The Story of Hospice

The story of hospice

In fourth-century Rome the concept of hospice, as a place to care for the sick and dying, first came into being under the direction of Fabiola, a member of the Roman patrician class, who was well known in her day as a generous provider of the care and comfort of the sick and dying. Over the next several centuries the Catholic Church continued to provide care to the poor and sick. In 1842, the term “hospice” was used for the first time to identify a place to care for the chronically ill and dying in France, where Mme. Jeanne Gamier is credited with establishing an institution dedicated to the care of the dying. Soon after this, an order of nuns known as the Irish Sisters of Charity cared for the terminally ill. They started a hospice in Ireland in 1879.

The creation of the “modern day Hospice” is credited to Dame Cicely Saunders who in the 1950’s in England realized that managing pain was not enough. She recognized that there were psycho/social and spiritual aspects of the dying process that needed to be addressed. She was told that if she wanted to do something about it she would have to become a physician and so she did. She obtained degrees in medicine and social work. In 1967 she founded St. Christopher’s Hospice in London. The focus was on individuals in the final stages of life living in dignity and comfort. Her approach involved a marriage of disciplines: pain management, emotional and spiritual support, and family counselling. The care was delivered by a team of medical and nursing professionals as well as social workers and spiritual counsellors. In 1969 Dame Cicely pioneered the first home care team taking St. Christopher’s care and philosophy out into the community.

In Canada the approach has been slightly different. In 1975, a palliative care unit was opened at the St. Boniface Hospital in Winnipeg and weeks later a similar palliative care unit was opened at the Royal Victoria Hospital in Montreal. Dr. Balfour Mount, a pioneer in hospice/palliative care in Canada, used the words “palliative care” rather than the word “hospice” because from the history of early lower Canada the word “hospice” in Quebec was commonly considered a place of last resort for the poor or derelict. The word “palliative” comes from the latin meaning “to cover or cloak, as in to care for”. As a result, the terms have been used interchangeably across Canada. This can be particularly confusing when we speak of the “Palliative Team” referring to the medical professionals, there may be an assumption that Hospice is involved or when we refer to a palliative unit or room in a hospice which may or may not be associated with Hospice.

The Palliative Care Foundation in Toronto released an official definition of hospice palliative care in 1981, stating that “Palliative care is active compassionate care of the terminally ill at a time when there is no longer responsive to traditional treatment aimed at cure and prolongation of life and when the control of symptoms, physical and emotional is paramount. It is multidisciplinary in its approach and encompasses the patient, the family and the community in its scope.” Two years later, the University of Ottawa created Canada’s first University Institute for research and education in palliative care. The Canadian Palliative Care Association was established in November, 1991 and opened its first office in Ottawa in February 1994. The organization later changed its name to the Canadian Hospice Palliative Care Association (CHPCA) due to hospice care and palliative care no longer being recognized as separate entities.