The Liberal Vannin Party (LVP) has issued a hard hitting press release regarding the use of the controversial Liverpool Care Pathway on the Isle of Man.

In the release LVP state Noble’s Hospital is registered to use the Liverpool Care Pathway which was developed by Marie Curie to assist and support those dying of a terminal illness and their families. The Pathway has subsequently been extended to include anyone who has an incurable condition and is probably dying. 

The release reproduces a letter from six professionals, published in the Telegraph newspaper on 3^rd September 2009, which questions the ‘Pathway’.

SIR – The Patients Association has done well to expose the poor treatment of elderly patients in some parts of the NHS (report, August 27). We would like to draw attention to the new “gold standard” treatment of those categorised as “dying”. Forecasting death is an inexact science.

Just as, in the financial world, so-called algorithmic banking has caused problems by blindly following a computer model, so a similar tick-box approach to the management of death is causing a national crisis in care.

The Government is rolling out a new treatment pattern of palliative care into hospitals, nursing and residential homes. It is based on experience in a Liverpool hospice. If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death.

As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients. Syringe drivers are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong.

It is disturbing that in the year 2007-2008, 16.5 per cent of deaths came about after terminal sedation. Experienced doctors know that sometimes, when all but essential drugs are stopped, “dying” patients get better.

This letter was signed by:

P. H. Millard
Emeritus Professor of Geriatrics University of London
Dr Anthony Cole
Chairman, Medical Ethics Alliance
Dr Peter Hargreaves
Consultant in Palliative Medicine
Dr David Hill
Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons
Dr Elizabeth Negus
Lecturer, Barking University
Dowager Lady Salisbury
Chairman, Choose Life

LVP point out there are many articles in UK press criticising the Liverpool Care Pathway and there are probably just as many quotes from relatives of people placed on the Liverpool Care Pathway who have nothing but praise for it. Therefore, LVP say it is time for an open and honest debate on the subject.

The lead nurse for the Liverpool Care Pathway at Marie Curie told Kate Beecroft, LVP Chairman, that it is like any tool - if it is used properly it is of benefit but used inappropriately it is worse than not using it at all. She also said that she was sadly aware that there were hospitals that were not using it appropriately. In addition she confirmed to Mrs Beecroft that anyone with an “incurable condition was eligible” for the Liverpool Care Pathway and that the definition of an incurable condition would include dementia.

LVP say they are not questioning the use of the Liverpool Care Pathway for the terminally ill in Hospice but feel that there are many questions that need to asked regarding it’s use in Noble’s Hospital for those with an incurable condition and who are probably dying.

LVP believe the first question should be regarding its legality as they believe that it is in breach of Articles 2 and 3 of the European Convention on Human Rights:

Article 2 Right to life

1 Everyone’s right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which this penalty is provided by law.

Article 3 Prohibition of torture

No one shall be subjected to torture or to inhuman or degrading treatment or punishment.

Peter Karran MHK, Leader of the LVP said: “I shall certainly be asking questions about the Liverpool Care Pathway and how it is used in Noble’s Hospital. Some of the questions that immediately spring to mind are:

• Who initially authorised the use of the Liverpool Care Pathway in Noble’s Hospital?
• Was this authorisation only for the use in respect of the terminally ill?
• When was this changed so that patients with incurable conditions and who were probably dying could be placed on the pathway and who authorised this?
• How long has it been in use?
• How many patients have been placed on this pathway in each year?
• How many of the above have died?
• Who monitors the use of the Liverpool Care Pathway in Noble’s Hospital?
• How is the use of the Liverpool Care Pathway monitored?

There are many more questions but answers to these would be a start.” 

He went on to say: “I have been a member of Tynwald since 1985, and a former member for Health, and I am unaware of any political decision taken to introduce the Liverpool Care Pathway which is actually worse than euthanasia. At least with euthanasia people are consulted on the actions that are to be taken. This once again an example of where the Council of Ministers and the present political system is allowing public officials with no political mandate to make such serious decisions and changes to policy that affect such a vulnerable section of our society.”

The Manx Herald fully supports LVP in its call for a debate on the subject; especially in light of the allegations we have received from members of the public that the DHSS operated or attempted a form of involuntary euthanasia on their relatives.

However, the Manx Herald remains sceptical, given our previous experience in this area, as to whether the DHSS will be willing to participate in the debate.