Palliative care--evolution of a vision.

MEDICINE & HEALTH/RHODE ISLAND Dame Cicely Saunders, MD, OM, DBE, established the first modern hospice, St Christopher’s, in 1967 in London. Prior to that time, terminally ill hospitalized patients did not “fit” the mission of hospitals – to cure. Physicians equated terminal illness with failure; thus terminally ill patients were often “placed... at the end of the hall.” Dame Cicely took it upon herself to help these patients, usually suffering from advanced cancer, with the goal of facilitating dignity and comfort as death approached. She founded St. Christopher’s Hospice, believing that dying people have the right to an improved quality of life, using pain control and social and emotional support to achieve psychological and spiritual contentment. Dame Cicely’s vision for end of life care soon spread to the United States where it became known as “palliative care.” Dame Cicely’s apprentice at St. Christopher’s, Florence Wald, MN, brought the new vision for end of life care to the United States, establishing the Connecticut Hospice in 1974. Known thereafter as “the mother of the American hospice movement,” Ms. Wald not only established an inpatient hospice similar to St. Christopher’s, but also developed the first home care program for terminally ill patients in the United States. From these small beginnings the American hospice movement grew rapidly. By the year 2000, hospice organizations in the US were serving an estimated 105,500 patients annually — 18,500 inpatients, and 87,000 home care clients.3 Since its articulation at St. Christopher’s four decades ago, the basic, comprehensive approach to palliative care has not changed, but the definition of palliative care has evolved – it has broadened significantly – as have unresolved issues of palliative care.