History, gender and culture in the rise
of palliative care
As the work of palliative care expands around the world, there is a growing interest in understanding more about how this field of activity first began to develop in its modern form. This chapter draws on a programme of research that has been developing since the mid-1990s and is now recognized as a key source of information about the history of modern hospice and palliative care.1 It explores how it was that in the nineteenth century a new interest in the care of the dying first began to emerge and describes some of the activities led by hospice pioneers at that time. It then goes on to analyse key developments taking place in the second half of the twentieth century that began to establish this work not just as the interest of religiously and philanthropically motivated individuals and groups, but as something that might be capable of finding a place within the wider systems of health and social care delivery. The history of modern palliative care is a short one, and many of those who have shaped it are still alive to tell their stories and to reflect on their experience. Learning from that history is a crucial way in which an increasingly specialized field can better understand its current dilemmas and also develop effective strategies for the future. But the modern field also has a pre-history and to make sense of that we must begin by looking back more than 150 years.
In many parts of Europe, North America and Australia, as the nineteenth century advanced, an epidemiological transition got underway that saw the beginnings of a shift in the dominant causes of death: from fatal infectious diseases of rapid progression to chronic and life-threatening diseases of longer duration. As this transition became more marked, the departure from life for many people became an extended and sometimes uneven process. Consequently, people called 'the dying' began to emerge more clearly as a social category and, over time, the most common place to end one's life began to shift from the domestic home to some form of institution. For the first time in history, special institutions were formed, often the work of religious orders or religiously motivated philanthropists, that were