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Care? No, this is a pathway to

killing people that doctors deem
worthless
By MELANIE PHILLIPS FOR THE DAILY MAIL
PUBLISHED: 17:45 EST, 14 October 2012 | UPDATED: 18:11 EST, 15 October 2012

158

View comments

For relatives anxious about a frail

loved one in hospital, few things
could surely sound more
reassuring than a care pathway.
It sounds like a well-worked-out
schedule for providing the best
possible approach to treating a
patient.
Accordingly, when relatives have
been asked to sign up to the
Liverpool Care Pathway (LCP),
thats precisely what they thought
they were agreeing to.
And, in theory, thats what it is
supposed to be. Devised by the
Marie Curie Palliative Care Institute
in the Nineties and adopted
nationwide in 2010, its aims are
laudable and appropriate.
For its objective is to ensure that a
dying person is treated in his or her
last days with as much dignity and
comfort as possible. Accordingly, it
rules out potentially distressing
interventions aimed at prolonging
The LCP's objective is to ensure that a
the dying process.
dying person is treated with as much

Certainly, it is an important principle dignity and comfort as possible.

of medical ethics that dying should
not be artificially prolonged, since
this is as pointless as it is degrading and even cruel.

In practice, however, the LCP has turned into something quite different.
For while in some cases it has been used properly as intended, with
numerous others it has become, instead, a backdoor form of euthanasia.

Precious
One of its ten key messages is that it neither hastens nor postpones
death. But, on the contrary, many examples have emerged where it has,
indeed, been used to hasten death.
Terminally ill patients have been heavily sedated and deprived of essential
nutrients and fluids in order to make them die more quickly.

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And there are claims that it is increasingly being applied without the
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knowledge of patients families, and when such patients still have a chance
of recovering for a few more precious weeks, months or even years of life.
One report last year found that as many as 2,500 families were not even
told that their relatives had been put on the LCP.
In other cases, relatives have suddenly discovered that a do not
resuscitate notice has been issued against the wishes of patient and
family.
One cancer patient who had
suffered a heart attack and been
put on the LCP had all his tubes
and drips removed, including
hydrating fluids, on the false
grounds that he was dying.
Once his horrified family realised
what was going on and took steps
to guard him in order to ensure he
was nourished and treated, he
recovered and lived for another
month.
Earlier this year, Patrick Pullicino, a
consultant neurologist and
professor of clinical neurosciences
at Kent University, told a
conference that the LCP had
become an assisted death
pathway for than 100,000 patients
each year.
Very likely, many elderly patients
who could live substantially longer
are being killed by the LCP, he
Professor Patrick Pullicino said doctors
said.
had turned the use of a controversial

Horrifyingly, the LCP has become

'death pathway' into the equivalent of
a self-fulfilling prophecy. When
euthanasia of the elderly
people are put on it, they are said
to be dying. But they may not be
dying at all not, that is, until they are put on the pathway, whereupon
they really do die as a result.
In other words, they are killed. Whats more, they are killed in a most cruel
and callous way through starvation or dehydration. And this in a health
service that is supposed to be a national byword for compassion!
This really is an obscene abuse of people who expect the NHS to care for
them, not kill them.
And how appalling that this has made patients terrified that the hospitals
supposedly taking care of them may try instead to kill them and that
their relatives feel they must defend their loved one from the medical staff.
Indeed, in these circumstances its not just the patients who are vulnerable
and open to abuse, but also their families, who may be in a state of shock
over their relatives condition and in no fit state to understand just what the
doctors or nurses are saying or doing.

Suspicions
So how can this awful situation have been allowed to develop? How can
hospitals governed by the ethical imperative to first do no harm be killing
patients in their care? How can the NHS have been turned in these
circumstances into a National Death Service?

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How can hospitals governed by the ethical imperative to first do no harm be killing
patients in their care?

The first and most cynical reason believed by a number of deeply

concerned doctors is that it is being done to save money. There are

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suspicions, based on much circumstantial evidence, that such patients are

being dispatched via the LCP because simply and crudely the
hospitals need their beds to meet overwhelming demand. This callous
disregard for the most needy is of a piece with the all too frequent abuse
of patients who are elderly, confused or difficult to manage and who may
be treated in hospital with indifference, neglect or even cruelty.
Indeed, the abuse of the LCP is not just about economics. More
fundamentally, it has arisen from a profound confusion in society caused
by a collapse of moral absolutes and a resulting inability to make the key
distinction between dying and killing.
This confusion lies at the heart of the powerful campaign to legalise
euthanasia.
It was graphically illustrated by the decision of the Voluntary Euthanasia
Society to change its name to Dignity In Dying, which deliberately muddled
dying with the taking of life thus playing on peoples fears and
sympathies around dying in order to sanitise euthanasia.
It is precisely this corruption of language that has sent us hurtling down
this most slippery pathway to killing.

Suffering
First, the word dying has been
applied to people suffering from
terminal illness or who are
considered by doctors or other
experts to have lives that are not
worth living, even when they are
not dying at all.
The second stage in this abuse of
language has been to re-label
actions designed to end the life of
someone who is not dying by
calling this helping them to die.
Such actions include the withdrawal
of food or water. But that is starving
or dehydrating someone to death.
And that is not helping them to die,
but killing them.
Yet that is precisely what has been
happening, ever since the courts
ruled in 1993 that the feeding tubes
could be removed from the
Hillsborough stadium disaster victim
Tony Bland, who was in a
persistent vegetative state,
because such artificial nutrition and
hydration were deemed to be
treatment.
The judges disingenuously claimed
then that this was not killing, but
allowing Tony Bland to die. But he
was not dying.

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The Liverpool Killing Pathway is driven

not just by crude economic calculation
but by a wider brutalisation of our
culture

With his case a fateful legal line was crossed. And so dying has become a
euphemism for killing.
The fundamental driver of all this is the belief that certain people are
better off dead because their lives are deemed worthless, a drain on the
public purse, or both.
The Liverpool Killing Pathway is driven not just by crude economic
calculation but by a wider brutalisation of our culture, at the heart of which
lies the erosion of respect for the innate value of human life.
And that way lies not just the degradation of the NHS, but a society devoid
of humanity itself.

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Comments (158)
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The comments below have been moderated in advance.

daisymay, auckland, New Zealand, 2 years ago

When my mother was in hospital with cancer, she had very good
care, and when the cancer advanced my mother refused to eat and
the nurses tried everything to get her to eat, in the final stages of
her cancer she was moved to a small ward with two beds and i
moved into the ward with her, I was told to keep moistening her lips
with lemon sticks, towards the end the Doctor came and increased
her morphine to make her more comfortable, i was then told to get
my family around her and not to give her any more lemon sticks as
the end was near, she died a few hours after, i could not fault the
hospital or the staff, they gave me all m y meals for 48 hours was
allowed to use the nurses shower, but I do think that because it
was a country cottage hospital the treatment was a lot better than
a large hospital, I would have hated my mother to have had to go in
one of the large hospital, staff do not have the time to spend with
patients.my mother knew all the staff in the hopsital she was in.
Click to rate

106

29

CathyEast, Norwich, United Kingdom, 2 years ago

I am a nurse of 20 years experience in community and practice

nursing in rural areas. We have been using Liverpool Care Pathway
for several years in my area. I have noticed an improvement in our
palliative care since we have adopted it. The hours and hours I have
spent sitting in meetings with Macmillan nurses, district nurses,
GPs, oncologists carefully discussing the minutiae of relatives'
feelings and patient's feelings, ideas, pain levels, ability to cope at
home, choice of place of death etc... In my experience, health care
professionals are enormously conscientious, visit dying patients on
days off, agonise over correct treatment regimes trying to balance
dignity and comfort against possible benefits of medical
interventions. If someone's gag reflex isn't working, giving fluids will
lead to aspiration pneumonia, kidneys may not be working to
process fluids either. Ridiculous article you should be ashamed.
Click to rate

392

77

Betsey, Reading, United Kingdom, 2 years ago

This article is poorly informed, scaremongering and irresponsible. I

am a palliative care nurse in an acute hospital. I have several years
experience working in a hospice. The aim of the LCP is to enable a
hospice level of end of life care in acute hospitals. Acute hospitals
have many varying priorities and demands and meeting the needs
of the dying patient can be difficult and challenging. The LCP
provides guidance and a framework so that people at the end of
their lives are cared for with compassion and dignity. Any treatment
provided is to relieve distressing symptoms - not to hasten death.
Click to rate

340

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annamcg, bolton, United Kingdom, 2 years ago

I want the LCP for my own death or for that of a friend or relative. In
this society full of unrealistic expectations, sometimes we need to
accept that we are all mortal and death comes to us all. I, for one,
will hope to pass away comfortably and peacefully - and accept my
fate with dignity.
Click to rate

190

39

Commentqueen, England, 2 years ago

This to me is far worse than the Jimmy saville story - if it's such a
good idea why are we the only Country in the World who uses it.?
Click to rate
Steph, Leics, 2 years ago

60

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I am in tears after reading this abhorrent article. As an NHS doctor I

work so so hard to do my best for patients and genuinely care for
their well being. We do our best to make people better. However
sometimes you cannot fight the course of nature and have to
accept that a patient WILL NOT recover from their illness and that
they are very sick indeed. In which case, we need to make them as
comfortable as possible to make their final hours as peaceful as
possible - both for them and their families. It is an extremely difficult
decision and only done if we believe all attempts to continue
actively treating their illness will be futile and cause the patient
more harm than good. We also only commence the LCP if the
patient is likely to be within the last 48 hours of life. We DO NOT
use it as a form of euthanasia. This article is so chronically
misinformed and ignorant from the start. It is absolutely disgusting.
I don't know what else to say.
Click to rate

449

52

Beccy, Edinburgh, United Kingdom, 2 years ago

This is the most ill-informed article I have read in a long time Melanie Phillips, you should be ashamed. The LCP, in my opinion,
is the best thing to happen in hospital medicine in many years.
Medicine, by its modern nature, is very interventionalist and the
LCP provides a tool for healthcare professionals to assess, with a
patient and their family, how much intervention is appropriate at the
end of life. I am sorry to hear of unsatisfactory care provided in
some of the examples above, but that is specific to each situation,
and not a reflection of care or the LCP in general. End of life care is
emotive enough, without this sensationalist ill-informed claptrap
causing fear, at a stage of life that is already naturally frightening. I
have seen exceptional care provided many times, meaning
individuals died with minimal distress and easing their loved ones'
grief. Although your sole goal may be selling newspapers, spare a
thought for those affected by your choice of subject matter
Click to rate

309

44

Lesmac24, St. Helens, United Kingdom, 2 years ago

This piece is the biggest load of drivel I have ever heard. 1. Fact:
people die, the pathway is designed to help people pass away
peacefully 2. Stating people may be using the pathway to release
beds, is just a ridiculous statement and the person making it
should defend this comment or remove it. 3. patients who are able
to tolerate food and drink are offered it and assisted in consuming
it. You would not put a dying patient through the trauma of inserting
a peg tube, just so they can consume food in the last few days.
Finally yes communication needs to be better with patients
relatives, but to basically say the pathway is used to kill patients is
totally unacceptable
Click to rate

220

39

capl5, London, United Kingdom, 2 years ago

Melanie Phillips, please try to investigate your subject properly

before you next write an article. This article is extremely ignorant,
poorly researched an deliberately provocative, even for a tabloid. I
think what needs to be realised by many is that sometimes doctors
cannot prevent death despite full treatment. In fact death is the one
CERTAINTY in life. If doctors could treat every sick patient, there
would be a lot of 200yr old people around. So the point of the LCP
is to ensure a dignified death - ie small doses of pain relief, antiagitation, anti sickness and anti-secretion medication and to stop
all unnecessary medications and painful procedures (eg. blood
taking). None of it causes death in a patient that is not otherwise
dying. The important point is being able to recognise when a patient
is dying despite the health professional team's best efforts and thus
allowing a dignified death rather than flogging the dying with futile
treatments. I know what I would prefer.
Click to rate

196

40

loobyloo2012, Leeds, United Kingdom, 2 years ago

What an ill informed article. Patients are placed on this only when
treatment options have been exhausted or none are available and it
is agreed that further treatment which can often be invasive or
unpleasant will just prolong the dying phase, this is not a decision
made quickly or to clear hospital beds!!! When patients are
reaching this end stage often blood tests, investigations and putting
needles in to give intravenous fluids are very distressing for the
patient. As a doctor I would not want this for myself or my loved
ones, I would rather be kept comfortable and it feels cruel to do this

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to patients for no benefit. When you reach the dying stage your
body doesn't need the food and fluid you normally do. Often nausea
is a problem and generally patients don't have any appetite. You
don't need fluid like normal so if we put up a drip to stop people
'dying of dehydration' fluid will often collect in their lungs or other
areas making it hard to breath which is distressing.
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gilet as she makes her
way to radio studios
The radio DJ, 33, looked
trendy
Cara Delevingne raises
eyebrows by REMOVING
her co-star's in teaser
clip from new movie
Paper Towns
Have they been
airbrushed from history?
Alec Baldwin looks
downcast as he steps
out in New York while
daughter Ireland seeks
help in rehab over
'emotional trauma'
He's taking the strain
Eye candy! Sarah
Harding shows off her
tanned and toned legs in
chic black playsuit as
she attends M&M's
event
Melting hot
Ryan Reynolds
watches on as stunt
double does all the
dangerous work on
Deadpool set... just four
days after being struck
by car in hit-and-run
Bake Off star Sue
Perkins quits Twitter
following death threats
from Top Gear fans after
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she was linked to

Jeremy Clarkson's job

If it ain't broke... Lauren

Pope changes into
tummy-baring white
two-piece after wearing
a similar floral outfit as
she party hops in
London
'Moon baby!' Ariana
Grande proudly
showcases her FOURTH
tattoo... a crescent
symbol on her neck
The hitmaker has so far
revealed four tattoos
Robert Downey Jr.'s
stunning wife Susan
displays her post-baby
body in an elegant
strapless gown at the
Avengers: Age Of Ultron
world premiere
'I'm so excited!': Josiah
Duggar, 18, joins
Instagram to introduce
Marjorie Jackson, 17,
who he's been courting
Reality star began his
courtship on April 6
March of the Bigfoot
celebs: Why DO so many
famous women have
such monster feet?
Kate, Scarlett and
Gwyneth all have big feet
Holy smoke! Rob Lowe
the priest spotted with
cigarette while chatting
to a nun on the set of
Apocalypse Slough in
Malta
Once a rebel, always a
rebel
Off-duty Kate Winslet
keeps it simple in skinny
jeans and leather jacket
after wowing fans in
THAT cleavageenhancing dress
Sexy in the city
Causing a Commotion!
Madonna suffers
backlash for THAT
onstage kiss with Drake
as the internet goes wild
with hilarious memes
Fans got creative
Georgina Chapman
shares Instagram photo
of flowers from her
'wonderful husband'
Harvey Weinstein - days
after he avoided
charges 'for groping
model'
Rival to the booty throne!
Meet Cuba's bikini-clad
answer to Kim
Kardashian, who claims
her derriere is 100%

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natural (and she

doesn't believe in
Photoshop either)

Talented Taylor Swift

lookalike carves out a
career as a professional
tribute artist - and
admits she regularly
gets mistaken for the
real deal
'Never say never!': Nick
Cannon reveals he's
open to a reconciliation
with estranged wife
Mariah Carey
Split last year
Gisele Bundchen flies
to her native Brazil to
strut down the Colcci
catwalk before her
runway retirement
The 34-year-old
supermodel will storm
her final catwalk at So
Paulo Fashion Week
It's raining Angels!
Candice Swanepoel and
her supermodel friends
wear see-through macs
in new Victoria's Secret
lingerie campaign
Not exactly a cover up
Woman in white!
Queen Letizia looks cool
in a crisp tailored suit to
give speech at a science
conference in Barcelona
Posed with her fans
'Can't be a slacker
forever!' Supermodel
Maggie Rizer shows off
her trim and toned bikini
body just NINE weeks
after giving birth to her
third child
Guy Ritchie and Jude
Law venture out
into Snowdonia National
Park to film Knights of
the Roundtable: King
Arthur
Action scenes
Can YOU spot the bride
wearing 1,500 Vera
Wang from the woman
in a 199 high street
gown... and which
bridesmaid looks
charming in Asda?
Transparent star
Jeffrey Tambor wishes
Bruce Jenner
'happiness and an
authentic life' ahead of
his Diane Sawyer
interview
He can relate
Glorious in green!
Samantha Cameron
shows support for
British designers in
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emerald wrap dress at

Conservative manifesto
launch

Hair today, gone

tomorrow: Tom Hardy
looks unrecognisable as
he steps out with newly
shaven head and scruffy
ginger beard
For a film role?
'Can't wait to meet my
bubba': Pregnant Billi
Mucklow gives fans a
first look at her baby as
she shares 3D
ultrasound scan
She's counting down
A little princess!
Monaco heir Andrea
Casiraghi and
wife Tatiana Santo
Domingo welcome a
baby girl
Princess Caroline's son
'I'm a very lucky girl...
he's hot': Charlize
Theron gushes about
beau Sean Penn... but
admits idea of marriage
is 'strange' to her
An item for a year
'They shot bullets at
us': Dancing With The
Stars vet Tony Dovolani
reveals he was almost
killed while growing up
in war-torn Kosovo
Made In Chelsea's
Louise Thompson looks
chic in skirt and jumper
... as three of her exboyfriends strip off for
Gok Wan's 'Get Your
Legs Out' campaign
Percy Sledge, singer of
When A Man Loves A
Woman, dies at 74
Music legend was
inducted into the Rock
and Roll Hall Of Fame in
2005
Meghan Trainor
flatters her figure in
leather mini skirt and
over-the-knee boots...
after stepping out to
greet her London fans in
tatty slippers
'It doesn't get any
better than this': Proud
dad Dan Osborne posts
picture of himself
holding children Teddy
and Ella in his arms
Got his hands full
Leona Lewis cuts a
casual figure as she
heads to the gym...
following claims she has
'slammed' former
mentor Simon Cowell on
new album
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'Thank you for fighting

these ageist battles':
Rita Ora takes to
Instagram to defend
Madonna... after icon is
slated for THAT kiss
Didn't see the problem
Red on red! Flamehaired Nicola Roberts
matches her scarlet
blazer to her famous
locks as she adds a
splash of colour to her
spring ensemble
'I emptied my account':
Girls star Jemima Kirke
reveals she had to
undergo an abortion
without any anesthesia
so that she could afford
to pay for the costly
procedure
'I'll have some wine
before I go on Twitter!'
Melanie Hill admits
nerves over fans'
reactions to her playing
Roy Cropper's new love
interest in Corrie
Confirmed! Billy Joel,
65, and his girlfriend
Alexis Roderick, 33, are
expecting a child
together this summer
He's finally found what
he's been looking for
'I don't obsess about
my weight': Kelly
Clarkson responds to
body-shamers as she
poses with her darling
River Rose on magazine
cover
'So fresh and so clean
clean!': Make-up free
Candice Swanepoel
displays her natural
beauty in a bikini selfie
South African model
strikes a pose
The 'fitspo' girls taking
over Fashion Week:
Yogis, ballerinas and
athletes star on the
catwalk at sporty We
Are Handsome show as
they declare 'strong is
the new skinny'
The look of love! Aaron
Taylor-Johnson, 24,
walks the red carpet
with supportive wife
Sam, 48, at Avengers:
Age Of Ultron world
premiere
'We're in it for the long
haul': Made In Chelsea's
smitten Stephanie Pratt
and Josh Shepherd
discuss marriage and
baby plans
Woah, steady on!
Rachel Hunter looks
sensational in a plunging
silk blouse and figurefitting skirt as she
promotes new TV show
in Cannes
Rod's ex is looking good

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Kim Kardashian and

Kanye West continue
their tour of the Holy
Land with daughter
North... as she shares
photos from inside
Jerusalem cathedral
Michelle Keegan
shows off her
sophisticated summer
designs and enviable
curves as she teases
fashion fans with new
Lipsy shots
VIDEO EXCLUSIVE:
Carey Mulligan gets
stuck in sheep cleaning
as Thomas Hardy's
heroine Bathsheba
Everdene in Far From
The Madding Crowd
Bust enough: Michelle
Mone shows off her
assets in plunging
animal print top as she
heads out for posh meal
Dined in London as she
sells Glasgow flat
Charity chic! Abbey
Clancy joins forces with
Victoria's Secret angel
Lily Donaldson in fashion
campaign for breast
cancer
Joining the fight
Can't take his eyes off
her! Chris Hemsworth is
mesmerised by wife
Elsa Pataky who puts
her cleavage on show in
a VERY low cut dress at
Avengers premiere
'I love you with all of my
heart and soul': Gary
Clark Jr gifts fiance
Nicole Trunfio with a
bunch of red roses and
a touching note on their
three-year anniversary
Still in love

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