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04-11-2012 | General practice | Article

Move to quell end of life row


Department of Health – Consultation on changes to NHS Constitution

medwireNews: Proposed changes to the NHS Constitution will ensure patients, their families and carers will be involved in decisions about their end of life care, the Department of Health has announced.

The move comes after concerns that some patients may have been put on the Liverpool care pathway without their relatives being properly informed.

The government is keen for more elderly people to be considered for end of life pathways, to help manage patients' last days more comfortably and to keep dying patients from being admitted to hospital unnecessarily.

But critics argue such pathways can be inhumane, while reports in the national press claimed that encouraging GPs to identify patients for end of life discussions amounted to drawing up "death lists" to save money.

RCGP Chair Dr Clare Gerada condemned the newspaper reports at the time. She said in a statement to the press: "Far from being 'sinister'… it is important that GPs talk sensitively to patients who are coming towards the end of their life about their wishes, such as whether they want to be cared for in their own home rather than in hospital."

The controversy has now led Glasgow-based GP Dr Des Spence to pen a defence of the Liverpool care pathway in the BMJ. He says it is "transforming" care for dying patients, which used to be poor and disorganised, with patients enduring hopeless interventions and left in pain.

"Used properly with senior supervision, the pathway offers structure to a peaceful, pain-free, dignified death at home - a good death," writes Spence. "The 'death lists' exist to tackle a taboo: they facilitate discussion about death with patients and families. But the newspapers are right: this pathway must be used with full explanation and the consent of all involved."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price, Senior medwireNews Reporter