What about the quality of palliative care and health care in Europe?

Prof. dr. Wim J.A. van den Heuvel

Palliative care works, so why is it rarely used? This question is recently raised by Morrison and Jacobson (1). Is it because it is the most difficult health care profession and therefore requires the highest qualified, all-round health care professionals? As articles in this issue of PALIAŢIA argue indeed expertise is needed. Expertise on communication, pain management, when to intervene or not and – if to intervene – how exactly (which opioid cocktail, which surgery technique etc.) and how is it financed. Or could it be, that palliative care mirrors the overall quality of care in a country?

If one wants to assess the quality of care of a country – which could be important to do when a pandemic like covid-19 strikes – what to look at?

Life expectancy, healthy ageing, the number of doctors/nurses/hospitals?

Or the money spend on health care as % of the Gross Domestic Product?

Research shows that the amount of money spend is not related to life expectancy or healthy ageing (2,3).

Another way to assess the quality of care in a country could be to look at palliative care in that country. In such case the first question maybe: “how many health care professionals are specialised in palliative care (accordingly international standards)?” followed by the question “is palliative care an integrated part of the health care system (organisationally and financially)?”

Recommendations of WHO and the Council of Europe in the last decade indicate that the availability and quality of palliative care is still disputable (if existing at all) even in Europe. So, there may be a problem with the quality of health care, including palliative care.

Maybe the best way to look for quality of care is to look back into the history of medicine, as done by S.B. Nuland (2). His historic analysis indicates that the essential meaning of what care means is lost over time and this also applies to health care professionals and health care organisations. Yes, we have our heroes in medicine and care: Vesalius, Pare, Harvey, Laennec, Semmelweis, Virchow, Nightingale.

But the most impressive one is Hippocrates. Why? Read the Oath of Hippocrates; the full one (not the abbreviation) and answer the questions ‘is this what health care professionals do these days?’ and ‘is this what health care organisation facilitate?’ The answers may stimulate all to realise better quality in health care.


  1. Morrison RS, Jacobson M. Palliative care works, so why is it rarely used? Follow the money. Available from: https://www.statnews.com/2021/03/23/palliative-care-works-so-why-is-it-rarely-used-follow-the-money/. [Accessed 1th April 2021].
  2. Heuvel WJA van den, Olaroiu M. How Important Are Health Care Expenditures for Life Expectancy? A Comparative, European Analysis. Available from: DOI:https://doi.org/10.1016/j.jamda.2016.11.027.
  3. Heuvel WJA van den, Olaroiu M. Determinants of Healthy Ageing in European countries. Gerontology and Geriatric Medicine 2019;4. Available from: DOI: 10.19080/OAJGGM.2019.04.555649
  4. Nuland SB. Doctors. The biography of medicine. A.A. Knopf Inc.:1988.