Speaking to the Royal Society of Medicine in London, Dr Patrick Pullicino claimed that physicians are using a care pathway (standardized health care process) that is designed to make terminal patients’ final days more comfortable are actually using it as a form of euthanasia. The Liverpool Care Pathway (LCP) is used in British hospitals for patients who are terminally ill or expected to die soon. Under the LCP, physicians are allowed to withdraw not only treatment but also food and water while their patients are heavily sedated. According to the Daily Mail newspaper, almost a third of patients - 130,000 - who die each year hospital or under Britain’s National Health Service care are on the LCP.
Professor Pullicino said he believes the LCP is being used as an "assisted death pathway" for patients on the LCP without clear evidence, according to the Daily Mail. Pullicino, who serves as senior consultant at East Kent Hospitals told the Royal Society of Medicine of having personally intervened to release a 71-year-old man from LCP. Despite claims that the septuagenarian was due to die very soon, he was treated successfully and survived a bout with pneumonia and epilepsy. "I removed the patient from the LCP despite significant resistance," Pullicino said. "His seizures came under control and four weeks later he was discharged home to his family.” He added, "The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway." The 71-year-old man lived for another 14 months before he suffered pneumonia again and was admitted to a different hospital. He was put on the LCP and died five hours later. The patient was an Italian who spoke poor English and a history of seizures, however he had a supportive family.
Pullicino said, “The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway.”
“Very likely many elderly patients who could live substantially longer are being killed by the LCP.”
“Patients are frequently put on the pathway without a proper analysis of their condition.”
“Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically.”
Pullicino said that patients who come off the LCP and live longer than anticipated become costly to the British taxpayer because of the added healthcare and support that are needed. "Very likely many elderly patients who could live substantially longer are being killed by the LCP. Patients are frequently put on the pathway without a proper analysis of their condition," he added. "Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically. This determination in the LCP leads to a self-fulfilling prophecy.”
Signaling the role doctors’ opinions play in putting patients on LCP, Pullicino said "The personal views of the physician or other medical team members of perceived quality of life or low likelihood of a good outcome are probably central in putting a patient on the LCP." Pullicino added, “If we accept the Liverpool Care Pathway we accept that euthanasia is part of the standard way of dying as it is now associated with 29 per cent of NHS deaths.”
LCP was originally developed as a set of guidelines for health workers to make patients as comfortable as possible during their last days and hours. LCP guidance recommends regular assessments for patients on the pathway, and also allows patients to be taken off LCP if they are judged no longer close to their demise.
Responding to Pullicino’s assessment, a British Department of Health spokesman said, "The Liverpool Care Pathway is not euthanasia and we do not recognise these figures. The pathway is recommended by NICE and has overwhelming support from clinicians - at home and abroad - including the Royal College of Physicians.” The spokesman said, "A patient's condition is monitored at least every four hours and if a patient improves, they are taken off the Liverpool Care Pathway and given whatever treatments best suit their new needs." The spokesman said that LCP is well accepted in the UK and abroad.
The British Parliament and the medical profession have consistently opposed the legalization of euthanasia or assisted suicide. Even so, advocates have continued their campaign to normalize the practice which is now accepted in other countries, such as the Netherlands.