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11/6/2012 10:14:00 AM
English hospitals get funds for applying controversial patient protocol
Catholic News Service
Patient Jack Trelor chats with Dominican Sister Catherine Marie at Rosary Hill Home, a Dominican-run facility in Hawthorne, N.Y., that provides palliative care to people with incurable cancer and are in financial need. English hospitals may take a different path for the dying, one that seems close to euthanasia.
Catholic News Service
Patient Jack Trelor chats with Dominican Sister Catherine Marie at Rosary Hill Home, a Dominican-run facility in Hawthorne, N.Y., that provides palliative care to people with incurable cancer and are in financial need. English hospitals may take a different path for the dying, one that seems close to euthanasia.
Catholic News Service


MANCHESTER, England — State-funded English health service hospitals are being paid millions of dollars to implement a controversial end-of-life patient-care protocol that critics say is a "euthanasia pathway."

Figures from 72 National Health Service hospital trusts show that more than 12.4 million pounds ($19.93 million) has been awarded over the past three years to hospitals that have met targets for adopting the Liverpool Care Pathway for dying patients.

The sample suggests that, if replicated across the whole National Health Service, an overall sum of nearly 30 million pounds ($48 million) has been spent on rolling out the Liverpool Care Pathway across the country.

The pathway was devised in a hospice in Liverpool in the late 1990s as a framework for treating cancer patients in their final days and hours. It often involves heavy sedation and the withdrawal of life-prolonging treatment, which under British law may include nutrition and hydration.

The revelations about financial inducements to adopt the pathway are controversial in Britain because they coincide with rising numbers of families who have contacted the media this fall with stories about how their relatives were mistreated after being placed on the pathway.

Some claim that the Liverpool Care Pathway was used to deliberately hasten the deaths of their relatives, while others say that they rescued loved ones by defying doctors and giving fluids to people who later recovered. Others complain that relatives were placed on the pathway without their knowledge or consent.

The National Health Service announced Oct. 26 that it would open an inquiry into the operation of the Liverpool Care Pathway, but this has met with criticism from some Catholic doctors, who say it is not independent because it will be conducted by professional groups that have previously defended the pathway.

Dr. Philip Howard, a Catholic physician based in London, told Catholic News Service in an Oct. 26 telephone interview: "There are so many people who have come out of the woodwork and expressed concerns that those concerns have got to be met."

He called for a system in which individuals can register concerns confidentially.

"There must be the opportunity to take it further, either through the hospital or through the coroner, and you need somebody who has the authority to head up that inquiry, and you need to ensure independence," Howard added. "The final outcome has to be open."

Liverpool Care Pathway critics say the system is dangerously flawed because, in many cases, it is not scientifically possible to predict when a patient is dying.

They claim the pathway's practice of sedation, then withdrawing food and fluid creates a "self-fulfilling prophecy," with most patients dying within 29 hours, according to the 2010-2011 audit of the pathway by Marie Curie Cancer Care.

The figures, which have been seen by Catholic News Service, were obtained using the 2000 Freedom of Information Act.

More than 100 trusts in England were asked how many people on the Liverpool Care Pathway had died in their care over the past three years and how much money was received in that time to meet goals on the implementation of the pathway.

By Nov. 1, 72 trusts had responded. Sixty-one, or 85 percent, reported using the Liverpool Care Pathway. The other 11 trusts had adopted a separate end-of-life pathway or were unable to provide information.

Of those using the pathway, 62 percent admitted to either receiving payments for meeting goals involved in its implementation or said they expected to receive rewards in the coming financial year.

Dr. Patrick Pullicino, a Catholic and a consultant neurologist of East Kent Hospitals University NHS Foundation Trust, which includes six hospitals, told CNS in an Oct. 26 statement that it was clearly unwise to attach financial incentives to the use of an end-of-life pathway.

"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," Pullicino said.

The Catholic bishops of England and Wales have not spoken out against the use of the Liverpool Care Pathway as yet. However, in September, Archbishop Peter Smith of Southwark, vice president of the Bishops' Conference of England and Wales, wrote to Jeremy Hunt, the British secretary of state for health, to ask for a "full and thorough" investigation into the pathway to assuage public concerns.

The Anscombe Bioethics Centre, the bioethical institute that advises the bishops, is also investigating if the alleged abuses are allowed by the authors of the pathway or if the pathway is being misused, sources told CNS.

The government encouraged the adoption of the Liverpool Care Pathway nationally in 2004 and recommended its use also for noncancer patients.

Figures show how the adoption of the pathway has been incentivized over the past three years through cash channeled to the NHS trusts via the Commissioning for Quality and Innovation payment framework.

This framework was introduced in 2010 to enable NHS commissioners to "reward excellence" by linking a proportion of health care providers' income to the achievement of local quality improvement goals, many of which include end-of-life care.

The Freedom of Information responses show how this works. For instance, the Walton Centre NHS Trust in Liverpool received a payment of nearly 67,000 pounds ($112,000) in 2010 when 12.2 percent of deaths of people in its care were people on the Liverpool Care Pathway.

The following year, nearly 22.8 percent of patient deaths were of people on the pathway, and the trust received a payment of 80,224 pounds ($129,000).

Barnsley Hospital NHS Trust received 155,417 pounds ($250,000) from the Commissioning for Quality and Innovation payment framework in the past two years and now has about 39 percent of all patient deaths via the Liverpool Care Pathway.

The British government's Department of Health has consistently defended the Liverpool Care Pathway, insisting in statements to the press over the past few months that it "is not euthanasia."

A Nov. 1 statement given by the department to Catholic News Service said that the national government did not dictate how the payments were made.

"The Department of Health does not centrally fund any payments for the use of the Liverpool Care Pathway, but local areas may choose to do so in order to improve the care and support given to people in their last days," the statement said.

"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," the statement added. "Staff must properly communicate with the patient and their family -- any failure to do so is unacceptable."



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