Doctors defend Liverpool Care Pathway as 'dignified' way to die - Telegraph.co.uk

The letter states the LCP "is used to care for patients, not to hasten their death".

It continues: "The decision to begin the care pathway is made in partnership with the patient and their carers.

"Such decisions would never be based on financial constraints, but always on recognition that a patient is dying and that further investigation and treatment would be futile, undignified and intrusive."

Some families have claimed the pathway is a 'one-way street' to death, but medics say regular re-assessment is a key part of it. About four per cent of those put on the LCP subsequently recover and come off it.

The letter argues that the pathway "promotes dignity in the last hours or days of life" and notes: "If a patient's condition improves this can be identified quickly; the care pathway can be discontinued at any time."

It concludes: "All of the healthcare professionals who have signed this letter have been involved in the care of dying patients; many of us have also cared for friends or relatives during the final days of their lives.

"This is how we would wish to be cared for at the end of our lives and our patients deserve to be offered nothing less."

Dr Natalie Silvey, who wrote and distributed the letter with the help of two colleagues, said they had penned it because the controversy had caused "a lot of distress among families of patients and doctors".

She said: "We wanted to highlight exactly what the pathway is and how it should be used."

She continued: "Before the LCP, there was not such a formal approach to end-of-life care."

That meant there were more instances of poor care in the final days of life, she said, including unnecessary medical treatments that were not in patients' best interests.

The letter was distrubted via Twitter, the social networking website.

The Liverpool Care Pathway was developed in the 1990s by Marie Curie Cancer Care for terminally ill cancer patients.

It has been adopted for use in general hospitals and rolled out rapidly throughout the NHS.

However, an audit by Marie Curie and the Royal College of Physicians last December found in six per cent of cases, patients or their families were not told of the decision to use the LCP.

In a quarter of hospital trusts, doctors or nurses did not inform patients or their families in at least half of cases.

Earlier this week, amid growing disquiet, ministers decided to act to address the problem.

Jeremy Hunt, the Health Secretary, said patients and their families had "a basic right to be involved in discussions and decisions affecting their end of life care".

On Monday Norman Lamb, the care minister, announced this right would be enshrined in the NHS Constitution, if agreed after a 12-week consultation.

Dr Silvey said it was "utterly unacceptable" when patients or their families were not fully informed.

During the recent debate it has also emerged that most hospitals in England are being given financial rewards worth millions of pounds to place patients on the LCP, a situation described as "absolutely shocking" by critics.

However, many doctors say these incentives are merely a reflection of how the NHS works and nothing more sinister.

But Mr Lamb has ordered an internal investigation into the payments, saying they should only be made when the LCP leads to "demonstrably better care".

Many continue to question the LCP and say neither step goes far enough.

Professor Patrick Pullicino, a consultant neurologist at East Kent Hospitals University NHS Foundation Trust, said: "The depth of concern and the extent of suffering that have come to light through people who have been on the pathway warrants nothing less than a formal government inquiry."