Saunders, Cicely (1918—)

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Saunders, Cicely (1918—)

Founder of the hospice movement for the care of terminal cancer patients and head of St. Christopher's, London, Britain's first modern hospice. Name variations: Cicely Saunders until 1980; Mrs. Cicely Bohusz or Dame Cicely Saunders from 1980. Born in Barnet, north London, England, in 1918; daughter of Gordon Saunders (an estate agent) and Chrissie (Knight) Saunders; attended Roedean School, St. Anne's College, Oxford, and St. Thomas's Hospital, London; married Marian Bohusz-Szyszko (a Polish artist), in 1980; no children.

Worked as a nurse (1939–43); served as an almoner (medical social worker, 1945–51); served as a doctor (1951—); was a research scientist (1957–59); was founder and head of St. Christopher's Hospice (1963—); taught a semester at Yale School of Nursing (1965); was an advocate for compassionate care of the dying, writer, broadcaster, and speechmaker.

Cicely Saunders founded the modern hospice movement, to provide care for dying cancer patients, and established the first British hospice in 1963 (opened 1967). She realized that British doctors and hospitals were dedicated to attempting cures, and that patients who had no prospect of recovery were out of place in their hands. In the 1940s and 1950s, she was ahead of her time in recognizing the close connection between a patient's physical, emotional, and spiritual condition, and drew frequent connections between her medical work and her profound Christian faith. Her hospice, St. Christopher's, and its many imitators throughout the world, are dedicated to care of the whole person at the end of life, rather than taking a narrowly medical view.

Saunders was born in Barnet, north London, in 1918 into an argumentative, ambitious family. She was the oldest of three children and the only daughter. Her father Gordon Saunders was a successful real-estate agent in Barnet. Her mother Chrissie Saunders , withdrawn and moody, feuded with him, and the parents separated after 28 stormy years of marriage. Cicely grew up tall and awkward. She was materially privileged and attended Roedean, one of England's elite girls' boarding schools, but hated it, being lonely and shy. In her last years there, however, she began to come out of her isolation and was appointed head of her house. From there she moved, after a year in a "crammer," to St. Anne's College, Oxford, to study philosophy, politics, and economics.

The onset of the Second World War in 1939 decided her to switch to nursing after just one year, despite the opposition of her Oxford tutors. She trained at the Florence Nightingale school, part of London's St. Thomas's Hospital, but after qualifying with distinction was unable to work as a war nurse because she was not physically strong enough. Saunders had slight curvature of the spine; the hard work made it worse, and led to a slipped disc and other orthopedic difficulties. Returning to Oxford, she finished her degree in 1945 then trained as an "almoner" (medical social worker) so that she could find another way into the helping professions. She already had an undefined sense that she would devote her life to aiding people in pain.

Volunteering to work evenings in St. Luke's hospital for the terminally ill, she learned to appreciate the importance of controlling pain with analgesic drugs, and they became central to her care philosophy thereafter. Further difficulties with her own health, and back surgery that year, made the problem of chronic pain something very close to her own experience.

The summer of 1945 not only saw her graduation; it was also the moment of her parents' emotionally exhausting separation (with her mother making threats of suicide) and of Cicely's own conversion to Christianity. She had had no formal religious upbringing, had declared herself an atheist at school, but now, after years of reading C.S. Lewis and other influential Christian writers, she was converted during a seaside vacation in Cornwall with a group of evangelical friends. Then and later, however, she was able to get along well not only with a wide variety of other Christians (the work of Catholic nuns was influential in her development of hospices) but also with agnostics and atheists, many of whom came to share her sense of mission.

Saunders' formative experience, and one she spoke of often in her subsequent career, was a meeting with David Tesma, a Polish Jew and refugee in England, who was dying of inoperable cancer in 1947. Her two-month contact with Tesma, and her recognition that hospitals offered him no place to die with dignity, resolved Saunders to create such a place. They fell in love and spent as much time as possible together even though he was desperately ill and confined to a hospital bed. Their time together made Saunders realize that the last moments of life can as easily be a time of emotional and personal growth as any other. He bequeathed her £500 in his will to start a hospice for terminal cancer patients and told her, "I will be the window in your home." That money became the nucleus of the funds for St. Christopher's even though 20 years were to pass before it opened. It is striking that when she fell in love again, 12 years later, the man was once again Polish, Antoni Michniewicz, and once again a terminal cancer patient in the last stages of his illness, whose death after a two-month romance brought her to an emotional collapse.

To talk of accepting death when its approach has become inevitable is not mere resignation on the part of the patient nor defeatism or neglect on the part of the doctor. Certainly they will take no steps to hasten its coming, but for both of them it is the very opposite of doing nothing.
—Cicely Saunders

Friends who sympathized with Saunders' ambition to create a care-center for terminal cancer patients urged her to train as a doctor, so that she could speak with authority in the medical community. Accordingly, she began medical school as a 33-year-old in 1951, back at St. Thomas's Hospital, and graduated in 1957. She also spent as much time as possible at St. Joseph's, a Catholic refuge for the incurably ill. The nuns there made up in enthusiasm and energy what they lacked in formal medical and nursing training, and the place provided a model for the kind of center Saunders would later create. Her advanced views on preventive pain control found a responsive audience among the nuns, and she began to lobby the British medical community for a new approach to medication. In her view, patients would be much happier, more easy to manage, have less sense of helpless dependency, and feel more confident, if they had ready and regular access to the painkillers they needed. Her experiments over a long period of time at St. Joseph's convinced her that this policy did not lead to addiction nor to the need for steadily increasing doses, which was then the orthodox view. She also favored oral over injected drugs, because they too gave the patient less sense of helplessness.

Another novelty in her treatment was her belief that it was best to tell terminal patients that they were in fact dying. Orthodox medical opinion preferred to continue holding out hope. At one point, working at St. Luke's as a visiting doctor, she answered a patient's question "Am I dying?" affirmatively and caused such dismay among the other doctors that she was asked to leave. Central to her philosophy from the 1940s on has been the belief that patients will benefit from preparing for their death rather than hoping vainly to avert it. Saunders realized, of course, and later taught her hospice's staff, that breaking news of this kind was momentous and often harrowing; they studied ways to prepare patients for the news and ways of discerning when they would be ready to learn it.

After years of study, advocacy, lobbying, fund-raising, and teaching, Saunders supervised the creation of a trust, which began work on St. Christopher's Hospice in Sydenham, south London, in 1963 and finished it four years later. Having come from a prosperous family and having been helped out financially by her father at crucial moments in her career, she had the faith that money was always available. She certainly proved to be an extremely talented fund raiser. With tales of her own experiences, and stories of suffering cancer victims, she spoke eloquently to individuals, trusts, and foundations, and was able to attract an influential and wealthy group of donors. A bishop laid the foundation stone and the hospice's first visitor—subsequently its official patron—was Princess Alexandra of Kent . Like her near contemporary Mother Teresa , then involved in similar work in Calcutta, Saunders knew just how to blend faith in God's mercy with hard-headed accountancy. Money was essential because she did not want the hospices to be developed or run by the National Health Service (NHS), the nationalized British system of healthcare since 1947. Private funding would offer her more control and more flexibility, but she was careful to work in close collaboration with influential NHS officers, to ensure that they would send and support poor patients, and that lack of funds would be no bar to admission.

Patients at St. Christopher's were treated with palliatives and painkillers sufficient to make the last days of their lives bearable. "With effective pain control," said Saunders, "you are giving the patient space to be themselves. Pain control allows the patient to complete their journey in the search for meaning. You can't tell another person what that meaning is, but you can give them value and help them find their own meaning."

She had also recognized, much earlier than most British doctors, that entire families are involved in the process of death. She therefore created far more liberal visiting hours for patients than conventional British medical facilities, and encouraged children to visit (most hospitals banned them). An on-site day-care center for the doctors' and nurses' own children, and a section for retired employees, added to the hospice's feeling of being a community integrated into daily life rather than shut away from it. Saunders recognized too that bereaved families often needed help when the patient had died, and arranged a "Pilgrims' Club" for them, under the guidance of a prominent psychologist, Dr. Colin Murray Parkes, who joined St. Christopher's staff.

Saunders' influence spread steadily. As longevity increased, terminal care was becoming a pressing issue throughout the developed world. Already renowned for her advocacy and research before St. Christopher's opened, she gave a speech at Yale's School of Nursing in 1963 which led to an invitation to teach there for a semester in 1965. Florence Wald , the Yale school's dean, went to work for a year at St. Christopher's soon after it opened. She and Elisabeth Kübler-Ross , both great admirers of Saunders, were instrumental in spreading the ideals of the hospice movement in the United States, and the first American hospices opened in 1974. They, like English volunteers and supporters, found Saunders a charismatic and sometimes daunting figure, and they repeated the story of an American visitor who asked if she might touch the great founder. "No you can't. I bite," Saunders snapped, adding, "I am not a cult figure." Saunders made a point of working at the hospice into her late 60s, keeping in close touch with the doctors, nurses, and patients, and teaching a rising generation on the basis of her lifetime's experience. By the time she retired from active daily involvement, care for the dying had become an established part of medical practice.

Saunders married late in life. Her brief, sad romances with the two Polish men had drawn her to a study of Polish life and history. One day in December 1963, her eye was caught by a painting in a London gallery exhibition, Christ Calming the Waters by the Polish artist Marian Bohusz-Szyszko. She bought it for the chapel of the hospice, on which work had just begun, and wrote the artist a letter of thanks, explaining to him that it would be a source of inspiration to dying cancer patients. He responded by offering her, as a gift, one of his major canvases. They met, and soon fell in love. Though he was married, his wife was still in Poland, behind the Iron Curtain, and they had been separated since 1939. Being a descendant of the haughty Polish Catholic aristocracy and a political refugee, he refused either to be divorced or to accept what might be construed as the charity of a well-to-do English woman. His wife died in 1975, however, by which time he and Saunders had been living together for a decade. Finally, in 1980 he and Saunders married quietly, without alerting any of their friends, families, or admirers. He was already 79 and she 61, but he lived on to the age of 93.

In her 60s, Saunders began to spend more time away from St. Christopher's, visiting hospices around the world, arranging conferences, and still working hard at fund raising. She also lobbied to have the type of terminal care she had pioneered integrated throughout the British medical system rather than confining it solely to hospices. In 1980, she was made a Dame of the British Empire by Queen Elizabeth II and in 1989 received the Order of Merit, another high honor. She was often asked to speak, broadcast, and write, and published or edited a long series of books and articles on the care of the terminally ill, despite her claim that writing was a terrible struggle for her.

Saunders remained an energetic and controversial figure into her 80s. She was particularly opposed to the voluntary and assisted suicide movement led, in America, by Dr. Jack Kevorkian. "Human nature being what it is," she told a reporter, "euthanasia … would not stay voluntary for very long…. To legalize the killing of patients is a very dangerous thing to do. You the patient are saying your life is not worth living and I, the doctor, am saying I agree with you." In her view it was much better to palliate the suffering and to counteract the patient's feeling of worthlessness; to her, the last days of life were still an opportunity for personal and spiritual growth. She feared that legalized euthanasia would put intolerable pressure on sick and elderly people to end their own lives prematurely, aware of the liability they might become for their relatives. Of her own impending demise, Saunders told a reporter in 1998: "Everyone else would like to have a stroke on the golf course, but I'd rather have cancer, because it does give us a chance to say thank you, and I'm sorry, and good-bye."