Benjamin Franklin achieved immortality in the 18th-century campaign for independence of the British colonies in North America. But he would equally have achieved immortality through his truism that “in this world nothing can be said to be certain, except death and taxes”. The latter may be circumvented through the resourcefulness of taxation experts, but death, despite the resources of modern medicine, remains an unavoidable outcome for us all.
This inevitability, combined with the fear of an undignified or painful death, has imposed a widespread dread of dying among the community and occasioned calls for active euthanasia. It has also spawned the ascendancy of palliative medicine, with its noble aim of supporting a good death: painless, dignified and peaceful.
A feature of modern health care is its penchant for outcomes, reports and league tables, as exemplified by the many reports on the quality of health, ill health and health services by national agencies such as the Australian Institute of Health and Welfare and international agencies such as the World Health Organization. In view of this obsession, it seems only natural that we are now regaled with a new quality index focusing on dying!
* Mayor S. UK is ranked top out of 40 countries on quality of death thanks to hospice network. BMJ 2010; 341: c3836.
Devised by the Economist Intelligence Unit, the business information arm of news magazine The Economist, the quality-of-death index ranks 40 countries using 24 indicators such as public awareness of end-of-life care and status indicators such as whether a country has a government-led palliative care strategy.* Using this approach, Australia ranks a very close second behind the United Kingdom; Denmark, Italy and Spain are in the middle, and China, Brazil and India rest at the bottom of the quality-of-death hierarchy.
Despite this reassuring news, most Australians would probably identify more closely with the sentiments of Woody Allen when contemplating death: “It’s not that I’m afraid to die, I just don’t want to be there when it happens”.
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