This is Lord Carlile.
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Lord Carlile: medics should face GMC over Liverpool Care Pathway
Doctors who put patients on a controversial end-of-life care plan without their consent should face being struck off, a leading legal expert has said.
Lord Carlile of Berriew said too many patients were being denied drugs, food and water in their last days of life without having given their “informed consent”.
The peer called for the Liverpool Care Pathway to be replaced, comparing it to the River Styx, which marked the threshold to the underworld in Greek mythology.
Lord Carlile, a QC and the former independent reviewer of terrorism laws, said many doctors acted “with great care” when placing patients on the pathway.
However, standards varied across the NHS to a “worrying” degree, leading to “very serious problems”, he warned.
The Liverpool Care Pathway was designed to ease the suffering of patients at the end of their lives, and can involve the removal of drugs and nutrition if these are not judged to be of benefit.
However, it has come under intense scrutiny in recent months amid concerns that up to half of patients are not told before being placed on the care plan.
Speaking to The Daily Telegraph, Lord Carlile said doctors must face disciplinary action from the General Medical Council if they fail to obtain informed consent before conducting “serious procedures”.
“Obviously, consent is obtained in many cases but the point is, it is not being obtained in some cases and that is unacceptable,” he said.
“I think that doctors who fail to inform their patients of any serious procedure, or their relatives if the patient is not of full (mental) capacity, are committing serious misconduct and therefore it would be a matter for the GMC to deal with such cases.”
The sanctions available to the GMC for serious professional misconduct would include being struck off from the medical register, effectively banned from work, although this would be a decision for the regulator, Lord Carlile said.
There may be “opaque circumstances” in which consent is impossible, he suggested, but added: “People need to know what’s happening to them.
Lord Carlile said he spent 10 years as a lay member of the GMC and saw doctors routinely struck off for failing to obtain consent.
“If a surgeon decided not to tell a sentient patient that in order to save his or her life he was going to have to remove a leg he would be struck off the register for serious professional misconduct,” he said.
“If there is a procedure that is intended or known to result in death then it seems to me that, above all other procedures, that should be the subject of informed consent.”
The Liberal Democrat peer warned of a wider decline in professional medical standards, with the erosion of the doctor-patient relationship.
“People will go onto the Liverpool Care Pathway as they approach death and they will be dealing in many cases with medical and nursing staff who have never seen them before,” he said.
“What is missing in my view is a close doctor-patient relationship which should be established wherever possible in cases where people are nearing death before a decision is taken which includes death as a certainty.”
An independent inquiry is under way, chaired by Baroness Neuberger, into the operation of the LCP. She is due to publish her findings in the summer.
At a meeting in the House of Lords earlier this week, Lord Carlile said the “best elements” of the LCP “could be part of a much-improved end-of-life strategy”.
However, the peer said any replacement for the pathway would need a new name.
“It does no good for Liverpool, it does no good for care and as pathways go it is nearer to the River Styx than the Mersey,” he said.
A national audit recently disclosed that almost half of dying patients who were placed on the controversial pathway were not told that life-saving treatment had been withdrawn.
The study suggested that about 57,000 patients a year are dying in NHS hospitals without being told that efforts to keep them alive have been stopped.
It also revealed that thousands of dying patients were not given drugs to make them more comfortable.
Jeremy Hunt, the Health Secretary, has described the pathway as “a fantastic step forward”.
He has insisted the protocol was far better than alternative arrangements and allowed those close to death to be comfortable and to spend their last hours with their families.