HOSPICE -

PALLIATIVE CARE
Palliative Latin word pallium,
meaning a cloak or cover.

Oxford English Dictionary
defines palliative as to relieve
without curing
ACCORDING TO WORLD
HEALTH ORGANIZATION,
PALLIATIVE CARE:
Provides relief from pain and other
distressing symptoms
Affirms life and regards dying as a
normal process
Intends neither to hasten nor to
postpone death
Integrates the
psychological and spiritual
aspects of patient care
Offers a support system to
help patients live as
actively as possible until
death

Offers a support system to help the
family cope during the patients illness
and in their own bereavement
Uses a team approach to address the
needs of patients and their families,
including bereavement counseling, if
indicated
Will enhance quality of life and
may also positively influence the
course of illness
Is applicable early in the course
of illness in conjunction with
other therapies that are
intended to prolong life
Palliative medicine utilizes a
multidisciplinary approach to patient
care, relying on input in formulating a
plan of care to relieve suffering in all
areas of a patient's life from:
physicians
pharmacists,
nurses,
chaplains,
social workers,
psychologists,
and other allied health
professionals

This multidisciplinary
approach allows the palliative
care team to address physical,
emotional and social
concerns that arise with
advanced illness.
HISTORY OF HOSPICE AND
PALLIATIVE CARE
Hospice is a philosophy of caring that respects
and values the dignity and worth of each person
and good hospice care is the practical expression
of that personal and professional commitment.
Hospices are for people approaching death, but
hospices cherish and emphasize life, by helping
patients (and those who love and care for them)
to live each day to the fullest.
MIDDLE AGES
Religious orders establish hospices at key
crossroads on the way to religious shrines like
Santiago de Compostela, Chartes and Rome.
These shelters helped pilgrims, many of whom
were traveling to these shrines seeking
miraculous cure of chronic and fatal illnesses.
Many died in these shelters while on their
pilgrimages.
During the Crusades, hospices were established
in many places in Europe and the near East to
care for the wounded and sick.
16TH 18TH CENTURIES
Religious orders offer care of the sick and dying
in locally or regionally based institutions. Most
people died 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 Ladys Hospice in Dublin caring only
for the dying.
Madame Garnier of Lyon Mary Aikenhead
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 die in a hospital or nursing
home.
1905
The Irish Sisters of Charity open St. Josephs
Hospice in East London, to care for the sick and
the dying.
EARLY 1900S
In London, St. Lukes Hospice and the Hospice of
God open to serve the destitute dying.
1935
Interest grows in the psychosocial aspects of
dying and bereavement, sparked by the work of
Worcester, Bowlby, Lindemann, Hinton, Kuber-
Ross, Raphael, Worden and others.
1957 - 1967
Cicely Saunders, a young physician previously trained as a
nurse and a social worker, works at St. Josephs 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. Christophers 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 to patients and families.
1968
Many hospice and palliative care programs open
in Great Britain in the years following, adapting
the St. Christophers model to meet local needs,
offering in-patient and home care.
1974
The first hospices in Canada opened at the St
Boniface General Hospital in November 1974
under the direction of David Skelton, followed a
short time later at the Royal Victoria Hospital in
Montreal.
New Haven Hospice (now Connecticut Hospice)
begins hospice home care in the United States,
caring for people with cancer, AIDS and other
fatal illnesses.
1975 - 1978
Hospices and Palliative care units are opened
across North America. These include hospices in
California, the palliative care unit at the Royal
Victoria in Montreal, the support team at
St.Lukes in New York City, and Church Hospice in
Baltimore.
1980S TO PRESENT
Hospice care, usually emphasizing home care,
expands throughout the United States and
Canada. In the United States, Medicare adds a
hospice benefit in 1984. Hospices began to care
for people with advanced AIDS.
Almost 3000 hospices and palliative care
programs serve the United States. There are well
established hospices and palliative care in
Canada, Australia, New Zealand, and much of
Asia and Western Europe. Hospices and palliative
care is now available in over 40 countries
worldwide, including many less-developed
Nations.
The World Heath 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.
The principles of good hospice and palliative care
are understood and accepted and all patients
who choose to accept hospice palliative care can
be assured of competent and compassionate
care in their home, in nursing homes, hospitals
and hospices.
INTERNATIONAL ISSUES
Opioid availability
Restricted access to suitable
cancer treatment facilities
Open, sensitive
communication