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Open Access Highly Accessed Debate

Quality end-of-life care: A global perspective

Peter A Singer123* and Kerry W Bowman145

Author Affiliations

1 University of Toronto Joint Centre for Bioethics, Toronto, Ontario, Canada

2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada

3 University Health Network, Toronto, Ontario, Canada

4 Mount Sinai Hospital, Toronto, Ontario, Canada

5 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada

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BMC Palliative Care 2002, 1:4  doi:10.1186/1472-684X-1-4

Published: 25 July 2002



Quality end-of-life care has emerged as an important concept in industrialized countries.


We argue quality end-of-life care should be seen as a global public health and health systems problem. It is a global problem because 85 % of the 56 million deaths worldwide that occur annually are in developing countries. It is a public health problem because of the number of people it affects, directly and indirectly, in terms of the well being of loved ones, and the large-scale, population based nature of some possible interventions. It is a health systems problem because one of its main features is the need for better information on quality end-of-life care. We examine the context of end-of-life care, including the epidemiology of death and cross-cultural considerations. Although there are examples of success, we could not identify systematic data on capacity for delivering quality end-of-life care in developing countries. We also address a possible objection to improving end-of-life care in developing countries; many deaths are preventable and reduction of avoidable deaths should be the focus of attention.


We make three recommendations: (1) reinforce the recasting of quality end-of-life care as a global public health and health systems problem; (2) strengthen capacity to deliver quality end-of-life care; and (3) develop improved strategies to acquire information about the quality of end-of-life care.