Palliative care is a relatively new field of medicine. It grew out of the modern hospice movement in the 1960s, and its history is still being written today as it continues to evolve as a specialty in countries around the world. The term “palliative care” was first used in 1974 by Dr. Balfour Mount, a surgical oncologist at the Royal Victoria Hospital and McGill University in Montreal.
Hospices have been taking care of the sick and dying since the 4th century—many of the hospices established in the 19th century still exist today as palliative care departments. The modern hospice movement was founded in 1967 by Dr. Cicely Saunders with the opening of St. Christopher’s Hospice in London, England. Until this time, very little attention had been devoted, in practice or in research, to the needs of the dying. Early research findings in the 1950s raised some public concern about the medical neglect of patients dying from cancer; however, it was Dr. Saunders’s work that helped draw wide attention to the suffering and needs of the terminally ill.
As a result of her many years of experience working with the dying—as a nurse, social worker, and then physician—Dr. Saunders identified the need for a new and dedicated approach to end-of-life care. She stressed the importance of understanding how physical and mental distress are connected, and that in order to effectively assess and treat pain and suffering, a patient’s “total pain” had to be addressed. Dr. Saunders described “total pain” as the sum of the patient’s physical, psychological, social and spiritual pain. This concept of “total pain” is central to the approach of modern palliative care.
At the same time as Dr. Saunders was revolutionizing end-of-life care and establishing St.Christopher’s as a centre of excellence in this field, the 1960s saw the work of Elisabeth Kübler-Ross, an American psychiatrist, challenge the attitudes of the medical community towards end-of-life experience and care. She advanced many important ideas, including home care, living wills and helping people die with dignity and respect. Dr. Kübler-Ross’s 1969 book “On Death and Dying” is still required reading in many healthcare disciplines.
In 1973, in response to the work being done by Dr. Kübler-Ross and Dr. Saunders, McGill’s Dr. Mount visited St. Christopher’s to learn more about the needs of dying patients, which had become a focus of his own work. In 1974, he became the founding director of the Royal Victoria Hospital Palliative Care Unit. He coined the term “palliative care” to distinguish this emerging field of medicine from hospice care. The word “hospice” was often associated with negative implications in French. “Palliative” comes from the Latin word “palliare”, which means to cloak or shield, suggesting a kind of protection from suffering for patients facing life-threatening illnesses.
The field of palliative care developed significantly in the 1970s and 1980s, and became increasingly identified as a specialized form of health care. Palliative medicine was first recognized as a specialty in 1987 in the United Kingdom. This recognition was seen to represent a shift away from traditional hospice and terminal care towards a model that extended to all patients facing serious illness, regardless of the diagnosis and stage of the disease. In 2002, the World Health Organization identified palliative care as a specialized field of health care, and currently uses the following definition:
“Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.”
In 2013, after almost 20 years of discussion, palliative care was officially recognized as a specialty by the Royal College Council of Canada.
This content was developed from the following sources :
- Canadian Hospice Palliative Care Association. Milestones in Hospice Palliative Care. www.chpca.ca/about-hpc/milestones-in-hospice-palliative-care/. Accessed March 31, 2022.
- Clark D. From the margins to centre: a review of the history of palliative care in cancer. Lancet Oncology 2007;8:430-38.
- Mission Hospice Society. History of Hospice Palliative Care. www.missionhospice.bc.ca/wp-content/uploads/2018/01/A-History-of-Hospice-Palliative-Care.pdf. Accessed March 25, 2022.
- NEJM Resident 360. Brief History of Palliative Care. https://resident360.nejm.org/content_items/history-of-palliative-care. Accessed March 14, 2022.
- Palliative Care McGill. History. www.mcgill.ca/palliativecare/about-us. Accessed March 28, 2022.
- Pilkey J, et al. Palliative Medicine—Becoming a Subspecialty of the Royal College of Physicians and Surgeons of Canada. Journal of Palliative Care 2017;20(10):1-8.
- Rome RB, et al. The Role of Palliative Care at the End of Life. The Ochsner Journal 2011;11(4):348-52.
- World Health Organization. Palliative Care. www.who.int/news-room/fact-sheets/detail/palliative-care. Accessed July 31, 2023