Britain leads the world in the quality of care it provides for the dying, leaving many developed nations lagging a long way behind, according to a study released Wednesday. State support for end-of-life care and an effective network of hospices put Britain top of the list of 40 countries, despite not having the best healthcare system overall, said a report by the Economist Intelligence Unit (EIU).
Researchers looked at factors including public awareness, availability of training and access to pain killers and doctor-patient transparency to compile the "quality of death" index. Australia ranked second on the global list followed by New Zealand and Ireland, with Germany, the US and Canada also featuring in the top 10.
Many rich nations were in the bottom half of the list, including Denmark (22nd) and Finland (28th). India scored worst at number 40, with Portugal, South Korea and Russia also in the bottom 10. In the worst cases, the study found the quality and availability of care was often poor and policy co-ordination was lacking. It said "few nations, including rich ones with cutting-edge healthcare systems" incorporate end-of-life care strategies into their overall healthcare policy.
In many of these countries, increasing longevity and ageing populations mean demand for end-of-life care "is likely to rise sharply", said the study. Falling birth rates, especially in developed countries, are likely to complicate the situation and, for the first time in history, the number of people over 65 will outnumber children under five years old, it added.
"For the end-of-life care community, this presents a new and complex set of problems," the report said. It also found the availability of pain-killing drugs, rated in the report as the most important practical issue in the standard of palliative care, was "woefully inadequate across much of the world". This is mainly due to concerns about the drugs' illicit use and trafficking, and a lack of training among medical personnel on how to administer them.
"The result of this state of affairs is an incalculable surfeit of suffering, not just for those about to die but also for their loved ones," the study said. Among the challenges faced by countries seeking to improve their end-of-life care is the task of overcoming perceptions of death and cultural taboos about dying.
In Chinese culture, death and dying are stigmatised to such an extent that both are considered taboo, said the study, adding that in Western societies curative treatments are given priority over palliative care. The report recommended more training for potential home carers, stating that palliative care need not mean institutional care and that many patients choose to die at home.
It cited data showing that more than 100 million patients and their family care-givers need palliative support annually, but fewer than eight per cent of them actually receive it. "Governments and providers are in a race against time," said the study, warning that the spread of ageing was rapidly outpacing efforts to provide much-needed care. Researchers interviewed doctors, specialists and other experts across the 40 countries listed, including 30 nations within the Organisation for Economic Co-operation and Development (OECD) and 10 others for which data was available.
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