Care for the dying is poor in many countries (News Feature)

By Kai Portmann Jul 14, 2010, 8:19 GMT

Singapore - Care for the dying is poor even in many highly developed countries despite demand for end-of-life care being likely to rise sharply because of increasing longevity and ageing populations, a report released Wednesday said.

'We live in a death-denying society where too many people are dying with unnecessary pain, with too much fear and unfinished business,' said Lee Poh Wah, chief executive of the Singapore-based philanthropic Lien Foundation, which initiated the study.

'In many parts of the world, hospice and palliative care is either non-existent or in its infancy with about 5 billion people living in countries with insufficient or no access to medications to control severe or moderate pain,' said the report, based on figures provided by the World Health Organization.

Conducted by the Economist Intelligence Unit, the Singapore study ranked 40 countries - 30 industrialized and 10 developing - according to their provision, quality, availability and cost of end-of-life care.

Britain scored the highest in the 'quality of death index,' closely followed by Australia and New Zealand.

Developing countries - including China, Brazil, India and Uganda - ranked at the bottom of the table. But there were exceptions, such as the southern Indian state of Kerala, which provided two-thirds of the country's palliative care services while representing just 3 per cent of its population.

Progress on end-of-life care was slow in those countries, the report said, adding that 'in the case of China and India, further problems are vast populations for whom end-of-life coverage extends to only a fraction of those in need.'

Britain, having led the world in establishing a hospice movement from 1967 was no surprise in coming first. But even many rich nations - like Denmark, Italy, Finland and South Korea, which ranked 22nd, 24th, 28th and 32nd, respectively - lagged far behind because the quality and availability of their palliative care was often poor and lacked coordination, the report said.

'In developed countries, medical services have all too often focused on preventing death rather than helping people meet death without suffering pain, discomfort and stress,' it said.

One of the barriers to progress in end-of-life care were taboos surrounding death, 'not only in Asian populations, but even in Western populations,' said Cynthia Goh, co-chair of the Worldwide Palliative Care Alliance.

She said that complicating the issue was that hospice care was often associated with 'giving up,' for example, in the United States, which ranked no higher than ninth in the index because of its enormous costs for end-of-life care.

In the US, appropriate care for the dying was often trumped by the 'cure-at-all-cost' attitude of doctors along with the strong religious views many families hold on the sanctity of life, the report said.

'We're the epicentre for the technologies that allow us to keep people alive for 60 additional days with no improvement in outcome but with substantial increase in costs,' it quoted Paul Keckley, executive director of the US-based consulting firm Deloitte Center for Health Solutions, as saying.

'Probably the most important practical issue that we need to do more on is the availability of drugs to control pain,' Goh said.

She said governments worldwide are wary of the illicit use of drugs and put in place excessively strict regulations to control the distribution of morphine.

'Legislation improving access to opioids ... will be crucial if millions around the world are not to be left to die in agony,' the report warned.

Because in most countries hospices and other care bodies currently rely on charitable donations and few countries had a national policy for palliative care in place, the study called for more state funding for end-of-life care and high-level support.

'How we care for the dying, the weakest, ... is a good measure of a nation's greatness,' Lee said.