2 History and Evolution of Hospice in the United States Today’s hospice care is rooted in the end-of-life movement that came to the United States from Europe in the latter half of the 20th century. This chapter outlines the development of the modern hospice movement. It also discusses the related legislative changes that supported the growth of hospice in the United States. After reading this chapter, you will be able to: ■ Demonstrate an understanding of the origin of hospice care ■ Identify turning points in the American hospice movement ■ Discuss how research helped shape end-of-life practices ■ Identify legislative changes that supported hospice care in the United States HOSPICE IN THE UNITED STATES Dame Cicely Saunders is credited as the foundress of the hospice movement. Saunders was trained as a nurse, social worker, and later as a physician. Her vision for hospice involved: ■ Developing a humane and systematic approach to end-of-life care ■ Devising an interdisciplinary approach to patient care ■ Supporting the spiritual growth of patients and hospice staff ■ Easing the pain and suffering involved in dying (Wright & Clark, 2012) Saunders initially anticipated that hospice workers would be organized in a way that was similar to that of a religious order (Wright & Clark, 2012). But, as Saunders worked with others who were interested in improving end-of-life care, a more expansive hospice movement began to take shape. Saunders and her colleagues developed the document “Aim and Basis,” which outlined the five premises of hospice care. With the scope of hospice defined, the first hospice, St. Christopher’s, opened in London in 1967. Fast Facts in a Nutshell Saunders’s passion for end-of-life care was partially fueled by her deep religious convictions and her belief that ministering to the dying was a religious calling (Wright & Clark, 2012). Around the same time, the end-of-life movement was beginning to take shape in the United States. Dr. Elisabeth Kübler-Ross was a key researcher who advanced end-of-life conversations by: ■ Conducting interviews with dying patients in the mid-1960s ■ Identifying that certain themes emerged over and over ■ Publishing her groundbreaking work On Death & Dying in 1969, which outlined the five stages that dying individuals go through when faced with a life-threatening condition. These were as follows: Slowly, health care professionals, researchers, and the public took interest in how death unfolded in America. Of special interest was how dying patients were treated in the hospital. In their book Awareness of Dying, Glaser and Strauss (1965) offered a telling account of how the technical expertise displayed by physicians and nurses contrasted with their interpersonal relations when working with dying patients. They found that health care professionals: ■ Were quite uncomfortable working with dying patients ■ Tended to avoid dying patients because they felt ill-prepared to discuss death ■ Increased their own feelings of ineptitude and distress by avoiding and isolating dying patients Fast Facts in a Nutshell
Denial and Isolation
Anger
Bargaining
Depression
Acceptance
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