repackaged and rebranded with replacements perpetuating errors central to the initial lethal dysfunction – imaginary prognoses of death, anticipatory prescribing of drugs via syringe drivers, and the withdrawal of food and fluids following a ‘best interest’ team decision.

Relatively new is the protection of such practices by secret courts which appear hostile not only to awkward families but also to contrary medical opinion.

Besides Professor Ahmadzei, those doctors ignored include Professor Patrick Pullicino, the former Kent consultant neurologist and LCP whistleblower. Three years ago Pullicino was asked by the family of ‘RS’, a Polish man in a ‘minimally conscious’ state, to give evidence in their battle with Plymouth Hospital. The Court of Protection rejected his argument that further tests were necessary for a confident prognosis, ruling that it was not in the patient’s ‘best interests’ to be kept alive. Then a weird thing happened: he was reported to the General Medical Council by a ‘right to die’ activist on the grounds that he ‘may have deliberately misdiagnosed the patient in the hope of saving his life’.

That a fitness to practice panel took three years to exonerate this brave and distinguished doctor from so spurious and speculative an accusation is incredible.

Is it fanciful to imagine that here is yet another example of the emerging phenomenon of ‘process as punishment’ in which innocent people are victimised by authorities where no law or rule exists to punish them, with the purpose of shutting them up? This latest development is surely a symptom of the takeover and corruption of nearly all our institutions by destructive totalitarian ideologies.

Dark days lie ahead when those who defend that most fundamental right of life are silenced. Who will be safe then?

Simon Caldwell will speak on ‘Fact and Fiction in The Beast of Bethulia Park’ ( at a Diocese of Portsmouth symposium on medical ethics in Winchester on Saturday March 16. Please click on this link for tickets. 

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Simon Caldwell
Simon Caldwell
Simon Caldwell is a freelance journalist, formerly of the Daily Mail, whose debut novel ‘The Beast of Bethulia Park’ is out now.. Click on this link to learn more and to order your copy. The sequel is expected in 2024.

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