A “good death” is difficult to quantify. It is also not easy to make a consensus. It is something most of us don’t want to talk about or even think about. However, how to define a good death has been central to the modern hospice movement, shaping its history over the last six decades. Cicely Saunders’ modern hospice movement began in England in the 1960s. It wasn’t until the 1970s that it reached America. As a nurse and social worker, Saunders saw a need to be filled in treating the dying. To improve end-of-life care Saunders went on to become a physician and pain management researcher, turning hospice into a philosophy and changing the whole paradigm of dying.[3]
Going back to medieval times, hospice meant a place of shelter. The word “hospice” derives from hospitium, sharing its origins with hospital and hospitality. During the Crusades, a hospice was where sick travelers could go to rest on a long journey. Hospices were often found in monasteries, not only caring for the dying but also the hungry and the poor. Death most often took place in the home.[4] During the Industrial Revolution, advances in medicine and social trends, such as smaller households, moved care for the dying from the home to the hospital. By the end of the 1950s, a majority of deaths took place in hospitals. In hospitals, dying people were given futile and experimental treatments or deserted by their doctors. Patients often died alone in excruciating pain.[5]
Cicely Saunders opened St. Christopher’s Hospice in South London in 1967, a 54-bed inpatient facility for the dying along with the world’s first home hospice services. St. Christopher’s combined compassionate care, pain management, teaching, and research. Saunders began by improving physical pain control for the dying with research on the use of morphine for end-of-life pain and scheduled pain dosing, whereby a patient didn’t need to wait till they were yelling out in pain before the next dose was given.
Saunders drew many of her ideas surrounding suffering, dignity, and death from Viktor Frankl, an Austrian psychologist, philosopher, and Holocaust survivor. Frankl’s “Man’s Search for Meaning” was published in 1959. Saunders references Frankl in a 1966 article, “The Care of the Dying,” where she notes, “We can learn from Frankl, a psychiatrist, who found a purpose and meaning in life and death in Auschwitz.”[6]
Frankl wrote about his attempt to find meaning as a prisoner in a Nazi concentration camp: “Human life, under any circumstances, never ceases to have meaning, and that this infinite meaning of life includes suffering and dying … hopelessness of our struggles did not detract from its dignity and its meanings.”[7]