Hospice is the organized provision of care for the dying. Medically, the hospice approach focuses on pain medications in order to ensure comfort, rather than on invasive life-sustaining technologies such as respirators, resuscitation, and artificial nutrition and hydration. Hospice typically provides team support for the dying, including medical and nursing care, psychological counseling, and clinical pastoral care as requested. Hospice is the major alternative to death in a hospital, where the medical approach is generally more aggressive. Hospices usually have their own specially designed buildings to facilitate a “dying well,” but most of their work involves teams that visit patients routinely in their homes to provide care. Hospice units are increasingly found in nursing homes.
The term “hospice” was coined by Dame Cicely Saunders, who was trained as a nurse, a medical social worker, and finally as a physician. Since 1948 she has been involved with the care of patients with terminal illness. She founded St. Christopher’s Hospice in London as the first research and teaching hospice linked with clinical care in 1967. Dame Saunders understood the historical usage of the term “hospice” as a place where travelers in need of shelter and rest might spend the night before journeying on. It occurred to her that dying is “like a journey,” and that people would need a special place of care before passing on. Thus, Dame Saunders applied the term “hospice” in this new context of journeying peacefully through death. Since her founding of St. Christopher’s, the hospice movement has unfolded in many parts of the world.
In the United States, the first hospices were formed in the early 1970s, usually in churches and synagogues. Hospice care was deeply controversial because of its philosophy that people dying of various diseases— especially cancer—did not need to be forced into invasive or burdensome medical treatments. Often, oncologists in established medical settings were sharply critical of hospices. Most oncologists at the time were men, and almost all those involved in the early hospice movement in the United States and elsewhere were women. Elizabeth Pitorak, for example, a nurse, founded the Hospice of the Western Reserve in Ohio. Some women who founded hospices were subjected to legal action and a number were incarcerated for brief periods of time as they fought for the rights of the dying. Throughout the 1970s and into the early 1980s, hospice was ridiculed as “second level” care or as “only care.” Many clinicians remained critical, asserting that hospice encouraged their patients to “throw in the towel” without fighting hard enough against death with every technology and drug available. Hospice was the center of the feminist ethics of care and it was pitted against the male-dominated “war against cancer.” The tension between hospice and tertiary medical centers is nowadays less dramatic, but still exists. There are many who think that hospice care is a step down for their loved one and therefore resist it.
Hospice, reflecting its origins in the Anglican spirituality of Dame Saunders and in the spiritual traditions of others faiths, retains a distinct appreciation for the “whole” person on the journey toward death. Hospice teams usually consist of a nurse, a social worker, and an individual trained in clinical pastoral care. While all established hospices now have physician directors, it is still the devoted nurse—most often a woman—who has the major hands-on leadership role. While many hospitals now have palliative care units, these typically lack the team approach that is typical of hospice care.
More than any other aspect of modern health care, hospice is the creation of women, who continue to sustain it in many respects. It represents a context in which the feminist ethics of care was able to supercede legal casuistry, the “war” against disease that often meant war against the well-being of patients and the dehumanizing aspects of high-tech medical environments in the interests of comfort, care in the most basic and important sense of the word, and human dignity.
It remains a monument to the moral creativity of caring women.