Hospice, History Of

Caring for the dying has been a human responsibility throughout recorded history. The word “hospice” comes from medieval institutions that offered practical and spiritual assistance to pilgrims on their way to the Holy Land. In the late 19th century, the Irish Sisters of Charity applied the term to those nearing the end of life's journey when they opened Our Lady's Hospice in Dublin, Ireland, and, later, St. Joseph's Hospice in London, England.

Subsequently, the word “hospice” has come to designate both a philosophy of care and programs specializing in end-of-life care. In this sense, hospice services are designed primarily to provide care for those who are dying or who have no reasonable hope of benefit from cure-oriented interventions, along with their family members.

Founding of the Modern Hospice Movement

Cicely Saunders (1918–2005) led the establishment of the modern hospice movement. After training as a nurse, a chronic back problem prevented her from functioning in that role. Saunders then retrained as a medical social worker and took a position in an oncology unit at St. Thomas's Hospital in London.

Meeting and eventually falling in love with an agnostic Polish Jew who had inoperable cancer helped Saunders crystallize some of her ideas. David Tasma was 40, separated from his family and country, in great physical pain, lonely, and dying after what he thought of as an unfulfilled life. Reflecting on his situation spurred Saunders to ask what she could do to relieve the suffering and meet the needs of others like him.

As her interests matured, Saunders volunteered at St. Luke's in Bayswater, a well-established home for the dying. Here, she noted that pain-killing drugs were given at regular intervals instead of waiting until the pain returned. Also, whenever possible, injections were avoided and drugs were given orally, a method that was easier for patients and for family members caring for patients at home. These basic principles later became fundamental in hospice care.

When Saunders shared her desire to work with dying patients with a physician friend, he told her there was much to learn about pain control and the way to do it was to study medicine because it was doctors who desert the dying. She soon began studies that led to her medical degree. After qualifying in April 1957, Saunders obtained a research scholarship in pain research at St. Mary's Hospital and began to implement her ideas at St. Joseph's Hospice, Hackney. Before long, she determined to organize a body of like-minded supporters, develop a plan for an independent hospice facility, raise money, purchase a site, and build the new facility.

St. Christopher's Hospice and Further Developments in England

St. Christopher's Hospice in southeast London opened in 1967 as a purpose-built, inpatient facility designed to implement the new goals of excellence in clinical practice, research, and education in care of the dying. Although a private charitable foundation independent of the National Health Service (NHS), St. Christopher's maintains good relations with the NHS and receives funding for patients transferred from NHS hospitals.

Like many early hospice programs, St. Christopher's primarily serves patients with far-advanced cancer, but has always accepted some individuals with motor neuron and other diseases. For everyone, care is addressed to whole person, including physical, psychological, social, and spiritual dimensions, and to their family members.

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