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Dame Cicely Saunders

22 June 1918 — 14 July 2005

Everyone knows of Florence Nightingale, the nurse whose selflessness
and energy in caring for soldiers during the Crimean War transformed
hospitals and made nursing a true profession. Her contemporary
counterpart was another Briton, Dame Cicely Saunders, who died earlier
this month at the age of 87. It was the capstone of a lifetime
specialising in care for the dying.

Dame Cicely’s achievement was to begin the modern hospice movement in
1967. There are now hundreds of hospices for the dying in Britain and
in more than 95 countries around the world. Without her work, the
euthanasia movement would undoubtedly have been far more persuasive and
legalised euthanasia would have spread much further. She showed that it
was possible to die peacefully and without great pain. For her, dying
was not something to be feared but was “as natural as being born”.
Partly due to her influence, palliative care has become recognised as a
distinct medical speciality.

Dame Cicely was a woman of wisdom. Although she was an eminent
clinician and researcher, she knew that care for the dying was not
simply a matter of managing patients’ pain. She developed a theory of
“total pain” which included its emotional, social, and spiritual
elements. “The whole experience for a patient includes anxiety,
depression, and fear; concern for the family who will become bereaved;
and often a need to find some meaning in the situation, some deeper
reality in which to trust,” she said.

Dame Cicely was also a woman with deeply Christian convictions, but her
hospices were open to people of all persuasions, and to those who had
none. “I once asked a man who knew he was dying what he needed above
all in those who were caring for him,” she once said. “He said, ‘For
someone to look as if they are trying to understand me.’ Indeed it is
impossible to understand fully another person, but I never forgot that
he did not ask for success but only that someone should care enough to
try.”

That wisdom was hard-won. Her well-to-do father disapproved of her
interest in nursing and so she enrolled at Oxford instead. When World
War II broke out, however, she took up nursing. But her back gave her
trouble and she had to switch to a degree in social work. In 1945 her
parents divorced and she converted from agnosticism to evangelical
Christianity. This happened all of a sudden, during a holiday in
Cornwall with some Christian friends. “It was as though I suddenly felt
the wind behind me rather than in my face,” she later said. “I thought
to myself: please let this be real. I prayed to know how best to serve
God.”

The answer came the next year when she fell in love with a dying Polish
Jew named David Tasma, the first of three romantic attachments to
Polish men. “He needed to make his peace with the God of his fathers,
and the time to sort out who he was,” she recalled. “We discussed the
idea of somewhere that could have helped him do this better than a busy
hospital ward.” When Tasma died, he bequeathed Saunders £500 — no mean
sum in those days — to start a hospice. “I’ll be a window in your
home,” he said.

Her mission in life was now clear to her: founding a home where the
dying would receive the best medical care along with affection and
understanding. A doctor told her that people would not listen to a
nurse, so at the age of 33 she began a medical degree. In 1957 she
qualified and obtained a research scholarship in pain management for
the incurably ill, at the same time working in a hospice for the dying
poor run by Catholic Sisters of Charity.

There she met the second Pole in her life, Antoni Michniewicz, who
showed her what death could be like when it was surrounded by loving
care. He inspired her to name her own hospice for people in the final
stage of life’s journey after Saint Christopher, the patron of
travellers.

In 1967 she opened St Christopher’s in London. Initially it had 54
in-patient beds with respite care and a home care service. The years of
planning which preceded this also brought to light Dame Cicely’s other
sterling qualities as a medical administrator, a fund-raiser and
publicist for her vision.

Three years after the death of Antoni she spotted a picture of the
Crucifixion in a gallery which she thought would be appropriate for the
hospice. She contacted the Polish artist, Marian Bohusz-Szyszko, and
ended up falling in love with him even though he was 18 years older. He
was a devout Catholic who still supported his estranged wife and it was
only after she died that Cicely married him. She was 61 and he was 79
and in poor health. She gave him constant nursing care and he ended his
days in St Christopher’s in 1995.   


She never gave up working, although she retired from active involvement
in St Christopher’s in 1985. In 2002 she launched the Cicely Saunders
Foundation which aims to promote research into palliative care, with a
focus on collaboration amongst the different specialties of healthcare.

According to an obituary in the London Times, many years ago she
told a questioner at a symposium that she would prefer to die with a
cancer which would give her time to reflect upon her life and to put
her material and spiritual affairs in order. And that is what happened.
She passed away at St Christopher’s of breast cancer.

As a clinician, Cicely Saunders will probably be remembered for a
relatively novel method of pain relief — administering sedation to
achieve a steady state in which a dying patient can still remain
conscious and have a reasonable quality of life, instead of reacting to
surging pain with intermittent sedation. She opposed euthanasia,
arguing that everyone had a right to die well, without pain and with
dignity, and that death can be a positive experience.

But on a deeper level, she was able to speak of death as a natural and
positive part of a complete life, translating some features of her own
Christian approach into a secular idiom.

Those who work in palliative care may have to realise that
they, too, are being challenged to face this dimension for themselves.
Many, both helper and patient, live in a secularised society and have
no religious language. Some will, of course, still be in touch with
their religious roots and find a familiar practice, liturgy, or
sacrament to help their need. Others, however, will not. For them
insensitive suggestions by well meaning practitioners will be
unwelcome.

However, if we can come not only in our professional capacity but in
our common, vulnerable humanity there may be no need of words on our
part, only of concerned listening. For those who do not wish to share
their deepest needs, the way care is given can reach the most hidden
places. Feelings of fear and guilt may seem inconsolable, but many of
us have sensed that an inner journey has taken place and that a person
nearing the end of life has found peace. Important relationships may be
developed or reconciled at this time and a new sense of self worth
develop.

The loudest voices in today’s debates over euthanasia are often its
champions, doctors whose credentials include public defiance of the law
by killing depressed and lonely patients. But in the long run, it will
probably be the softer and more humane voice of Dame Cicely Saunders
who helped hundreds to a peaceful death: “You matter because you are
you, and you matter to the last moment of your life.”

Michael Cook is editor of MercatorNet.