By Sarah Murray, writer on business, society and the environment
Across the world, the question of whether or not people should have the right to end their own lives is gaining attention. But while the debate is an important one, for me, an equally important question is how to extend the right kind of care to people living in pain and distress or with incurable conditions. And while progress is being made, we are still failing to meet this basic human need.
This is the message that emerged during my research for a report that accompanies a new index assessing countries around the world on their provision of palliative care. The 2015 Quality of Death Index—commissioned by Singapore’s Lien Foundation and developed by the Economist Intelligence Unit—ranks 80 countries on how well they are doing on this.
In the past five years, as the report reveals, advances have certainly been made. And on the policy front, one of the most important moments came last year when the World Health Assembly passed a resolution calling on member states to integrate palliative care into their national healthcare systems.
But while international declarations are one thing, putting aspirations into practice is quite another. And when it comes to palliative care, the obstacles are not to be underestimated.
For a start, modern healthcare systems are often built on a culture that prioritises cure rather than care. Too often, the focus is on prolonging life through expensive, painful and potentially fruitless medical interventions, rather than alleviating pain and emotional distress.
In many places, a shortage of trained doctors and nurses limits the availability of care. And reimbursement incentives—which in countries such as the US have followed a model in where payments are made for individual procedures rather than overall results—need to be shifted to accommodate the more holistic approach of palliative care.
Moreover, as much of the evidence shows, palliative care is generally more cost effective than the alternatives. One review of the literature found that it was often cheaper than other forms of care and that in most cases the cost difference was statistically significant.
Economics aside, there is a moral agenda here. I found it interesting, for example, that when in 2009 the woefully poor access to painkillers in India was brought to the world’s attention, it was not by a medical journal or healthcare report. It was by Human Rights Watch.
Since then, as the Quality of Death Index reveals, India has made progress in providing painkillers to its citizens, relaxing the outdated drugs laws that once made it hard for doctors to prescribe morphine. And a number of teaching programmes are appearing across the country.
On the whole, income levels provide a strong indicator of the availability and quality of palliative care, as you can see from the countries in the upper echelons of the Quality of Death ranking (the UK comes first with Australia and New Zealand in second and third place).
Yet beacons of hope are emerging in unexpected places. In Mongolia, for example, visionary doctor Odontuya Davaasuren has introduced the concept of palliative care to a country that was previously unaware of such services. Thanks to her tireless campaigning, Mongolia has a growing number of hospices, palliative care is part of social welfare legislation and morphine is available on prescription.
Meanwhile, through an innovative programme developed by Hospice Africa Uganda, a pioneering institution founded by Anne Merriman, Uganda is making opioid painkillers available throughout the country.
But even in places that do well in the Quality of Death Index much more work needs to be done before all those in need of care are accommodated.
In New South Wales, for example, most palliative care in the state, which is home to one-third of Australia’s population, is still carried out by nurses and, outside the Sydney area, only a handful of specialist doctors practice palliative care.
Meanwhile, despite evidence of its economic benefits and the fact that at some point most people will be in need of palliative care, a tiny proportion of healthcare research goes into this branch of healthcare. And while attitudes are changing, discussions about the end of life between patients and doctors are still not the norm.
But the clock is ticking. As the world’s population ages rapidly, the number of people living longer but with a number of chronic conditions means demand for care is likely to increase dramatically in the coming years. This makes investing in developing better palliative care services an urgent task.
Of course, for some people, no amount of palliative care will alleviate the suffering. And in these cases, the argument for allowing people to end their lives is a strong one. However, the right-to-die campaign should not be allowed to eclipse what I believe is the other critically important debate—the discussion about the right to a peaceful, comfortable and pain-free end of life.
Original article published by Sarah Murray at https://www.linkedin.com/pulse/deaths-long-shadow-finding-better-way-out-sarah-murray?published=t
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of The Economist Intelligence Unit Limited (EIU) or any other member of The Economist Group. The Economist Group (including the EIU) cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.
