Dame Cicely Saunders
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7510.238 (Published 21 July 2005) Cite this as: BMJ 2005;331:238
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Dame Cicely Saunders was my hero too - as a medical student in the
1960s I did a special project on Care of the Dying Patient, based almost
solely on her work and later, as a trainee GP
and with almost no experience, I used her principles in the care of my
first dying patient ouside hospital.
She was an old lady with terminal uterine cancer, living with her son
and his family in a council house with a bed downstairs in the front room.
I visited her regularly and arranged for morphine injections to be given
as needed. I was to be married in July, but in May, when it became obvious
that she was near the end, on one of my visits her family were all waiting
for me and presented me with a wedding present, a lamp in the shape of a
thistle which I have always kept in my office waiting room. She died
peacefully soon afterwards, but the experience was one of the most
positive and formative of my career.
Competing interests:
None declared
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I was deeply saddened to hear of Dame Cicely's death.
After a brief correspondence, our Hospice here had only just opened, she
encouraged me to join a workshop at St. Christopher's while I was on
holiday in England in 1988. Just meeting her and talking to her was the
highlight of that first visit. I enjoyed it so much that I went back
whenever I could. And have kept in touch with a few of the staff I met on
my first visit.
I think I must have read everything she wrote - she was my hero. I suppose
I always felt she was indestructible. Her legacy will be hard to surpass.
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None declared
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In early 1970 being in London I was introduced to Dame Cicely
at St Christopher's [not St.Thomas´s Hospicium as originally posted] (still in development) and understood that what
she was doing, were of the great impact in the treatment of terminally ill
patients. She encouraged doctors to strictly observe individual patients
and reaction for pain killers on them and timing of introducing it.The
doctors from USA and whole Europe were always visitors there. The
atmosphere in the ward was like in normal hospitals, patients not all the
time unconcious because of overdose pain killers or anxiously waiting for
the next injection. We must remember that 30 years ago terminally ill
patient had limited access to the pain killers in fear of drug addiction
and conception of hospicium treatment were rather unknown or unpopular.
We invited her through Polish Surgical Association and she delivered
lectures in Gdansk and in Warsaw.
In private life she was very friendly an nice person-I retain not only
her professional letters.
She had done a magnificent job in her life.
Competing interests:
None declared
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The enormity of Dame Cicely's work cannot be denied. By fighting for
those who were marginalised by modern Medicine, she injected a much needed
dose of humanity into our practice.
During her life she worked as a nurse, medical social worker,
volunteer and physician - before the concept of a multi-disciplinary team,
or a speciality of Palliative Medicine. She fought for what she believed
in, against the tide of professional opinion; despite the sexism; and
without the ideal funding, for what was the right and decent thing to do.
We have now been left with a growing recognition of the importance
and need for Palliative Care in our global society. Indeed, some would say
that this should be fundamental to clinical practice – a more holistic
approach that listens to the patients and families. This is easier said
than done in other specialities, on an acute ward, given the workload and
inexperience of the junior team in Palliative Care. This, however, is our
fight – to continue the high standards of clinical work and research that
have been set; to ensure that the education disseminates to the areas of
need; and to advocate the needs of the patients and families, to improve
the care for the dying and the living.
I recently received a poem from a service, commemorating the life of
one of our patients. It seems fitting for Dame Cicely Saunders and has
been permitted for use by the family. The author is unknown.
That woman is a success
who has lived well,
laughed often and loved much;
who has gained the respect
of intelligent people
and the love of children;
who has filled their niche
and accomplished their task;
who leaves the world better
than they found it;
who has never lacked appreciation
of earth's beauty
or failed to express it;
who looked for the best in others
and gave the best they had.
Competing interests:
None declared
Competing interests: No competing interests
Cicely Saunders opposed euthanasia. She once invited Sir Iain Chalmers onto a committee and disinvited him after he told her he belonged to the Voluntary Euthanasia Society. I am writing this with his consent.
Competing interests:
None declared
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Total Pain is a concept that was defined by Cicely Saunders and which
is taken to mean the suffering that takes into account all of a person's
physical, psychological, social, spiritual and practical struggles(1).
Nessa Coyle(2) also wrote that a diagnosis of a life threatening illness
jars open a door of awareness, the same door which, for most of our lives,
comfortably allows us to keep thoughts about death in the background. For
many individuals the opening of this door precipitates a crisis, and an
acute encounter with great total pain. All of this occurs in the context
of a modern society which is ill equipped to handle news of possible
death(3). Consequently, after diagnosis of a life threatening or life
limiting illness, a patient's close family and friends may deny that their
loved one is dying or might die from his/her illness. Additionally, as
death is now routinely hidden from social view and in fact,
medicalised(4,5), this medicalisation, which professionalises the rituals
of caring for those who are seriously ill or dying, can result in a
situation where only the physical symptoms are given priority(3).
Therefore, following diagnosis, the patient may be acutely isolated, with
total pain at risk of being left untended. We suggest that certain aspects
of palliative care, such as day care, have much to offer from the point of
diagnosis. We urge health professionals, patients and their families to
access or refer to the help that is available from palliative care
services, in particular, the day units with well developed support
services. Such help must be offered irrespective of whether the diagnosis
pronounces the end of life or may yet still offer hope of the resumption
of more life, for once the door of mortality is opened, the good life will
never be quite the same again.
References
1. Obituary. Dame Cicely Saunders. 2005. Available at:
http://bmj.bmjjournals.com/cgi/content/full/331/7509/DC1 (Accessed 20
July, 2005)
2. Coyle N. The Existential Slap – a crisis of disclosure.
International Journal of Palliative Nursing 2004; 10:520
3. O’Gorman SM. Death and dying in contemporary society: an
evaluation of current attitudes and the rituals associated with death and
dying and their relevance to recent understandings of health and healing.
Journal of Advanced Nursing 1998; 27: 1127-1135
4. Thomas C, SM Morris and D Clark. Place of death: preferences among
cancer patients and their carers. Social Science & Medicine 2004; 58:
2431–2444
5. Clark D. Between hope and dying: the medicalisation of dying. BMJ
2002, 324:905-907.
Competing interests:
None declared
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While writing this obituary I was, by coincidence, visiting a friend in a hospice (not St Christopher's). It was my first visit to any hospice and a disappointment: my friend was in a cramped and institutional 3-bedded room, and she was often in pain.
Competing interests:
None declared
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Dear Sir,
Dame Cicely Saunders has left us with both an invaluable legacy and
an enduring challenge with her passing.
The Hospice Movement was born in 1967 from her distress at witnessing
the unnecessary suffering of others. It is to our collective shame that 38
years later the Channel 4 Dispatches programme ‘On Pain of Death’ was
broadcast last night.
Professor Laurie Taylor’s account of death in Britain today was
harrowing. Most of us will die in considerable pain, not in our own bed
but in a hospital ward, where doctors will hesitate to prescribe adequate
pain relief through ignorance and fear.
Why is this so? Is palliative care part of the core curriculum of
medical schools?
Are there training courses for doctors to attend to bring them up to date
on the latest techniques? Should there be incentives for doctors to
specialise in palliative care? Why is quality of death not a government
priority?
I don’t know the answers to these questions, but I do know that I
agree with St. Augustine that the greatest evil that a person can
experience is physical pain.
Competing interests:
None declared
Competing interests: No competing interests
On Death & Dying
In the 1970's I attended a day conference in Perth Western Australia,
with I think the title 'On Death & Dying'. I had trained as a nurse
both in Edinburgh and Australia and felt that neither of these topics had
been addressed during my training, so I went to the conference, at which I
heard Dame Cicely Saunders speak for the first time.
It was wholly inspirational and has informed and influenced my
practice for the past 30 years. I hope that over these years I have
managed in a small way to cascade what I learned then.
How many thousands of others have been influenced by her during her
life I cannot imagine.
Competing interests:
None declared
Competing interests: No competing interests