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Dame Cecily Saunders

The the mother of modern hospice care passes on.

12:00 AM, Jul 19, 2005 • By WESLEY J. SMITH
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RALPH NADER once mused to me about what a terrible thing it was that Jack Kevorkian was (at the time) the world's most famous doctor. He was right. That distinct honor should have belonged to Dame Cecily Saunders, the founder of the modern hospice movement who died last week at age 87 in London at St Christopher's, the hospice she founded in 1967.

Dame Cicely, as she was known affectionately in England, was a nurse and devout Anglican who was working as a medical social worker in a London hospital in the years immediately following World War II. She met a Jewish immigrant, named David Tasma, who had escaped the Warsaw ghetto, only to lie dying in a London hospital at the age of 40. Tasma was alone in the world and Saunders made a special point to visit with him every day. Their friendship changed our world.

As Saunders and Tasma spoke of his impending death, she began to comprehend "what he needed--and what all of the other dying patients and their families needed." Saunders had an epiphany. She told me, "I realized that we needed not only better pain control but better overall care. People needed the space to be themselves. I coined the term 'total pain,' from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated. I have been working on that ever since."

Saunders work was a "personal calling, underpinned by a powerful religious commitment," wrote David Clark, an English medical school professor of palliative care and Saunders's biographer, to whom she has entrusted the organization of her archives. So strong was Saunders's faith in what she perceived as her divine calling, she began volunteering as a nurse at homes for the dying after work. Urged on by her deep desire to help dying people, she went to medical school at the age of 33, this at a time when there were few women doctors.

Saunders focused her medical practice on helping dying people and alleviating pain. She obtained a fellowship in palliative research and began work in a hospice run by nuns, where pain control was unevenly applied, a nearly universal problem at the time, causing much unnecessary misery. Saunders conceived of putting patients on a regular pain control schedule, which, in her words, "was like waving a wand over the situation."

Believing firmly that "the St. Christopher's project [was] divinely guided and inspired," she became an activist, energetically raising money for the new project, and in the process, raising the consciousness of the medical establishment. Saunders' initial idea was for St. Christopher's hospice to be a "sequestered religious community solely concerned with caring for the dying." But the idea soon expanded from a strictly religious vision into a broader secular application, in Clark's words, a "full-blown medical project acting in the world."

SAUNDERS SUCCEEDED beyond even her own wildest hopes. St. Christopher's opened in a London suburb in 1967 and jump-started the modern hospice movement. "We started in-home care in 1969," Saunders said, "the majority of our work is out in the community." Saunders soon exported hospice to North America. In 1971, she sent one of her team doctors to New Haven, Connecticut, to help found the first modern hospice in the United States, from whence it spread nationwide.

AS I PONDER Dame Cicely's life, I reflect upon the death of my father in 1984. Dad fought the good fight against colon cancer for about two years until the day he was sitting on a hospital bed contemplating a bile drainage bag doctors inserted to prevent jaundice caused by tumor blocking his bile duct. Dad looked at the bag taped to his inner thigh. He sighed deeply and his shoulders sagged and he looked up at me with an expression I had never seen before. That was it, I knew. Dad had made a momentous decision: his fight to stay alive was over.

As a society, we too often make dying a shameful thing, something unnatural to be hidden away in a dark corner. Mom and I were determined that wouldn't happen to Dad, that just because he was dying that did not mean his life was over. We shifted emphasis from cure and life prolongation, to comfort, dignity, and peace. That meant hospice, which then was still a relatively novel concept.

Dad benefited tremendously from hospice care. His last several months were peaceful, pain-free, and nurtured. He was cared for deeply by my mother and by dedicated hospice professionals. He would spend hours sitting on a bench in his back yard overlooking his beloved cactus garden, contemplating his life and the ultimate issues raised by human mortality. As an only child, I carried a heavy burden, not only in caring for my father, but also my mother, who was devastated by the depth of her pending loss. Hospice provided me with grief counseling--before Dad died--an invaluable aid in helping me help my folks. Dad died in a veteran's hospital hospice unit in Los Angeles, and with his passing he gave me an invaluable gift: my father taught me how to die with dignity, courage, and fortitude.

I also reflect upon Frank's death. Frank was my childhood best friend's father and my "second dad." In 1997, he also died of colon cancer. Unfortunately, unlike my father, it was difficult for his family to get his doctor to agree to hospice care, causing him much unnecessary suffering. But once admitted to hospice, Frank's life changed from one of intense pain and suffering, into a relaxed, peaceful, pain-free ending. "Hospice was so wonderful." Frank's wife, Jean, recalled. "I will never forget the depth of care showed by the doctor and the nurses, particularly Jill, who came every day to visit. They showed Frank such tremendous compassion. It is hard to believe that there are people in the world who are so deep down compassionate to strangers. But there are. They are sincere and wonderful about it."

Frank's last words to me, spoken quietly and with great dignity just three days before his passing, reflected the quality of care he received: "I am ready to die."

My good friend Julia died this last April 1, at the too early age of 50, from breast cancer. Julia had three young children and she was determined that they would always know that she didn't leave them easily. For nine years she fought with grit and determination against her spreading disease.

Julia's spirit was more than willing but finally, her body gave out. Julia received excellent hospice care for the remaining months of her life, during which time she remained a central figure in her family, her symptoms managed as she slowly weakened. She received such good care that she enjoyed a leisurely lunch with her husband Colin, my wife Debra, and me at a restaurant near her home a mere four days before she died.

There is a direct through-line of compassion and love from David Tasma in 1948, to my father in 1984, to Frank in 1997, and Julia in 2005, and now to Dame Cecily herself in 2005--to the millions of others who have benefited from hospice care since 1967. None of this would have happened had Cecily Saunders not come to the realization that dying isn't dead: It is living, and that means no one should be denied dignity, love, and inclusion as they pass through their final days. The good she did cannot be measured.

Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant for the Center for Bioethics and Culture. He is the author of Culture of Death: The Assault on Medical Ethics in America, from which much of this article was adopted.