Report: Views and Experiences with End-of-Life Medical Care in Japan, Italy, the US, and Brazil

In partnership with The Economist, the Kaiser Family Foundation conducted a cross-country survey of adults in Japan, Italy, the United States, and Brazil about people’s views and experiences related to aging and end-of-life medical care. These four countries are each at a different stage of population aging. On one end of the spectrum, Japan is the world’s oldest country (27 percent are ages 65 and older) and has the longest life expectancy along with a shrinking overall population . Italy is not far behind, with a population that is 21 percent elderly, the largest proportion among European nations . The United States is in the middle of the aging trajectory, with the share of the population ages 65 and older expected to grow from about 15 percent in 2015 to 24 percent by 2060 . At the other end of the spectrum, Brazil has a relatively young population today, but due to recent changes in mortality and fertility, the share of the population that is elderly is expected to double (from 7 percent to 14 percent) by 2031.

Four-Country Comparison: Five Key Takeaways

1. Despite the demographic and cultural differences between these four countries, there are some common themes that emerge from the survey results. For example, in each country surveyed a majority say their government is not well-prepared to deal with the aging population, and residents are more apt to give their health care system a negative rating than a positive one when it comes to providing end-of-life care. In another area of commonality, majorities in all four countries express a preference to die at home, but fewer say they expect to die at home than say that is their wish. Large majorities across countries also feel that doctors should be completely honest with seriously ill patients, regardless of their prognosis.
2. When asked about priorities for health care at the end of people’s lives, majorities across three of the four countries (Japan, Italy, and the U.S.) prioritize reducing pain and stress over extending life as long as possible. Similarly, when asked what is important in thinking about their own death, “living as long as possible” ranks last on a list of seven possible factors in these three countries. Brazil stands out as an exception on these measures, with a larger share placing a priority on extending life, both in general and for themselves personally.
3. When it comes to discussing and planning for the end of life, majorities across countries say death is a subject that is generally avoided rather than something people feel free to talk about. However, the U.S. stands out from other countries, with higher shares reporting having conversations with loved ones about their end-of-life wishes and having these wishes written down.
4. About one in five adults in each country surveyed say they were involved in helping to make medical decisions for a loved one who died in the past five years. Acting as a medical decision-maker for someone who died appears to influence people’s own personal end-of-life preparations; in Japan, the U.S., and Brazil, those who served as a medical decision-maker for someone else are more likely to say they’ve had a serious conversation with a loved one about their own end-of-life wishes, and to have those wishes in a written document.
5. While most of those who experienced the death of a loved one report positive experiences overall, some negative reports are not uncommon. Majorities across countries say their loved one’s wishes about medical care were followed, that their spiritual and religious beliefs were respected, and that they died with friends or family present. Still, substantial shares of those who experienced the death of a loved one (particularly in Japan and Brazil) say the person experienced more pain than was necessary (about four in ten in Brazil, about three in ten in Japan, and a quarter in the U.S. and Italy) or that they did not have access to appropriate medical treatments for prolonging life (about four in ten in Japan and Brazil, one-third in Italy, and 18 percent in the U.S.). About one in five of those experiencing the death of a loved one across countries say their loved one received medical care that placed an undue burden on the patient’s family.

Access the report here