The modern hospice movement grew out of the work of British physician Cicely Saunders with dying patients in the late 1940s. Saunders spent more than ten years working toward the opening of St. Christopher's Hospice in London,in 1967 as a teaching and research facility facility dedicated to the physical, emotional, and spiritual care of the dying. Hospice spread to the U.S. and other countries, and with it the new field of palliative medicine.
Saunders remembers the dying patient who inspired her in 1947:
"I went to see him, and then I followed him and visited him about twenty-five times during the two months that he was dying in a very busy surgical ward. And he was David Tasma, and he is really the founder of the modern Hospice movement."
"When David died, having quietly come back to the faith of his fathers, but not seen a rabbi or anything, he made me his executor and left me this legacy. He said, 'I'll be a window in your home' and it turned out to be five hundred pounds. So that's why we have a commitment from the beginning to openness, openness to the world, openness of course to patients and their families, but openness among ourselves, and I didn't realize all of that to begin with, I just had the rather symbolic picture of a window."
"But two other things he said, or one he said and one I knew about him, were equally important, sort of pillars of Hospice, and the first was, I only want what is in your mind and in your heart. He wanted me to say something to comfort him and I was repeating Psalms, which I knew by heart; and then I said, 'Well, shall I read something to you?' and that's how he used that phrase. But thinking about it afterwards, I realized or began to realize that it could mean everything we could offer of the mind, and that would mean research and constant inquiry and constant learning and increase in understanding, but it had to be given with the friendship of the heart." (From the Oral History of Dame Cicely Saunders, 1993)
Hospice substituted pain medication on demand for the time-based dose regimens used in hospitals. Many physicians working with the terminally ill and disabled now argue that medication, including narcotics, should be administered in the amount necessary to provide patient comfort and relief; but others are deterred by the legal restrictions and social stigma attached to narcotic use.
"The greatest fear of the dying and their families is the fear of pain. Sadly, this fear has often been justified. Terminal pain is frequently treated ineptly and the public myth that death from cancer involves unremitting distress is perpetuated. The statement 'I'm waiting for the pain to start' continues to be heard.
"There are many reasons why terminal pain has been so poorly controlled. Until recently, the care of the dying has rarely been included in the training of doctors and nurses. With a few notable exceptions, medical and surgical textbooks have ignored the problems of pain control." (From: Cicely Saunders. Living with Dying: a Guide to Palliative Care. New York: Oxford University Press, 1995)
In 1996, the American Pain Society made a strong position statement regarding Treatment of Pain at the End of Life, arguing that suffering patients would turn less often to assisted suicide if appropriate pain treatment were available to them.
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