Ask most Canadians and they will tell you that Canada is the best country in the world to live in and will probably want to stay here until their life ends.  However, according to the Economic Intelligence Unit (EIU), Canada is far from the best country to die in.  Earlier this month, the EIU released a report that measured the Quality of Death for 40 countries in the world.  Tied with the United States in 9^th place, Canada has a great deal of work to do if our baby-boomer population wants to have peace of mind during their final days. 

 The Breakdown
Canada’s overall ranking has to do with four specific criteria.  The four categories along with their weighted value and Canada’s ranking (out of 40) for each category is as follows:

 1) Basic End-of-Life Healthcare Environment (20%) – ranked 20^th

2) Availability of End-of-Life Care (25%) – ranked 9^th

3) Cost of End-of-Life Care (15%)  – ranked 27^th

4) Quality of End-of-Life Care (40%) – ranked 5^th 

 Looking at these results, it is clear there is something wrong with this picture.    Ranking 5^th place worldwide, Canada has one of the highest quality end-of-life care available yet can’t seem to provide a high quality of death overall.  It’s not because we don’t have the resources.  We rank highest in the availability of painkillers and since 2008, all 17 of our medical schools are obligated to train physicians in palliative care.

So what’s the problem?   
The healthcare environment and cost to Canadians poses a dramatic barrier in achieving an overall high quality of death. 

 Due to Canada’s outstanding landmass, the palliative services that Canada does offer cannot support our citizens. According to the report, Canadians, like many regions in Africa, rely more on interspersed community based support from volunteers, families and friends for palliative care compared to other developed countries.   Sadly, as a result, less than 5% of Canadians receive adequate end of life care services.

 With little to no government funding, palliative services are costly.  The refundable tax credit that is available for respite or informal caregivers is peanuts compared to the actual cost of looking after a palliative patient.  And, places that offer palliative care services like the West Island Palliative Care Residence has to raise its remaining balance of $1,300,000 from donations each year, after it receives its portion of the operating budget from the government.

 When it comes to other countries, Canada ranks lowest in our willingness to discuss death.  From a culture where death has become more of a medical phenomenon, Canadians have distanced themselves from the holistic experience of death.

 So what’s next?
Hopefully at this point, Harper’s eyes have been opened.  It’s been 3 years since he disbanded the End-of-Life Care Secretariat and we still haven’t seen a formal national policy on palliative care. 

 Canadian citizens need to step up their awareness of what palliative care has to offer and with that, comes an understanding of the need for discussions about death.  Talking about death is not an easy subject to broach but when it comes time to prepare for the inevitable, it is justifiable to question how an individual is going to experience their end of life.  In Canada, when the answer is that they probably won’t experience it the way they want to, then something needs to be done.

 You could always move to the UK, who are currently ranked #1, but you shouldn’t have to. In the end, when Canadians experience end-of-life care, it’s really good and that is definitely something we should be proud of. The trained professionals are available; making them accessible is the next step.

 For the full report from the EIU and the list of indicators for each category click here.