Quality end-of-life care: A global perspective

Peter A Singer ¹^,2^,3 and Kerry W Bowman ¹^,4^,5

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

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

³University Health Network, Toronto, Ontario, Canada

⁴Mount Sinai Hospital, Toronto, Ontario, Canada

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

author email corresponding author email

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


Published:	25 July 2002

Abstract

Background

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

Discussion

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.

Conclusions

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.