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QUALITY of DEATH: an index

In July the Economist published the results of a lengthy first-ever global study into the Quality of Dying in 40 countries. This study was commissioned by the Singaporese Lien Foundation and performed by the Econimist Intelligence Unit (EIU). It presents an Index that ranks countries according to their provision of end-of-life care. Read further to see some conclusions and comments.

comment RJ, webmaster: The Lien Foundation is based in Singapore and a fervent advocate for Palliative Care. In the whole study the isseu of euthanasia (in whatever form) or assisted dying has not been actively addressed, thus emphasizing on the Palliative Care as prime criterium for “good” end-of-life care. Had the issues of (physician) assisted dying been included, countries with legalizations on this would have been higher up in the ranking. It is only amazing then that The Netherlands ends on 7th place overall.

Major parameters, next to other criteria, used in the ranking were:

– the delivery of basic palliative care,

– the costs involved,

– the quality of that (palliative) care

– the availability of such palliative care

Looking at those criteria it is not strange that the UK comes out as first overall. When considering different criteria separately, results are a little different: The Netherlands, Australia , New Zealand and Norway come out first in terms of affordability, Switzerland is first when it comes to providing a good basic end-of-life care environment and Belgium, together wit the UK and Ireland score highest on the issue of public awareness of end-of-life care.

Some other conclusions were:

  • Combating perceptions of death, and cultural taboos, is crucial to improving.
  • Public debates about euthanasia and physician-assisted suicide may raise awareness, but relate to only a small minority of deaths.
  • Drug availability is the most important practical issue.
  • State funding of end-of-life care is limited and often prioritises conventional treatment.
  • More palliative care may mean less health spending.
  • High-level policy recognition and support is crucial.
  • Palliative care need not mean institutional care, but more training is needed.”

Quotations from the EIU report:

“Quality of life” is a common phrase. But “quality of death” is another matter. Death, although inevitable, is distressing to contemplate and in many cultures is taboo…… For the first time in the history of humanity, people over the age of 65 will soon outnumber children under the age of five. This will happen some time during the next few years. By 2030, the number of people aged 65 and older is projected to reach 1bn (or one in eight of the global population), rising even more sharply (by 140%) in developing countries.”

And:  “People are certainly living longer, healthier lives, with smaller numbers dying of communicable or infectious diseases, particularly in developed countries…. However, with longevity comes more complex diseases of ageing that are harder and more costly to manage… and the proportion of survivors who are free of health problems is shrinking.

For the end-of-life care community, this presents a new and complex set of problems. For while cancer—the catalyst for the creation of many hospice and palliative care services—has a fairly well established prognosis, conditions such as cardiovascular disease, dementia and Alzheimer’s disease, arthritis, and diabetes are less predictable. These chronic illnesses bring about a slow decline, with a number of incidents, most of which are managed but any one of which might result in death.”

“As a result, demand for end-of-life care services is likely to rise sharply. Too often such care is simply not available: according to the Worldwide Palliative Care Alliance (WPCA), while more than 100m people would benefit from hospice and palliative care annually, less than 8% of those in need access it.”