Dame Cicely Saunders began the great work of modern palliative care. Let’s continue it – LifeSite

(LifeSiteNews) — Last week, I was introduced to the name of Dame Cicely Saunders, the Anglican (but very pro-Catholic) doctor who founded modern palliative care, and I’m delighted to have learned more about her.

If you recall, I had asked Alex Schadenberg of the Euthanasia Prevention Coalition what optimal palliative care looks like. As the crimson tide of medically assisted suicide has swept over Canada and now threatens Scottish shores, I wanted to know what our best defences look like.

Alex told me that a “true death with dignity” relies on someone “being with the (dying) person, caring about the person, and helping them work through the final issues of living.”

“This is the kind of palliative care that Dame Cicely Saunders created,” he added. “This is the kind of palliative care we need.”

I’m thinking that we need care like that not just for the dying, but those with chronic pain, depression, or disabilities who might also fall victim to MAiD, but that’s a subject for another article.

READ: The dying deserve high-quality palliative care, not assisted suicide

Cicely Saunders was born in England in 1918 and died in the London palliative care home she founded, St. Christopher’s, in 2005. She began her medical career as a nurse, and when back pain made her tasks impossible, she became a medical social worker, or “almoner” as the profession was then called. In1948, she was inspired by a dying patient to dedicate her life to helping people live their last days as well as possible. To further her dream of opening a modern home for the dying, one that combined medical treatment with pastoral care, she qualified as a medical doctor. Though intense fundraising, and while lecturing, writing, and above all, listening to her patients, she succeeded in founding St. Christopher’s Hospice in 1967.

“The patron saint of travellers would thus accompany those making their final earthly journey,” Professor David Clark noted in his edition of Dame Cicely’s 1959-1999 letters.

The hospice offered a better place to die than the usual two alternatives: crowded, noisy hospital wards or a home without adequate pain relief. St. Christopher’s built upon the old Christian (indeed monastic) traditions of serving the dying with compassion, kindness and friendship, not medical detachment or patronizing lies. The patient, not a doctor’s he-man fight against death, was the focus. Natural death was not there regarded as a failure at all; in 1963, Dame Cicely wrote that dying patients and their families could make “an achievement of this part of their lives as of any other.”

At the same time, the hospice pioneered cutting-edge pain management. One (then) innovative treatment was to give a dying patient a dose of analgesics (painkillers) before the last one had worn off and he or she was in pain again. “Constant pain needs constant control” was one of Dame Cecily’s mottos. (She also argued that morphine and diamorphine were much more effective than cocaine and alcohol, which really shows how far we’ve come.) Hitherto doctors had been worried about dying patients becoming acclimatized or addicted to the drugs, but Dame Cecily illustrated that this was not a valid concern.

Dame Cecily was adamantly against euthanasia – by 1970 a subject of keen public debate – and, according to Clark, she “treated the relief of pain as a most vital component in confronting the issue of euthanasia… It was therefore important to her to demonstrate to the public that pain can be prevented.”

And it wasn’t just physical pain she was concerned about. Attention to “total pain” was one of Dame Cicely’s key principles; for the first time in a long time, doctors were asked to consider the relationship of mental pain to physical pain and vice versa. Dame Cicely believed medical students and others should (in her words) “look at various facets of a dying patient’s distress, beyond the requirement for analgesics to the need for human understanding and practical social help.” Thus, the dying person’s physical, psychological, emotional, spiritual, and social needs all had to be acknowledged. Dame Cicely was adamant that doctors should give patients an opportunity to talk.

Listening itself has a therapeutic effect on many symptoms,” she wrote in a letter to the British Journal of Medicine in 1963 when she was working at the Catholic St. Joseph’s hospice, a home for the dying poor founded by the Sisters of Charity in 1905. “Anxiety and depression can be helped by drugs, but it is the true listener who helps most of all.” The result was that St. Joseph’s, they did not see “intractable fear and depression but rather the growth of acceptance and serenity.”

I have called Dr. Saunders “Dame Cicely” throughout this piece, but as a matter of fact she was not awarded her title until 1980, by which time she was internationally famous. According to Professor Clark, palliative care was first recognized as a specialty in her native Britain in 1987 and her concept of “total pain” was a major element of the discipline. By the time she died, there were 200 hospices in the UK, and similar programs in 115 other countries.

Today, you can still find her philosophy in British hospices. The two nearest me are in Edinburgh: St. Columba’s and Marie Curie. Both were inspired by Dame Cicely’s work, and Marie Curie’s website expresses her ideas beautifully:

At Marie Curie, we define a good death (or good end of life experience) as having the right care, support and systems in place, so you feel protected and safe, and your carers and loved ones understand what support is available. (…) When you get to live well right up until you die, and what matters most to you has been listened to and respected, that’s what a ‘good’ death looks like.

Interestingly, Marie Curie acknowledges that many people don’t have a good death (apparently one person in the UK every five minutes), and a contact at the Archdiocese of St. Andrews and Edinburgh told me that he thinks the problem of palliative care in Scotland is “quantity rather than quality.” Thus, for my next article, I will try to find out why so few people have access to excellent palliative care

Dorothy Cummings McLean is a Canadian journalist, essayist, and novelist. She earned an M.A. in English Literature from the University of Toronto and an M.Div./S.T.B. from Toronto’s Regis College. She was a columnist for the Toronto Catholic Register for nine years and has contributed to Catholic World Report. Her first book, Seraphic Singles,  was published by Novalis (2010) in Canada, Liguori in the USA, and Homo Dei in Poland. Her second, Ceremony of Innocence, was published by Ignatius Press (2013). Dorothy lives near Edinburgh, Scotland with her husband.

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