| A Short History...
Each
society throughout history has evolved special ways
of caring for the dying and the bereaved. For example: in old
China the “death houses” offered a place for the destitute
dying to stay; in New Zealand, Maori customs give practical
support for the family at the time of death, and encourage the
community to participate in the mourning rituals; in East
Africa, wise elders give both practical and spiritual support
to the dying and bereaved.
In Western Europe and North America
until the 19th Century, caring for the dying and the bereaved
was seen primarily as the job of the family and the church. In
the last 100 years, dying has increasingly been seen as a
medical event, not as a milestone in the life and history of a
family.
In the United States today, over
3,000 local hospice and palliative care programs
offer specialized care to people suffering from fatal
illnesses, such as cancer. Good hospices are rooted in, and
responsive to, the communities they serve, and to the people
who live and die there.
Competence . . .
Communication . . . Compassion . . .
hallmarks of excellence in hospice care.
...from the Middle Ages
to the 21st Century
Middle Ages: Religious orders establish “hospices”
at key crossroads on the way to religious shrines like
Santiago de Compostela, Chartres and Rome. These shelters
helped pilgrims, many of whom were traveling to these shrines
seeking miraculous cure of chronic and fatal illnesses, and
many of whom died while on their pilgrimages.
16th-18th Centuries: Religious orders offer care to
the sick (including the dying) in locally or regionally based
institutions. Most people die at home, cared for by the women
in the family.
1800s: Madame Garnier of Lyon, France opens a
“calvaire” to care for the dying. In 1879 Mother Mary
Aikenhead of the Irish Sisters of Charity opens Our Lady’s
Hospice in Dublin, caring only for the dying. By the late 19th
Century, the increase in municipal or charitably-financed
infirmaries, almshouses and hospitals, and the expansion of
medical knowledge, begins the process of “medicalizing” dying.
(By the mid-20th Century, almost 80% of people in the U.S.A.
die in a hospital or nursing home.)
1905: The Irish Sisters of Charity open St.
Joseph’s Hospice in East London, to care for the sick and the
dying.
Early 1900s: In London, St. Luke’s Hospice and the
Hospice of God open to serve the destitute dying.
1935-1990s: Interest grows in the psychosocial
aspects of dying and bereavement, sparked by the work of
Worcester, Bowlby, Lindemann, Hinton, Parkes, Kubler-Ross,
Raphael, Worden and others.
1957-67: Cicely Saunders, a young physician
previously trained as a nurse and a social worker, works at
St. Joseph’s Hospice, studying pain control in advanced
cancer. Here Dr. Saunders pioneered in the regular use of
opioid analgesics given “by the clock” instead of waiting for
the pain to return before giving drugs. This is now standard
practice in good hospice and palliative care.
1967: Dr. Saunders opens St. Christopher’s Hospice
in London, emphasizing the multi-disciplinary approach to
caring for the dying, the regular use of opioids to control
physical pain, and careful attention to social, spiritual and
psychological suffering in patients and families.
1968-75: Many hospice and palliative care programs
open in Great Britain in the years following, adapting the St.
Christopher’s model to local needs, offering in-patient and
home care.
1974: New Haven Hospice (now Connecticut Hospice)
begins hospice home care in the United States, caring for
people with cancer, ALS and other
fatal illnesses.
1974-78: Hospices and palliative care units open
across North America. These include Hospice of Marin in
California, the Palliative Care Unit at the Royal Victoria
Hospital in Montreal, the Support Team at St. Luke’s Hospital
in New York City, and Church Hospital Hospice in Baltimore.
1980s: Hospice care, usually emphasizing home care,
expands throughout the United States. Medicare adds a hospice
benefit in 1984. Hospices begin to care for people with
advanced AIDS.
1990-2000: Over 3,000 hospices and palliative
care programs serve the United States. There is
well-established hospice and palliative care in Canada,
Australia, New Zealand, and much of Asia and Western Europe.
Hospice and palliative care is now available in over 40
countries worldwide, including many less-developed nations.
World Health Organization
sets standards for palliative care and pain control, calling
it a “priority.” But studies show that most patients still
receive little or no effective palliative care, and pain is
often very poorly controlled, primarily due to lack of medical
knowledge, to unfounded fears of addiction, and (in
less-developed nations) to shortage of opioids.
21st Century: The
principles of good hospice and palliative care are understood
and accepted, and all patients with advanced illness, and
their families, are assured of competent and compassionate
care in their homes, in nursing homes and in hospitals. |
