A group of British doctors who treat the terminally ill said they were worried that some are dying prematurely because of guidelines on dealing with patients in their final hours.
In a letter to The Daily Telegraph newspaper Thursday, six palliative care specialists said the "tick-box approach to the management of death" could become a self-fulfilling prophecy.
The guidelines, which are not mandatory, were designed by a hospice in Liverpool and recommended as a model in 2004 by the body that sets national health care standards.
They lay out signs that a patient is close to death - including loss of consciousness and difficulty swallowing - and say that once an assessment has been made doctors may remove medication or intravenous drips that are no longer effective.
The letter-writers said the problem with the guidance was that "forecasting death is an inexact science" and that some patients might be denied food or fluids, or put under sedation with the result that signs of improvement might be missed.
"It is supposed to let people die with dignity, but it can become a self-fulfilling prophecy," said Dr. Peter Hargreaves, one of the signatories. "Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway."
"Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway," he told the Telegraph, adding that, "What they are trying to do is stop people being over-treated as they are dying.
"It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking."
Marie Curie Cancer Care, the charity that drew up the guidelines, said the procedures had "improved the end of life experience for thousands of people" and claimed the doctors' letter would cause unnecessary fear.
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Also Thursday, a report by management consultants McKinsey&Co. advised the health service to cut a tenth of its 1.5 million-strong work force over the next five years to make up a budget shortfall. It also suggested the NHS sell off hospitals and cut back on some services.
The government said it had rejected the proposals, which were among many submitted by consulting firms after the government asked for suggestions on how to make up a 20 billion pound ($33 billion) shortfall expected by 2014.
"The government does not believe the right answer to improving the NHS now or in the future is to cut the NHS work force," Health Minister Mike O'Brien said.
Details of the study were published Thursday by the Health Service Journal. McKinsey&Co. refused to comment.
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