Curative medical treatment is clearly a blessing and we are fortunate to live in a time when many illnesses are treatable and curable. There comes a time, however, when the end of life is inevitable. No cure is possible, no prolongation of life is appropriate beyond the days the body can sustain life on its own. At that point, the greatest need of the patient is to end his/her life in dignity and with freedom of pain.

    In our great-grandparents’ time, birth and death were commonplace in the family home and accepted as natural events. With time and the advance of medicine, birth and death were transplanted to a new and often strange environment: the modern hospital, where family members were merely guests and control rested with unknown health professionals.

    Hospice had its roots in the Middle Ages when shelters called hospices were available to travelers who had nowhere else to stay. It took the modern Hospice movement and three special women to pioneer new ways of thinking about death and dealing with the dying.

    The British physician, Cicely Saunders, has worked as a nurse, a social worker, and a physician. At age 33 she returned to medical school to specialize in pain control for the terminally ill. She organized and became director of the St. Christopher’s Hospice in London in 1967. Her goal was to keep patients active, alert, and in charge of decisions about their own care for as long as possible. Concerned that the needs of terminally ill patients were being ignored because curative options had been exhausted, Dr. Saunders is quoted as saying, “There is never nothing more that can de done.” Her emphasis on palliative care (comfort-oriented care) and pain management, emotional care and spiritual care enhances the patient’s quality of life.

    Elizabeth Kubler-Ross has studied death and dying since the 1960’s. She has added much to our knowledge of dying in America. She says, “Taking care of terminally ill patients is a privilege and a gift which teaches us not only about dying but about living. All of those who have the courage to care for dying patients will be enriched by this experience.” Through her studies, she developed a comprehensive description of the five stages of denial, anger, bargaining, depression and acceptance that are all part of the dying experience.

    Mother Teresa is best known for her work among the dying destitute in Calcutta, India. She states, “Food, shelter and care are what the dying need, but even greater is their need for being wanted. What you can do, I cannot do, and what I can do you cannot do. Together we can do something beautiful for God.”

    Bringing death out into the open and making sickness and loss a time of sharing and remembrance has been difficult. The first American hospice was started in New Haven, Connecticut in 1974. Since then, hospice has gone from being a little-known medical alternative to a major option in health care. From the beginning, the American model stressed hospice as a home service. Over 200,000 people have chosen to spend the last few days or weeks of their life at home, cared for by their families, with the support and assistance of a hospice team of professionals (physicians, nurses, certified nurses aides, clergy, social workers, volunteers, etc.).