Its inflexible application by nursing staff of Liverpool Community Health NHS Trust was subject to scrutiny after the poor care delivered to a relative of Rosie Cooper MP.
In July 2013, the Department of Health released a statement which stated the use of the LCP should be "phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient".
[3] However, The Daily Telegraph reported that the programme was just rebranded and that its supposed replacement would "perpetuate many of its worst practices, allowing patients to suffer days of dehydration, or to be sedated, leaving them unable to even ask for food or drink.
[6] The programme suggested the provision of treatments to manage pain, agitation, respiratory tract secretions, nausea and vomiting, or shortness of breath (dyspnoea) that the patient may experience.
[7] However, a 2016 Cochrane Systematic Review concluded "there is limited available evidence concerning the clinical, physical, psychological or emotional effectiveness of end-of-life care pathways.
[11] A 2006 study published in the same journal found that, despite some "initial scepticism", the doctors and nurses who were interviewed saw the approach as having a valuable place in hospice care, though its use on "dying" patients on general wards was not addressed.
[14] A 2009 survey of 42 carers providing the pathway was published in the Journal of Palliative Medicine, it found that 84% were "highly satisfied" with the approach and that it enhanced patient dignity, symptom management and communication with families.
[15] Research into its use outside the British healthcare system has not, however, demonstrated the same results: a cluster phase II trial conducted in Italy showed no statistically significant improvement in patients' symptom control.
[3] A 2008 article in the American Journal of Hospice and Palliative Care criticised the Liverpool Pathway for its traditional approach and not taking an explicit position on the artificial hydration for critically ill patients.
[5][25] In contrast, The Times welcomed the pathway as an attempt to address patients' wishes and warned about "alarmist" press coverage of the scheme.
[29] In a 2012 letter to The Daily Telegraph, six doctors belonging to the Medical Ethics Alliance, a Christian medical organisation,[29] called on LCP to provide evidence that the pathway is "safe and effective, or even required", arguing that, in the elderly, natural death is more often painless, provision of fluids is the main way of easing thirst, and "no one should be deprived of consciousness except for the gravest reason.