A Brief History of Hospice Care

In tribal and the pre-Christian era (PreHistory-500AD) when there was a life-threatening illness the community as a group responded because death often posed a direct threat to the entire community. As individuals worked for the common good of the group when an individual was sick or had sustained an injury requiring care then their family and the group would support the individual. Of course, there was also superstition, so in some societies, the ill person would be excluded from the group and left to die on their own or supported by a close loved one. Often one special person would be given the role of ‘medicine’ woman or man. These people were said to have healing powers and were thought to be most closely in touch with the higher powers of gods and spirits.

– death rates for mother and child extremely high
– Child mortality: 40-60% died before the age of 5
– few people lived over 40 yrs
– most relied on spirits and gods to protect, heal and give meaning to life
– long hours of hard physical labour necessary to stay alive
– almost all resources devoted to survival.

In Europe with the spread of Christianity, monasteries started to take in the sick and those disabled and unable to support themselves. Then wealthy women and widows in the 6 & 7 century started working in these monasteries as the first ‘nurses’. In Medieval times, at the time of the Crusades, 1095 to the end of the seventeenth century, weary travellers found places of refuge in monasteries and nunneries. Often they were in ill health and many spent their last days cared for, by the monks and nuns and lay women. The word “hospice” comes from the Latin word hospes: meaning to host a guest or stranger.
As medicine and hospitals developed, ill people were treated in ‘hosp’itals but because germ theory was unknown, disease would often spread and people would die from acquired infections. Families often preferred to keep their loved ones at home, fearing that they would not leave “the house of death” as the hospitals were sometimes called. Neighbours would help support the family with food and clothing.

After WWII, hospitals gained a better reputation as medicine improved and more lives were saved. But those who died were seen as the failures of the medical system as everything was directed to save lives.
The name hospice was first applied to the care of dying patients by Mme Jeanne Garnier who founded the Dames de Calaire in Lyon, France, in 1842. The name was next introduced by the Irish Sisters of Charity when they opened Our Lady’s Hospice in Dublin in 1879 and St Joseph’s Hospice in London (1905).

In 1967, Dame Cicely Saunders started St Christopher’s Hospice after being inspired by a patient, David Tasma, whom she met in 1948 when he was hospitalised with an inoperable cancer and she, a former nurse, was working as a medical social worker. The two had discussed how she might one day open a place that was better suited to pain control and preparing for death than a busy hospital ward. When he died, he bequeathed £500 and told Saunders, “I will be a window in your home,” Since then her ideals have spread around the world, which gave her the reputation of being the founder of the modern hospice movement.
In 1969, a book based on more than 500 interviews with dying patients was published, written by Dr Elisabeth Kubler-Ross. The book called “On Death and Dying” became a best seller and took death out of secrecy and into public awareness and discussion for the first time. Kubler-Ross argued that home-care was preferable over institutional care and that patients should be able to participate in decisions regarding their treatment.

Today, hospice is no longer a place, but rather an ideal and philosophy of care for the patient with a life-limiting illness and their loved ones facing a difficult journey. The purpose remains the same – for them to find rest, to be cared for and to gather courage to face the remaining days of their journey together.