Is it Better to Die in America or England?

From Ezekiel Emanuel:

Death in America is frequently compared unfavorably with death in other countries, where people may not be as focused on extending life with every possible intervention. As Ian Morrison, the former president of the Institute for the Future, once wrote: “The Scots see death as imminent. Canadians see death as inevitable. And Californians see death as optional.” He added, “Americans and the American health care system are uncomfortable with the inevitability of mortality.” 

But is it actually true that end-of-life care in America is more invasive and expensive than in other countries?



We just published in the Journal of the American Medical Association the first systematic international comparison of end-of-life care for patients dying with cancer. We focused on cancer because, in developed countries, it is the second leading cause of death and the most expensive per patient. The good news is that, despite perceptions, the United States is actually not the worst when it comes to caring for these patients. In fact, on some important measures, we provide the best in end-of-life care.

...

the focus should be less on reducing end-of-life spending and more on moving away from fee-for-service medicine, which incentivizes more care rather than better care....



Last, and most important, there is a reason for hope. While the process has been slow, the United States has improved care at the end of life. In the mid-1980s, more than 70 percent of American patients who died with cancer did so in the hospital. We have cut that number by over two-thirds. And the use of chemotherapy near the end of life, while still high, is also lower than in the past. Interestingly, the trends we observed suggest improvement in what the United States does well, but also some worsening in using the I.C.U. more.

But we can and should do better. We should start by providing universal access to the highest-quality palliative care as the default for all Americans near the end of life.

Is It Better to Die in America or in England? - The New York Times