Le NHS se défend en expliquant qu’il a été mal compris par des médecins des soignants malformés.
Ces consignes ont conduit à priver des patients de nourriture et de boisson, et de les droguer sans réserve.
Toujours pour se défendre le NHL a prétendu qu’il s’agissait d’infirmières sont compassions dirigées par de jeunes médecins dont on attendait des décisions de "vie ou de mort" bien au-delà de leurs compétences, après de longues heures de travail ou durant les week-ends.
Le scandale est si fort que le ministre en charge Norman Lamb a déclaré qu’il prendrait les mesures nécessaires pour réassurer les patients et les familles, ceux dont le pronostic est évalué à moins de six mois -entre parenthèses à tort ou à raison-.
Ces directives de consensus développés par le NHS sont comparables à un véritable permis de tuer si cette option se développe.
Jane Cummings, officier en chef pour les infirmières en Angleterre a déclaré qu’elle se devait de rassurer tout le monde, et en particulier les patients considérés en fin de vie. C’est dire le niveau d’inquiétude soulevé par ces nouvelles normes hospitalières concernant la fin de vie.
Il faut ajouter que les hôpitaux et leur personnel étaient réputés recevoir des primes de résultat, en diminuant ainsi le coup des traitements des six derniers mois de l’existence ou supposés tels.
Le titre d’un des articles ci-dessous : « Les hôpitaux gratifiés pour mettre les patients sur le chemin de la mort. Gratification en espèces pour pour les groupes qui atteignent les objectifs recommandés par le NHS à Liverpool. »
L’article stipule qu’il s’agit d'au moins 30 millions de livres sterling ainsi allouées aux hôpitaux qui ont atteint les objectifs.
Des critiques acerbes montrent que ces gratifications financières peuvent influencer l’orientation du travail des médecins et du personnel soignant.
L’un de ces critiques le professeur Patrick Pullicino pense d’une part que le diagnostic de mort imminente est purement subjectif et que de mettre une incitation financière visant à en finir plus vite n'est vraiment pas une bonne idée, et perturbe le processus de décision.
Il évoque un nombre de 100 000 cas par an.
L’association pour la médecine palliative a ordonné une enquête.
Le Dr Tony Cole président du Medical Ethics Alliance pressure group déclare que : « Certes si la mort est accélérée d’un seul jour cela économise environ 200 livres au NHS. Mais ma position est que cette mesure n’est pas nécessaire et extrêmement dangereuse. »
Liverpool care pathway for dying patients to be abolished after review
Review heard that regime meant to extend hospice- type care to hospitals led to patients being drugged and deprived of fluids
The Liverpool care pathway recommends that in some circumstances doctors withdraw treatment, food and water from dying patients. Photograph: Montgomery Martin/Alamy
The Liverpool care pathway is to be abolished following a government-commissioned review which heard that hospital staff wrongly interpreted its guidance for care of the dying, leading to stories of patients who were drugged and deprived of fluids in their last weeks of life.
The government-commissioned review, headed by Lady Neuberger, found it was not the pathway itself but poor training and sometimes a lack of compassion on the part of nursing staff that was to blame, while junior doctors were expected to make life-and-death decisions beyond their competence after hours and at weekends. The review says individualised end-of-life care plans must be drawn up for every patient nearing that stage.
"Caring for the dying must never again be practised as a tickbox exercise and each patient must be cared for according to their individual needs and preferences, with those of their relatives or carers being considered too," said Neuberger. "Ultimately it is the way the LCP has been misused and misunderstood that had led to such great problems."
She said it was too late to turn the clock back and salvage the LCP, which was devised to try to extend the positive experiences of dying hospice patients into the hospital setting. But in replacing it, the NHS must make care of the dying part of its core business, she said.
"What we have also exposed in this review is a range of far wider, fundamental problems with care for the dying – a lack of care and compassion, unavailability of suitably trained staff, no access to proper palliative care advice outside of 9-5, Monday to Friday."
The government confirmed it would phase out the LCP and said it would require all hospitals to review the care of dying patients. Every such patient should in future have a named senior doctor in charge of their care.
The care minister, Norman Lamb, said: "We hope the actions we have taken today will reassure patients and their families that everyone coming to the end of their life is getting the best possible care and that concerns are being dealt with swiftly.
"I have personally heard families describe staff slavishly following a process without care or compassion and leaving people suffering at the end of their lives. This is something we cannot allow to go on.
"People's final days should be as comfortable and dignified as possible. That is why there is a place for thoughtful and careful end-of-life care that involves patients and their families, but it is clear what we have now needs to be replaced so we can create a better way of doing this."
The review listened to harrowing stories from families who had not been told their loved one was expected to die and, in some cases, were shouted at by nurses for attempting to give them a drink of water. Nursing staff had wrongly thought, under the LCP guidance, that giving fluids was wrong. Some patients were put on the pathway and treatment was withdrawn, only for them to make a recovery, albeit temporarily. Communication was very poor and medical staff sometimes dodged painful discussions with patients and families, the review found.
The review strongly criticised the Nursing and Midwifery Council, which – unlike the General Medical Council, which regulates doctors – offered no guidance to nurses on the care of the dying. That must change "as a matter of urgency", said Neuberger.
The NMC said it was already looking at standards of conduct, performance and ethics of nurses, following the Francis report into Mid-Staffordshire hospital. "In light of the independent review into the Liverpool care pathway the NMC must make sure that it is issuing the right guidance for nurses and midwives," it said. "We will be working with relevant stakeholders and studying the recommendations laid out in this review."
Jane Cummings, chief nursing officer for England, said: "I would like to reassure everyone, particularly patients on the LCP and their families, that NHS England and the NHS is passionate about ensuring that every patient receives the best possible care at the end of their life. I have been a nurse for over 30 years and know how important care at the end of life is for our loved ones. I say this both on a professional and a personal level.
"The review and NHS England recognise the good principles of end of life care in the LCP, but there have been failings in the quality of care in some areas and this is never acceptable. Caring for someone when they are dying is difficult and emotional even for experienced healthcare professionals. But the NHS exists to provide personal and compassionate care to patients and their loved ones when they most need it. Most of the time we do get it right but we have to get it right for everybody. Issues such as poor communication with relatives have nothing to do with any particular care plan. That is just poor care and we don't want it in the NHS."
The review makes 44 recommendations, including the phasing out of the LCP over six to 12 months as individual care plans for the dying are brought in. It says that only senior clinicians must make the decision to give end-of-life care, along with the healthcare team, and that no decision must be taken out of hours unless there is a very good reason.
It says there must be no incentive payments to hospitals to put patients on end-of-life care, as occurred with the pathway. This was intended to offer encouragement to adopt best practice but has been interpreted as payments to speed up patients' demise.
Hospitals bribed to put patients on pathway to death: Cash incentive for NHS trusts that meet targets on Liverpool Care Pathway
- Some hospitals set target of two thirds of all deaths should be on LCP
- At least £30m in extra money handed to hospitals to achieve these goals
- Critics warn financial incentives could influence the work of doctors
Hospitals are paid millions to hit targets for the number of patients who die on the Liverpool Care Pathway, the Mail can reveal.
The incentives have been paid to hospitals that ensure a set percentage of patients who die on their wards have been put on the controversial regime.
In some cases, hospitals have been set targets that between a third and two thirds of all the deaths should be on the LCP, which critics say is a way of hastening the deaths of terminally ill patients.
At least £30million in extra money from taxpayers is estimated to have been handed to hospitals over the past three years to achieve these goals.
Critics of the method warned last night that financial incentives for hospitals could influence the work of doctors.
The LCP involves withdrawal of life-saving treatment. Patients are sedated and most are denied nutrition and fluids by tube. On average a patient put on the Pathway dies within 29 hours.
One of the leading critics, hospital consultant Professor Patrick Pullicino, said: 'Given the fact that the diagnosis of impending death is such a subjective one, putting a financial incentive into the mix is really not a good idea and it could sway the decision-making process.'
LCP is thought to be used in more than 100,000 cases a year.
Yesterday the Association for Palliative Medicine, which represents doctors working in hospices and on specialist hospital wards, announced it is organising an inquiry into the method.
The LCP is intended to ease the final hours of patients who are close to death and to spare them the suffering associated with invasive treatment.
Payments to hospitals to introduce it are made through a system called Commissioning for Quality and Innovation, or CQUIN, which channels money to hospital trusts through NHS 'commissioners'.
The use of CQUIN payments to encourage the spread of the LCP through the wards and to persuade doctors to meet Pathway targets was revealed in answers to Freedom of Information requests.
Among trusts that confirmed the use of targets was Aintree University Hospitals NHS Foundation Trust, which said that in the financial year which ended in March the percentage of patients who died on the Pathway was '43 per cent against a target of 35 per cent'.
Over the year the Trust received £308,000 for achieving 'goals involving the Liverpool Care Pathway'. Salford Royal NHS Foundation Trust had CQUIN payments connected to the Liverpool Care Pathway almost halved after failing to reach targets.
The Trust was offered £73,385 for increasing numbers of patients who die at home rather than in hospital.
Part of the scheme was a target for the number of patients discharged from hospital to die at home after being put on the Liverpool Care Pathway.
This would have paid £36,392 if a 47.6 per cent target had been reached. Its FOI statement said: 'The Trust achieved 45.5 per cent so funding for the LCP element was reduced to £18,600.'
'Given the fact that the diagnosis of impending death is such a subjective one, putting a financial incentive into the mix is really not a good idea and it could sway the decision-making process.'
Professor Patrick Pullicino
FOI replies so far received by the Mail suggest that if the money paid by NHS commissioners were spread equally around all NHS acute hospitals, it would mean £30million has been sunk into the campaign to put the Pathway into universal use since 2009.
The Department of Health defended LCP payments by target last night. A spokesman said: 'It is right local areas try to improve the care and support offered to dying people as it means patients are more comfortable and treated with dignity in their final days and hours.
'We are clear the Liverpool Care Pathway can only work if each patient is fully consulted, where this is feasible, and their family involved in all aspects of decision-making. Staff must properly communicate with the patient and their family – any failure to do so is unacceptable.'
But Dr Tony Cole, chairman of the Medical Ethics Alliance pressure group said: 'If death is accelerated by a single day that will save the NHS nearly £200 – that is the estimated cost of a patient per day in hospital.
'My position on the LCP is that it is inherently dangerous and unnecessary.'
Liverpool Care Pathway: 'They told my family I was dying'
The Liverpool Care Pathway was developed to support patients as they near death. But the reality for patients and families has been mixed.
The system, which can involve withdrawal of medication, food and fluids, was developed at the Royal Liverpool University Hospital and the city's Marie Curie hospice in the 1990s to provide a model of best practice in the care of dying patients.
Critics dubbed it the "road to death" and accused the NHS of killing off thousands of elderly patients. Supporters say it helped their relatives have a peaceful and dignified death.
Last month, an independent review recommended the LCP be phased out in England, within the next six to 12 months.
One patient under the LCP was 90-year-old Kathleen Vine. Four months after doctors at a hospital in the south-east of England used it to care for her, she is back at home and in good spirits.
Her granddaughters, Helen Bishop and Alison English, say the LCP was used as a justification for sedating Mrs Vine and denying her food and water.
"Nan didn't want to die, it wouldn't even have been euthanasia. So, as far as we're concerned, it would have felt to us as if our Nan would have been starved to death and killed," Alison said.
Mrs Vine was taken to hospital with a dislocated shoulder, and a few days after being admitted she developed pneumonia.
"All I remember is they weren't feeding me. Up above my bed they put 'nil by mouth' and I was begging for food," she recalled.
She said that when she asked doctors and nurses for food, she was ignored.
"I was being left to die. If it hadn't have been for my family I would be dead now. I would just have been another statistic on the books."
Her family were told she had 48 hours to live but when her granddaughters visited her in hospital they said she did not look like someone who was dying.
"Nanny was sitting up in bed and she was saying, "I'm really hungry, I'm really thirsty," said Helen.
"We were ushered into an office with five medical staff and told about the LCP and that Nan was very elderly and her system was shutting down and there was not a lot they could do. So they would withdraw the food and meds and let her go peacefully.
"We said, 'but she's got a dislocated shoulder, how can this happen?' And they were saying, 'she is very old' and we had five people staring at us and it was very intimidating," Helen said.
The sisters said they were never told the reason that Mrs Vine was supposed to be dying.
"I spoke to the nurse and said I need to know what she's dying of. I have a science background and I need to see evidence. Show me some stats now to explain why you've given up on her," said Helen.
"She was pleading for water. The nurse said 'I've been told I can't give her anything.'"
The Liverpool Care Pathway
The pathway was developed during the late 1990s at the Royal Liverpool University Hospital, in conjunction with the Marie Curie Palliative Care Institute.
It was intended to provide uniform, high-quality, dignified care for dying patients - whether they were in hospital, at home, in a care home or in a hospice.
Previously, there were concerns that care had been patchy, with some hospitals failing to meet acceptable standards and accusations that people were subjected to invasive treatment and testing that offered no chance of preventing death, but merely prolonged their suffering.
Under the LCP, patients were regularly reviewed to ascertain whether medication should be stopped - and whether fluids should be withdrawn once they ceased to be able to eat and drink.
However, families have complained relatives were put on the pathway without their consent, and that death has been hastened in people who were not dying imminently.
Critics say that it is impossible for doctors to predict when death is imminent, so the decision to put a patient on the pathway is at worst self-fulfilling.
The recent independent review for England, 'More Care Less Pathway', found that the LCP was regularly used as a justification for withholding food and water.
But John Ellershaw, a professor of palliative medicine who led the team that developed the LCP, told BBC Radio 4 that should not be happening.
"Nowhere does the Liverpool Care Pathway say you must withdraw hydration or you must withdraw food. What it says is you should be encouraging patients to take food as appropriate and oral hydration as appropriate.
"If the patient is unable to take oral hydration then you should consider whether artificial fluids are appropriate."
"I think if healthcare professionals are telling relatives or patients that they can't have hydration because the LCP says they can't, then they're not reading the guidance or interpreting it correctly," he said.
The day after their grandmother had been put on the pathway Alison and Helen were visited by an end-of-life nurse.
"He asked if we had thought of a funeral and how to tell our daughters… I was saying I just can't believe she came in with a dislocated shoulder and now we're being told she's dying, but we don't know what she's dying of.
"At that point Nanny woke up and she had a full conversation with him… She flirted with him, telling him what lovely eyes he had, asking if he's married, does he have children. Later I said to him, 'That's not a dying person. She's chatting you up. This can't be right."
Alison and Helen didn't want to complain as the nursing staff were "brilliant", but said they got the impression that "the staff's hands were tied and they had to do what they were told. When we first found out she was put on LCP the nurses seemed visibly shocked. One nurse shook her head in disbelief."
They both agree that for terminally ill patients the LCP can be a good thing, in that it provides a less intrusive way to spend one's final hours.
But in their grandmother's case they felt that the medicine and food that she needed to recover was being withheld.
"When she was on morphine she was confused and not making sense - which was totally out of character. But they took her confusion as a sign of dementia.
"We were brought up to think that doctors and nurses know more than us about medical matters. So, our initial reaction was to believe the medical staff and we were almost made to feel silly for questioning them," said Helen.
My mum had a very peaceful passing - clearly the LCP can be used to make sure that people can die with dignity and that families are given time and space to come to terms with what's going on”
"But what we were saying was there's one thing we need, to be comfortable with you continuing not to feed our Nan, we need to know what she's terminally ill with. The LCP is for terminally ill people, so what is she dying of?"
But the medical staff could not tell them, apart from the fact that she was old.
In a statement, the hospital trust said: "Diagnosing a patient as having reached the end of their life is not a simple or straightforward task and we recognise this.
"As such, when a decision is taken to place a patient on the Liverpool Care Pathway, it is done so with close monitoring and review. If a patient shows any signs of improvement, the Liverpool Care Pathway is discontinued.
"Use of the pathway does not mean that food and drink are withheld. Staff will always assist patients on the pathway to eat and drink for as long as they are safely able to do so. This is also subject to regular monitoring and review."
Following the questions raised by Mrs Vine's granddaughters the hospital decided to start feeding her again and she quickly recovered.
She said she feels lucky compared to the other elderly people who were on her ward. "I had my family there, but a lot of people didn't have family."
But not everybody has had a bad experience of the Liverpool Care Pathway.
It is now four months since Sam Long's 69-year-old mother died in the Royal Berkshire Hospital in Reading. She was admitted after suffering a brain haemorrhage that left her unconscious and unlikely to survive - according to specialists from two different hospitals.
"My mum had a very peaceful passing - clearly the LCP can be used to make sure that people can die with dignity and that families are given time and space to come to terms with what's going on," Sam said.
"As far as I'm concerned the essence of Mum had gone before we got to the hospital. My observation of her over those three days was that she was dying on a cellular lever. I think if that's the inevitable outcome then people should have the choice to be able to pass pain-free."
She said that, afterwards, reading stories in the newspapers about patients being deprived of food and water she "felt sick".
"I am not at all dismissing any of those experiences but it was so different from our experience. I did question, had we done the right thing? Some of the stories that I read, for those families - that must be hell.
"I read things about hospitals being set targets for putting people on the plan, and I thought 'was my Mum part of some target?' But I never felt that the nursing staff had given up on her."
Sam has concerns about what will replace the LCP.
"My Dad says if he becomes terminally ill he wants to go on the LCP like Mum. But he can't, and I think that's a great shame. I certainly don't think it should be dismissed out of hand."
What is the Liverpool Care Pathway?
The Liverpool Care Pathway aims to improve care of the dying
An independent review of the controversial palliative care practice known as the Liverpool Care Pathway (LCP) has been announced, many newspapers report.
The LCP is intended to allow people with a terminal illness to die with dignity. But there have been a number of high-profile allegations that people have been placed on the LCP without consent or their friend’s or family’s knowledge.
Concerns have also been raised about hospitals receiving payments for increasing the number of patients who are placed on the LCP.
Care minister Norman Lamb is quoted as saying: "It is clear that everyone wants their loved ones' final hours of life to be as pain free and dignified as possible, and the Liverpool Care Pathway is an important part of achieving this aim."
"However, as we have seen, there have been too many cases where patients were put on the pathway without a proper explanation or their families being involved. This is simply unacceptable."
"Today I have committed to appoint an independent chair to review how end of life care is working and oversee the reviews into the LCP. This will report back to me in the new year. This review will also consider the value of locally set incentives, and whether they are leading to bad decisions or practice."
Daily Mail article on LCP ‘highly misleading’ says BMJ editor – update December 11 2012
The editor of the British Medical Journal (BMJ), Dr Fiona Godlee, has released a public letter to the Daily Mail claiming that it is "misleading readers by publishing a highly inaccurate article on the care of severely disabled newborn babies".
The Daily Mail’s front page story – Now sick babies go on death pathway: Doctor's haunting testimony reveals how children are put on end-of-life plan – was based on a piece from the 'personal view' section of the BMJ entitled How it feels to withdraw feeding from newborn babies.
In her letter Dr Godlee voices concern that the Mail's report did not reflect that the anonymous doctor who wrote the piece in the BMJ does not practise in the UK or in Europe. She highlights also that the doctor did not mention the Liverpool Care Pathway.
The Mail’s article included the following quote: "One doctor has admitted starving and dehydrating ten babies in the neonatal unit of one hospital alone". In fact, the doctor in question said that such situations were "very rare", having occurred 10 times in 13 years of practice in a large specialist hospital.
The doctor who wrote the BMJ article is quoted as saying: "To juxtapose the article with pictures of healthy babies misrepresents the clinical situation entirely. Some babies are born without intestines or with other abnormalities that make oral feeding physically impossible. Others have such catastrophic medical conditions that continued artificial hydration would only prolong the dying process. One would never undertake a decision to forgo artificial feeding if it could in any way benefit the child. Parents request cessation of this treatment, and the health team deliberates about this extensively before any action is taken, not the other way round."
What is palliative care?
Palliative care is medical treatment designed to make people with terminal illness feel as comfortable as possible – both physically and emotionally. It can be used to relieve symptoms but not cure a condition.
What is the Liverpool Care Pathway?
The LCP was developed during the late 1990s at the Royal Liverpool University Hospital, in conjunction with the Marie Curie Palliative Care Institute. It was intended to provide the best quality of care possible for dying patients in the last hours and days of life, whether they were in hospital, at home, in a care home or in a hospice. It was widely seen as a way of transferring the model of “excellence” in the care provided in hospices to other healthcare settings such as hospitals and care homes.
The goal of the LCP is to ensure a death is as dignified and as peaceful as possible. It may involve, for example, reviews of:
- whether any further medications and tests (such as taking the patient’s temperature or blood pressure) would be helpful
- how to keep the patient as comfortable as possible, for example, by adjusting their position in bed or providing regular mouth care (some illnesses or treatments can cause over- or underproduction of saliva)
- whether fluids should be given, when a patient has stopped being able to eat or drink
- the patient’s spiritual or religious needs
According to the Marie Curie Palliative Care Institute, the LCP can “guide the delivery of care for the dying to complement the skill and expertise of the practitioner using it … the goals of care prompt staff to consider the continued need for invasive procedures and whether current medications really are conferring benefit”.
The LCP is recommended as a model of best practice by the Department of Health and has been adopted in many UK hospitals and other healthcare settings. Deborah Murphy, a national nurse lead for the LCP, calls it “a process that inspires, motivates and truly empowers the generic workforce in caring for the patient and their family in the last hours or days of life”.
Why was the Liverpool Care Pathway introduced?
The LCP was introduced because, during the 1990s, there was an increasing consensus in the UK medical community that standards of end-of-life care were patchy. Some hospices provided excellent treatment, but some hospitals did not meet the same standards. In particular, concerns were expressed about issues such as:
- patients being subjected to invasive testing and treatment that offered no chance of preventing death
- causing unnecessary pain and suffering by needlessly prolonging life
Why has it been controversial?
According to newspaper reports, several families have complained about use of the care pathway. Some relatives have claimed that their loved ones were put on the pathway without their consent and some have said it has hastened death in relatives who were not dying imminently. Critics say that it is impossible for doctors to predict when death is imminent, so the decision to put a patient on the pathway is at worst self-fulfilling.
It would be inappropriate to comment on individual cases. If there were failings, as has been alleged, it could be that these were the result of professionals not following the recommendations of the LCP, rather than faults with the LCP itself. For example, the LCP recommendations make it very clear that:
- while legal consent is not required to place a patient on the LCP, the fact that the plan is being considered should always be discussed with a relative or carer and, if possible, the patient themselves
- there should never be an occasion when a relative or carer who is named as the main contact is not informed when a diagnosis that the person is dying has been made
- withdrawal of nutrition and fluids should never be a routine option, but done only if it is felt to be in the best interests of the patient, judged on a case-by-case basis
The media has also reported that use of the pathway is being encouraged for financial reasons, linked to targets. The Daily Telegraph reports that almost two-thirds of NHS trusts using the LCP have received “payouts” totalling millions of pounds for hitting targets related to its use. While these financial incentives do exist, they are designed to support the implementation of better care. It is disappointing to see the level of cynicism in this story, with the unspoken – and hardly credible – implication that doctors and nurses would routinely hasten patients’ deaths so that their hospital would make money.
What about people who have survived the Liverpool Care Pathway?
There have been reports, including in the Daily Mail, that people have “survived” the Liverpool Care Pathway. It is cause for celebration that someone who was believed by health professionals to be dying has survived. Indeed, guidance for health workers on the LCP states: “Uncertainty is an integral part of dying. There are occasions when a patient who is thought to be dying lives longer than expected and vice versa. A second opinion or the support of a palliative care team may be required”.
What do health professionals think?
The LCP has been praised by many doctors for its aim to make life for those who are imminently dying as comfortable as possible, rather than using artificial efforts to prolong life. A recent article by a GP in the British Medical Journal argued that the pathway had "transformed" end-of-life care and offered a “good death” when used properly.
What does the Department of Health say?
The Independent reports that the Department of Health says that it doesn’t provide direct financial incentives for trusts to use the LCP. However, local areas may choose to have these in place.
A Department of Health spokesman told the Independent: “The LCP is supported by more than 20 leading organisations, including Marie Curie Cancer Care and Age UK, as a way to help meet the care and dignity needs for those who are at the end of their life.
“We are clear the LCP can only work if each patient is fully consulted, where this is feasible, and their family involved in all aspects of decision-making. Staff must properly communicate with the patient and their family – any failure to do so is unacceptable."
How can I have a say about my end of life care?
Those with a terminal illness or approaching the end of life may wish to think in advance about plans for the future of their care. This is sometimes called advance care planning and involves thinking and talking about your wishes about how you are cared for in your final months. Read more about planning for end of life care.
You can write down your wishes in what is called an ‘advance decision’, sometimes known as an advance decision to refuse treatment (ADRT) or a living will. This is a decision you can make now to refuse a specific type of treatment at some time in the future. It lets your family, carers and health professionals know whether you want to refuse specific treatments in the future. This is so that they will know your wishes if you are unable to make or communicate those decisions yourself.
If you have a relative who is terminally ill you should – where feasible – be consulted and kept informed about the plan of care, including use of the Liverpool Care Pathway. Health staff should also check with families that they understand the LCP.
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