Hospice - 12th to late 20th Centuries
Understanding palliative care begins with the story of hospice. ‘Hospice’ comes from a Latin word hospitium, meaning hospitality, and was used in the Middle Ages in Europe and Mediterranean regions to describe a place of rest for travellers and pilgrims. Established and run by religious orders, these places offered special hospitality and care to travellers who were far from home and to people who were ill or dying. The hospice disappeared for a while, but re-emerged in the 19th century in the UK and France particularly, again run by religious orders, and again caring for people who were terminally ill, but also providing accommodation for the incurable and destitute.
Late 20th Century Palliative Care
The modern use of the term hospice dates from 1967 with the opening of St Christopher’s Hospice, London, established by Dr Cicely Saunders, later Dame Cicely Saunders (1918 – 2005). At that time there was a growing awareness that 20th century medical advances, while offering a cure for many illnesses, also resulted in the health system ignoring those people who could not be cured. Cicely Saunders, originally a nurse, then a social worker (almoner), finally studied medicine to meet this challenge, the neglect of the suffering of the terminally ill. Her work in building St Christopher’s Hospice and her approach to pain and symptom management, recognizing the multi-dimensional nature of suffering and the need for emotional, psychological and spiritual support for both the terminally ill patient and their family was the foundation for modern hospice and palliative care practice.
The term ‘palliative care’ was first used in 1975 by Canadian surgeon Balfour Mount, an early Saunders pupil. Returning to French speaking Quebec, he needed to avoid the word hospice because of the poor reputation, particularly the connotation of destitution, associated with these institutions in France. Mount developed a comprehensive hospital-based service at the Royal Victoria Hospital, Montreal that included an in-patient ward, consultation service, home care programme, and bereavement support service under the name Palliative Care service by which he meant non-curative therapy aimed at improving the quality of life.
Palliative Care in South Australia
Palliative Care in South Australia began in its current form in 1980 when the Southern Hospice Association was formed and the first hospice service was the Southern Community Hospice Service in 1983 at Flinders Medical Centre under the guidance of Professor Ian Maddocks. This co-incided with the first hospice, Goode Wing, Kalyra Hospital at Belair– later to become Daw House Hospice in 1988.
The Mary Potter Home, at Calvary North Adelaide had existed as a traditional hospice, a ‘home for the dying’, offering special care for the terminally ill since 1902. The Little Company of Mary nuns is a nursing order founded by Mary Potter (1847-1913) with a special mission to accompany the dying with prayer, as well as provide practical support. In 1986 it became Mary Potter Hospice when Calvary Hospital embraced the modern hospice philosophy of care with the development of the medical and multi-disciplinary team, and creation of formal links with the Royal Adelaide Hospital. Dedicated Palliative Care beds were established in 1989 at the Royal Adelaide Hospital.
The Philip Kennedy Hospice at Largs Bay, part of the a larger nursing home run by the Knights of the Southern Cross, was built in 1985 and served the Western Palliative Care service at the Queen Elizabeth Hospital (QEH) until palliative care beds were opened at the QEH in 2004. Hospice beds, more recently called palliative care beds, were established at Lyell McEwen and Modbury Hospitals to service the northern metropolitan area.
The Royal District Nursing Society has delivered dedicated palliative care in Adelaide to patients and families in their homes since 1980, with support from Domiciliary Care services. These services have worked in conjunction with the specialist palliative care services, and the patient’s general practitioner.
Regional and rural communities in South Australia have supported the development of palliative care in their communities, with the opening of dedicated palliative care beds in their local hospitals – Whyalla 1988, Mt Gambier 1989, with other regional centres setting up similar services concurrently. Metropolitan palliative care services have supported regional nurse and GP teams in many country towns and remote areas of South Australia through the Commonwealth Medical Specialist Outreach Assistance programme (MSOAP), but this is now formalised in the South Australian Palliative Care Plan 2009-2016, with formal links created between specialist services in Adelaide and rural services.
Palliative Care South Australia Inc
Formed in 1983 as the Hospice Association of South Australia, in 1986 the hospice association became The South Australian Association for Hospice and Palliative Care. In 1998 the organisation became The Palliative Care Council of South Australia. In 2010 the of was dropped and in 2014 the use of the term Council was also deleted in order for the Board to adopt the new national identity for palliative care and we are now named Palliative Care South Australia Inc (PCSA).
Palliative Care Australia
Formed by representation from each of the state and territory palliative care organisations, in 1990 the Australian Hospice and Palliative Care Association became the national voice and peak body for palliative care. Becoming simply Palliative Care Australia in 1998 it has provided a platform to work together linking research, developing standards and quality measures, advocating for policy development and to provide a forum to solve the common issues that arise in palliative care across the states and territories. www.palliativecare.org.au