The Future of the Liverpool Care Pathway in Caring for the Dying in Intensive Care

Abstract

It followed a series of articles that were published over preceding months by the Daily Mail focusing on a scandal that may have seriously dented public trust in our healthcare system: the misuse of the Liverpool Care Pathway (LCP). The articles were met with acclaim by those concerned that the pathway might be tantamount to euthanasia, and with concern and anger by the pathway's advocates. Some proclaimed that the coverage was sensationalist; others that it was a justified expose clearly in the public’s interest. Whatever the perspective, there is no smoke without fire. The question that now needs to be asked is whether the problem lies with an abusive process, or a process that has been abused; the most altruistic invention in the wrong hands can become a potent weapon. For clarity, this article considers the role of the LCP in the context of the intensive care unit (ICU); though it is interesting to consider why the LCP was developed, and how a tool principally intended to emulate the hospice model of care in hospitalised cancer patients, ended up being promoted as a ‘one size fits all’ pathway for every dying patient in the hospital. Indeed one should question whether it is, or ever has been, an appropriate tool for use in the ICU. It is also of interest to analyse how such a public crisis of confidence came to fruition, what we can learn from it, and where we go from here. Evolution of the LCP