A social movement
Initially, modern hospice and palliative care in the West had many of the qualities of a social movement supported by wider forces:
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consumerism and increasing discernment among the users of health and social care services
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demographic trends, which allowed substantial numbers of individuals to volunteer in local hospices
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greater affluence, which led to an increase in charitable giving.
The movement may well have contributed to a new openness about death and bereavement that has been in evidence since the late twentieth century. Inspired by charismatic leadership, it is a movement that has:
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condemned the neglect of the dying in society
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called for high quality pain and symptom management for all who needed it
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sought to reconstruct death as a natural phenomenon, rather than a clinical failure
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marshalled practical and moral argument to oppose those in favour of euthanasia.
Indeed, for Cicely Saunders and her followers, such work serves as a measure of the worth of our culture.
Palliative care as a speciality
At the same time other interests were at work. In several countries (Britain, Australia, Canada and the US) professional recognition of this emerging area of expertise seemed desirable. Recognition of the speciality of palliative medicine first occurred in the UK in 1987. This was seen by some as a turning point in hospice history. It was part of a wider shift away from 'terminal' and 'hospice' care towards the concept of palliative care.
Modernisers claim that specialisation, the integration of palliative care into the mainstream health system and the development of an 'evidence-based' model of practice and organisation are crucial to long-term viability. Others mourn the loss of early ideals. They also regret what they perceive to be an emphasis upon physical symptoms at the expense of psychosocial and spiritual concerns.
Care earlier and for all
By the end of the twentieth century, however, a growing commitment to a model based on evidence was emerging.
Two forces for expansion were also clearly visible. First was the impetus to move palliative care to an earlier point in the progression of the disease, thereby integrating it with curative and rehabilitation therapies and shifting the focus beyond terminal care and the final stages of life. Second, there was a growing interest in extending the benefits of palliative care to those with diseases other than cancer, in order to make 'palliative care for all' a reality.
The new speciality was therefore delicately poised. For some, such integration with the wider system was essential for success; for others it has marked the entry into a risky phase of new development in which early ideals might be compromised.
As hospice and palliative care continues to evolve, the hope remains that the benefits of a model of care previously available to just a few people at the end of life will, in time, be extended to all who need it - regardless of diagnosis, stage of disease, social situation or means.
More hospice history
Read about other chapters in hospice history including:
