A few years ago the UK's Department of Health approved the Liverpool Care Pathway - so called because it was developed at the Royal Liverpool Hospital - for use in NHS hospitals.Patients can be placed on the pathway "in the last hours or days of life," enabling food and water and drugs treating their condition to be withdrawn "to avoid unnecessary and burdensome intervention," and if necessary the patient sedated.
Doctors say the pathway has prevented suffering for dying patients. Predicting the time of death is difficult, however, and some patients taken off the pathway have recovered and lived for a considerable period.
Critics say patients are sometimes placed on the pathway too early, and sedation can mask their subsequent condition. The pathway, they say, can be reduced to a "tick box" ritual, and there could be a refusal to take the patient off the pathway once placed on it. With food and fluids removed and the patient sedated, death would then become a self-fulfilling prophecy.
The Department of Health says doctors must always discuss with relatives whether to place patients on the pathway.
A report of an audit this year by the Marie Curie Palliative Care Institute, in collaboration with the Royal College of Physicians, just published - it says care of the dying overall was of high quality, but concerns remain regarding education and training - shows two things: the number of patients with terminal illnesses on the Liverpool Care Pathway has almost doubled in the past two years, and in one NHS trust where patients have been placed on the Liverpool Care Pathway, fewer than half their families have been informed.
Overall, where data has been supplied by hospitals, doctors discussed plans with relatives in 94 per cent of cases, but this still leaves thousands of families who were not advised what doctors were doing.
Why are families not told? Because it's easier not to? Because families might object? Because doctors think they know best? Or is this euthanasia by the back door?
We should be told.
