The Liverpool Care Pathway – a matter of life and death

Posted 24/07/2013

The recent review of the Liverpool Care Pathway (LCP) has brought to the fore concerns about the issues surrounding end of life care. The LCP, designed to alleviate suffering in the final stages of a person’s life, has been highly controversial, raising concern as to when it is appropriate to withdraw life sustaining treatment from a patient, how such a decision should be taken, and who should take such decisions. One of the more controversial aspects is the extent to which the views of the patient’s nearest family members, have on occasion, not been listened to.The Government commissioned review led by Lady Neuberger has recommended phasing out the LCP over the next six to twelve months with decisions about end of life care only to be taken by senior clinicians. Whilst being in a situation where decisions about end of life care need to be made is not one any of us like to contemplate, ensuring that you or those closest to you are involved in the decision making process may be achieved in one of two ways. The first is by making an Advance Decision or ‘Living Will’. This is a document made by you whilst you have mental capacity stating whether or not you would wish to receive life sustaining treatment if the issue arises at a time when you are incapable of expressing your views.

Although Living Wills have been around for some years, for many years their legal status was in doubt. However, since 2007 they have been recognised as legal documents so long as certain formalities are complied with. Advance Decisions should be reviewed on a regular basis. If you have an Advance Decision which was made before 2007 or one that has been drawn up without the benefit of legal advice, this should be checked to ensure that it meets the formalities required by legislation.An alternative to an Advance Decision is a Health and Welfare Lasting Power of Attorney. This is a document by which you appoint one or more attorneys, empowering them to make personal decisions on your behalf if you are incapable of making those decisions yourself, most importantly this can include the power to make decisions about end of life care. One of the criticisms of the LCP has been the refusal of local staff to accept the decisions of the patient’s closest family where no Health and Welfare Lasting Power of Attorney exists. 

By making a Health and Welfare Lasting Power of Attorney you can place these important decisions in the hands of those who you trust the most.  It is important to note that if you have made an Enduring Power of Attorney or a Property and Financial Affairs Lasting Power of Attorney, these do not confer upon your attorneys power to make decisions about life sustaining treatment and end of life care as these powers only give your attorneys authority to deal with your financial business and property matters.In the case of either document, it is necessary for you to be mentally capable of completing the documents at the time they are signed, and whilst you may be capable of making either document in the last stages of life, it is preferable and easier to plan ahead whilst you are in good health.For further advice regarding these issues, please contact our Lifetime Planning team.