Palliative medicine

Abstract

First there was terminal care, then there was palliative care, and now there is supportive and palliative care. What is going on? Why the need to re-name, to re-brand? Have we palliative care practitioners changed what we do or do we wish to define ourselves in a different way? Elements of both are probably true. Palliative medicine is a fairly new specialty, and like many new specialties it needs to inform its colleagues of its place and role. It began with, and grew out of, the hospice movement, led by Cicely Saunders in response to the poor standard of care she saw dying patients receiving within the UK National Health Service. Saunders wanted to give a “voice to the voiceless”. She set up St Christopher's Hospice in London, a place where people receive good care at the end of their lives, but also a place that has acknowledged the importance of education and research from its inception. Saunders' training as a social worker, nurse, and doctor, and her profound Christian faith, catalysed a holistic approach to patients' care that incorporated pain and symptom control as well as attention to the psychological, social, and spiritual aspects of suffering. Hospice and palliative care, while generally viewed positively, were nevertheless seen, and are still seen by many, as delivering only terminal care—ie, for the last few days or weeks of life.