Few countries offer quality end-of-life care.

Categories: Care, Education, Featured, Opinion, and Research.

Have you ever wondered what it would be like near the end of your life and in need of care, and you can’t access the care or key and basic essential services that you need? Many people around the world in need of palliative care experience discomfort, they lack basic essential services and die without dignity. Low and middle-income countries are worst affected due to fewer health resources and lack or very limited allocation of resources to healthcare services more so in palliative care services.

A recent study was conducted by Duke University and Lien Center for Palliative Care in Singapore indicates that out of 81 countries ranked in the study only 6 countries earned grades A while 36 earned Ds and Fs in the provision of quality end of life care. You can find a press release on the article here. More than 1200 caregivers, 181 palliative care experts were surveyed on 13 weighted factors that people most often listed as important, including proper management of pain and comfort, having a clean and safe space, being treated kindly, and treatments that address quality of life, rather than merely extending life.

“Society should also be judged on how well people die,” says Eric Finkelstein, a palliative care expert and professor with Duke-NUS and the Duke Global Health Institute in Durham, North Carolina, who led the study. “Many individuals in both the developed and developing world die very badly—not at their place of choice, without dignity, or compassion, with a limited understanding about their illness, after spending down much of their savings, and often with regret about their course of treatment. These things are very common.”

It’s no coincidence that most of the survey’s top scorers are wealthy countries with well-funded health systems, while low- and middle-income countries fared worse, says Stephen Connor, Executive Director of the Worldwide Hospice Palliative Care Alliance and one of the study’s co-authors. “The overwhelming need for palliative care is in low and middle-income countries, where less than a third of services exist,” he notes. In the U.S., he says, resources are often invested in last-ditch efforts to extend life, rather than measures to ensure comfort and quality of life in a patient’s final days.

Everybody deserves a better end-of-life experience. It is time to focus on the quality of care provided during end-of-life care because this is a fundamental aspect of human dignity. Advocacy efforts are critical and that is why organisations such as The Worldwide Hospice and Palliative Care Alliance (WHPCA) strive to ensure no one with a life-limiting condition should live and die with unnecessary pain and distress due to lack of access to quality care. To learn more about WHPCA please click here.

“Perhaps the main conclusion from this important exercise is that most people in the world die badly—many through no treatment at all and many through excessive often futile treatment that increases suffering,” says Richard Smith, a palliative care expert and former editor of the British Medical Journal.



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