Editorials

Quality care at the end of life

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7349.1291 (Published 01 June 2002) Cite this as: BMJ 2002;324:1291

Should be recognised as a global problem for public health and health systems

  1. Peter A Singer, Sun Life Financial chair in bioethics and director (peter.singer@utoronto.ca),
  2. Kerry W Bowman, bioethicist
  1. University of Toronto Joint Centre for Bioethics, University of Toronto, 88 College Street, Toronto, Ontario, M5G 1L4, Canada
  2. Mount Sinai Hospital and University of Toronto Joint Centre for Bioethics

    Worldwide, 56 million people die each year, 85% of these in developing countries. 1 2 Yet little is known about the quality of care they receive at the end of their lives. The movement for improving the quality of care at the end of life is primarily focused on industrialised countries. Until it is seen as a global problem for public health and health systems, efforts to improve it will not make much impact in the world.

    Public health

    Quality of care at the end of life is a global public health problem because of the large number of people involved. If each death affects five other people in terms of giving informal care and grieving relatives and friends, the total number of people affected each year by end of life care is about 300 million, or 5% of the world's population.

    Some of the interventions that could be used to improve care are in the realm of public health. These include large scale, culturally specific, educational programmes for public health workers and the public; population based strategies to destigmatise death and put it into the mainstream of health systems; and changes in social policies in relation to care for orphans.

    Improving care at the end of life will require research in public health. Of the many papers …

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