History of Hospice Palliative Care

As early as the 4th century, the first hospices date back to when Christians in Europe provided care to the sick and destitute. “Hospice” (noun) is derived from the Latin word “hospitium,” which means hospitality or hospitable when it referred to a place of shelter and rest for weary or ill travelers on a long journey.  “Palliative” (noun or adjective) or “palliate” (verb) is derived from the Latin “palliare,” which means to cloak.

1948: Physician Dame Cicely Saunders, began her work with the terminally ill and eventually applied the name hospice to specialized care for dying patients.

1967: Dame Cicely Saunders creates create the first modern hospice—St. Christopher’s Hospice, a sixty bed facility for the terminally ill, opened in July 1967 in London, UK. It quickly became a source of inspiration to others. As the first “modern” hospice, it sought to combine three key principles: excellent clinical care, education, and research. It therefore differed significantly from those homes for the dying which had preceded it and sought to establish itself as a centre of excellence in a new field of care. Its success was phenomenal, and it soon became the stimulus for an expansive phase of hospice development, not only in Britain, but also around the world. From the outset, ideas developed at St Christopher’s were applied differently in other settings. Within a decade it was accepted that the principles of hospice care could be practised in many settings: in specialist in-patient units, but also in home care and day-care services. Hospital units and support teams were established that brought the new thinking about dying into the heartland of acute medicine.

1969: A book based on more than 500 interviews with dying patients is published, entitled, On Death and Dying.  Written by Dr. Elisabeth Kubler-Ross, it identifies the five stages through which many terminally ill patients progress.  The book becomes an internationally known best seller.  Within it, Kubler-Ross makes a plea for home care as opposed to treatment in an institutional setting and argues that patients should have a choice and the ability to participate in the decisions that affect their destiny. The work of Elizabeth Kubler-Ross in challenging the medical profession to change its view of dying patients brought about great change and advanced many important concepts such as living wills, home health care, and helping patients to die with dignity and respect.

1974:  The first palliative care unit opened at Winnipeg’s St. Boniface General Hospital. Within a matter of weeks, the second palliative care unit in Canada opened at the Royal Victoria Hospital in Montreal, Quebec by Canadian physician Dr. Balfour Mount who also coined the term ‘palliative care’ as it is used in the modern context.

1981:  The Palliative Care Foundation in Toronto, Ontario proposed a definition of palliative care. They stated that “Palliative care is active compassionate care of the terminally ill at a time when they’re no longer responsive to traditional treatment aimed at cure and prolongation of life and when the control of symptoms, physical and emotional is paramount. It is multidisciplinary in its approach and encompasses the patient, the family and the community in its scope.”

1986: The World Health Organization (WHO) defines palliative care.

2000: PBS series On Our Own Terms: Moyers on Dying in America is the focus of national education and engagement programs.

2005: In the UK, there were just under 1,700 hospice services consisting of 220 inpatient units for adults with 3,156 beds, 33 inpatient units for children with 255 beds, 358 home care services, 104 hospice-at -home services, 263 day-care services and 293 hospital teams. These services together helped over 250,000 people in the UK 2003 and 2004.

2006: Pope Benedict XVI equated palliative care with “the preservation of human dignity” and defended the provision of care to the sick as a human right.

2007: The Worldwide Palliative Care Alliance is formed to address global care needs at the end-of-life.

2009:The first pan-European centre devoted to improving palliative care and end-of-life care was established in Trondheim, Norway. The centre is based at NTNU’s Faculty of Medicine and at St. Olav’s Hospital/Trondheim University Hospital and coordinates efforts between groups and individual researchers across Europe, specifically Scotland, England, Italy, Denmark, Germany and Switzerland, along with the United States, Canada and Australia.

2014: Worldwide Palliative Care Alliance’s Global Atlas of Palliative Care at the End of Life declared palliative care as a human right.

2017: Bill C-277, the “Framework on Palliative Care in Canada Act”, becomes law.  The goal of this private member bill is of making end-of-life health care better for Canadians from coast to coast.

2018: Health Canada publishes A Framework for Palliative Care in Canada.

Cicely Saunders
Photo: Google Images
Elizabeth Kubler-Ross
Photo: Google Images
Balfour Mount
Photo: Google Images