End of Life Care

Canada and the World

Current Events with a Canadian Perspective

Last update

21 July 2011

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Helping the Dying

on their Final Journey

End-of-life care varies widely among developed

countries and a new survey says the

United Kingdom is the place that does it best

The Economist Intelligence Unit, a division of The Economist magazine, has examined the palliative care systems in 40 mostly rich countries.

The report, published on July 14, 2010, was commissioned by the Lien Foundation, a Singapore philanthropic organization.

It found that rarely do nations incorporate end-of-life care into their health systems; one of the few that does is Britain, the nation that tops the list in the Quality of Death Index.

A Commitment

to End-of-life Care

Writing in The Globe and Mail (July 22, 2010) André Picard comments that the U.K. “has decided, as a matter of public policy, that the quality of death is as important as the quality of life.

“The care itself is good and publicly funded. Health-care providers are trained in palliation, painkillers are used liberally at the end of life…”

And, The Economist recognizes that Britain tops the field despite having a “far-from-perfect healthcare system.”

Reasons for Poor Performance

Scandinavian countries, which are usually at the forefront of socially progressive policies, fall down in end-of-life care; Norway was 13th, Sweden 16th, Denmark 22nd, and Finland 28th.

The reason given for the relatively poor performance in this area is that death has become medicalized and medical professionals focus all their expertise on keeping patients alive rather than easing them into death when it’s inevitable.

The United States (9th) does a better job in palliative care but, says The Economist, “discussion of end-of-life care often inflames religious sentiment that holds the sanctity of life paramount. The issue is complicated by the perception that ‘hospice care’ is often associated with ‘giving up’. ”

Asian Countries Rank Low

Japan, which ranks 23rd, has a high proportion of elderly people and the numbers are driving up the cost of health care leading to a rationing of resources.

Japan Today (July 14, 2010) says “Another factor is that home-based care for the dying is not well-accepted in Japan, where such care still tends to be more institution-based, driving up the cost.”

China ranked 37th and India came in last. The highest ranked Asian country was Taiwan at 14th.

End-of-life Care a Global Problem

Cynthia Goh, is Co-chair of the World Palliative Care Association. In a news release (July 14, 2010) she points out that, “While more than 100 million patients and family care-givers worldwide need palliative care every year, less than eight percent actually receive it. Palliative care is a human right, yet there are millions of people, especially in the developing world, dying in pain and distress every year.”

Ms. Goh says that pain control is the central issue for many people as they reach the end of their lives. Opiates, such as morphine, can relieve patients of the worst agony but there is often a reluctance to use these highly addictive drugs, denying access to them for five billion people.

“The main obstacles we have to overcome,” says Goh “are governments’ excessive concerns around illicit drug use, as well as a lack of training for doctors and nurses on how to administer these drugs.”

Sources

“The Quality of Death.” The Economist, July 14, 2010.

“There Are a Lot Better Places to Die than Canada.” André Picard, The Globe and Mail, July 22, 2010.

“Japan Ranks Poorly in Global ‘Quality of Death Index.’ ” Japan Today, July 14, 2010.

“World’s First Index on the Quality of End of Life Care Highlights the Global Barriers to Achieving Universal Palliative Care.” World Palliative Care Association news release, July 14, 2010.

QUALITY OF

DEATH INDEX

1. United Kingdom - 7.9

2. Australia - 7.9

3. New Zealand - 7.7

4. Ireland - 6.8

5. Belgium - 6.8

6. Austria - 6.6

7. Netherlands - 6.3

8. Germany - 6.2

9. Canada - 6.2

10. United States - 6.2

11. Hungary - 6.1

12. France - 6.1

13. Norway - 6.0

14. Taiwan - 6.0

15. Poland - 6.0

16. Sweden - 5.9

17. Luxembourg - 5.7

18. Singapore - 5.5

19. Switzerland - 5.4

20. Honk Kong - 5.3

21. Czech Republic - 5.2

22. Denmark - 5.1

23. Japan - 4.7

24. Italy - 4.4

25. Iceland - 4.3

26. Spain - 4.2

27. Slovakia - 4.2

28. Finland - 4.1

29. Greece - 4.0

30. South Africa - 3.8

31. Portugal - 3.8

32. South Korea - 3.7

33. Malaysia - 3.7

34. Turkey - 2.8

35. Russia - 2.8

36. Mexico - 2.7

37. China - 2.3

38. Brazil - 2.2

39. Uganda - 2.1

40. India - 1.9

“In Canada, only 16 to 30 percent of those who die receive specialized hospice or end-of-life care.”

André Picard

Globe and Mail