Cicely Saunders and the Birth of the Hospice Movement

Today hospice care is a normal part of the health system in many countries. It began with one person’s response to the suffering of dying patients. This article tells that story and how it reached the United States.

Who was Cicely Saunders?

A British woman who trained as a nurse, then as a medical social worker, and finally as a doctor. She was born in London in 1918 and, according to King’s College London, died at St Christopher’s Hospice on July 14, 2005. Hektoen International notes that she held that “a society which shuns the dying must have an incomplete philosophy.”

Who was David Tasma?

A dying patient who changed her course. KCL says he was a Polish man she cared for as a medical social worker in the 1940s. When he died in 1948, he left her £500 and the wish that he be “a window” in her future home for the dying. Sources differ on where and when they met. The openDemocracy essay by historian David Clark says 1947, in a London hospital. The hospice’s entrance still has a plain pane of glass in memory of that window, according to MyHero.

What did she learn about pain?

That it should be prevented, not chased. Hektoen says that at St Joseph’s Hospice, an older home for the dying, she first saw morphine given on a schedule instead of “as needed,” and her thinking moved from responding to pain to preventing it. Sources describe her concept of “total pain” as covering physical, emotional, social, and spiritual suffering. KCL adds practical struggles. She is said to have coined the term after hearing a patient say that “all of me is wrong,” according to the openDemocracy essay.

What was St Christopher’s?

The first modern hospice. It opened in 1967 in Sydenham, south London. KCL says it was the first to combine teaching and clinical research, pain and symptom control, and compassionate care. Hektoen’s account of the US movement says Saunders stressed that “hospice” was not only a type of building, but a concept of care. She had many predecessors. Hektoen notes that the Hospices de Beaune in France were founded in 1443, and that Irish Sisters of Charity opened St Joseph’s Hospice in London in 1902.

How did it reach the United States?

Through Yale. NHPCO’s timeline says Saunders lectured at Yale in 1963, and that in 1965 Florence Wald, then dean of the Yale School of Nursing, invited her to be a visiting faculty member. Wald later spent time at St Christopher’s, in 1968 according to NHPCO and in 1969 according to New World Encyclopedia. Wald then led a team with two pediatricians and a chaplain, and Connecticut Hospice in Branford, Connecticut, opened in 1974, Hektoen reports. Some accounts date the founding effort earlier, so the exact year depends on what counts as the start.

How did hospice come to Medicare?

After years of debate in Congress. Provider magazine says lawmakers authorized a temporary Medicare hospice benefit in 1982, and four years later made hospice payment permanent and extended it to patients in nursing facilities. Hektoen’s US account dates the 1982 addition to September 3 and calls it one of the movement’s biggest victories. For how the benefit works today, see Medicare and Hospice Coverage.

What about palliative care?

It grew from the same ideas. New World Encyclopedia says Canadian physician Balfour Mount coined the term “palliative care.” The openDemocracy essay notes that British medicine formally recognized the field in 1987, twenty years after St Christopher’s opened. See Hospice vs. Palliative Care.

Where can I learn more?

See What Is Hospice?, Types of Hospice Care, and Before You Need Hospice.