The press, the terminal care pathway, the politician, and the hubris.

photograph of Jeremy Hunt, Secretary of State for Health, wearing his best beatific smile. He has just announced that in order to protect patients and their relatives from (implicitly) trigger-happy doctors and those unfeeling faceless bureaucrats who dared incentivise the Liverpool Care Pathway, he plans to ‘enshrine the “basic right” of patients to be involved in decisions when they are mortally sick’.1 The article is the latest in an escalating series of ‘revelations’ by the Daily Mail, pithily summarised by Margaret McCartney.2 Hospitals, it was claimed, were being ‘bribed to put patients on pathway to death’.3 Coincidentally, I am about to examine a 360-page PhD thesis for which someone has spent 3 years researching the implementation of the Liverpool Care Pathway and — by their own admission — barely scratched the surface of the clinical, social, and organisational complexities involved. A recently published theoretical paper examined the decision to enter a patient on the Liverpool Care Pathway and concluded that while there is guidance in abundance: