One of the most influential female figures of the 20th century, Dame Cicely Saunders transformed the way society viewed care for the dying. She was the founder of the modern hospice movement, and her legacy continues to affect how many of us will be cared for as we approach the end of our lives.
Cicely’s new ideas of person-centred care emerged from her unique multi-disciplinary experience as a nurse, medical social worker, doctor and researcher. She introduced effective pain management and the concept of ‘total pain’, the idea that suffering encompasses all of a person’s physical, psychological, social, spiritual, and practical struggles.
The author of over 85 globally acclaimed publications, Cicely received many honours and awards for her work, including twenty-five honorary degrees from the UK and overseas. In recognition of her significant contributions to palliative care, Cicely was made a Dame of the British Empire in 1979 and awarded the Order of Merit in 1989.
How Cicely became Cicely
Cicely was born in Barnet, Greater London, in 1918. She was educated at Roedean School then went to St Anne’s College, Oxford, to study philosophy, politics and economics in 1938. A year later, WWII intervened, and she became determined to do something more useful. She paused her studies at Oxford and went to study nursing at the Nightingale School of Nursing at St Thomas’ Hospital. Towards the end of her training, she injured her back and reluctantly gave up nursing after qualifying as a State Registered Nurse in 1944.
She returned to St Anne’s in 1945 to commence training as a medical social worker, or what was then called a lady almoner. She cared for patients with terminal illnesses as an almoner at Archway Hospital from 1945 and as a volunteer at St Luke’s Hospital, London. During her time at Archway, she cared for a dying Polish man named David Tasma. In a matter of weeks, they developed a deep bond, and they started discussing the possibility that Cicely might establish a special place more suited to those in his condition. Their exchanges served as a great inspiration to Cicely and later became emblematic of her philosophy of care. When he died in 1948, David left Cicely £500 and the prophecy ‘Let me be a window in your home’.
A striking feature of Cicely’s early work was her articulation of the relationship between physical and mental suffering. Cicely believed that there was no such thing as intractable pain and argued that if physical pain was alleviated, then mental pain was also relieved. At that time, doctors focused on curing illnesses and patients were often provided with inadequate pain relief. Cicely was not prepared to accept this. Having been told that her ideas would never be accepted in medicine unless she was a doctor, Cicely enrolled at St Thomas’s Medical School (now King’s GKT School of Medical Education) aged 33 and graduated in 1957.
The following year, she was awarded a research scholarship by the Halley Stewart Trust to work on pain control for the terminally ill at St Mary’s Hospital, Paddington. At the same time, she worked at St Joseph’s Hospice where she used her research and medical skills to help the nuns improve care for the dying poor in Bayswater. She developed new record-keeping and pain control methods. Patients were given continuous pain relief and not forced to wait until their pain returned as they were at the time. She distinguished between pain levels and she used medicines to relieve other problems such as breathlessness, bedsores, nausea, depression and constipation.
The first modern hospice
While working at St Joseph’s, Cicely devoted herself to establishing a new kind of hospice that combined compassionate care with medical care. In 1967, her vision became a reality when St Christopher’s Hospice in Sydenham, London, opened. St Christopher’s became widely recognised as the first modern hospice because it was the first to combine teaching and clinical research, pain and symptom control with compassionate care.
Cicely served as the Medical Director, Chairman and Founder/President of St Christopher’s Hospice for 34 years. At the same time, she also contributed to several grant-giving trusts as Member of the Medical Research Council, Deputy Chairman for the Attendance Allowance Board, a Founder, and Hon. President of the National Council for Hospice & Specialist Palliative Care Services, Trustee of the Elizabeth Clark Trust and Trustee of the Goldsmiths' Charitable Trust.
The first Institute of Palliative Care
In 2002, in her early eighties, Cicely set up The Cicely Saunders Foundation (now Cicely Saunders International). A key objective for the charity was to establish our Institute, integrating the best research, education, information and care in one vital hub. Cicely said, that “We need to go on learning so that in 10 years time we are doing things better than we are now." The Institute opened in February 2010 in partnership with King’s College London, Cicely's alma mater. It was the world's first purpose-built institute for palliative care.
Cicely developed breast cancer but continued to work, even from her deathbed. She died at St Christopher’s on 14 July 2005. Her work continues through us at the Cicely Saunders Institute and Cicely Saunders International.