... people who have worked in general and chronic wards do seem to think it is rather epoch-making that every one of our patients looks peaceful, contented, and free from pain, whenever they come round the hospice. I do not pretend for a moment that [it] is my work... . Of course, most of the work is just the good nursing.1
When British physician Cicely Saunders wrote those words to a colleague, she was in the process of blending the religious roots of hospice with an academic model of clinical research on pain control for terminally ill cancer patients at St. Joseph's Hospice in London. In preparation for building St. Christopher's, a hospice of her own, she wrote a series of letters to physicians in the United States to learn more about how Americans cared for terminally ill cancer patients. In 1963, Saunders made the first of many trips to the United States to visit medical centers and universities across the country and to lecture about the benefits of the "good nursing" and her work at St. Joseph's. Her eloquent descriptions of the hospice philosophy of care resonated with a small but growing cadre of idealistic nurses, clergy, and physicians who believed that medical care for the dying had grown increasingly impersonal and technologically managed. At the time Saunders began her correspondence wirh the Americans, she did not know that broad economic, social, and cultural changes underway in the United States were creating an environment ripe for reform. Nor could she have foretold how the transadantic transfer of knowledge, research, and ideals would serve as a catalyst to ignite the American hospice movement.
This article examines transitions in community-based care for the dying before and after the inception of the American hospice movement. Specifically, the early development of modern hospices in Britain and the state of Connecticut (1945-1974) is used as a case study to examine the interplay among religion, nursing, and the modern conceptualization of hospice. Beginning with a discussion of the antecedents of modern hospices, the article explores how these shaped Saunders's conceptualization of hospice as both place and systematic approach to eating for the dying. This is followed by an examination of how and why the transadantic exchange of knowledge and ideas brought a multidisciplinary group together to advance hospice as a necessary health care reform in the United States and the challenges the group faced as they moved toward integrating hospice into the American medical system.
In reconstructing the history of hospice, I argue that, aldiough the modern hospice concept may have been in sharp contrast to standard medical and nursing care for the dying in some academic medical centers, it was not wholly different from nursing care provided at home and in specialized homes for the dying in both Britain and the United States. Although few of these homes were called hospices, they were critical to the modern conceptualization of hospice as both a place and philosophy of care for the dying.
Previous studies of the American hospice movement typically begin by tracing the word hospice, linking earlier hospices to the creation of modern hospitals, and then quickly move to Cicely Saunders and the founding of the modern hospice movement.2 As historian Clare Humphreys argues, this preoccupation with the term "hospice" has resulted in the obfuscation of the role that other earlier homes for the dying played in caring for the terminally ill.3 Moreover, the centrality of medical institutions and physicians in these analyses obscures the significance of the roles of families, nurses, and religious groups in community-based care for the dying and the development of modern hospices. Building on previous scholarship on the institutionalization of life's beginning and end in Canada and home care in the United States, this study illuminates the links between faith traditions, personal ideologies, shifting professional paradigms, culture, and class that remain invisible in much modern scholarship of hospice. …