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.
Hospice is a newcomer to the health care industry. The hospice movement in the United States has its roots in the work of British physician Dame Cicely Saunders and Dr. Elisabeth Kubler-Ross, who brought the subject of dying into the open. They explored ways to improve the process of dying and shed light on the needs of patients during this important passage. Most importantly they brought awareness to the importance of patients as individual, unique human beings with individual needs and rights deserving of respect.
In the 1960s, as medical science was discovering dramatic new ways to combat disease and save lives, a handful of people in Europe and the U.S. were looking at how to help people at the end of life. At this time, Dr. Saunders, who began working with dying patients in the 1940s, founded the first modern hospice -- St. Christopher's Hospice in London, England. She was inspired by a dying patient who, at the end of life, requested words of comfort and acts of kindness and friendship. Dr. Saunders came to believe and to teach, "We do not have to cure to heal."
In 1964, she began teaching at Yale University School of Nursing in Connecticut about holistic hospice care and how it enhances the quality of life of terminally ill patients. An important component of hospice care was appropriate pain management. To aid in her teaching, Dr. Saunders would show students photographs of patients that dramatically illustrated the difference in them once pain and symptoms were controlled.
Several years later, Dr. Elisabeth Kubler-Ross published her best-selling book "On Death and Dying." Based on interviews with dying patients, she identified five stages of grief - denial, anger, depression, bargaining and acceptance. Time Magazine said of the book, "It has brought death out of the darkness."
The first hospice in America, the Connecticut Hospice, opened in 1974, followed shortly by an in-patient hospice at Yale Medical Center and a hospice program in Marin County, California. Four years later, the U.S. Department of Health, Education and Welfare published a report citing hospice as a viable concept of care for terminally ill people and their families that provides humane care at a reduced cost. By the late 1970s, the Health Care Financing Administration started hospice demonstration projects across the country.
The Medicare Hospice Benefit was made permanent in 1986. Today most states also provide hospice Medicaid coverage. This coverage for hospice services enabled the movement to grow as more and more hospices were formed across the country. Hospices evolved from volunteer-based, grassroots organizations into health care companies with paid staff and quality practices. As more people learned about what hospice offers, they chose hospice care for their loved ones or themselves.
Today there are more than 3,200 hospices across the country - some are part of hospitals or health systems, others are independent; some are nonprofit agencies, others are for-profit companies. According to the National Hospice and Palliative Care Organization, in 2000 about one in every four Americans who died received hospice care at the end of life - roughly 600,000 people.
