Killing patients who are difficult to manage is becoming common in the UK

An article written by Steve Doughty and published in the Daily Mail in the UK on June 19. The article reports on a research by Professor Patrick Pullicino that found that approximately 29% of all deaths in the UK are prematurely ended by use of the Liverpool Pathway, a plan that defines a patient as futile and then withdraws all treatment and care, including hydration and nutrition.


The article in the Daily Mail article states:

Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly. 

He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country. 

It is designed to come into force when doctors believe it is impossible for a patient to recover and death is imminent. 

It can include withdrawal of treatment – including the provision of water and nourishment by tube – and on average brings a patient to death in 33 hours.

The article estimates that approximately 130,000 people die prematurely or through euthanasia by omission related to the Liverpool Pathway. The article states:

There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 per cent – 130,000 – are of patients who were on the LCP. 

Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’.

Pullicino suggests that these deaths are often related to the need to control costs or a way of dealing with difficult patients. The article states:

He cited ‘pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients’ as factors. 

Professor Pullicino revealed he had personally intervened to take a patient off the LCP who went on to be successfully treated. 

He said this showed that claims they had hours or days left are ‘palpably false’. In the example he revealed a 71-year-old who was admitted to hospital suffering from pneumonia and epilepsy was put on the LCP by a covering doctor on a weekend shift. 

Professor Pullicino said he had returned to work after a weekend to find the patient unresponsive and his family upset because they had not agreed to place him on the LCP.
‘I removed the patient from the LCP despite significant resistance,’ he said. 

‘His seizures came under control and four weeks later he was discharged home to his family,’ he said.

The article then explains how the Liverpool Pathway can be equivalent to euthanasia

He (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. 

This determination in the LCP leads to a self-fulfilling prophecy. 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.’ 

He 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.’ 

Experts including Peter Millard, emeritus professor of geriatrics at the University of London, and Dr Peter Hargreaves, palliative care consultant at St Luke’s cancer centre in Guildford, Surrey, warned of ‘backdoor euthanasia’ and the risk that economic factors were being brought into the treatment of vulnerable patients.

The article concludes by quoting authorities who do not consider the Liverpool Pathway to be euthanasia. The article stated:

A 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. 

‘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 Liverpool Pathway was originally established as guidelines to be used when the person was known to be dying and nearing death. Now that it is being routinely used for people who are not yet dying or elderly people who are difficult, it can be clearly stated that the Pathway is being abused.

Further to that, the Liverpool Pathway works by withdrawing all treatment and then using larger doses of morphine to ensure that the person does not suffer from the symptoms of dehydration. Clearly, the abuse of the Liverpool Pathway is a form of euthanasia by omission.

It is tragic when society becomes so cold and heartless that it simply ignores such rates of elder abuse.

Previous article about the same issue.

Previous article - Elderly patients dying of thirst.