This week, concerns rose over British doctors’ use of aso-called “death pathway” on patients who may have months or even yearsof life left. Speaking to the Royal Society of Medicine, ProfessorPatrick Pullicino, a doctor and consultant, suggested that pressure toclear 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” orLCP, which was developed in hospices in the 1990s. The purpose of the LCPis to comfort the terminally ill who have no chance of making arecovery. In the mid-2000s the NHS adopted the LCP as a recommendedpractice nationwide for patients who were not expected to survive.
At present, 29 percent of all patients who die in Britain have beenplaced on the Liverpool Care Pathway by their doctors. Presumably, allof 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 atany other specific time, is not possible scientifically. Thisdetermination in the LCP leads to a self-fulfilling prophecy. Thepersonal views of the physician or other medical team members ofperceived quality of life or low likelihood of a good outcome areprobably 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 beenplaced 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, “Hisseizures came under control and four weeks later he was discharged hometo his family.” The elderly man lived another 14 months until hecontracted pneumonia and returned to the hospital. At this point, he wasplaced on the LCP and died hours later.
The NHS maintains thatthe LCP is not akin to euthanasia. However, the determination that deathis imminent is, as Dr. Pullicino notes, a “self-fulfilling prophecy.”Once patients are placed on the LCP by a doctor, the patient’s death isboth inevitable and relatively swift. Absent intervention by anotherdoctor, there is not going to be a case where the LCP’s use will bejudged improper.