Saunders, Dame Cicely Mary Strode
Saunders, Dame Cicely Mary Strode
- Barbara Monroe
Dame Cicely Mary Strode Saunders (1918–2005)
Saunders, Dame Cicely Mary Strode (1918–2005), physician and founder of the modern hospice movement, was born on 22 June 1918 at Linden Lodge, Bedford Avenue, Barnet, Hertfordshire, the daughter of (Philip) Gordon Saunders (d. 1961), land surveyor, and his wife, Mary Christian, née Knight (d. 1968). She had two brothers, John (b. 1920) and Christopher (b. 1926). Her supportive father became a senior partner with the estate agents John D. Wood & Co. His children enjoyed all the material comforts of a prosperous family, although Saunders later spoke of having a very distant relationship with her mother. Tall and shy, she described herself as 'sadly unpopular' at school (Saunders and Swann, 58). At the age of fourteen she was sent to Roedean School. Initially unhappy, she eventually made friends and became head of house.
In 1938 Saunders went to St Anne's College, Oxford, to read philosophy, politics, and economics, her parents having disapproved of her earlier ambition to become a nurse. In 1940, after the outbreak of the Second World War, she interrupted her studies to begin training as a nurse at St Thomas's Hospital in London. She described that period as 'the first time in my life I felt I really belonged and fitted in' (Saunders and Swann, 58). The friendships she made with her nursing set continued for the rest of her life and it was at this time that she deepened her love of music and enjoyed singing in a choir. Four years later, to her bitter disappointment, she was forced to leave nursing following the exacerbation of spinal problems that had troubled her since childhood. She returned to Oxford, gained a war degree, and in 1945 qualified with a diploma in public and social administration. She began training as a hospital almoner at St Thomas's Hospital.
It was while working as an almoner at London's Archway Hospital in 1947 that Saunders met the first of three Polish men who were to change the course of her life. David Tasma was a Jewish refugee from the Warsaw ghetto and she was drawn to his lonely suffering. A close relationship developed and they discussed the idea of creating a more home-like environment where those coming to the end of their lives could be offered hope and comfort. When Tasma died in 1948 he left her £500 'to be a window in your home' (Du Boulay, 58). It was Tasma who told Saunders, 'I want only what is in your mind and in your heart' (ibid., 56). Saunders quoted this in speeches throughout her life, emphasizing that good care required both scientific rigour and loving compassion.
Saunders's life's work was now determined. Her vision to establish her own home for the dying was underpinned by her religious faith, discovered while on holiday in Cornwall with Christian friends. It was, she said, 'as if a switch had flipped' (Du Boulay, 49). In order to understand more about the needs of the dying she began work as a volunteer at St Luke's, a home for the dying in Bayswater. Norman Barrett, a surgeon, told her that if she wanted to make an impact she must study medicine: 'It's the doctors who desert the dying', he said (ibid., 63). Saunders commenced medical training in 1951; she graduated MB BS in 1957 and took up a research fellowship at St Mary's School of Medicine in 1958.
To further her studies of pain management in the incurably ill Saunders started work at St Joseph's, a Catholic hospice for the dying poor in Hackney. She was well accepted by the nuns and began to encourage the regular use of oral opioids rather than pursue the standard hospital practice of inadequate and infrequent injections of morphine that left many patients abandoned to uncontrolled pain and ignored by doctors, who saw dying as failure. She began to formulate her concept of total pain: the need to pay attention to social, emotional, and spiritual needs, as well as delivering a systematic approach to symptom control. Her ideas were first published in 1958 in an article, 'Dying of cancer', in St Thomas's Hospital Gazette. She described 'a team who work together to relieve where they cannot heal, to keep the patient's own struggle within his compass and to bring hope and consolation to the end'. This was followed by an influential series of six articles for the Nursing Times in 1959, which received favourable reviews in The Lancet. Saunders began to lecture widely, using personal stories of patients' suffering based on over 1000 meticulously recorded case histories. These narratives were to have a huge impact on the increasing numbers of clinicians who came to hear her speak.
It was while she was at St Joseph's that Saunders met a second Pole, Antoni Michniewicz. They had a passionate, spiritual relationship confined to short meetings on the ward. She later said, 'I loved him very much … he taught me what it was like to be dying and to be bereaved' (Daily Telegraph). The deaths soon afterwards of ‘Mrs G’, another patient with whom Saunders had enjoyed a mutually supportive friendship for over seven years, and of her father in 1961, left Saunders prostrated by grief. None the less she continued to pour her energies into planning and fund-raising for her own hospice, to be called St Christopher's, after the patron saint of travellers.
By the end of 1959 Saunders had drawn up a ten-page proposal for the hospice and St Christopher's was registered as a charity in 1961. In 1963 her brother Christopher found her a site on Lawrie Park Road in Sydenham and building began in 1965. Saunders worked tirelessly and discovered a remarkable talent for marshalling others to her cause, including major charitable trusts, London's merchant companies, and members of the British establishment. St Christopher's admitted its first patients in 1967, the opening ceremony being performed by Princess Alexandra, St Christopher's patron. Subsequently Saunders commented that it took '19 years to build the home around the window'. She had initially thought of creating an Anglican religious community but broadened her vision so that St Christopher's became a place that welcomed staff and patients of any faith or none, thus creating a model capable of wide adaptation. However, Saunders's strong Christian faith was a fundamental factor in her commitment to the dying and remained an anchor throughout her life. She was a long-standing opponent of the legalization of euthanasia and was an important influence on the report by the Church of England, On Dying Well (1975), which rejected the argument for euthanasia, asserting that everyone should have the right 'to die well', without pain and with dignity.
The opening of St Christopher's is widely recognized as the birth of the modern hospice movement and the next twenty years saw a surge of interest in Saunders's new approach to the care of the dying, particularly in the United States where she undertook lecture tours in 1963, 1965, and 1966. Inspired by meeting Saunders, Florence Wald, dean of the Yale University school of nursing, established the first hospice home care team in America at New Haven. Saunders was to be medical director of St Christopher's for the next eighteen years. She was primarily an outstanding bedside clinician but was determined to evaluate the new approaches to care and recruited a team of leaders in their fields to do so. The professor of pharmacology at St Mary's Hospital in London, Harold Stewart, was the chairman of St Christopher's research committee. He was supported by John Hinton, professor of psychiatry at the Middlesex, who wrote a widely influential Penguin paperback, Dying, in 1967, and undertook significant studies on the quality of the care that was being delivered. Robert Twycross worked as research fellow at St Christopher's and began the programme of studies on oral morphine and diamorphine which were to revolutionize the practice of the relief of chronic pain, demonstrating that morphine given orally in the right dose, at the right interval, could provide constant pain relief without addiction.
Saunders always believed that ‘hospice’ referred not to a building but to a philosophy of care that needed a sound academic footing in order to become an integral part of general healthcare systems. The fifty-four in-patient beds at St Christopher's were quickly followed by the development in 1969 of the first service to deliver care to patients in their own homes, led by Mary Baines, a local GP who had helped with weekend on-call cover for the hospice. Colin Murray Parkes from the Tavistock Institute supported the development of care for family and friends and the bereavement service was launched in 1970, followed by day care.
Saunders emphasized that the St Christopher's model should not be slavishly copied but needed adapting to local needs and cultures, as her voluminous correspondence supporting service developments across the world demonstrated. She enjoyed her increasing acclaim but was never too busy to respond to those with a genuine interest in care of the dying. She understood that hospices could never respond to the needs of all and that education would be vital in the drive to improve care of the dying in other settings. In 1973 a purpose-built study centre was opened. Gillian Ford, then deputy chief medical officer for England, was seconded to St Christopher's to oversee its development, and by the time of Saunders's death over 50,000 healthcare professionals had trained there. Ford was to be instrumental in achieving recognition of palliative medicine as a speciality by the Royal College of Physicians. Another friend from medical school days, Tom West, returned from work as a missionary doctor in Africa to become Saunders's deputy in 1973 and medical director in 1985, when Saunders retired from the role to become chairman of council.
Throughout her life Saunders wrote and taught, enjoying international lecture tours. In the eighteen years of her medical directorship, she was the author of over eighty-five publications, some of them translated into several languages; these included the edited volumes Management of Terminal Malignant Disease (1978) and Living with Dying (1983). She received prizes and honours from many countries including more than twenty-five honorary degrees. In 1977 she became the first person for more than 100 years to receive an honorary doctorate of medicine from the archbishop of Canterbury, and in 1987 she was awarded the British Medical Association's gold medal for services to medicine. Other honours included the Onassis prize for services to humanity (1989) and the Franklin D. Roosevelt four freedoms medal for worship (2000). She was made a DBE in 1980 and in 1989 received the rare honour of entry into the Order of Merit. In 2001 St Christopher's was awarded the Conrad N. Hilton humanitarian prize of $1 million, which Saunders received on behalf of the hospice from Kofi Annan, secretary-general of the United Nations, in New York.
On 31 January 1980, in the parish church of St Philip in Sydenham, Saunders married the third Pole in her life, Marian Bohusz-Szyszko (1901/2–1995). He was seventeen years her senior and the relationship was to provide the sense of personal joy and confidence she had sought all her life. Bohusz was an artist and the couple had met in 1963 when he was exhibiting in London. Saunders admired his intense religious works and bought one for the walls of the hospice. A long friendship began and Bohusz became artist in residence at St Christopher's, setting up a studio in the hospice. After the marriage his health became ever poorer and he died at St Christopher's in 1995. In Bohusz's later years Saunders became increasingly involved in his nursing care and more tied to the house they shared at 51 Lawrie Park Gardens, close to the hospice. After his death she once again began to lecture and travel. In 1998 her eightieth birthday was celebrated with a conference in her honour at the Royal College of Physicians, London. In 2000 she retired as chairman of St Christopher's to become founder-president and helped in the development of Cicely Saunders International, a new foundation to further international research in palliative care. She continued to come into her office in the hospice on most days.
Saunders's vision of holistic care, supporting family as well as patient, caught the imagination of the public as well as professionals. She was the subject of a biography, many articles in newspapers and popular magazines, television documentaries, and films for professional audiences. She was photographed on hundreds of occasions and her husband painted her portrait several times. Two images stand out: a bronze head, which captures her unflinching determination, completed by the sculptor Nigel Boonham in 2001; and the portrait commissioned from Catherine Goodman for the National Portrait Gallery, and unveiled there in April 2005 in Saunders's presence.
Saunders was an imposing and sometimes intimidating figure in whom personal motivation and professional aspirations combined to create a vision that changed the practice of medicine and transformed the care of the dying. People everywhere responded to Saunders's insistence that death must not be seen as failure, but as part of life and to her assertion that people should be able to live until they die. As she put it, 'You matter because you are you and you matter to the last moment of your life. We will do all we can to help you, not only to die peacefully but to live until you die' (Nursing Times, 1976, 72.1003–5). Her energy and enthusiasm were irrepressible; she often commented, 'There is still so much more to be done.' She was an inspirational leader. She also had a wonderful sense of humour and an inclination to gossip, and took pleasure in a daily ‘whisky on the rocks’. By the time of her death there were some 200 hospices in the UK and similar programmes in 115 countries across the world. She died in St Christopher's Hospice of metastatic breast cancer on 14 July 2005. She continued to see visitors up to the end and remembered, close to her own death, to ask after the dying father of one of her nurses. Following cremation at Beckenham crematorium on 29 July her ashes were buried on 2 September, with those of her husband, in the garden of St Christopher's. Over 2000 people attended the memorial service held on 8 March 2006 in Westminster Abbey.
- C. Saunders and Y. Swann, ‘When I was a child’, Woman's Weekly (17 Dec 1991), 58 [interview]
- D. Clark, ed., Cicely Saunders, founder of the hospice movement: selected letters, 1959–1999 (2002)
- D. Clark and others, A bit of heaven for the few? An oral history of the hospice movement in the United Kingdom (2005)
- The Times (15 July 2005)
- Daily Telegraph (15 July 2005)
- The Independent (15 July 2005)
- The Guardian (16 July 2005)
- BMJ (23 July 2005)
- The Lancet (20 Aug 2005)
- Pain, 118 (2005)
- S. du Boulay, Cicely Saunders: founder of the modern hospice movement (1984)
- D. Clark, introduction, in C. Saunders, Cicely Saunders: selected writings, 1958–2004 (2006)
- WW (2005)
- private information (2009)
- personal knowledge (2009)
- b. cert.
- m. cert.
- d. cert.
- King's Lond., personal memorabilia, diaries, photographs and other items [http://www.kcl.ac.uk/iss/archives/]
- Lancaster University, End of Life Observatory, letters, writings and other archives [http://www.eolobservatory.net/history/index.htm]
- BFINA, The Frost interview, M. Catherwood (director), BBC2, 19 Sept 1974
- BFINA, ‘A window in your home’, The light of experience, J. Wilcox (producer), BBC2, 19 Sept 1976
- BFINA, ‘St Christopher's Hospice’, Songs of praise, S. Hammond (producer), BBC1, 31 Jan 1988
- BFINA, current affairs footage
- BFINA, performance footage
- Madison Deane Initiative, ‘Pioneers of hospice: changing the face of dying’, 2005 [www.pioneersofhospice.org]
- M. Bohusz, oils, 1970–79, St Christopher's Hospice, London
- photographs, 1977–81, Photoshot, London
- photographs, 1977–2001, Getty Images, London
- photographs, 1977–2001, PA Photos, London
- M. Bohusz, oils, 1980–89, St Christopher's Hospice, London
- J. Bown, photograph, 1989–90, repro. in The Observer
- A.-K. Purkiss, bromide fibre print, 1990, NPG
- S. Amery, bronze bust, 1990–99, St Thomas's Hospital, London
- G. Bruce, brush monochrome on prepared paper, 1992, Royal Collection
- N. Sinclair, bromide print, 1995, NPG
- C. Djanogly, photographs, 1999, repro. in Centurions: a photographic tribute to 100 men and women who have changed the face of 20th century Britain (1999)
- photographs, 1999–2003, Camera Press, London
- N. Boonham, bronze head, 2001, St Christopher's Hospice, London
- C. Goodman, oils, 2005, NPG
- M. McCartney, photograph, repro. in Good Housekeeping (Oct 2002)
- obituary photographs
Wealth at Death
£949,971: probate, 22 Dec 2005, CGPLA Eng. & Wales