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Centenary of the woman who revolutionised care for the dying

Until 1967, doctors often saw dying as a failure and something they shouldn’t play an active role in. This was until St Thomas’ graduate Dr Cicely Saunders pioneered a complete change in the treatment of people at the end of life, and opened a ground-breaking hospice.

During WW2, despite the disapproval of her parents, Saunders trained at the Nightingale School of Nursing at London’s St Thomas’ Hospital (now part of King’s Faculty of Nursing, Midwifery & Palliative Care). She then became a hospital almoner – the equivalent of a social worker today – and met a Polish man who changed the course of her life.

Patient David Tasma was a Jewish refugee from the Warsaw ghetto who was dying of cancer. He and Saunders discussed the idea of creating a home-like environment where those coming to the end of their lives could be offered hope and comfort. When David died, he left a sum of money to Saunders that could be used to help make their vision a reality.

Saunders developed the concept that end-of-life environments should pay attention to people’s social, emotional, psychological and spiritual needs. She described ‘a team who work together to relieve where they cannot heal, to keep the patient's own struggle within his compass and to bring hope and consolation to the end’. She suggested that they should also take a systematic approach to controlling symptoms, when standard hospital practice at the time was to give inadequate and infrequent injections of morphine that left many patients in uncontrolled pain.

The birth of the modern hospice

 

After planning, building and fund-raising for her own hospice, and taking time out to complete a medical degree at St Thomas’, Saunders admitted the first patients to St Christopher’s in south-east London in 1967. The hospice combined clinical research, expert pain and symptom relief with holistic care and support for both patients and their family and friends. It was a place where patients could garden, write, talk and get their hair done – very different from any other hospital or hospice setting at the time.

This is widely recognised as the birth of the modern hospice movement.

Throughout her career, Saunders continued to evaluate new approaches to care and suggest improvements. This included carrying out studies demonstrating that morphine given orally in the right dose, at the right interval, could provide constant pain relief without addiction. She also oversaw the development in 1969 of the first service to deliver care to patients in their own homes and worked to get palliative medicine recognised as a speciality by the Royal College of Physicians.

By the time of her own death in 2005 there were some 200 hospices in the UK and similar programmes in 115 countries across the world: some way to achieving Saunders’s aim that ‘death must not be seen as a failure, but as part of life.’

Cicely Saunders vision is continued today through the work of King’s Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation which supports not only end-of-life care but also helps people to live well and improve the quality of life for people facing the problems associated with complex life-threatening illnesses. 

Read more at: https://www.kcl.ac.uk/nursing/departments/cicelysaunders/index.aspx