Liverpool Care Pathway (UK): Deadly Danger of Treating Patients as Category Members Instead of Individuals

Many hospitals and nursing homes in the UK have adopted something called the Liverpool Care Pathway, in which dying patients are sedated—whether or not they need it to control unrelievable pain, apparently—and then denied food and water until death.

Currently about 16.5  percent of deaths in the UK occur while sedated—which is far more than the hospice experts I have talked with have told me is necessary to actually alleviate suffering.  Indeed, they tell me sedation is rarely necessary in hospice practice  If that is true, and I intend to do some more research on this, the Pathway misuses the legitimate treatment of palliative sedation, and mutates it in some cases into a method of causing death, known as terminal sedation.  This means that sedation is sometimes administered, not because the individual patient actually needs the procedure, but because he or she has been reduced to a category member, and that’s how members of the category are treated.

That’s a prescription for disaster. And now, a woman was almost dehydrated to death after being put mistakenly on the Pathway.  From the story:

AN 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened. Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients.

Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying.

Why are we surprised? The Pathway is a blunt intstrument, and the uniqueness of each case is lost in the drugs sedating effects.  Even though its authors believed they had created a nuanced protocol, that is never how these things are actually applied in clinical practice.  Eventually, such “pathways” threaten to transform medicine into a paint-by-the numbers technocracy.

And look at what it took to save Hazel from dehydration:

Fenton was admitted to hospital suffering from pneumonia. Although Ball acknowledged that her mother was very ill she was astonished when a junior doctor told her she was going to be placed on the plan to “make her more comfortable” in her last days. Ball insisted that her mother was not dying but her objections were ignored. A nurse even approached her to say: “What do you want done with your mother’s body?” On January 19, Fenton’s 80th birthday, Ball says her mother was feeling better and chatting to her family, but it took another four days to persuade doctors to give her artificial feeding.

This is a consequence of surrendering care approaches to cost/benefit/best care bureaucratic panels.  It becomes an excuse to merely write people off, particularly in a utilitarian environment where “quality of life” may determine the way the patient’s life is perceived by caregivers.

How many Hazel Fosters have died by dehydration who might have lived, or who could have spent their last days—pain controlled but awake and aware—surrounded by family?  There is no way to know.