Dame Cicely Saunders

The remarkable woman who founded the modern hospice movement died this month in the institution she founded.

Dame Cicely Saunders

22 June 1918 -- 14 July 2005

Everyone knows of Florence Nightingale, the nurse whose selflessness and energy in caring for soldiers during the Crimean War transformed hospitals and made nursing a true profession. Her contemporary counterpart was another Briton, Dame Cicely Saunders, who died earlier this month at the age of 87. It was the capstone of a lifetime specialising in care for the dying.

Dame Cicely’s achievement was to begin the modern hospice movement in 1967. There are now hundreds of hospices for the dying in Britain and in more than 95 countries around the world. Without her work, the euthanasia movement would undoubtedly have been far more persuasive and legalised euthanasia would have spread much further. She showed that it was possible to die peacefully and without great pain. For her, dying was not something to be feared but was “as natural as being born”. Partly due to her influence, palliative care has become recognised as a distinct medical speciality.

Dame Cicely was a woman of wisdom. Although she was an eminent clinician and researcher, she knew that care for the dying was not simply a matter of managing patients’ pain. She developed a theory of “total pain” which included its emotional, social, and spiritual elements. “The whole experience for a patient includes anxiety, depression, and fear; concern for the family who will become bereaved; and often a need to find some meaning in the situation, some deeper reality in which to trust,” she said.

Dame Cicely was also a woman with deeply Christian convictions, but her hospices were open to people of all persuasions, and to those who had none. “I once asked a man who knew he was dying what he needed above all in those who were caring for him,” she once said. “He said, ‘For someone to look as if they are trying to understand me.’ Indeed it is impossible to understand fully another person, but I never forgot that he did not ask for success but only that someone should care enough to try.”

That wisdom was hard-won. Her well-to-do father disapproved of her interest in nursing and so she enrolled at Oxford instead. When World War II broke out, however, she took up nursing. But her back gave her trouble and she had to switch to a degree in social work. In 1945 her parents divorced and she converted from agnosticism to evangelical Christianity. This happened all of a sudden, during a holiday in Cornwall with some Christian friends. “It was as though I suddenly felt the wind behind me rather than in my face,” she later said. “I thought to myself: please let this be real. I prayed to know how best to serve God.”

The answer came the next year when she fell in love with a dying Polish Jew named David Tasma, the first of three romantic attachments to Polish men. “He needed to make his peace with the God of his fathers, and the time to sort out who he was,” she recalled. “We discussed the idea of somewhere that could have helped him do this better than a busy hospital ward.” When Tasma died, he bequeathed Saunders £500 -- no mean sum in those days -- to start a hospice. “I’ll be a window in your home,” he said.

Her mission in life was now clear to her: founding a home where the dying would receive the best medical care along with affection and understanding. A doctor told her that people would not listen to a nurse, so at the age of 33 she began a medical degree. In 1957 she qualified and obtained a research scholarship in pain management for the incurably ill, at the same time working in a hospice for the dying poor run by Catholic Sisters of Charity.

There she met the second Pole in her life, Antoni Michniewicz, who showed her what death could be like when it was surrounded by loving care. He inspired her to name her own hospice for people in the final stage of life’s journey after Saint Christopher, the patron of travellers.

In 1967 she opened St Christopher’s in London. Initially it had 54 in-patient beds with respite care and a home care service. The years of planning which preceded this also brought to light Dame Cicely’s other sterling qualities as a medical administrator, a fund-raiser and publicist for her vision.

Three years after the death of Antoni she spotted a picture of the Crucifixion in a gallery which she thought would be appropriate for the hospice. She contacted the Polish artist, Marian Bohusz-Szyszko, and ended up falling in love with him even though he was 18 years older. He was a devout Catholic who still supported his estranged wife and it was only after she died that Cicely married him. She was 61 and he was 79 and in poor health. She gave him constant nursing care and he ended his days in St Christopher’s in 1995.   

She never gave up working, although she retired from active involvement in St Christopher’s in 1985. In 2002 she launched the Cicely Saunders Foundation which aims to promote research into palliative care, with a focus on collaboration amongst the different specialties of healthcare.

According to an obituary in the London Times, many years ago she told a questioner at a symposium that she would prefer to die with a cancer which would give her time to reflect upon her life and to put her material and spiritual affairs in order. And that is what happened. She passed away at St Christopher’s of breast cancer.

As a clinician, Cicely Saunders will probably be remembered for a relatively novel method of pain relief -- administering sedation to achieve a steady state in which a dying patient can still remain conscious and have a reasonable quality of life, instead of reacting to surging pain with intermittent sedation. She opposed euthanasia, arguing that everyone had a right to die well, without pain and with dignity, and that death can be a positive experience.

But on a deeper level, she was able to speak of death as a natural and positive part of a complete life, translating some features of her own Christian approach into a secular idiom.

Those who work in palliative care may have to realise that they, too, are being challenged to face this dimension for themselves. Many, both helper and patient, live in a secularised society and have no religious language. Some will, of course, still be in touch with their religious roots and find a familiar practice, liturgy, or sacrament to help their need. Others, however, will not. For them insensitive suggestions by well meaning practitioners will be unwelcome.

However, if we can come not only in our professional capacity but in our common, vulnerable humanity there may be no need of words on our part, only of concerned listening. For those who do not wish to share their deepest needs, the way care is given can reach the most hidden places. Feelings of fear and guilt may seem inconsolable, but many of us have sensed that an inner journey has taken place and that a person nearing the end of life has found peace. Important relationships may be developed or reconciled at this time and a new sense of self worth develop.

The loudest voices in today’s debates over euthanasia are often its champions, doctors whose credentials include public defiance of the law by killing depressed and lonely patients. But in the long run, it will probably be the softer and more humane voice of Dame Cicely Saunders who helped hundreds to a peaceful death: “You matter because you are you, and you matter to the last moment of your life.”

Michael Cook is editor of MercatorNet.