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Bradbury Hospice
The first dedicated hospice in Hong Kong

Hospice is a type of care and a philosophy of care which focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature. The concept of hospice as a place to treat the incurably ill has been evolving since the 11th century. The modern hospice began to emerge in the 17th century, but many of the foundational principles by which modern hospices operate were pioneered in the 1950s by Dame Cicely Saunders. Although the movement has met with some resistance, hospice has rapidly expanded through the United Kingdom, the United States and elsewhere.


The early development of hospice[]

Linguistically, the word "hospice" is derived from the Latin hospes, a word which served double-duty in referring both to guests and hosts.[1] The first hospices are believed to have originated in the 11th century, around 1065, when for the first time the incurably ill were permitted into places dedicated to treatment by Crusaders.[1][2] In the early 14th century, the order of the Knights Hospitaller of St. John of Jerusalem opened the first hospice in Rhodes, meant to provide refuge for travelers and care for the ill and dying.[3] Hospices flourished in the Middle Ages, but languished as religious orders were dispersed.[1] They were revived in the 17th century in France by the Daughters of Charity of Saint Vincent de Paul.[3] France continued to see development in the hospice field; the hospice of L'Association des Dames du Calvaire, founded by Jeanne Garnier, opened in 1843.[4] Six other hospices followed before 1900.[4]

Meanwhile, hospices were established as well in other areas. In the United Kingdom, attention was drawn to the needs of the terminally ill in the middle of the 19th century, with Lancet and the British Medical Journal publishing articles pointing to the need of the impoverished terminally ill for good care and sanitary conditions.[5] Steps were taken to remedy inadequate facilities with the opening of the Friedenheim in London, which by 1892 offered 35 beds to patients dying of tuberculosis.[5] Four more hospices were established in London by 1905.[5] Australia, too, was seeing active hospice development, with notable hospices including the Home for Incurables in Adelaide (1879), the Home of Peace (1902) and the Anglican House of Peace for the Dying in Sydney (1907).[6] In 1899, New York City saw the opening of St. Rose's Hospice by the Servants for Relief of Incurable Cancer, who soon expanded with six locations in other cities.[4]

Among the more influential early developers of Hospice were the Irish Sisters of Charity, who opened a hospice in Harold's Cross, Ireland in 1879.[4] It proved to be very busy, with as many as 20,000 people—primarily suffering tuberculosis and cancer—coming to the hospice to die between 1845 and 1945.[4] The Sisters of Charity expanded internationally, opening the Sacred Heart Hospice for the Dying in Sydney in 1890, with hospices in Melbourne and New South Wales following in the 1930s.[7] In 1905, they opened St Joseph's Hospice in London.[3][8] It was there in the 1950s that Cicely Saunders developed many of the foundational principles of modern hospice care.[3]

The rise of the modern hospice movement[]

Saunders was an English registered nurse whose chronic health problems had forced her to pursue a career in medical social work. The relationship she developed with a dying Polish refugee helped solidify her ideas that terminally ill patients needed compassionate care to help address their fears and concerns as well as palliative comfort for physical symptoms.[9] After his death, Saunders began volunteering at St Luke's Home for the Dying Poor, where a physician told her that she could best influence the treatment of the terminally ill as a physician.[9] Saunders entered medical school while continuing her volunteer work at St. Joseph's. When she achieved her degree in 1957, she took a position there.[9]

Saunders, who emphasized focusing on the patient rather than the disease, disseminated her philosophy internationally in a series of tours of the United States that began in 1963.[10][11] In 1967, Saunders opened St. Christopher's Hospice. Florence Wald, the dean of Yale School of Nursing who had heard Saunders speak in America, spent a month working with Saunders there in 1969 before bringing the principles of modern hospice care back to the United States, establishing Hospice, Inc. in 1971.[12][13]

At around the same time that Saunders was disseminating her theories and developing her hospice, in 1965, Swiss psychiatrist Elisabeth Kübler-Ross also began to consider the social responses to terminal illness, which she found inadequate at the Chicago hospital where her American physician husband was employed.[14] Her 1969 best-seller, On Death and Dying, was influential on how the medical profession responded to the terminally ill,[14] and along with Saunders and other thanatology pioneers helped to focus attention on the types of care available to them.[10]

Hospice care around the world[]

File:Mamilla StVincent.jpg

Hospice Saint Vincent de Paul, Jerusalem

Hospice has faced resistance springing from various factors, including professional or cultural taboos against open communication about death among physicians or the wider population, discomfort with unfamiliar medical techniques, and professional callousness towards the terminally ill.[15] Nevertheless, the movement has, with national differences in focus and application, spread throughout the world.[16]

In 1984, Dr. Josefina Magno, who had been instrumental in forming the American Academy of Hospice and Palliative Medicine and sat as first executive director of the US National Hospice Organization, founded the International Hospice Institute, which in 1996 became the International Hospice Institute and College and later the International Association for Hospice and Palliative Care (IAHPC).[17][18] The IAHPC, with a board of directors as of 2008 from such diverse countries as Scotland, Argentina, Hong Kong and Uganda,[19] works from the philosophy that each country should develop a palliative care model based on its own resources and conditions, evaluating hospice experiences in other countries but adapting to their own needs.[20] Dr. Derek Doyle, who was a founding member of IAHPC, told the British Medical Journal in 2003 that through her work the Philippine-born Magno had seen "more than 8000 hospice and palliative services established in more than 100 countries."[18] Standards for Palliative and Hospice Care have been developed in a number of countries around the world, including Australia, Canada, Hungary, Italy, Japan, Moldova, Norway, Poland, Romania, Spain, Switzerland, the United Kingdom and the United States.[21]

Hospice care in Canada[]

Canadian physician Balfour Mount, who first coined the term "palliative care", was a pioneer in the Canadian hospice movement, which focuses primarily on palliative care in a hospital setting.[22][23] Having read the work of Kubler-Ross, Mount set out to study the experiences of the terminally ill at Royal Victoria Hospital, Montreal; the "abysmal inadequacy", as he termed it, that he found prompted him to spend a week with Saunders at St. Christopher's.[24] Inspired, Mount decided to adapt Saunders' model for Canada. Given differences in medical funding in Canada, he determined that a hospital-based approach would be more affordable, creating a specialized ward at Royal Victoria in January, 1975.[23][24] For Canada, whose official languages include English and French, Mount felt the term "palliative care ward" would be more appropriate, as the word hospice was already used in France to refer to nursing homes.[23][24] Hundreds of palliative care programs followed throughout Canada through the 1970s and 1980s.[25]

However, as of 2004, according to the Canadian Hospice Palliative Care Association (CHPCA), hospice palliative care was only available to 5-15% of Canadians, with available services having decreased with reduced government funding.[26] At that time, Canadians were increasingly expressing a desire to die at home, but only two of Canada's ten provinces were provided medication cost coverage for care provided at home.[26] Only four of the ten identified palliative care as a core health service.[26] At that time, palliative care was not widely taught at nursing schools or universally certified at medical colleges; there were only 175 specialized palliative care physicians in all of Canada.[26]

Hospice care in the United Kingdom[]

File:Canterbury 002 St Thomas Hospice.jpg

St Thomas Hospice, Canterbury

The hospice movement has grown dramatically in the United Kingdom since Saunders opened St. Christopher's. According to the UK's Help the Hospices in 2009, UK hospice services consisted of 220 inpatient units for adults with 3,203 beds, 39 inpatient units for children with 298 beds, 314 home care services, 106 hospice at home services, 280 day care services, and 346 hospital support services.[27] These services together helped over 250,000 patients in 2003 & 2004. Funding varies from 100% funding by the National Health Service to almost 100% funding by charities, but the service is always free to patients.

Hospice care in the United States[]

Main article: Hospice care in the United States

Hospice in the United States has grown from a volunteer-led movement to improve care for people dying alone, isolated, or in hospitals, to a significant part of the health care system. In 2005 more than 1.2 million individuals and their families received hospice care. Hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, twenty-four hour/seven day a week access to care and support for loved ones following a death. Most hospice care is delivered at home. Hospice care is also available to people in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals, and prisons.

The first United States hospital-based palliative care programs began in the late 1980s at a handful of institutions such as the Cleveland Clinic and Medical College of Wisconsin. By 1995, hospices were a $2.8 billion industry in the United States, with $1.9 billion from Medicare alone funding patients in 1,857 hospice programs with Medicare certification.[28] In that year, 72% of hospice providers were non-profit.[28] By 1998, there were 3,200 hospices either in operation or under development throughout the United States and Puerto Rico, according to the National Hospice and Palliative Care Organization (NHPCO).[28] According to 2007's Last Rights: Rescuing the End of Life from the Medical System, hospice sites are expanding at a national rate of about 3.5% per year.[29] As of 2008, approximately 900,000 people in the United States were utilizing hospice every year,[30] with more than one-third of dying Americans utilizing the service.[31]

Hospice care in other nations[]

1980 saw the opening of a hospice in Harare, Zimbabwe, the first in Sub-Saharan Africa.[32] In spite of skepticism in the medical community,[15] it was followed by others in 1993, in Nairobi and Kenya.[32] Japan opened its first hospice in 1981, officially hosting 160 by July of 2006.[33] The first hospice unit in Israel was opened in 1983.[34] The first modern free-standing hospice in China opened in Shanghai in 1988.[35] The first hospice unit in Taiwan, where the term for hospice translates "peaceful care", was opened in 1990.[15][36] The first free-standing hospice in Hong Kong, where the term for hospice translates "well-ending service", opened in 1992.[15][37] The first hospice in Russia was established in 1997.[38]

See also[]


  1. 1.0 1.1 1.2 Robbins, Joy (1983). Caring for the Dying Patient and the Family, Taylor & Francis.
  2. Connor, Stephen R. (1998). Hospice: Practice, Pitfalls, and Promise, Taylor & Francis.
  3. 3.0 3.1 3.2 3.3 Connor, 5.
  4. 4.0 4.1 4.2 4.3 4.4 Lewis, Milton James (2007). Medicine and Care of the Dying: A Modern History, Oxford University Press US.
  5. 5.0 5.1 5.2 Lewis, 21.
  6. Lewis, 23-25.
  7. Lewis, 22-23.
  8. Foley, Kathleen M.; Herbert Hendin (2002). The Case Against Assisted Suicide: For the Right to End-of-life Care, JHU Press.
  9. 9.0 9.1 9.2 Poor, Belinda; Gail P. Poirrier (2001). End of Life Nursing Care.
  10. 10.0 10.1 Spratt, John Stricklin; Rhonda L. Hawley, Robert E. Hoye (1996). Home Health Care: Principles and Practices, CRC Press.
  11. Lewenson, Sandra B.; Eleanor Krohn Herrman (2007). {{{title}}}, Springer Publishing Company.
  12. Connor, 5.
  13. Sullivan, Patricia. "Florence S. Wald, 91; U.S. Hospice Pioneer", The Washington Post, November 13, 2008. Accessed November 13, 2008.
  14. 14.0 14.1 includeonly>Reed, Christopher. "Elisabeth Kubler-Ross: Psychiatrist who identified five stages of dying - denial, anger, bargaining, depression and acceptance", The Guardian, 2004-08-31. Retrieved on 2009-02-19.
  15. 15.0 15.1 15.2 15.3 Kirn, Marie (June 1, 1998). Book review 1 (2): 201-202.
  16. Bernat, James L. (2008). Ethical Issues in Neurology, 3, revised, Lippincott Williams & Wilkins.
  17. Saunders, Cicely M.; David Clark (2005). Cicely Saunders: Founder of the Hospice Movement : Selected Letters 1959-1999, Oxford University Press.
  18. 18.0 18.1 Newman, Laura (2009-09-27). British Medical Journal (327 (7417)).
  19. IAHPC Board of Directors. International Association for Hospice & Palliative Care. URL accessed on 2009-02-21.
  20. IAHPC History. International Association for Hospice & Palliative Care. URL accessed on 2009-02-21.
  21. Standards for Palliative Care Provision. International Association for Hospice & Palliative Care. URL accessed on 2009-02-21.
  22. Forman, Walter B.; Denice Kopchak Sheehan, Judith A. Kitzes (2003). Hospice and Palliative Care: Concepts and Practice, 2, Jones & Bartlett Publishers.
  23. 23.0 23.1 23.2 Feldberg, Georgina D.; Molly Ladd-Taylor, Alison Li (2003). Women, Health and Nation: Canada and the United States Since 1945, McGill-Queen's Press - MQUP.
  24. 24.0 24.1 24.2 Andrew Duffy. A Moral Force: The Story of Dr. Balfour Mount. Ottawa Citizen. URL accessed on January 1, 2007.
  25. Feldberg et al., 343.
  26. 26.0 26.1 26.2 26.3 Fact Sheet: Hospice Palliative Care in Canada. Canadian Hospice Palliative Care Assocation. URL accessed on 2009-02-21.
  27. Facts and figures. Help the Hospices. URL accessed on 2009-02-19.
  28. 28.0 28.1 28.2 Plocher, David W.; Patricia L. Metzger (2001). The Case Manager's Training Manual, Jones & Bartlett Publishers.
  29. Kiernan, Stephen P. (2007). Last Rights: Rescuing the End of Life from the Medical System, revised, MacMillan.
  30. includeonly>Hevesi, Dennis. "Florence S. Wald, American pioneer in end-of-life care, Is dead at 91", New York Times, 2008-11-14. Retrieved on 2009-03-21.
  31. While Hospice Care Is Growing, Not All Have Access. Forbes. URL accessed on 2009-03-21.
  32. 32.0 32.1 Parry, Eldryd High Owen; Richard Godfrey, David Mabey, Geoffrey Gill (2004). Principles of Medicine in Africa, 3 revised, Cambridge University Press.
  33. Objectives. Japan Hospice Palliative Care Foundation. URL accessed on 2009-02-21.
  34. Ami, S. Ben Palliative care services in Israel. Middle East Cancer Consortium. URL accessed on 2009-02-21.
  35. Pang, Samantha Mei-che (2003). Nursing Ethics in Modern China: Conflicting Values and Competing Role, Rodopi.
  36. Lai, Yuen-Liang (September, 1997). Palliative medicine and the hospice movement in Taiwan. Supportive Care in Cancer 5.
  37. Bradbury Hospice. Hospital Authority, Hong Kong. URL accessed on 2009-02-21.
  38. Russia’s first hospice turns ten. Russia Today. URL accessed on 2009-02-21.

Further reading[]

  • Saunders, Cicely M.; Robert Kastenbaum (1997). Hospice Care on the International Scene, Springer Pub. Co..

External links[]

Palliative care