Suffering at the End of Life: the State of the World

Oct 28, 2013
Our experience of dying may vary considerably depending on factors such as the cause of our death, whether we have family or friends to care for us, where we live in the world and the availability of good healthcare. This report was published to coincide with the first World Hospice and Palliative Care Day in 2005. Chapters include: 'Suffering at the end of life -- is it inevitable?'; 'Suffering at the end of life -- a picture of inequality'; 'Hospice/palliative care -- a response to suffering at the end of life'; and 'Global palliative care -- the way ahead'.
  • Nowhere is global inequality more apparent than when looking at life expectancy. People living in the least developed countries have a much lower life expectancy at birth than those in high-income countries and also a higher infant mortality rate.
  • Developing countries have two-thirds of the global disease burden, but only around 5% of the world's resources for controlling and combating disease, such as doctors, nurses, drugs, equipment and funds.
  • Morphine and other pain-killing medicines are essential to reduce suffering at the end of life. At present, there are huge differences in the availability and use of such drugs with the consumption of morphine as a prescribed medicine much lower for people living in developing countries than in developed ones. Cost is one reason. Half the worlds population lives on less than US$2 a day, so government action to make the drugs affordable is crucial. Low use is also a consequence of some governments restricting the use of morphine for medicinal purposes and lack of education or suspicion on the part of those who may prescribe it.
  • Given morphine's proven place in the relief of suffering, its potentially low cost and the availability of clear, simple policies and advice for its use, failure to adopt it on a wide scale is unacceptable.
  • Hospice or palliative care has been identified as a relatively cheap and effective means of meeting the needs of those nearing the end of their lives, thereby ensuring that they do not suffer unnecessarily. Uganda was the first African country to make palliative care for those with AIDS and cancer part of its national health plan, including appropriately trained service providers and easily available, affordable morphine.
  • It is estimated that in an ideal world 100 million people could benefit from basic palliative care. This number is made up of over 33 million dying people (60% of the total number dying in the world each year) and their 66 million family members, companions or carers (based on a conservative estimate of 2 people giving care and support for every person that dies).
Linked Data show/hide