Although the wishes of patients to be cared for and die in preferred places are well documented, it is not always clear what characteristics are used to classify the place of death. According to the National End-of-Life Care Intelligence Network (NEoLCIN), a good indicator of the quality of end-of-life care is when the place of death and preferred placed of death are the same (Public Health England (PHE), 2019). Therefore, patients' quality of life is arguably a precursor to a dignified death. The profile of a place of death includes a number of locations with specific definitions. The place of death is recorded by the Office for National Statistics (ONS), which examines death certificates data and lists patients' own homes, hospitals, hospices and care homes as the main places in which patients die. However, the description of own home only considers where the person usually spends most of their life and, therefore, often excludes nursing and care homes or other institutions where people live communally (Office for National Statistics, 2019). Hospitals include both NHS-based and private ones, as well as acute and community health and care trusts. Deaths recorded in care homes include both residential and nursing homes, which are run privately or through the NHS and local authorities. However, there is no real specification of length of stay in order for this location to be considered as the place of death. Although the NEoLCIN includes hospices as places of death, this definition is broader than that of traditional hospices, to include the many independently funded charities such as Sue Ryder, Marie Curie and other specialist caring centres. Although these are independent institutions, patients can move from across these to NHS hospitals and vice versa, creating a challenge for defining the patient's place of death. Further, it is also not clear how places of death are recorded, given that hospices are now also providing care in the community, hospitals and nursing/care homes.
The classification of place of death as ‘other’ locations is both interesting and confusing. Under ‘other’ are places that exclude all the above mentioned places as well as schools, universities, detention centres, monasteries, prisons, etc. Surprisingly, psychiatric hospitals are listed under ‘other’, as there is no real explanation as to how they differ from mainstream hospitals within the NHS. The classification is intriguing, but the real point is the confusion that arises from such a broad classification, when these institutions are so distinct from each other. It is also possible that the nature and type of death vary and ought to be recorded accordingly. The main issue and point of concern here is the use of such an ‘othering concept’, which, as is often the case, conveys a poor message about the lack of importance of death occurring in such locations. The argument is that, such deaths or locations are not perceived as equally important and do not, therefore, deserve a specific category of their own. The issue with using ‘other’ here is influenced by the sociological understanding that othering is often used to denote undesirable objectification of other people, and, therefore, when used with places of death, portrays these places in a negative way.
While places of death are important to understand, it is even more important that there is an accurate record of them and that each location is classified individually. While we understand that places of death mentioned in this article are linked to palliative care deaths, it is acknowledged that other places of death, for example, in the case of airway, motorway or shipping/sailing accidents military- or war-related and terrorist-inflicted deaths, are also being recorded.
Finally, what is important for every health professional in the community is whether the place of death for each patient corresponds to their preferred place of death, which, importantly, requires prior understanding of patient preferences.