Selman, L. (2024).
BMJ, q2815.
Here is an excerpt:
End-of-life care hasn’t just been medicalised, it has been deprioritised. Healthcare systems and education focus on cures and life extension, sometimes at the expense of quality of life and compassionate care for dying people.
In the UK, about 90% of dying people would benefit from palliative care, but 25% don’t get it. Demand is set to rise 25% over the next 25 years as lifespans increase and health conditions grow more complex, yet the sector is already critically underfunded and overstretched. Just a third of UK hospice funding comes from the state, with the remaining £1bn raised annually through charity shops, fundraising events, and donations. This funding gap sends a clear message: care for dying people is less valued than aggressive treatments and high-tech medical advances. (It’s surely no coincidence that 9 in 10 of the clinical and care workforce in UK hospices are women, reflecting a long history of “women’s work” being undervalued.)
This patchwork funding model leaves rural and other underserved communities with glaring gaps in care, particularly for children. As demand for palliative care rises, the case for proper government funding for end-of-life care provision in care homes and the community, including hospices, grows ever more urgent.
In the meantime, stark inequities exist in access to hospice, palliative, and bereavement services. Marginalised communities face the greatest number of hurdles in accessing support at a time when compassion is most needed. Ethnic minority groups, in particular, encounter language barriers, inadequate outreach, and a shortage of culturally competent providers. Thirty per cent of people from ethnic minority groups but just 17% of white people say they don’t trust healthcare professionals to provide high-quality end-of-life care.
Here are some thoughts:
Selman highlights the significant challenges and ethical concerns surrounding end-of-life care in the UK. Despite 90% of dying people benefiting from palliative care, 25% do not receive it, and demand is expected to rise by 25% over the next 25 years due to increasing lifespans and complex health conditions. However, the sector remains critically underfunded, with only a third of hospice funding coming from the government and the rest relying on charitable efforts. This funding gap reflects a societal undervaluation of end-of-life care compared to high-tech medical interventions, raising ethical questions about priorities and the equitable distribution of resources.
The article also sheds light on stark inequities in access to palliative and bereavement services, particularly for marginalized communities. Ethnic minority groups face additional barriers, such as language difficulties, inadequate outreach, and a lack of culturally competent care providers. Trust in healthcare professionals for end-of-life care is significantly lower among ethnic minority groups (30%) compared to white individuals (17%), highlighting systemic failures in addressing the needs of diverse populations. These disparities underscore the ethical imperative to ensure equitable access to compassionate, culturally sensitive care for all.
Ultimately, the piece calls for a reevaluation of societal and healthcare priorities, emphasizing the need to balance life extension with quality of life and dignity in dying. It advocates for increased government funding, culturally competent care, and a shift in values to prioritize compassion and equity in end-of-life care. These issues are not only practical but deeply ethical, reflecting broader questions about how societies value and care for their most vulnerable members.
