“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”
‘How people die remains in the memory of those who live on’
An encounter with one patient in 1948 was the catalyst for the Hospice Movement. The challenge to undertake appropriate pain and symptom control together with experience in further listening to patients in the small number of homes especially planned for dying people, finally came together during the 1960s as the impetus for the first modern hospice which opened in 1967.
Since then, palliative care has been developing worldwide and has shown that the basic principles demonstrated in those early years can be interpreted in various cultures and with different levels of resources.
Symptom control by a multi-professional team backed by research and education of both professionals and public has spread both into home care and into general hospitals.
The family is seen as the unit of care as it finds its own potential, searches for meaning and makes the achievements possible at the end of life.
Saunders was an exemplary woman, with an educational record that only added to her already impressive mark in our history books. As a young woman she was educated at Roedean School and St. Anne’s College Oxford, where she left to study nursing at St. Thomas’ Hospital during World War II. Once the war ended, she would return to Oxford to complete her degree in Public and Social Administration and later became a Lady Almoner, or chaplain.
She soon realized, though, that her ideas would not be accepted without a medical degree. A resolute young woman, Saunders soon became a doctor, earning her medical degree at St. Thomas’ Medical school in 1957.
Symptom control by a multi-professional team backed by research and education of both professionals and public has spread both into home care and into general hospitals. The family is seen as the unit of care as it finds its own potential, searches for meaning and makes the achievements possible at the end of life.
“Suffering that encompasses all of a person’s physical, psychological, social, spiritual and practical struggles.”
Cicely Saunders described in her concept of ‘total pain’ how to see the patient’s spiritual suffering in relation to physical problems, referring to narrative and biography, and the importance of understanding the experience of suffering in a multifaceted way.
Dame Cicely Saunders defined the concept of total pain as the suffering that encompasses all of a person's physical, psychological, social, spiritual, and practical struggles.
Cicely Mary Strode Saunders was born on this date, 22 June, 1918, at Linden Lodge, 45 Bedford Avenue in Barnet, about 18 miles north of London. https://goo.gl/maps/AFZNEx3nUoDckjks8
What’s in a name?
Dame Cicely Saunders
The
modern hospice
is a resting place for travellers
but above all
it is concerned with journeys of discovery.
For
patients,
a discovery of what is most lasting
and important for them
as they unravel some of the knots
of deceit and regret;
for
those who love them,
the discovery of their own strengths in new
roles,
Josh Groban - You Raise Me Up (Official Music Video) | Warner Vault
When I am down, and, oh, my soul, so weary
When troubles come, and my heart burdened be
Then, I am still and wait here in the silence
Until you come and sit awhile with me
You raise me up, so I can stand on mountains
You raise me up to walk on stormy seas
I am strong when I am on your shoulders
You raise me up to more than I can be
You raise me up, so I can stand on mountains
You raise me up to walk on stormy seas
I am strong when I am on your shoulders
You raise me up to more than I can be
You raise me up, so I can stand on mountains
You raise me up to walk on stormy seas
I am strong when I am on your shoulders
You raise me up to more than I can be
You raise me up, so I can stand on mountains
You raise me up to walk on stormy seas
I am strong when I am on your shoulders
You raise me up to more than I can be
You raise me up to more than I can be
Cicely Saunders today may be regarded as a radical innovator, because she was introducing methods of care that were radically new in the 1960s. She had no hesitation in using major painkillers – with caution but without any reticence – especially morphine and its derivatives, while clearly aiming not only to soothe but even to prevent the acute pain which dying patients can find so hard to bear. Contrary to the beliefs firmly entrenched in medical circles and in public opinion, she demonstrated that the proper handling of these drugs avoided the creation of any narcotics addiction or any suddenly fatal respiratory depression, consequences that so many doctors of that period feared.
“Palliative
care in the context of advanced disease and end-of-life care in the
final months and weeks of life represents the last phase of health and
social care for citizens before their death. These are matters of huge
importance which create enormous challenges for health professionals,
patients, families, and policy-makers. The acceptance of death as an
unavoidable outcome and the inclusion of it in a care system whose
pre-eminent goals are cure and rehabilitation is a complex matter. When
death is seen as a medical failure rather than a natural inevitability,
then supporting end-of-life patients and their loved ones with their
physical and mental needs becomes problematic. For most of the 20th
century, this situation was the reality throughout the world. However,
in the late 1960s this began to change. In 1967 Cicely Saunders founded
St Christopher’s Hospice in South London, the first modern hospice in
England, combining clinical care, psychological support, education and
research”1.
These
are the opening words to the report commissioned by the European
Parliament on palliative care in the European Union. It recognises the
crucial role played by one woman, who trained as first a nurse, then a
social worker and finally as a doctor, who managed to revolutionise the
care of terminally ill patients suffering in agony.
Combining
her work as social worker with her home visits to the sick as a
volunteer, Cicely Saunders discovered in the years immediately following
the Second World War the shortcomings in English hospitals regarding
pain relief, especially for patients in the advanced stages of cancer.
In 1948 she regularly visited David Tasma, a cancer patient and survivor
of the Warsaw Ghetto, who was dying of cancer and experiencing extreme
pain and symptoms that were very badly managed by the medical practice
of those days. He also felt an urgent need to recount his life story and
tell people that he was dying before his time. While listening to him,
Cicely Saunders discovered the reality of physical pain endured by many
patients, made even greater by psychological and spiritual anguish,
which led her later on to coin the term “total pain”. Deeply influenced
by this discovery, she decided to devote her life to relieving such
suffering and then embarked on her studies to become a doctor.
After
qualifying as a doctor, she was put in charge of a hospital service at
St Joseph’s Hospice that cared for patients suffering from malignant
tumours in their advanced phase. She showed that, together with
carefully listening to the patient, the regular administration of
powerful painkilling drugs such as morphine, with dosage and frequency
calculated to soothe and even prevent all pain, and also paying
attention to various other symptoms, enabled the patient find effective
relief without creating either drug-dependency or life-threatening
respiratory depression, which were deemed inevitable consequences of the
effective and prolonged use of such drugs2.
2
Cf. Avril Jackson, «Histoire et rayonnement mondial», in: D. JACQUEMIN
(dir.), Manuel de soins palliatifs, 2nd édition, Paris, Dunod, 2001, p.
21-30.
Drawing
upon this experience, nineteen years after her meeting with David Tasma
and having collected the requisite funds, Dr Saunders finally opened St
Christopher’s Hospice in 1967. Its mission was principally to receive
terminally ill cancer patients suffering from pain. The institutional
form she chose was that of a “charitable foundation” working outside the
British National Health Service. Cicely Saunders’ initiative quickly
became established in the United Kingdom and in Ireland. By 1977,
twenty-six Hospices had opened their doors, all based on the St
Christopher’s Hospice model. That was the start of what came to be known
as “The Hospice Movement”3.
3 Avril Jackson, op.cit., p. 26.
Since
both the term and the institutional form of “Hospice” had negative
connotations in French-speaking countries, Dr Balfour Mount, who had
himself trained at St Christopher’s Hospice, decided to change the
terminology. Back in Quebec in 1975, he opened a care centre, fully
integrated in the Montreal University Hospital, for the treatment of
“end-of-life” patients in pain. This included a 12-bed unit for
inpatients, a homecare service and a mobile unit that could be consulted
by all services in the hospital. To define the care being given, he
chose the term “palliative care”, and to describe this kind of care at
institutional level he used the term “palliative care unit”4.
4
Cf. Balfour M. Mount, “The problem of caring for the dying in a general
hospital; the palliative care unit as a possible solution”, Canadian
Medical Association Journal, Vol. 115, n° 2, July 17, 1976, pp. 119-121.
Source:
OPINION OF THE WORKING GROUP ON ETHICS IN RESEARCH AND MEDICINE ON PALLIATIVE CARE IN THE EUROPEAN UNION
When Cicely Saunders opened St Christopher’s in 1967 she brought together, for the first time in the world, a large number of patients with terminal illness and staff who were committed to discover and then teach the best ways of caring for them. Previously these patients would have been scattered – in various hospital wards or at home. There were a few hospices, mostly opened around 1900. The patients in them received excellent nursing and spiritual care but there was minimal medical input, for it was generally believed that the doctor’s role was to cure. These patients were, of course, incurable.
It sounds like Cicely was a very strong character and also a good friend.
Both! She was a very strong leader, a clear thinker, discerning, and had a good sense of humour. She was insightful, and she knew what she wanted and she got it, but not without a lot of hard work. Her other remarkable advantage was that she started out as a nurse and then became a social worker and then, so that she could fulfill her dream, she went to medical school and became a physician. So she was a one-person team! This gave her a broad experience with the whole person needs of both patient and family. We became very close friends.
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