The best & worst places to die

October 11, 2015 6:37 PM

The Economist's Quality of Death Index for 2015 was published last week. It attempts to measure the quality of palliative care in 80 countries. The top three countries (in order) are Britain, Australia, and New Zealand. And the bottom three countries? Philippines, Bangladesh, and Iraq. Here is The Economist's summary and here is the full report.
posted by Sir Rinse (14 comments total)

Noting that euthanasia is still illegal in all parts of Australia...
posted by wilful at 7:08 PM on October 11, 2015 [1 favorite]

Legal here in Canada now! The federal government has until February to pass framework legislation (the SCC put their ruling on hold for one year).

I'm not a churchy person anymore, but when I was a kid, the church my mother took me to had a team of lay people who performed palliative care with dignity and compassion, allowing people to choose how they wanted to exit the world. And this was in the 80s. It is sickening that we force people to suffer. (There's a community around that church that is enthusiastically pro-justice--palliative care, the first chapter of Dignity (the queer Anglican movement), the first to march in a Pride parade, keeping the doors open at night through the winter for homeless people, maintaining Toronto's memorial to homeless people who die on the streets, etc etc etc.)

Said it before, saying it again: we have no choice about how we enter the world. We have the absolute and unabridged right to decide how we leave it. Good on the UK and Aus and NZ for being good at palliative care. Canada needs, as in so many things, to up its game.
posted by feckless fecal fear mongering at 9:18 PM on October 11, 2015 [4 favorites]

I couldn't even manage to read any of the infographics. That was a really badly designed layout. OTOH, someone want to buy me a 4K screen?
posted by Samizdata at 10:20 PM on October 11, 2015

I enlarged it by pressing Ctrl and + until it was readable. That worked.
posted by Too-Ticky at 10:26 PM on October 11, 2015

Also not legal in the UK. And, having watched two family members die from cancer in the last year in what is ostensibly the best country in the world to die in...this is not a solved problem. Feels like it's being measured on a scale from bad to somewhat less worse, rather than bad to actually good or humane.
posted by terretu at 11:47 PM on October 11, 2015 [3 favorites]

I work in senior care in the State of Washington, where euthanasia is partially legal, as physician assisted suicide. I frequently work with palliative cases. And even though we have some stellar hospice services, and some of the best pain care in the country, I can't put us on this list for one simple reason: healthcare costs. I see individuals and families stretched to the breaking point, financially and emotionally, trying to pay for those services. It breaks my heart to see that struggle, and to watch people make hard, hard choices to compromise on the quality of their care because "affordable" is a nonsense word here. America will never be a good place to die, or to live, until national health coverage is a reality here.
posted by skookumsaurus rex at 12:16 AM on October 12, 2015 [11 favorites]

Once they figured in cost, I'm surprised the US didn't plummet down the ranking. All I can figure is, by the time you're dying, most of your costs are being covered by Medicare or Medicaid, so the cost is somehow hidden?
posted by Thorzdad at 5:16 AM on October 12, 2015

Three clicks just to get to the PDF which shows the country profiles? Really, The Economist? I had higher hopes than that.

Also, I'm rather curious as to why they decided to only publish interviews with the countries at the top of the list. Isn't it also important to find out why the other countries don't have the resources in place that the countries at the top of the list have?
posted by TrishaLynn at 5:21 AM on October 12, 2015

Everyone: The Economist? I had higher hopes than that.
posted by sneebler at 6:44 AM on October 12, 2015

Just wanted to point out that palliative care and euthanasia are two totally different issues?
posted by cacofonie at 6:45 AM on October 12, 2015

(on preview: well, not totally different).

i have ms, and if the worst comes to the worst (which seems unlikely right now, thankfully), i'd like euthanasia to be available.

but i also worry about how something that - i am not sure of the adjective, strong? - is made accessible.

i have known various cases where doctors did not tell the whole truth to patients. where, for example, someone was dying from cancer, but did not know. did not know until near the end, because the doctor, or the establishment, or society, felt that "it would be better" for them. much of this is class, and money. the victims were generally poor. one was a servant (a nanny, or nana - see askme for people telling me how wonderful such an institution is). but even from me - european, wealthy, male, pretty much top of the food chain - information has been withheld.

euthanasia isn't just a tickbox that you can select. it needs a sufficiently open and egalitarian (which may be euphemisms or synonyms for wealthy, or educated, or honest, or even "like what i arbitrarily expect") society for it to be fair. because i can see people euthanizing their nanas like they would their dogs (sure, people love their dogs; they just don't consider them fully autonomous individuals).
posted by andrewcooke at 6:54 AM on October 12, 2015

Just wanted to point out that palliative care and euthanasia are two totally different issues?

Not just that. Palliative care and hospice care are not the same. Palliative care has a role in many non-terminal cases, and is not the same as hospice care, although it is a major part of hospice care. In the context of dying or terminally-ill patients, hospice care is the more accurate term.
posted by jedicus at 7:21 AM on October 12, 2015 [2 favorites]

For the record, I've never had a client exercise their right to physician assisted suicide, so beyond the fact that it exists I'm fairly unfamiliar with the process. I do wonder if the kind of barriers to access that andrewcooke points out is a factor there. I also know that effective pain management in hospice situations greatly improves emotional wellness, so maybe few people choose to pursue PAS, even if it is easy to find.
posted by skookumsaurus rex at 8:07 AM on October 12, 2015

One thing I noticed during that last two weeks of my father's life earlier this year: It seemed to me that the - excellent - staff at the London hospital he was in were very restricted in what they could say to people and their families. In retrospect it's quite clear that what was happening was like a sine wave, with apparant recovery at the top and worrying illness at the bottom until the wave dipped below a line and he died. And I'm sure that the staff treating him knew that, it must have been a familiar pattern, but couldn't tell us. Similarly, there's a ward where they evidently send people to die (I should know that, I read Doctor in the House), but they can't tell people that that's what it is, he's just been moved to a "quieter ward". I can see that relatives would cause a lot of fuss. There had been so many calls to attend the hospital that when it finally came to it I was quite blasé, and looking back the nursing staff were quite clearly hinting "This is it", but weren't able to say it out loud.

Also, straight off a life support machine isn't a good look.
posted by Grangousier at 11:27 AM on October 12, 2015