History of Hospice

Most people would like their loved ones to live as well as possible as long as possible even with an incurable disease. At some point, however, aggressive treatment of the loved one's disease or diseases may force them to decide that the burden exceeds the benefit. This frees them to choose quality over simple length of life.
 
Treatment of symptoms continues and may include chemotherapy and anti-biotics, but their purpose is palliative, that is, only to relieve pain. Care in the last phase of life becomes more comprehensive rather than less, so that with a new perspective the patient and family can focus more on maintaining comfort for as long as the patient has left. This emphasis on quality of life gives them the opportunity to reconcile both with each other and with God and to grow in their awareness of deeper spiritual values. By saying good-bye, grieving together, and offering each other hope for a future together, they share one of the most important events in the life of the family. The purpose of hospice is to make this possible.
 
The hospice movement is considered by some to be a post-modern reaction to the modernist desacralization of the person and community. The triumphalist attitude toward the conquest of nature and disease has brought improvement in standards of living but has undermined the traditionalist reverence for the human transition from this life to the next. All the world religions at their core have viewed death as a natural phase of life, as something that should be accepted without fear and even as the greatest moment of one's life.
 
The hospice movement to avoid the prolongation of suffering from useless effort to conquer death or from the opposite extreme of ignoring the dying was not invented thirty years ago in America. The culture of accepting the inevitable in order to focus on easing the path from one phase of life to another has roots extending back centuries and even millennia to periods when dedicated spiritual leaders gave nurturing refuge to those in need because God loves every person and because hospice is a beautiful means for care givers to return this love. This ancient tradition has now been revived in the modern hospice movement in which caring for the dying is not considered to be so much of a burden as an opportunity to ease the path of one's fellow beings from this world to the next.
 
The modern revival of the hospice concept came to fruition during the cultural turmoil of the 1960s, when Dr. Cicely Saunders defined and pioneered a hospice program in 1968 at St. Christopher's Hospital in London, and when the next year Elisabeth Kubler-Ross published her On Death and Dying in America, which now ranks with Rachel Carson's book, The Silent Spring, from the same era as a classic in developing new perspectives on life and death.
 
Both of these seminal thinkers focused on the power of new technologies and chemical processes in modern civilization. At the time, the greatest frontier in medicine was cancer research, and Dr. Saunders began her career by improving methods of pain control in terminally ill cancer patients. This developed into the concept of "sheltering" the dying from pain by new techniques of palliative care, which then expanded naturally into the idea of holistic treatment of all terminal pain, including the psycho-social and the spiritual.
 
The profound teaching of Dame Cicely Saunders throughout her active professional life is indicated by her often quoted insight: "The community needs the dying to make it think of eternal issues. We are indebted to those who can make us learn such things such as to be gentle and to approach others with true affection and respect." She had returned full circle to the original concept of hospice that has existed in all cultures since the beginning of human life.
 
The concept and practice of hospice care as a new, holistic discipline is a permanent part of modern life, because it is an important response to changing cultural conditions. Perhaps the most important are: 1) a reaction against the impersonal secularization of society and the accompanying desacralization of life, as discussed above; 2) the renewal of spirituality in all religions as part of a broader cultural transformation; 3) greater awareness of the availability of assisted suicide and of hospice care as a better alternative at the end of life, similar to the choice between abortion and adoption at its beginning; 4) organized grass-roots efforts to provide life-affirming answers to such ethical questions; 5) demographic changes evident in the burgeoning elderly community, combined with the emergence of an educated and organized majority demanding better value and service through alternative methods of care and treatment; 6) the revolution in all fields of social science toward emphasis on quality of life; 7) technological and pharmacological advances that make quality improvement possible; and 8) advances in the health care delivery system demanded by the tax-payers who want better care at a fiscally and politically sustainable cost.
 
The unique purpose of hospice, as distinct from the curative medical model, is to provide appropriate care and a caring community of family and hospice team members sensitive to the patient's needs so that the person cared for may remain in familiar surroundings and better prepare mentally and spiritually for the major transition from this life to the next.