IRELAND’S HOSPICE movement will be buoyed by the Quality of Death Index, which ranks 40 countries on how they deal with end-of-life care. It reinforces the value of hospice and palliative care and highlights the gains that have been made.
Importantly it demonstrates what is already apparent from the national audit on end-of-life care in hospitals, that this country is as good as others in how it cares at end of life. International surveys deserve caution and multiple caveats. However the report, by the Economist Intelligence Unit for the Lien Foundation, is immensely valuable and has some surprising findings. The UK is the best place in which to die and Ireland ranks a healthy fourth in the overall ratings. It is ninth on cost of end-of-life care, fifth in quality of such care, and seventh on its availability.
With the UK and Belgium, Ireland rates highest on evidence of public discussion on end-of-life care, a finding which will encourage the Irish Hospice Foundation. Only in the “basic end-of-life healthcare environment” does Ireland slip to 17th, a category which includes social security health expenditure, nurse and doctor numbers, GDP, dependency ratios, life expectancy and hospital bed counts.
Ireland’s hospice care has many gaps, among them the inequalities in provision, but it can be encouraged by the advances in countries such as Romania and Hungary, the Indian state of Kerala which the report calls a “beacon of hope”, and Uganda where Anne Merriman, an Irish doctor, has been instrumental in the care of 160,000 patients and the training of 7,000 personnel. Prosperity is not a guarantee of good end-of-life care. It can be provided despite economic and other barriers, one of the hearting lessons from the report.
Other issues include the fact that few nations incorporate palliative care strategies into their overall healthcare policy, the importance of combating certain perceptions of death and cultural taboos, lack of access to drugs, and limited state funding of palliative care. It is stressed that palliative care need not be institutional and that more training is vital. The report also notes that while public debate about euthanasia and physician-assisted suicide gain media attention, these issues affect only a tiny proportion of the terminally ill.
This international ranking of end-of-life care highlights issues and raises questions of considerable consequence to the 30,000 people who die annually in Ireland, and their families.