PHOTO: CLIFF SKARSTEDT

A career of compassion

HÉLÈNA KATZ | Thirty years ago Dr. Cicely Saunders opened St. Christopher's Hospice in London, England, so that terminally ill people would have a place to die peacefully. That humanitarian action launched a worldwide movement.

Saunders gave the fall's second Beatty Memorial Lecture last week on "Lessons in Living From the Dying." She also received an honorary degree at convocation last Thursday.

In her lecture, Saunders told of being inspired by a patient, David Tasma, whom she met in 1948 when he was hospitalized with an inoperable cancer and she, a former nurse, was working as a medical social worker. The two discussed how she might one day open a place that was better suited to pain control and coming to terms with death than a busy hospital ward.

Tasma, who was 40 when he died, left her £500 and told Saunders, "I will be a window in your home," she recalled. "David Tasma, who thought he'd made no impact on the world by his life, started a movement," she told the packed crowd in the Noel Fieldhouse auditorium.

After he died, Saunders volunteered for three years at St. Luke's Hospital, where the physical discomfort of dying patients was better treated. "For the first time I saw the constant pain of terminal cancer getting constant relief."

At a doctor's urging, she enrolled in medical school to learn more about proper pain management and gain the clout to convince doctors to listen to her ideas about care for dying patients.

Finally, in 1967, she opened St. Christopher's. "It took me 19 years to build a home around the window," she says, referring to Tasma's legacy. The approach at the hospice was to recognize and treat both the needs of the patient as a whole person and the needs of the family, to alleviate suffering rather than fight a disease, and to see dying as a time where there is still the potential for healing and growth.

Saunders recounted how a young woman visited her dying father at St. Christopher's every day. With the support of an experienced social worker, the daughter used her father's dying days to work through her feelings for him and to forgive him for the abuse he had inflicted on her when she was a child.

Valuing the individual and his or her experience is central to the palliative care movement, said Saunders. Indeed, its philosophy is: "You matter because you are you and you matter until the moment you die."

Saunders said she has always been against euthanasia precisely because it makes vulnerable people feel they are a burden and they ought to opt out. The answer, she said, is to provide better care for the dying to make people feel they're still an important part of society.

A regional study in the U.K. that interviewed caregivers found that while 24 percent of the deceased had wished for an earlier death, only 3.6 percent were said to have asked for euthanasia.

She noted that Britain's House of Lords Select Committee on Medical Ethics, a New York State task force studying the same issue and Canada's Senate committee on euthanasia and assisted suicide all recommended extending palliative care rather than changing the laws to make euthanasia easier.

Today, St. Christopher's has more than 300 staff and 800 volunteers and has inspired the foundation of similar centres worldwide. McGill's own Palliative Care Service was established in 1974 by Dr. Balfour Mount, based on the principles established by Saunders.

Mount had conducted a survey at the Royal Victoria Hospital which demonstrated that the needs of dying patients were not being met. With Saunders's support, Mount was able to establish a hospice setting within a teaching hospital, and the Vic's hospital-based model has since been adopted by the World Health Organization and health care institutions in more than 30 countries. Palliative medicine is now a recognized specialty in the U.K., Australia and New Zealand.

"The movement for palliative care has arisen around the world as a protest against the pain, isolation and neglect of dying people," Saunders said.

Working with the dying has taught Saunders about living. "It's made me realize the enormous potential people have at the end of their lives," she said.

"People move fast in a crisis and if the crisis is knowing your life is coming to an end, you see people reconciling with their families, reconciling with themselves, sorting out what really is important."

And what of her own death? Saunders wants one that will give her time to tie up loose ends.

"Everyone else would like to have a stroke on the golf course. I'd rather have cancer because it does give us a chance to say thank you and I'm sorry and goodbye  and I would like to tidy up my desk," she added mischievously.

The death of her husband two-and-a-half years ago at the age of 93 offers Saunders some inspiration. After spending 10 years facing a series of life-threatening illnesses, the art professor told his wife, "I am completely happy. I've done what I had to do with my life. I'm ready to die." Saunders thinks we would all be lucky if we came to the end feeling the same way.