There are better places in the world to die than Canada. Unfortunately, there aren’t very many ways of expressing that fact without inducing cringes and breaking a few taboos, which is one reason Canada ranks below a number of other countries in end-of-life care. A recent report suggests that as the global population ages, quality of death will have to factor into how we evaluate our overall quality of life. The report, titled The Quality of Death: Ranking end-of-life care across the world , ranks 40 countries for quality of death. Canada is ranked ninth out of forty countries, tied with the United States but well behind Britain, which tops the list. Click here to read the report
Four areas of end-of-life-care were tested in evaluating the national ranking: Basic end-of-life healthcare environment, availability of end-of-life care, cost of end-of-life care, and quality of end-of-life care. Each of these categories has been assigned a weighting by the researchers’: environment (20 percent), availability (25 percent), cost (15 per cent) and quality (40 percent).
Furthermore, 27 individual indicators were used that fall into three broad categories (quantitative, qualitative and, status) also factor into the rankings. The scores on the chart below are out of 10 and are an aggregate of all the compiled data, rounded to one decimal place, which accounts for some countries appearing to have identical scores but different rankings.
Canada’s poor ranking is partly a result of the cost of end of-life care, even if we rank highly for the availability of pain-killing medicine. The report notes that, “while the Canadian government has shown a heightened interest in recent years in improving access to palliative care, and hospitalization is 100 percent funded by the state, homecare may still be a considerable burden. A recent study in the journal Palliative Medicine found that Canadian families frequently shoulder 25 percent of the total cost of palliative care.”
The report also claims that Canadians, citizens and policy makers alike, are reluctant to discuss death openly. We may know how to prolong life medically, but comparatively, death is a taboo subject in Canada, which means improving end-of-life-care simply is not a healthcare priority. The size of the country and dispersion of the population also means that there is little or no palliative care across much of the country. In Canada, only 16 to 30 per cent of those who die receive specialized hospice or end-of-life care.
As the report, argues, for the “first time in the history of humanity, people over the age of 65 will soon outnumber children under the age of five. This will happen some time during the next few years. By 2030, the number of people aged 65 and older is projected to reach 1 billion (or one in eight of the global population), rising even more sharply (by 140%) in developing countries.”
The effects of aging populations are compounded by longer life spans, fewer communicable diseases, medical treatments that prolong life, and fewer family and social supports throughout old age. That is to say, more people are living longer, but their quality of life may depreciate as they age. If we in Canada hope to improve our quality of life with high quality end-of-life care, we may just have to become more comfortable talking about death. To read the story of a palliative care nurse who is pushing to reform Canada’s palliative care system, please click here.