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Friday, July 23, 2010

We've still got a lot of work to do...

It seems Britain is the best place in the world to die. Canada sits tied with America in 9th place out of 40 countries, based on the results of the newly created Quality of Death Index, which ranks countries according to their provision of end-of-life care. It also shows the best places to die in Canada are Victoria, Edmonton and the Niagara region

Britain topped the index, prepared by the Economist Intelligence Unit, because it takes hospice and palliative care seriously: It has decided, as a matter of public policy, that the quality of death is as important as the quality of life.

There are four principal reasons for the mediocre showing:
  • End-of-life care is poorly coordinated
  • It is expensive and many services and drugs needed at the end of life are not covered
  • Patient-centred care is lacking - wishes of patients are not respected nearly enough
  • There is a shortage of policy leadership
André Picard from the Globe and Mail writes:
As the quality-of-death report notes, there are many taboos surrounding death that have hampered open discussion of end-of-life care. We have to move beyond the religious sentiment that holds life is sacrosanct, and ensure palliative care so that death is dignified. We also have to make the distinction between euthanasia and physician-assisted suicide, which relate to a tiny minority of deaths, and the broader concept of hospice/palliative care, which is a must for everyone with a terminal illness.
Patients should be able to expect, as an integral part of their health care, effective pain management, emotional and spiritual support, and comfort and care from compassionate and skillful people who are committed to honouring their dignity.

WE welcome your comments on this article. This news definitely deserves thoughtful, clear discussion.


  1. It is very important to note that the availability of assisted dying is not reflected in the Economist Quality of Death Index. The rationale is that this only affects a small minority of patients. Perhaps the Economist needs to do some more thinking in this area, since, for many people, knowing that the option is available, even if they do not make use of it, is a great relief to those who are dying. Since they know they can opt for assistance in dying, they do not need to worry about unbearable pain at the end of life. The Economist Intelligence Unit obviously did not factor this into their calculations, and so the Netherlands is ranked near Canada on the scale. This cannot be right.

  2. I follow the rationale of making clearer what is available at the end of life, but the term "assisted dying" surely means different things to different people. It seemed to me for example that if refusal of food and fluids by the patient is included in the general presentation, in which no punitive therapeutic measures are instituted as a reactive pattern by physicians or care givers, then a good death is certainly being assisted.

    Perhaps the term assisted dying should be left nebulous. On Page 18 the paper touches on these issues. In the quote by David Praill one is left with the question of where does one find the 10% of palliative care doctors in UK who are NOT opposed to assisted suicide. It would be helpful to know the exact question which was asked in the survey. If a patient refuses therapy, fluids and food is it considered to be suicide? If one gorges on high cholesterol foods, smokes and drinks excessive amounts of alcohol is this suicide? The concepts merge into fuzzy issues.