Painfully slow progress on palliative care

Abstract

To meet death without a surfeit of pain and discomfort is a fundamental right. Yet, according to The Quality of Death, a report published by the Economist Intelligence Unit, it is a right denied to all but 8% of patients who need palliative care worldwide every year. The authors used a range of indicators to rank 40 countries by the quality and availability of their end-of-life care. The UK holds the top spot overall, bearing testament to the strides made since the foundation of St Christopher's Hospice—the first dedicated palliative care hospice in the world—in 1967. Globally, however, the picture is one of low standards and slow progress. Brazil, Russia, India, and China—which account for 40% of the world's population—occupy four of the bottom six places in the list, along with Mexico and Uganda. But even patients in developed nations such as South Korea (32nd), Japan (23rd), and Denmark (22nd) are being denied access to good end-of-life care through a combination of inadequate policy, poor training, poor access to painkillers, and cultural barriers. In a world where death and taxes are the only certainties, taxes are considered the more palatable topic for discussion. Death and dying remain taboo subjects in many cultures, which presents a major barrier to improving end-of-life care. Deeply embedded attitudes will not change overnight, but campaigns such as Dying Matters, which launched in the UK earlier this year, show that it is possible to engage with the public and foster an acceptance of death as a natural process. A more pressing practical concern is that about 5 billion people worldwide lack access to opioid pain relief, mainly because of fears the drugs will reach the black market. Even where opioids are available, inadequate training often means doctors are unable to safely administer them. What is clear is that none of the impediments to improving end-of-life care will be overcome without strong leadership and detailed support from policy makers. With people older than 65 years soon to outnumber children younger than 5 years for the first time in recorded history, time is very much of the essence.