Cicely Saunders, RIP

When Dame Cicely Saunders died this past summer at the age of 87, few Americans noted her passing. But her influence on medicine and caregiving has been enormous. Credited with being the founder of the modern hospice movement, Saunders forever altered the way the medical profession treats the terminally ill. In the process, she helped foster respect for life and for the dignity of those suffering from illness.

Dame Cicely’s vision began with a chance encounter, in 1948, with David Tasma, a Polish man who had escaped from the Warsaw Ghetto and was dying of cancer in the hospital where Saunders was serving as a nurse and medical social worker. Her experience with Tasma convinced her that end-of-life care, especially the management of pain for terminally ill patients, was inadequate. After attending medical school she founded St. Christopher’s Hospice in South London in 1967, a place that she hoped would “help the dying to live until they die and their families to live on,” as the London Telegraph reported.

The physical alleviation of pain was not Saunders’s only concern, however. A committed Christian who had experienced a dramatic conversion, she included spiritual well-being among the things that should be encouraged and nurtured in the dying. In her book, Living With Dying, published in 1983, she wrote about the need for end-of-life caregivers to consider the “mental, social, and spiritual pain” of their patients as well as their physical pain.

In an early article outlining her ideas for end-of-life care, Saunders indicted medical professionals for failing to grasp just how important they were to patients who were suffering from terminal illnesses. “It appears that many patients feel deserted by their doctors at the end,” she wrote. “Ideally the doctor should remain the center of a team who work together to relieve where they cannot heal, to keep the patient’s own struggle within his compass and to bring hope and consolation to the end.” Her criticism did not necessarily endear her to other doctors, and pursuing her vision of better end-of-life care meant that Saunders frequently found herself challenging shibboleths of the medical profession. As the British Medical Journal (BMJ) noted, “She abolished the prevailing ethic that patients should be cured, that those who could not be cured were a sign of failure, and that it was acceptable and even desirable to lie to them about their prognosis.” As a result, she was at times a pugnacious opponent. As the Telegraph noted in its obituary, “Though she was widely revered as a sort of secular saint, it was only through being tough and authoritative, and often downright difficult, that she succeeded in forcing the medical profession to acknowledge what medicine can do for the dying.”

Saunders was also a fierce critic of the euthanasia movement. As the Telegraph reported, she was the “guiding influence” behind a report issued by the Church of England in 1976 about dying. “In rejecting the argument that chronic pain justifies euthanasia,” the Telegraph noted, “the report drew attention to the fact that correct medical and nursing treatment can usually remove pain or reduce it to a minimum and can help the survivors as much as the dying.” Impending death is no excuse for ending life, Saunders argued; rather than rush to kill the dying in the name of ending their suffering, we should focus on practical measures for alleviating their pain and spiritual means to make their final moments worth living.

Saunders devoted her entire life to the effort to improve end-of-life care (she did not marry until the age of 67). The movement she launched eventually spread to other countries, including the United States where she sent one of her St. Christopher’s doctors to New Haven, Connecticut, in 1971, to start a hospice. As she grew older, honors and awards proliferated. A foundation in her name sponsors pain research, and her portrait now hangs in London’s National Portrait Gallery.

This “grand dame and natural leader,” as the BMJ described her, was often compared to Florence Nightingale. But in many ways Saunders’s contribution was greater: While Nightingale’s pioneering work improved and professionalized the extant job of nursing, Saunders created the medical specialty of palliative care from scratch. It would not exist without her extraordinary vision and efforts. Millions of seriously and terminally ill patients around the world have benefited from her treatment philosophy; they have spent their final moments free from pain, surrounded by loved ones in a comfortable environment. And her firm and morally serious position on euthanasia continues to resonate. As Wesley Smith concluded in the Weekly Standard, “None of this would have happened had Cicely Saunders not come to the realization that dying isn’t dead: It is living, and that means no one should be denied dignity, love, and inclusion as they pass through their final days. The good she did cannot be measured.”

When asked once how she herself hoped to die, Dame Cicely said that she would prefer to know that she was dying, so that she could put her affairs in order, consider her spiritual obligations, and have time to reflect on her life. When she died of cancer in July, she was indeed able to do all of this in the hospice that she had created. Hers was truly a death — and a life — with dignity until the end.