Euthanasia accounts for nearly a third of all deaths in the National Health Service, a senior physician has said.
Professor Patrick Pullicino (pictured), an NHS neurologist, said sick and elderly people who were not dying from their illnesses were routinely being killed by being placed on the Liverpool Care Pathway (LCP).
He told a Medical Ethics Alliance conference at the Royal Society of Medicine in London that he believed patients were killed sometimes because they were “difficult to manage” or because NHS staff faced pressure to free up hospital beds.
He said the lack of an evidence-base for putting patients on the LCP made it an “assisted death pathway” and not a care pathway.
“If we accept the LCP we accept that euthanasia is part of the standard way of dying as it is now associated with 29 per cent of NHS deaths,” he said.
“Very likely many elderly patients who could live substantially longer are being killed by the LCP.”
In the worst case scenario his estimates suggest an epidemic of covert euthanasia in the NHS, involving the annual deaths of nearly 130,000 people from some 450,000 people who die in hospitals each year.
Fewer than three per cent of patients are removed from the pathway with the rest taking an average of 33 hours to die.
Once a patient is placed on the pathway they are heavily sedated then their food and fluid is withdrawn so they are starved and dehydrated to death in an induced coma. Families do not have the legal power to object.
The LCP is supposed to be used only when prognoses indicate that patients are “in their last hours or days of life”.
But Professor Pullicino said patients were routinely placed on the pathway without any prognostic tests being made at all.
Pressure on beds ‘a factor’
“Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically,” he said.
“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: “Factors like pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients cannot be excluded.”
The pathway, he said, was “seriously undermining evidence-based medical practice and the doctor-patient relationship”.
Sensationally, he also revealed how he had personally intervened to take a patient off the LCP who was later successfully treated.
The 71-year-old man of Italian origin was suffering from pneumonia and epilepsy and was put on the LCP by a covering doctor on a weekend shift.
“I removed the patient from the LCP despite significant resistance,” said Professor Pullicino.
“His seizures came under control and four weeks later he was discharged home to his family,” he said.
The man required substantial nursing care when he returned home and he was readmitted to a different hospital 14 months later, again suffering from pneumonia. This time died five hours after he was placed on the LCP.
In breaking his silence, Professor Pullicino has emerged as one of the most senior medics in Britain to criticise the LCP, and follows the warnings of three senior palliative care experts who raised similar grave concerns nearly three years ago.
He is the Professor of Clinical Neuroscience at the University of Kent, Visiting Professor of Neurology at St George’s University, London, and the Adjunct Professor of Neurology and Neuroscience at the New Jersey Medical School in the US.
The LCP has proved controversial since it was developed in a Liverpool hospice by Marie Curie, the cancer charity, to reduce the suffering of patients in their final hours.
But in 2004 it was recommended as a model by the National Institute for Health and Clinical Excellence and rolled out across the country.
It is now considered to be “gold standard health care”, recently endorsed by Paul Burstow, the Liberal Democat Care Services Minister.
Targets are being set for the implementation of the LCP and hospitals and managers are being assessed on how successfully they adopt the pathway.
‘Like a birthing plan that ends in death’
A Department of Health spokesman denied that the LCP was being used for euthanasia.
He 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 ever four hours and if a patient improves, they are taken off the Liverpool Care Pathway and given whatever treatment best suits their new needs.”
But Dr Philip Howard, a Catholic NHS hospital doctor in Surrey, said that he also believed the LCP meant large-scale euthanasia by stealth and the practice would soon bypass arguments over whether euthanasia should be legalised.
Patients are put on the LCP increasingly by multi-disciplinary teams than by physicians, he said, adding that this indicated management decisions supplanted medical judgements.
“It is like planning a delivery. It’s like a labour plan, a birthing plan, that ends in death,” he said.
“It is a decision with an end in view. The patient is dying. Why? Because we say they are dying. Why? Because we have decided.”
He said: “That’s a worry when you have the problem of getting it wrong.”
This article first appeared in Diocese of Shrewsbury
