Even before the COVID-19 pandemic, 81 countries, rich and poor, mostly do poorly on how well their health systems provide for the physical and mental wellbeing of patients at the end of life.

The survey of end-of-life care showed only six countries earned grades of A, while 36 earned Ds or Fs. The United Kingdom and its nationalized health care is often criticized for treatment delays or panels that determine what care someone should receive, but when it comes to death they ranked first. Ireland, Taiwan, Australia, South Korea and Costa Rica also earned A's in what 181 palliative care experts across the globe chose from 13 weighted factors that people most often listed, including proper management of pain and comfort, having a clean and safe space, being treated kindly, and treatments geared toward quality of life rather than extending it.  

In the US, doctors fight for every life to the end, but that earns the American medical community a C rating, 46th of 81 countries. 

The authors are clearly critical of the excessive often futile treatment at the end of lives that they believe increases suffering. Resources should be spent on measures to ensure comfort and quality of life in a patient’s final days rather than last-ditch efforts to keep people alive.

“We spend so much money trying to get people to live longer, but we don’t spend enough money in helping people die better,” says Eric Finkelstein, professor with Duke-NUS Medical School in Singapore. 

The good news for patients is that if people are allowed to die better they wouldn't be treated like recreational drug addicts and denied access to pain medications, as happened due to the CDC during the Obama administration. The paper may also spur policy changes so people can make a real end-of-life plan.

CITATION: “Cross Country Comparison of Expert Assessments of the Quality of Death and Dying 2021,” Eric A. Finkelstein, Afsan Bhadelia, Cynthia Goh, Drishti Baid, Ratna Singh, Sushma Bhatnagar, Stephen R. Connor, Journal of Pain and Symptom Management, Dec. 21, 2022. DOI: 10.1016/j.jpainsymman.2021.12.015