Among the garbled political mudslinging and habitual sorrow at England’s early exit from yet another international sporting tournament, in October we Brits learnt that there is, after all, light at the end of the tunnel with the proud proclamation that the UK is the best place in the world to die. At last, something to counter the country’s bad weather and sometimes questionable pub food in the competitive struggle for national pride. The Economist Intelligence Unit’s (EIU’s) finding came from a study of end-of-life care in 80 countries and hit the headlines during this year’s Hospice Care Week – an annual national celebration of the contribution that hospices have made, and continue to make, to the UK and to the hundreds of thousands of families that they support.
It is a proud claim, and one which owes itself to the vision of those in the UK who have fought for better end of life care over the last fifty years and more. The modern UK hospice movement began in the 1960s when a woman by the name of Dame Cicely Saunders took it upon herself to create an institution which could provide compassionate, specialist, dedicated care to people who were dying. Dame Cicely recognised the inadequacy of hospital care for the dying and had the determination to do something about it. Today every city town and village has a local hospice, mostly run as charities and privately funded through donations from the communities that they serve. Each one commands high respect for the expert care it provides, free to those who need it, and driven by the principle that a good death – one free from pain and fear, surrounded and supported by those who love and care for us – is not a luxury; it’s a fundamental human right. Over the past fifty years the UK has revolutionised end-of-life care: making it accessible, compassionate, understanding, holistic, and so much more.
But, of course, behind every success there is a counter-narrative and the EIU’s ‘Quality of Death Index’ tells us as much about the disparity of end of life care as the relative sanctity of those lucky enough to be at the top of the pile. Take Ghana, for example. Although 51st on the list, the country’s mid-table position masks the reality for the majority of the population. The development of treatments for cancer and HIV/AIDS patients has positively contributed to its overall quality of care, but EIU’s assessment of end-of-life care in Ghana is otherwise largely damming. It finds that “a range of structural flaws hinders the affordability and accessibility of Ghana’s palliative care services” specifically citing lack of research, coordination, workforce, training opportunities, funding, psycho-social support and public understanding.
The inequalities in access to care are stark. Situated slightly North East of Accra, the impressive Sweden Ghana Medical Centre offers the very best cancer care. Jutting out of the sparse hot landscape like a recently landed spaceship the ultra-modern Centre provides expert medical support to people who travel from across West Africa. But, to most, that level of care isn’t an option. What’s more, hospice care can provide the supportive, community-based services which are so vital alongside this specialist medical treatment. Perhaps one of Ghana’s best examples of this is the Accra-based Ripples Health Care, a pioneer in home-based palliative care. Ripples is an NGO which understand the power of holistic support in coping with terminal illness: mixing physical, emotional, social and spiritual. But funding is extremely tight which means that inevitably the poor are left behind. Ripples is battling to keep afloat amid a sea of need.
It’s easy to get caught up in the comparative rankings of a league table. But behind these figures – in all countries – are the people who have suffered and are suffering because of our inability to fulfil their fundamental human right to a good, peaceful, pain-free, compassionate death. Nurturing the individuals and organisations which are behind these emerging hospice-like structures is essential if we are to challenge this, for Ghana and for us all. They represent nothing less than the green shoots of a new human rights movement.
As the best place in the world to die, the UK’s role is clear. Rather than spending too much time basking in our own success it is time to take our place in challenging the geographical frontiers of the hospice care movement. The people of Ghana, Africa, and the world demand and deserve access to a good death as much as any of us in the UK does. If one of the UK’s greatest success stories during the 20th century was the advancement in a national system of palliative care which respects and responds to the needs of its people, then the challenge for the 21st is to break the global inequality lurking behind that success. The time has come for the modern hospice movement to flourish around the world. Human rights don’t recognise national borders. Nor should we.