History of Hospice Palliative Care

The first hospices date back to the fourth century when Christians in Europe provided care to the sick and destitute. The word hospice is derived from the Latin word hospitium, which means hospitality or hospitable when referencing a place of shelter and rest for weary or ill travelers.  Palliative (noun or adjective) and palliate (verb) are derived from the Latin palliare, which means ‘to cloak.’

1948: Physician Dame Cicely Saunders begins her work with the terminally ill and eventually applies the name hospice to specialized care for dying patients.

1967: Dame Cicely Saunders establishes the first modern hospice—St. Christopher’s Hospice, a sixty-bed facility for the terminally ill, in London, UK. As the first modern hospice, it sought to combine three key principles: excellent clinical care, education, and research. It therefore differed significantly from those homes for the dying which had preceded it and sought to establish itself as a centre of excellence in a new field of care. Its success was phenomenal, and it soon became the stimulus for an expansive phase of hospice development, not only in Britain, but also around the world. From the outset, ideas developed at St Christopher’s were applied differently in other settings.

1969: A book based on more than 500 interviews with dying patients is published, entitled, On Death and Dying.  Written by Dr. Elisabeth Kubler-Ross, it identifies the five stages through which many terminally ill patients progress. The book becomes an international best seller. Kubler-Ross argues for home care as opposed to treatment in an institutional setting and advocates that patients should have a choice and the ability to participate in the decisions that affect their destiny. The work of Elizabeth Kubler-Ross in challenging the medical profession to change its view of dying patients brought about great change and advanced many important concepts such as living wills, home healthcare, and helping patients to die with dignity and respect.

1974:  The first palliative care unit opens at Winnipeg’s St. Boniface General Hospital. Within a matter of weeks, the second palliative care unit in Canada opens at the Royal Victoria Hospital in Montreal by Canadian physician Dr. Balfour Mount who also coins the term ‘palliative care’ as it is used in the modern context.

1981:  The Palliative Care Foundation in Toronto proposes a definition of palliative care. They state that “palliative care is active compassionate care of the terminally ill at a time when they’re no longer responsive to traditional treatment aimed at cure and prolongation of life and when the control of symptoms, physical and emotional, is paramount. It is multidisciplinary in its approach and encompasses the patient, the family, and the community in its scope.”

1986: The World Health Organization (WHO) defines palliative care.

2000: The PBS series On Our Own Terms: Moyers on Dying in America is the focus of national education and engagement programs.

2005: In the UK, there are just under 1,700 hospice services consisting of 220 inpatient units for adults with 3,156 beds, 33 inpatient units for children with 255 beds, 358 home care services, 104 hospice-at -home services, 263 day-care services, and 293 hospital teams. These services together help over 250,000 people.

2006: Pope Benedict XVI equates palliative care with “the preservation of human dignity” and defends the provision of care to the sick as a human right.

2007: The Worldwide Palliative Care Alliance forms to address global care needs at the end-of-life.

2009: The first pan-European centre devoted to improving palliative care and end-of-life care is established in Trondheim, Norway. The centre is based at NTNU’s Faculty of Medicine and at St. Olav’s Hospital/Trondheim University Hospital and coordinates efforts between groups and individual researchers across Europe, specifically Scotland, England, Italy, Denmark, Germany, and Switzerland, along with the United States, Canada, and Australia.

2014: Worldwide Hospice Palliative Care Alliance’s Global Atlas of Palliative Care at the End of Life declares palliative care to be a human right.

2017: Bill C-277, the “Framework on Palliative Care in Canada Act,” becomes law. The goal of this private member bill is to improve end-of-life healthcare for all Canadians.

2018: Health Canada publishes A Framework for Palliative Care in Canada.