Death on the Wards - Channel 4 Dispatches

21 February 2013

Dispatches investigates the truth behind allegations that tens of thousands of seriously ill people have been put on a pathway to death - likened to legalised euthanasia - and claims from families that doctors have callously killed off patients who could have had months or even years of life to live.

Death on the Wards interviews leading specialists, terminally ill patients and families. And, it reveals the results of the first survey of thousands of doctors into how the process of dying is managed in our hospitals.

The Liverpool Care Pathway (LCP), which originated in the hospice movement for cancer patients, is intended to ease the often lengthy and painful process of dying.  A key principle is to stop treating a patient’s underlying condition if treatment is judged to be futile or harmful.

Official guidelines now mean that every hospice and hospital has to have an approved end of life pathway, and the LCP is by far the most prevalent. An estimated 130,000 people last year died after being placed on the LCP and many of us can expect to have our deaths, or those of our loved ones, managed using the pathway.

However, the process has become hugely controversial. It is not only those with terminal cancer who are now being put on the LCP. Many more patients are now put on the pathway following other illnesses such as strokes and some families are claiming that their relatives could, and should, have lived longer.

At the heart of the controversy is a simple question: can doctors accurately tell when someone is dying? Dispatches includes an exclusive interview with leading neurologist Professor Patrick Pullicino, who believes they can't. "There is no data for telling that somebody is in the last hours or days of life," he tells the programme. "If you start to say somebody has a poor prognosis then you make it a self-fulfilling prophecy."

Professor Pullicino believes the case of one his patients proves him right. Salvatore De Francisci was placed on the LCP, not by him, but by doctors on a weekend team who judged his condition to have seriously deteriorated to the point he had hours to live. When returning to work, Professor Pullicino insisted Sammy be taken off the pathway. Within days he was allowed home and subsequently lived with his family for a further 14 months.

Speaking to the media for the first time, his daughter Rosaria Squire tells Dispatches: "It wasn't time for him to go. I did mention to the nurse, I did say to them my dad's not a number, he's my dad; he's a husband, a granddad. And I wanted my dad home with us."

Dispatches also interviews Professor Sam Ahmedzai, one of the UK’s leading palliative care doctors. He has more than 30 years' experience in this area yet chooses not to use the LCP with his patients.  "I've no doubt that many patients do achieve a good, calm, peaceful death," he says. "The problem is that it's not always initiated at the right time, on the right patient, and the medication and the actual things that are taken away can sometimes aggravate a person's dying rather than smooth it over."

The allegations have now become so serious that the government has ordered a review to look at all aspects of the LCP, including whether cost pressures play a role. While the review is being conducted, Dispatches, in conjunction with the British Medical Journal, has carried out the first ever survey of thousands of palliative care doctors to find out what they think of the pathway.

However, many doctors support the use of the pathway. One of them is Dr Kate Granger. She is in a unique position: diagnosed with a rare cancer just before her 30th birthday, she's decided she wants to go on the LCP and is worried that the backlash is beginning to affect its use. "What would we do if we got rid of it? What would happen to these patients?" she tells Dispatches. "That really worries me, and what - what would happen to me? Would I get the comfortable, dignified, serene death that I would like? I'm not sure."