Quality End-of-Life Care in the Face of “A Global Moral Failing”

“Modern medicine’s focus on mastering each part of the human body and the diseases that make them malfunction has generated remarkable power to sustain life. But this focus… has neglected the dying and their suffering, as if repressing a shameful secret.” (1)

Dr. Raj conducting a home visit, Trivandrum Southern India

Dr. Raj conducting a home visit, Trivandrum Southern India

This “shameful secret,” revealed in the 2015 Quality of Death Index (2), is

no secret to Dr. M. R. Rajagopal, co-author of a new piece in the Lancet that reviews the 2015 Index. As the founder and Chairman of Pallium, India, he has brought palliative care to the fore in India through education, advocacy, and service provision. Through various initiatives, he has dramatically expanded access to palliative care in India’s state of Kerala and beyond.

Dr. Rajagopal and Pallium, India, are CFHI partners and offer CFHI students the opportunity to learn firsthand about palliative care in Kerala.

Ms. Hema and Dr. Raj on home visits Pallium India

Ms. Hema and Dr. Raj on home visits

The 2015 Index findings indicate that poor countries can, under the right circumstances, offer effective palliative care. The authors point out that while most of the top scorers in terms of palliative care provision are high income countries, several low and middle income countries (for example, Mongolia and Uganda) did score much better than certain high income countries such as Russia and Saudi Arabia. Findings in the report also indicate that investment in palliative care can actually save money for healthcare systems in the long run.

Despite notable limitations in the 2015 Index (lack of a comparable instrument for validation; the fact that it excludes countries from the study which offer no palliative care services whatsoever, to name two), the authors offer this conclusion: “The 2015 Quality of Death Index is an insightful and credible effort that laudably calls attention to the woefully inadequate care for some of the neediest and most vulnerable patients across the world, those near the end of life.”

Many thanks to Eric L. Krakauer and M. R. Rajagopal for drawing attention to this critically important issue that affects millions, and will become increasingly pressing as more of the world’s population lives longer and with a higher  number of non-communicable diseases.
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  1. Eric L Krakauer, M R Rajagopal, www.thelancet.com, Vol 388, July 30, 2016, page 444
  2. Economist Intelligence Unit. 2015 Quality of Death Index: ranking palliative care across the world. https://www.eiuperspectives.economist.com/healthcare/2015-quality-death-index
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