It has been announced that

'The UK ranks first in the 2015 Quality of Death Index, a measure of the quality of palliative care in 80 countries around the world released today by The Economist Intelligence Unit (EIU). Its ranking is due to comprehensive national policies, the extensive integration of palliative care into the National Health Service, a strong hospice movement, and deep community engagement on the issue. The UK also came top in the first Quality of Death Index, produced in 2010. The Quality of Death Index... is based on extensive research and interviews with over 120 palliative care experts from across the world.'

The EIU placed the UK first in 2010 as well, and the researchers' most recent summation of palliative care in the UK (p75) is a ringing endorsement:

'A pioneer in palliative care, the United Kingdom maintains cutting-edge services and is the world's best location to receive terminal care and pain-alleviating treatment.'

'Education is a strong point. A wide range of publicly-funded generalist courses are available for students and mid-career trainees. Specialist courses are abundant and free, and palliative care is a stand-alone academic speciality. Consultation, hospitalisation and medications are free. Generous subsidies provide long-term funding for hospices and specialised units.

'Patients may have to make partial contributions for home care. Guidelines are regularly reviewed and consistently enforced. Respect for patient rights is central to medical culture, from transparency in clinical disclosure to availability of psycho-social support.

'Transparency is a hallmark of the UK system, which is receptive to constructive feedback and displays a commitment to understand grievances and improve services. The media has investigated cases of substandard care and raised general public awareness and palliative care is now seen as a national priority. Community engagement is central to the NHS model, and trained volunteers assist professional teams in everything from patient care to fundraising.'

The report also considers (p48) how the provision of high quality end of life care sits with the concept of euthanasia):

'...while the right to die is a reality in some countries and the subject of debate in many others, advocates for palliative care argue that this reflects an inability to care adequately for people at the end of their lives. "Euthanasia is not a substitute for palliative care," says Ms Callaghan [of Palliative Care Australia].

'Increasing debate about assisted dying represents a failure for the field, says Dr Byock. "The reason that assisted suicide laws are polling so well these days is that the public has a well of fear, anger and distrust about the care they will receive and how they and their families will die," he says. "And the hard truth is that this is well founded."

'In his book Being Mortal, writer and surgeon Atul Gawande suggests that the high number of people seeking assisted suicide in the Netherlands is not a measure of success. "Our ultimate goal, after all, is not a good death but a good life to the very end," he writes.

'Of course, there will always be cases where palliative care cannot end suffering. Dr Gawande goes on to say he would support laws permitting prescriptions allowing people to end their lives when suffering at the end of life is unavoidable and unbearable.'