Living Fully Until We Die

Today, hospice is an accepted part of American medicine. One out of three terminally ill Americans uses hospice care. People increasingly assume that hospice is part of the dying process. They also assume a key hospice principle: that people should be cared for in such a way that they can live fully until they die. Few realize that the modern hospice movement is young and that Christian faith motivated its founder.

The modern hospice movement is rooted in a much older idea of hospitality. Indeed, the term comes from the same Latin root as hospital and hostel. Places of hospitality were not confined to the Latin-speaking world, however. Greeks, Indians, Romans, early Christians, and Muslims all built places where pilgrims and travelers, particularly the sick, could rest and find care. In modern times, Christians showed their commitment to hospitality for the hurting by building hospitals and, at the end of the 19th century, the first institutions dedicated solely to caring for the dying. Called hospices, these institutions lacked the fully formed philosophy that would characterize the modern movement, they but did offer inspiration to the movement's founder, Dame Cicely Saunders.

Saunders established the first modern hospice, St. Christopher's, in 1967. Located in London, St. Christopher's was the result of Saunders' experience treating dying people, her belief that people could flourish even as they died, and her sense of Christian call.

A wind behind her

Saunders' route to both medicine and faith took some time. Born in 1918, she went to Oxford in 1938 and studied politics, philosophy, and economics. World War II sent her on a different path. She stopped her studies in 1940 to become a nurse. When a bad back forced her from nursing in 1944, she returned to school and became a medical social worker. In the midst of her schooling, she went on vacation with some Christian friends and converted to Christianity. "It was as though I suddenly felt the wind behind me rather in my face," she reflected afterward.

In 1947, it became clearer what she would do with God's strength at her back. While working at a London hospital, she met David Tasma, a Polish survivor of the Warsaw Ghetto and a terminally ill cancer patient. They fell in love. They also agreed that the care dying people received did not allow dying to be what it could be: a time to make peace with friends, family, and one's own life. When Tasma died, he left Saunders his fortune of 500 pounds and told her, "I'll be a window in your home." Saunders later remembered that David's words felt like God tapping her on the shoulder and saying, "You've got to get on with it."

Getting on with it was not simple. Saunders worked for several more years among the dying before training to be a doctor. After completing her studies, she worked at St. Joseph's, one of the hospices started by the Catholic Church at the end of the 19th century. There she began to develop and disseminate her philosophy about caring for dying people. Saunders recognized that terminally ill patients dealt with more than physical pain. Doctors needed to consider their "total pain," or the combination of their physical, spiritual, emotional, and mental pain. Rather than acceding to the medical field's final words on a dying patient—"there is nothing more we can do"—Saunders proposed that the medical community could do much. In addition to managing pain, Saunders advocated listening to patients' stories and concerns and responding with emotional and spiritual support.

Her time with patients confirmed that dying was a spiritual matter. St. Joseph's taught Saunders that "a hospice is a stopping place for pilgrims. For many of ours it is the last journey. If we can help them to be quiet by relieving their physical and mental burden, we can see so clearly that the real work is not ours at all but Our Lord's, Who by His saving death draws near to all the dying."

In the midst of Saunders' work, she experienced personal loss. While at St. Joseph's, she fell in love with another dying patient, Antoni Michniewicz. His death in 1960 was followed by the death of Saunders' father in 1961. Saunders later described this time as one of intense grieving. Both her work and her own experience demonstrated that families and friends of terminally ill patients needed support.

The first modern hospice

In 1967, Saunders opened St. Christopher's hospice, a place dedicated to patient treatment as well as to teaching and research. Although Saunders had published many articles about caring for terminally ill patients and had become a recognized authority on the subject, she knew that spreading her message would take time and more research. Her success, however, was remarkable. Her hospice philosophy spread abroad—the first hospice in America opened in 1971—and St. Christopher's became a center of training, study, and care. Her reception of the title "Dame Commander of the British Empire" in 1980 and the prestigious Templeton Prize in 1981, as well as a host of other awards, demonstrated the significant influence of her work in the medical community and beyond.

Saunders also used St. Christopher's to show how religion could be integrated into the experience of dying. Her hospice was open to Christians and non-Christians alike but had, she said, a Christian foundation. She also claimed that treating physical pain gave patients freedom—a freedom she saw them use "in time for family reconciliations, in deepening relationships, and in all the sorting out of beliefs and memories that can help others say, with Pope John XXIII, 'My bags are packed—I can go with a tranquil heart at any moment.'"

Even after her retirement in 1985, Saunders actively promoted her movement as well as her beliefs about the intersection of faith and dying. She strongly condemned euthanasia. Hospice, according to Saunders, encouraged people to live fully until they died. Convinced that with modern drugs people need not die in pain, she claimed that euthanasia precluded the work of a good death—the reconciliation with mortality, with family, and with God that occurred as people died. "It is not for us to say that the suffering is fruitless," she wrote, "nor that there is nothing more for the patient to do or learn in this life." People were not the own masters, she claimed.

Saunders' last decades were marked—as her life had been—by loss, joy, and faith. In 1980, she married a man she had long loved, Polish artist Marian Bohusz-Sysko. When they had first met in 1963, he was married but estranged from his wife. Saunders and Bohusz-Sysko married after his wife's death, and he died at St. Christopher's in 1995. As he was dying he told Cicely, "I am completely happy. I have done what I had to do in my life, and I am ready to die." Cicely believed Marian's death was a "good death," the kind that hospice encouraged by bringing into the secular world of medicine Christian ideas of hospitality, reconciliation, and God's presence in suffering. Hospice, she asserted, also brought people of various faiths and no faith together in a way that was deeply rooted in Saunders own Christian faith. As she wrote, "Death remains a mystery, but we have been shown that while it divides it can also unite."

Dame Cicely Saunders died in 2005—in the hospice she founded.

Sarah E. Johnson is assistant professor of religion at Gustavus Adolphus College in Saint Peter, MN.