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• One in four people are not likely to discuss death-related issues with their aging parents, even if a parent is terminally ill and has less than six months to live.
• Fewer than 25 percent of Americans have thought about how they would like to be cared for at the end of life and have put it in writing.
• 36 percent say they have told someone about how they want to receive treatment at the end of life, but people include "passing comments" in this category. Even so, 50 percent of Americans overwhelmingly say they will rely on family and friends to make end-of-life decisions.
• Nearly 80 percent of Americans do not think of hospice as a choice for end-of-life care; 75 percent do not know that hospice care can be provided at home; fewer than 10 percent know that hospice provides pain relief for the terminally ill; more than 90 percent of Americans do not know that hospice care is a fully covered Medicare benefit.

The NHF calls it a national "communications challenge."

Hospice care has come a long way since its inauspicious beginnings in the late 1950s in Britain. More than 40 years later, 3,000 programs have been launched in the United States and more than 450,000 patients have sought hospice care in their last stages of life.

Making more people aware of the benefits of hospice care has been a challenge. The medical establishment excels at curing people and is hard-pressed to surrender to death, which smacks of failure. This reticence also sometimes leaves patients ill-equipped to face their final days. A recent study conducted by the University of Chicago found that nearly 40 percent of the 258 doctors surveyed said they "would knowingly give inaccurate estimate of survival time, even if the patient had specifically asked for a frank prediction. Most doctors erred on the side of optimism" (Chicago Tribune, June 19). But beyond institutional resistance, the pragmatic youth-oriented culture we live in also works against having this conversation.

Balm of Gilead is among the first palliative-care units in the nation trying to change the tide. And only Balm of Gilead has worked with local Christian churches and other religious groups to help make it work. The small cadre of pioneers on Cooper Green's fourth floor are linking the medical establishment with the hospice movement and inviting religious believers to join in. More and more, Balm of Gilead and other palliative-care units are getting those 75 percent of patients destined to die in impersonal institutions into the hands of someone who cares about their pain, their families, and their spiritual life. Like the words of the black spiritual for which it is named, Balm of Gilead stands behind this truth: "There is a balm in Gilead that makes the wounded whole."

Amos Bailey notes that hospice care was "an antiphysician movement" in its beginnings. In the 1940s a British "almoner," or patient's advocate, named Cicily Saunders (now Dame Cicily) had witnessed the difficult isolated deaths of terminally ill patients, and her heart was moved. She felt a calling to serve and help them. She spoke to a trusted friend, a physician, who told her, "Go study medicine. It is the doctors who desert the dying." She completed her medical degree in 1957 at the age of 39, and after much prayer and meditation came up with a plan. St. Christopher's Hospice was born in 1967 in a London suburb, and with it the hospice movement.

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October 22 2001, Vol. 45, No. 13