The Liverpool Care Pathway (LCP), Euthanasia and the Green Party

The Liverpool Care Pathway (LCP), Euthanasia and the Green Party

Considering that the Green Party in Victoria, Australia, are aiming to have the Law Reform Commission investigate legislation for ‘voluntary euthanasia’ (April 2015) the following history of the LCP (Liverpool Care Pathway), is pertinent. The LCP (Liverpool Care Pathway) was implemented in the United Kingdom, purportedly to make the lives of those who were terminally ill more comfortable. However, reports in the main stream media with respect to the numbers who were put on this, without terminal illnesses, were worrying (to say the least), and described as ‘horrifying’ in one Daily Mail article:

Daily Mail October 15, 2012: Care? No, this is a pathway to killing people that doctors deem worthless Horrifyingly, the LCP has become a self-fulfilling prophecy. When people are put on it, they are said to be dying. But they may not be dying at all — not, that is, until they are put on the ‘pathway’, whereupon they really do die as a result. [ 1 ]

Other mainstream media articles about the Liverpool Care Pathway (LCP) include:

Daily Mail 20 June 2012:NHS hospitals are using end-of-life care to help elderly patients to die because they are difficult to look after and take up valuable beds, a top doctor has warned. "Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically. This determination in the LCP leads to a self-fulfilling prophecy. Professor Pullicino said he believed the LCP was being used as an "assisted death pathway" with patients placed on the LCP without clear evidence. [ 2 ]

New American 20 June 2012: Doctors are supposed to identify a patient who is bound to die in the near future. The plan then can include withdrawal of treatment, including the provision of water and nourishment by tube. Patients are typically heavily sedated. [ 3 ]

The Telegraph: October 30 2012: NHS millions for controversial care pathway The majority of NHS hospitals in England are being given financial rewards for placing terminally-ill patients on a controversial ‘pathway’ to death, it can be disclosed. [ 4 ]

The Daily Mail: July 15 2013: Families were not told their loved ones were on the 'pathway' to death [ 5 ]

The National Institute for Health and Care Excellence (NICE) in the United Kingdom (London) is responsible for guidelines regarding ‘end of life’ care. The NHS is legally obliged to provide funding for medicines and treatments recommended by NICE’s board. [ 6 ] The NICE (National Institute for Clinical Excellence) Quality standard for end of life care for adults,NICE quality standard [QS13 ][ 7 ]

NICE (National Institute for Clinical Excellence) also advises on and teaching sex in primary schools. In June 2010, the National Institute for Health and Clinical Excellence produced draft guidance for schools recommending that children as young as five should be given sex and relationships education. [ 8 ]

The National Institute of Clinical Excellence was previously located at 11 Strand, London (hence of the John Adam St Gang, also known as the Committee of 300, or the Olympians). [ 9 ]

The LCP was scrapped [10] after investigated by Baroness Neuberger (House of Lords in the United Kingdom). However, Baroness Julia Neuberger is involved in mandating ‘behaviour change’ in the UK [11], often implemented via fines. Her brother-in-law David Neuberger is president of the Supreme Court in the United Kingdom. [12 ]

The Telegraph reported that the LCP program was merely rebranded: The discredited Liverpool Care Pathway is to be “rebranded” rather than abolished, senior doctors have said....doctors who led criticism of the pathway say new draft guidance, seen by the Daily Telegraph, outlining a replacement scheme will perpetuate many of its worst practices... [ 13 ]

Considering that the Green Party in Victoria, Australia, is now keen to have the Law Reform Commission consider legislation for euthanasia, (April 2015) such treatment as the Liverpool Care Pathway for the elderly (who are not ill) may not have gone very far away. A Greens bid to get Victoria's Law Reform Commission to examine euthanasia has been delayed. Party leaders in the state's upper house agreed to not to vote on the motion after it looked like it would fail. But the Greens say a vote will be held in May on whether the commission should report on euthanasia laws. [14]

















Quote from the above article:

Considering that the Green Party in Victoria, Australia, is now keen to have the Law Reform Commission consider legislation for euthanasia, (April 2015) such treatment as the Liverpool Care Pathway for the elderly (who are not ill) may not have gone very far away.

The LCP is certainly not very far away at all.

Although the LCP (Liverpool Care Pathway) was scrapped in the UK (Daily Mail, 15 July 2013 [1] ) it was stated in the Daily Mail December 2013 that it was being ‘rebranded’ rather than axed. [2]

St Vincents, ‘Collaborative Centre of the University of Melbourne’, and ‘Centre for Palliative Care’  produced a report May 2011, titled  ‘LCP: End of Life Care and Care Pathways in Victoria Report and Recommendations’. Funded by the Department of Health Victoria.  [3]

It states:

Liverpool Care Pathway

The Liverpool Care Pathway (LCP) is the most widely used end of life care pathway internationally. The majority of end of life                care pathways and integrated care pathways in use throughout Victoria are approved modifications of the LCP or a version of the LCP. The LCP is the recommended best practice model by the Department of Health in the UK. The LCP undergoes a rigorous process of ongoing improvement and development including comprehensive audits and a dedicated research program. The LCP has been implemented into hospitals, residential care homes, hospices, and in the individuals own home / community. The most recent version, Version 12 was developed as part of a two year consultation exercise with UK hospitals. Version 12 is now available. The ethos in this and previous iterations has not changed since its initial inception in 1994








For centuries doctors have been giving dying patients overdoses of morphine and other drugs which incidentally result in their deaths while being necessary to relieve pain. No doctors are being prosecuted for this, and rightly so. I saw this happening in Port Kembla palliative care ward while my uncle was there. The staff do a great job of helping people to die pain-free, and weeks before they might have died if nature took its horrible course. I think until all these potential problems are thought through, decriminalization might be the way to go. On the other hand a few years back Bulli hospital doctors decided my 98 year old grandfather, who'd only suffered a minor fall, should be euthanased. They described to me exactly how they would do this by sending him to Palliative Care and withdrawing food and water. They had already stopped feeding him and he was telling me he was hungry and wanted a cup of tea. I informed these doctors in no uncertain terms that I would be reporting them to the Coroner and they'd be answering some very difficult questions. I told them to get him some food and a cup of tea immediately and remove the drip in his arm. Amazingly, though I was not officially 'next of kin', this was done within minutes and one happy grandfather went back home. He always wanted to live to 100 and he did so, dying a few days before his 101st birthday. 

I do know that people with very painful and terminal conditions are dying from the pain relief, I have seen this happen too. Hence I don't understand the need for legislation. It's already happening.

However, I find the comments on this video odd, and disturbing, as to why people might follow the path of euthanasia. Carolyn Wallace assumes she knows what people are thinking (she does not) , and contradicts herself.


I checked out the video. My mother is in aged care and I'm happy with her treatment which is palliative. We talked about what would happen years ago so I have her instructions. Any legislation would be exclusive of the elderly suffering from any kind of cognitive defect as they couldn't give consent. People need to make a 'living will' setting out their end-stage wishes. The whole thing is fraught with problems and I'd prefer to see euthanasia decriminalized rather than specifically legislated. I was reading some old newspapers on the Trove website the other day and there were a lot of cases of people who tried to commit suicide being prosecuted, fined and even jailed. Thank goodness it's no longer a crime. 

maybe you didn't watch the video closley enough - if your mother is an aged care the treatment is possibly 'a palliative approach to care'.  If it is 'palliative care' them she possibly has a terminal illness (diagnosed).  And that is very different.

I have only just realised that the Greens Party is also keen to see estate tax re-introduced - euthanasia and estate tax are certainly interesting combinations.  Particularly in light of what Carolyn Wallace says about the potential consequences if euthanisia is legalised.

The Greens policy says its proposed death tax would exempt family farms, small business worth less than $5 million and the family home. They don’t specify a rate, but in the United States their estate tax rate is 55 cents in the dollar.

Transcript of Carolyn Wallace's interview:

Carolyn Wallace is the director of clinical services at Southern Cross Care, Tasmania’s leading aged care provider.

Q: Why is the aged care sector such a large stakeholder in end of life care?

People only ever come to residential aged care when there is no other option left for their care. Usually it’s the last place they live. At our ‘Rosary Gardens’ facility, for instance, in the last 12 months the average length of stay for a new resident is just under 60 days.  So people really are coming at the end of their life for end of life care.

Q: Are there misconceptions about the dignity of living and dying in an aged care facility?

That’s partly because people know nothing about what aged care is, and so they assume, and a lot of the pro-euthanasia information, puts across the impression that death is undignified unless it’s very deliberate when actually that is not the case. Most Australian aged care facilities adopt what’s a philosophy called a palliative approach to care. It’s not palliative care. What most people think of as palliative care is actually end of life or terminal care. But a palliative approach to care embraces the W.H.O. definition of palliative care which affirm life, consider that death is normal and that the role of palliative care and the palliative approach is to neither hasten nor postpone death. So a palliative approach is built on that premise. It’s an evidence-based approach and its aim is to improve people’s quality of life through…and particular people with a life limiting illness…through early identification and assessment of any issues and concerns, be they physical, health related, medical, cultural, spiritual, all aspects and it also adopts a very open and positive attitude to death….The residents, even those with a significant cognitive impairment, know that this is their last home. People chose to work in aged care because they feel that the aged have a value and the experienced staff in aged care realize that one of their primary roles is to assist somebody to live the end of their life with some dignity and with some value. As I said before a palliative approach neither hastens nor postpones death but the staff pride themself that one of their main goals is to help people have a good death.

Q: Do the elderly have control over their end of life medical treatment?

Aged care is one of the areas of nursing where there is impeccable assessment over the whole gamut of the person’s needs, not just their physical needs. Any competent person in this state can decline any medical treatment option that may be offered to them, at any stage. That includes things that may be quite simple such as an investigation. Any competent person can decline to have that now, there’s no need to have anything special or any special legislation to make that happen, everyone has that right now.  Any person, any adult, can also plan for what they would like to have happen, when they are no longer able to do that for themself. Anybody can make an advanced directive. In a person who is no longer competent, who hasn’t made an advanced directive, we and their treating GP would always speak to their families before embarking on a course of treatment such as something as simple as antibiotics for a chest infection.   At any time people have the right to say ‘no, that’s enough’, or ‘no, I don’t want that’.  

Q: If euthanasia or assisted suicide were introduced what type of pressure would the elderly experience in an aged care environment?

Residential aged care is community living, and so people live in a community with people they didn’t know before they came here and there is a sense of community amongst them. So if Mrs Brown in room 10 decides, she and her family decides, that she is going to euthanase herself, her family will talk to her friends, Jean and Shirley and Bill and the other people with whom she has lived for some time and their families and that will set people thinking about their self worth ….and residents will think, well should I not, should I do that, and it may be something they have never considered before. They may think that they’re a burden on their family; my daughter now has to travel 20 kilometers 3 times a week to visit me, that’s an imposition on her, so perhaps if I took the same path as Mrs Brown perhaps I could save my daughter that trouble. There are lots of financial implications for people, perhaps instead of having that short holiday on the gold coast my son and daughter-in-law could now have a nice overseas holiday if they could access my estate. A lot of these are unintended consequences of Mrs Brown euthanasing herself. However, they are very real consequences,  and so you’ve got people who are happy and happy that their quality of life was what they would expect it to be at that stage of their life are now finding … they’re questioning that value and people are actually devaluing themselves and devaluing their contribution.  I think the atmosphere…it’s a very cruel thing to do. It would be a very cruel atmosphere in the facility, it would very quickly become full of people who think I’m actually here, I probably shouldn’t be here, I probably should have had the courage to euthanase myself but I haven’t,  therefore I am even less than those people who have chosen to do that.

Q: What type of pressure and abuse are the elderly already subject to?

There are two things that fall into the resident abuse category that you see every day in an aged care facility. One of those is what I would term petty or minor financial abuse, where relatives regularly ask the elderly resident for money. The other thing that you see regularly is people enforcing some social isolation on their family members by limiting who can visit, by not helping family members who were significant  to the resident who can’t get themselves there independently by always having some excuse  why they can’t come, and those people often only encourage visitors who will follow a particular line of thought  that the family wants, so if you had a family member  who was keen that mum went  down the euthanasia path…those sorts of people…and sometimes they don’t realize that they’re doing  it, would discourage very actively  visitors who might give mum a different perspective or  encourage mum to question this particular family member’s view. If you have that family member whose opinions inform the rest of the family’s and that person thought that mum should euthanase herself, very quickly that family member will influence others

Q: Is there a need to introduce euthanasia or assisted suicide in view of the standard of end of life care in Tasmania?

My personal view is I don’t think the legislation is necessary at all. Any individual has the right now to decline or refuse any treatment option that is offered to them. Palliative care services work very well in all but a very few extreme cases and you shouldn’t write legislation for the extreme cases, you should write it for the multitude as it were….


Furthermore, with aged care facilities (as they are now called) staffed as they are, I am having difficulty imaging the 'dignity of dying'.

I know of one facility involved in aged health which employs staff from overseas on temp working visas, facilitates and supports their application for permanent residency (not sure if this is via claiming exceptional circumstances or the promise of employment for a minimum of 2 years), after which presumably through an informal agreement, the workers are given the flick (too expensive now as they have to be paid proper wages), and replaced with more temp working visa staff. Rinse and repeat.

While I don’t know all the details, and unsurprisingly those involved play their cards close to their chests, it keeps staff costs down for the business, and the low skilled worker secures a fairly hassle free ticket into the country. Also unsurprisingly, some of these workers have no interest in wiping the arses of aging Aussies, and the attitude and practices they bring to the job would make your blood curdle.

This type of thing is a fairly open secret if you mix in those circles.


ALL you have to do is ask around and you will find plenty of unpleasant stories about what is now going on in the  'aged care facilites', (and the intention is to add euthanasia and estate taxes to this mix?) 



looks like aged care facilities' residents who are unhappy and whose family don't visit much are vulnerable to euthanasia

(described as a 'blessing')