This week, concerns rose over British doctors' use of a
so-called "death pathway" on patients who may have months or even years
of life left. Speaking to the Royal Society of Medicine, Professor
Patrick Pullicino, a doctor and consultant, suggested that pressure to
clear beds was leading to the equivalent of euthanasia for thousands of seriously ill patients.
The National Health Service is Britain's socialized medicine scheme.
At issue this week is something called the "Liverpool Care Pathway" or
LCP, which was developed in hospices in the 1990s. The purpose of the LCP
is to comfort the terminally ill who have no chance of making a
recovery. In the mid-2000s the NHS adopted the LCP as a recommended
practice nationwide for patients who were not expected to survive.
At present, 29 percent of all patients who die in Britain have been
placed on the Liverpool Care Pathway by their doctors. Presumably, all
of these patients are terminally ill, but as Dr. Pullicino explains,
this is a self-fulfilling prophecy:
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.
To bolster his case that the LCP was sometimes used improperly, Dr.
Pullicino told a personal story about an elderly patient who had been
placed on the LCP by a doctor working a weekend shift. When Professor Pullicino came back to work the next week, he took the elderly man off the LCP. The result was, "His
seizures came under control and four weeks later he was discharged home
to his family." The elderly man lived another 14 months until he
contracted pneumonia and returned to the hospital. At this point, he was
placed on the LCP and died hours later.
The NHS maintains that
the LCP is not akin to euthanasia. However, the determination that death
is imminent is, as Dr. Pullicino notes, a "self-fulfilling prophecy."
Once patients are placed on the LCP by a doctor, the patient's death is
both inevitable and relatively swift. Absent intervention by another
doctor, there is not going to be a case where the LCP's use will be