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History of Hospice |
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 John
F. Tomczak is the author of Shared Knowledge - Dealing With
Bereavement.
John's passion is to make all Canadians
aware of how hospice societies can help
them and their loved ones at a time
of need.
John
has been recognized for his many
exemplary contributions as a board
member of Victoria Hospice Society and
the Independent Living Housing Society
as well as a founding member of Canada's
first bereavement self help group.
John is
the owner of
bereavement.ca
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A Short History of Hospice and Palliative Care
By John F. Tomczak
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.
My
book “Shared Knowledge” is focused on the bereaved.
However the care of the bereaved, as we know it,
comes from the hospice movement.
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 Lady’s
Hospice in Dublin caring only for the dying. 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. Joseph’s Hospice
in East London, to care for the sick and the dying.
Early 1900s
In
London, St. Luke’s 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.
Joseph’s 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. Christopher’s 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.
Christopher’s 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 ALS 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.Luke’s in New York
City, and Church Hospice in Baltimore.
1980s
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.
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| Copyright John
F. Tomczak. All rights reserved |
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For more information on bereavement support, or to
purchase Shared Knowledge, click on the
book cover. |
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