Seeking good deaths

Seeking good deaths

The idea of a good death may seem like an oxymoron.

But if you stop to think about it, it’s what we all wish for at the end of life. According to an article published in the British Medical Journal in 2000, there are 12 key principles to a good death. Among them are pain control, knowing when death is coming and retaining some control over what happens, and being afforded dignity and privacy in your final moments.

Not surprisingly, having the choice of where to die was also on the list. Although most people would prefer to die at home, this is not the reality for most patients. A new CIHI analysis shows that 63% of the 18,427 adult Atlantic Canadians who passed away in 2007–2008 died in hospital. Of those, approximately 59% received palliative care.

Health Care Use at the End of Life in Atlantic Canada found that this population spent more than 475,900 days in hospital—averaging about 26 days there in the last 360 days of their lives.

Data from Statistics Canada shows that in 2007, two-thirds (67%) of Canadians died in hospital.

Despite being the preferred location of most end-of-life patients, home may not always be the most appropriate place to die if sufficient support is not available to their caregivers.

Faced with an aging population, and what one Canadian senator deemed a looming palliative patient tsunami, we need to assess our health and social systems’ capacity to deal with future end-of-life care.

This is particularly true in Atlantic Canada, where residents are older than in other parts of the country. By 2031, seniors will comprise a quarter of the population. This will effectively see the wave hit the region 25 years ahead of the rest of the county.

Drawing on vital statistics and hospital administrative data, the intent of this report is to provide health program managers, ministry staff, policy-makers and others with information to help deliver the most appropriate end-of-life care for their residents. Understanding where individuals die is important in planning and providing care at the end of life. Identifying patterns of hospital use and location of death can help to better tailor health care services for end-of-life patients.

"We wanted to spotlight end-of-life care in our region, as this essential health service is often overshadowed by the competing priorities of other acute health areas," says Terri Ann Brophy, Special Projects Lead in CIHI’s Atlantic office.

"We know that meeting the complex needs of these patients is a huge challenge for health planners and providers. And while death is our inevitable fate as humans, we hope this report provides information that helps ensure more of these are good deaths."