The Quality of Death: Ranking end-of-life care across the world

[MichaelB]

Here is an interesting paper on a little discussed topic - “The Quality of Death: Ranking end-of-life care across the world” http://graphics.eiu.com/upload/QOD_main_final_edition_Jul12_toprint.pdf. The research was sponsored by the Lien Foundation http://www.lienfoundation.org/ and conducted by EIU, a unit of The Economist magazine. http://www.eiu.com/site_info.asp?info_name=qualityofdeath_lienfoundation&page=noads&rf=0

A sample of the executive summary.

The UK leads the world in quality of death; many developed nations must work to catch up. The UK has led the way in terms of its hospice care network and statutory involvement in end-of-life care, and ranks top of 40 countries measured in the Index (see Figure 1). This is despite having a far-from-perfect healthcare system (indeed, it ranks 27th on the Basic End-of Life Healthcare Environment sub-category, which accounts for 20% of the overall score). But the UK is top in the Quality of End-of-Life Care sub-category, which includes indicators such as public awareness, training availability, access to pain killers and doctor- patient transparency (and accounts for 40% of the overall score). However, in the overall score, many rich nations lag a long way behind: these include Denmark (22nd), Italy (24th), Finland (28th) and South Korea (32nd). In these cases the quality and availability of care is often poor and policy co-ordination lacking.

This is particularly interesting in the US, where end of life health care represents a very large share of total medical expenses, there is rather intense focus on cost containment, and end of life palliative care appears to cost much less.

 

[Purron]

I found this very troubling. It wasn't a problem for my MIL who recently passed away in a nursing home. We arranged for help from a local hospice organization who made sure she got the pain meds she needed.


Drug availability is the most important practical issue.

Pain control is the point from which all palliative care stems, and the availability of opioids (morphine and its equivalents) is fundamental

to quality of end-of-life care. But across the world an estimated 5bn people lack access to opioids, ​

principally due to concerns about illicit drug use and trafficking. A lack of training is also a problem, with many doctors and nurses ignorant of how to administer them.​