Historically, the word ‘hospice’ meant a place of care, but in much of Canada it has now come to describe a program of care. ‘Palliative’ is based on the Latin palliates, meaning to cloak, mask, or shield and refers to the management of palliative symptoms. In British Columbia, we use the terms hospice and palliative care interchangeably.
Hospice palliative care is a worldwide movement with a tradition going back to ancient times. For example, in the eastern parts of the Roman Empire, there were houses that offered a place of refuge for the needy; not only to the sick and dying, but also to the hungry wayfarer, the woman in labour, orphans and the poor. These sanctuaries became known as hospitium, from which the modern terms hospital, hospice, hostel and hotel are derived.
Soon hospices were to be found along pilgrim routes as well as at mountain passes and river crossings where travellers met great hazards. Gradually local people also came to rely on these houses. This tradition of hospice care continued into medieval times under religious orders such as the Benedictines, who were charged with care for the needy.
Later, the running of hospices began to be secularized and there gradually emerged medical care provided by professional physicians within the institution of the hospital. The development of the modern hospital however led to medical care that distanced itself from the notion of a hospice. This was because modern science had moved away from the spiritual dimension of human existence. Death was not seen as a state of being, but rather as a failure to affect a cure. Thus, care of the dying and especially of the terminally ill was not a focus of medical care even though the means to alleviate distressing symptoms had greatly improved.
In the early part of the 20th century modern hospice style care for the terminally ill was provided mainly by Christian houses. One example is the Irish Sisters of Charity at St. Joseph’s Hospice in England, where, in 1905, a third of the beds were for patients with a prognosis of three months or less to live.
Not until the 1950’s did hospice palliative care receive new impetus. Then, Cicily Saunders, a physician with a deep concern for the inability of her fellow physicians to care adequately for the dying, established St. Christopher’s Hospice in London.