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End of life 'quality' index

Posted Jul 16 2010 10:53am

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

2010 The Economist Intelligence Unit


Available online PDF [39p.] at:

 “…………..“Quality of life” is a common phrase. The majority of human endeavours are ostensibly aimed at improving quality of life, whether for the individual or the community, and the concept ultimately informs most aspects of public policy and private enterprise.

Advancements in healthcare have been responsible for the most significant quality-of-life gains in the recent past: that humans are (on average) living longer, and more healthily than ever, is well established. But “quality of death” is another matter. Death, although inevitable, is distressing to contemplate and in many cultures is taboo.

Even where the issue can be openly discussed, the obligations implied by the Hippocratic oath—rightly the starting point for all curative medicine—do not fit easily with the demands of end-of-life palliative care, where the patient’s recovery is unlikely and instead the task falls to the physician (or, more often, caregiver) to minimise suffering as death approaches. Too often such care is simply not available: according to the Worldwide Palliative Care Alliance, while more than 100m people annually would benefit from hospice and palliative care (including family and carers who need help and assistance in caring), less than 8% of those in need access it.

Few nations, including rich ones with cutting-edge healthcare systems, incorporate palliative care strategies into their overall healthcare policy—despite the fact that in many of these countries, increasing longevity and ageing populations mean demand for end-of-life care is likely to rise sharply. Globally, training for palliative care is rarely included in healthcare education curricula. Institutions that specialise in giving palliative and end-of-life care are often not part of national healthcare systems, and many rely on volunteer or charitable status.

Added to this, the availability of painkilling drugs—the most basic issue in the minimisation of suffering—is woefully inadequate across much of the world, often because of concerns about illicit use and trafficking. 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. Clearly, the deeper inclusion of palliative care into broader health policy, and the improvement of standards of end-of-life care—raising the “quality of death”—will also yield significant gains for humanity’s quality of life……….”


Executive summary

Note on definitions

Introduction: new challenges in managing the end of life

1. The Quality of Death Index

Index methodology

A high quality of death

A low quality of death

2. Cultural issues in end-of-life care

Attitudes to death and dying

Levels of debate across the globe

The law and the decision to die

Three contrasting attitudes to death

3. The economics of end-of-life care

A variety of funding models

Romania: from last to leader

Kerala: the community model

Long-stay patients shift the balance

4. Policy issues in end-of-life care

Government recognition

The availability and use of opioids

Integration of care into mainstream services

Uganda: a beacon in Africa

Building capacity for home-based care

The importance of training

5. Conclusions

Appendix: Index methodology

This report and more information on the Quality of Death Index can be found at:

More information on the Quality of Death Index is also available at the website created by the Lien Foundation, the sponsor of the research:

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