The concept of palliative care
The concept of palliative care - specialized support for the terminally ill - was pioneered by British nurse, social worker, and doctor Cicely Saunders. In 1967, Saunders founded the world's first purpose-built hospice, St Christopher's, in London. Saunders believed that dying people should be treated with compassion, respect, and dignity, with access to painkilling medicine to alleviate their suffering. This ethos led to Saunders' theory of "total pain the idea that a patient's physical pain was one aspect of overall distress that included emotional, social, and spiritual elements. After opening St Christopher's Hospice, Saunders advocated that every terminally ill patient should be listened to as an individual, receive tailored medical treatment, and be given holistic care by a team of specialists up until their death. Saunders developed her ideas during a time of great change in British healthcare. Founded in 1948, the National Health Service (NHS) provided free healthcare for all. In its early days, however, the NHS provided little in the way of care for the terminally ill. Such patients often spent their last hours in hospital, with doctors administering generic pain medication. Having a doctor present at a patient's deathbed is a modern phenomenon. Historically, doctors had focused purely on curing disease rather than aiding the terminally ill. In medieval Europe, an early death caused by disease or disaster was commonplace and often quick, but by the late 19th century, advances in medicine and science meant people were generally living longer. A longer life increased the chances of a longer death from diseases such as cancer, and the possibility of a protracted period of pain and suffering. Having a doctor present, armed with judicious doses of opium or laudanum (a tincture of opium), became as important as having a priest at the deathbed. In the early 20th century, doctors were still a long way from developing a process for identifying requirements for end-of-life pain relief. They usually gave all dying patients morphine, and repeated the dose only when the effects of the previous one had worn off. Patients were in constant dread of the next wave of pain. Another source of anxiety for dying patients was their isolation. Most patients wanted their lives to end at home, given the choice, but only the wealthy could afford to have a physician present. From 1948, NHS-funded hospitals became the place where most terminally ill people in Britain died. There were also a small number of homes, called hospices, that tended to the needs of the dying, but they typically relied on older traditions of religious care and were almost entirely separate from the NHS.