History of Palliative Care

“In the end, it’s not the years in your life that count.  

It’s the life in your years.”

Abraham Lincoln

History of Palliative Care

The concern for the quality of end of life has not always been a prime consideration. One Canadian doctor found it in his heart to change this.  Due to his lifelong dedication to the comfort of dying patients, end of life care came to be known as Palliative Care.  This is the tremendous contribution that this Canadian doctor made in medical history.  It’s important that I update my dear readers with this bit of historical information. I hope you find it interesting and useful.   

Dr. Balfour Mount as a child accompanied his father, a doctor, to visit a terminally ill patient. Dr. Mount was so moved by this calm and positive experience, he not only became a doctor when he grew up, but he also became the founder of Palliative Care in Canada, and a leading proponent for the field worldwide. Dr. Mount recognized that experiencing a good quality of life at the end of life was an important ingredient to living. He cared about how dying people were treated at the end of their lives.

Dr. Balfour Mount’s Inspirations

Dr. Mount followed the work of two women: Cicely Saunders, a nurse and social worker in England, and a psychiatrist from the United States called Elisabeth Kubler-Ross.  Cicely Saunders founded Saint Christopher’s Hospice in the 60s, a stand-alone hospice, to ensure that end-of-lifers would be treated with dignity, focusing on their comfort, living without as much pain as possible, mentally and spiritually, also tending to their families.  In the United States, Elisabeth Kubler Ross identified the stages patients experience. She came up with the five stages of grief, denial, anger, bargaining depression, acceptance.  Hospitals were generally acclimated to spending money on getting people better. They saw comforting end-of-lifers as a separate responsibility, best relegated to hospices and other such institutions.

Launching Palliative Care

history of palliative care

Dr. Mount introduced the idea that medical services to the dying could be administered within the walls of a general hospital launching a palliative service at the Royal Victoria Hospital in Montreal.  Unbeknownst to Dr. Mount, two other physicians, David Skelton and Paul Henteleff, founded a unit for “terminal care” at the Saint Boniface Hospital in Winnipeg.  The idea of focusing on improving the quality of the end of life of the patient, regardless of place, must have gone into the mass consciousness, because this was happening independently of one another.

The emphasis of relieving physical suffering was one thing, but these doctors also address the psychological, social and spiritual suffering their patients were experiencing, not to mention saving money by reducing their visits to the emergency room, and other expensive interventions at the end of life.  The field has only been officially recognized in Canada as a medical subspecialty since 2013.

As in the United States, most terminally ill patients say they want to die at home, but the majority of people end up dying in hospitals, with many not receiving palliative care until the last month of life.  Many others are even opting to hasten their death. This may be due to the lack of palliative care bringing them relative comfort for a natural end.

Dr. Mount fought hard to convince the Royal Victoria to give him beds and resources to launch a palliative unit in the early 70s, and he too interviewed terminally ill patients.  What he revealed is what he suspected, a huge disconnect between the patients and their doctors.  It was the doctors who made the decision whether to discuss the nature of their patient’s disease WITH the patient, while the majority of the patients felt they needed to be told, that they had a right to know.  Some patients walked around with a terminal illness for years until they understood the magnitude of their condition. And they had no pain control system in place, nor did their doctors address their emotional distress.  

Palliative Care Vs Hospice

To boot, many colleagues at the Royal Victoria were told that the term “les hospices” had a connotation in French of a dumping ground with inadequate care.  At least the word, “palliative” came from the Latin word for “cloak”, meaning improving the quality of life, like cloaking symptoms.  That’s when Mount decided he would use the term, Palliative and apply it to caring for the dying.

Finally, people saw how important it was to treat terminally ill patients with honor, dignity and regard at the end of their lives.  Palliative care in Canada became an accepted part of the health care system.  Yes, it took until 2013 for it to be accepted, but accepted it has been. And now terminally ill patients can at least have a better end of life experience.  

I hope my dear Readers found the above information interesting and valuable.

It’s your life.  Enjoy the journey.  And, remember to bring love into everything you do!

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