International Association for Hospice & Palliative Care

International Association for Hospice & Palliative Care

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Promoting Hospice & Palliative Care Worldwide


2005; Volume 6, No 8, August



Many ways to help support palliative care.

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Message from the Chair & Executive Director:
Kathleen M. Foley, MD
Liliana De Lima, MHA

Tributes: To Dame Cicely Saunders

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Dr. Ripamonti

Book Reviews:
Roger Woodruff, MD

IAHPC Board Member’s Page:Must Oncology be our Home?

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Editor's Notes:
Dr. William Farr

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Tributes To Dame Cicely Saunders

Copied from the Cicely Saunders Foundation website

Cicely Saunder’s obituaries barely capture her extraordinary contributions as one of the most important social change agents of the twentieth century. Through her thoughtful and determined advocacy for the care of the dying, she has educated society and much more slowly, the health care profession, in the concepts of hospice and palliative care. She defined and shaped the discipline of symptom control and supportive therapy for the most vulnerable of our populations, the dying. By creating St. Christopher’s Hospice as a “place” to care for the dying, she modeled a health care system where personhood and dignity were preserved, pain managed and family centered care provided. In a medical culture where opioid drug therapy was indicated only for acute pain and tolerance and addiction risk was thought to limit long term use, Saunders showed the safety and efficacy of opioid drug therapy and its impact on improving the quality of life for patients suffering from moderate to severe pain. Her observations were ground breaking and opened the door to our current advances in pain management and the redefinition of tolerance and addiction risk. Her clinical work has transformed society’s perspective on the treatment of suffering.

Whether one is in Singapore, Hong-Kong, Japan, South Africa, India - in a developed country or a developing country - hospice care is strikingly the same despite broad cultural differences. An international perspective shows the universality of Cicely Saunders’ vision for improving the quality of life of the dying.

Saunders’ efforts have clearly influenced the American approach to the care of the dying. Approximately 2.5 million Americans die each year and over 20% currently receive hospice care in the last days of their lives. There are over 3200 hospice care programs and payment for care is supported through a Hospice Medicare Benefit. The standards, domains of care and emphasis on a patient and family centered approach are all modeled after Cicely Saunders’ philosophy and principles of care.

As IAHPC works to transform healthcare systems nationally and internationally into systems that acknowledge the care of the dying as a priority and reduce the patient, physician and institutional barriers that currently thwart the full integration of palliative care, Cicely Saunders’ vision and achievements serve to remind us that it is a reachable goal. Her writings, lectures and her role modeling care at St. Christopher’s will forever serve as our guiding light. We honor her willingness to be the public face for dignified dying and for her tireless, unselfish advocacy.

Kathleen Foley, Chair IAHPC


Cicely Saunders deserves to be listed among The Greats of Medicine. She saw a need and reacted to it. What made her different from the rest of us was that we too saw the need but did nothing about it. Thousands of doctors and nurses, social workers and others have now adopted what have come to be known as the principles of hospice care but it needed a Cicely Saunders to start the process, to highlight the need, to startle and challenge the world, and to make people like us uncomfortable until we tried to follow her pointing finger.

She deserves to be counted among The Greats because she kept her message simple.  Even the principles she managed to express simply, though many of us who have followed have made them more complicated and convoluted as we have strived to emulate not her teaching but that of our scientific peers and their sophistication..

She deserves to be named a Great because, more than most of us today, she knew that she had to speak for, to be an advocate for the patient, knew that winning politicians was vital, and knew that hospice-type care had to be "evidence-based", something that some have failed to associate with hospice and palliative care.

As she told many of us, she knew that hospice care was needed, not only in London where she worked but worldwide. Never did she envisage that its principles would spread so rapidly, never did she think they would be understood, adopted and adapted for such a kaleidoscope of cultures as has happened.   In a sense she was as surprised and as delighted as we have been. Never did she change her advice to those who came asking her how to prepare and get started - " Don't waste time. If you see there's a need, get on with it and get started.  You'll soon see how best to do it!" To some of us that is somewhat naive. If we had all agreed with that we in IAHPC would not be promoting our "Getting Started" section on our website. Nevertheless her advice had the effect of making people think what exactly they needed, making them act rather than prevaricate.  It was, after all, what she herself had done and done with such success and to such effect.

It may be that some will remember features of her personality that they would have liked to change, but few of us would be in this work today had it not been for her, or those whom she inspired, those who took her principles to the far corners of the earth. How seldom do most of us get the chance to meet one of The Greats.

Dr. Derek Doyle, Scotland
Former President of the College of the International Hospice Institute and College, IAHPC Board member


Dame Cicely was a tireless clinician, teacher and educator and her lectures and writings had an enormous impact on all of us working in Palliative Care. She provided us with a solid foundation, a sense of belonging and confidence as we started our journey into the care of terminally ill patients and their families.

The first generation of pioneers in our field have given us the gift of their wisdom and hard work and have empowered us to build clinical and academic programs we could not have dreamed of 20 years ago. As the first among these giants Dame Cicely also provided us with the example of her life and works and hopefully she will continue to inspire future generations of health care professionals who want to embrace Palliative Care.

Eduardo Bruera, M.D.
Professor & Chair
Department of Palliative Care & Rehabilitation Medicine (Unit 8)
UT M. D. Anderson Cancer Center
Houston, TX 77030
Past Chair of IAHPC


She walked among us for so many years; it is now difficult to think that Dame Cicely will not be traveling with us on the long road of making palliative care/hospice available everywhere. I started my professional career in the early days during the development of the discipline of hospice/palliative care. It was a time when there was a small scientific base on the subject of symptom management, but a time during which a significant amount of work was being done by Dame Cicely and the scholars working with her at St. Christopher’s. Soon we had a foundation upon which we could begin to function. Her message was clear, very understandable and transferable to those of us working in the US at the time.  Through the years she led us, actually “walked with us,” on a glorious journey down a path to a better understanding of the true needs of the dying and their families while providing us with a vastly improved approach of how to help those in great need of comfort. Many have followed in her footsteps, and have added to the knowledge base we have today. In 2002, the Cicely Saunders Foundation was formed. In the Mission Statement, Dame Cicely writes, “ … This Foundation sets out to make a major contribution in an area of universal need – researching and disseminating further evidence based knowledge in a field that has an impact and importance worldwide.” It is clear that we still have a long way to go to full fill her/our dreams. I am sure we will eventually get there.

On behalf of our team, and the millions of dying people who have been touched by and benefited from the implementation of her principles, we all say Thank You Dame Cicely for you dedication, foresight and courage!

We send our sincere condolences to her family, friends and colleagues at St. Christopher’s Hospice.

William Farr, PhD, MD, Vice Chair IAHPC


We would like to express our sincere condolences to the family, friends and all like-minded persons because of the loss of the well-known founder and pioneer of the modern hospice movement ­ Dame Cicely Saunders.

She was the best example for all palliative care professionals and the bright lighthouse for those countries, where palliative care makes merely its first steps in development.

Her progressive ideas as well as our good memories about her will always remain in our hearts and minds to continue improving quality of life of the dying people everywhere.

Natalia Carafizi
National Association of Palliative Care of Moldova,
Charity Foundation for Public Health "Angelus Moldova", Hospice "Angelus"


Websites to read more:

Cicely Saunders Foundation URL:

The Foundation website has an audio interview of Dame Cicely by Professor Irene Higginson

St. Christopher’s Hospice URL:

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