“The best places to die”

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7408.173 (Published 24 July 2003) Cite this as: BMJ 2003;327:173
  1. Peter A Singer (peter.singer@utoronto.ca), Sun Life Financial chair and director,
  2. Michael Wolfson, assistant chief statistician
  1. University of Toronto Joint Centre for Bioethics, 88 College St, Toronto, Canada M5G 1L4
  2. Statistics Canada, Ottawa, Ontario, Canada K1A 0T6

    Improving end of life care requires better population level data

    Although the oldest health statistics are based on death certificates, one of the weakest areas of health information is how we die. For example, in Canada 220 000 deaths occur each year. We know how many people died, and whether it was from cancer, heart disease, or other causes. But we have no idea how many of these people died in pain, hooked up to life support they didn't want, or alone. In the absence of systematic information and monitoring of end of life care and comparisons across health regions (or health care organisations) there is no possibility of learning what is possible (those regions with the highest ratings), nor of tracking whether improvements are occurring.

    Twenty years ago, the challenge was to engage healthcare workers in the care of the dying. Ten years ago, the challenge was to engage healthcare organisations in quality improvement efforts on end of life care. Today, the challenge is to develop systematic and comprehensive information on the quality of end of life care at the population level.

    Canada, like many countries, has a well developed health information structure—organisations such as Statistics Canada and the …

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