Cicely Saunders, Founder of the Hospice Movement: Selected Letters, 1959-1999 (review)

Gracefully selecting about 700 from a correspondence of some 7000 letters written over a forty-year period, David Clark, Professor of Medical Sociology at the University of Sheffield, has created a remarkable self-portrait of Dame Cicely Saunders. To help the reader, he groups the letters into three consecutive time periods and precedes each with a brief biographical discussion. Thirty photographs further enrich the text.

Dame Cicely studied philosophy and economics at Oxford and then trained to be a nurse. A back injury caused her to give up nursing, after which she worked for several years as a medical almoner—what we today might call a case manager or medical social worker—before qualifying in 1957 at the age of thirty-nine as a physician. She was the first modern doctor to dedicate her entire career to patients at the end of their lives. David Clark quotes these lines from her first paper: "It appears to me that many patients feel deserted by their doctors at the end. Ideally the doctor should remain the center of 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."

Passionate in her devotion to patients, Dame Cicely appears to draw her strength from a deep religious commitment to her Anglican beliefs. As she writes in an early letter to Jack Wallace, a close friend and supporter, in her efforts to create the Hospice at St. Christopher's:

29 October 1959. I think that you know that I have been interested in the problems of the dying for a number of years and qualified [in Medicine] with that work in mind. For the past year I have had a Fellowship here and have been working in two of the Homes which only take in patients who are actually dying of cancer. It has been infinitely interesting and rewarding both from the medical and the spiritual point of view (p. 16).

What I found critical in this passage and throughout her correspondence is her ability to find the care of the dying "infinitely interesting and rewarding from both the medical and the spiritual point of view." That capacity to be both scientist and empathic physician, competent and compassionate, the good physician as described by the medical ethicist Edmund Pellegrino, is what most distinguishes her.

It is quite remarkable to discover that an early source of inspiration was David Tasma, a Jewish patient from Poland and a survivor of the Holocaust, whose death in the 1940s motivated Dame Cicely to explore the care of the dying. As with Tasma, her relationship to her patients is far deeper and often more painful than most physicians would allow. Yet it seems that the emotional relationship that she has established with many patients enriched her spiritual beliefs and strengthened her commitment to the new discipline of palliative care.

As a committed Christian, she holds that physician-assisted suicide and euthanasia are morally wrong and can be made unnecessary if we learn how to recognize and meet the needs of the terminally ill. Yet these strongly held beliefs do not prevent her from an active correspondence with such exponents of euthanasia as Derek Humphry, the founder of the Hemlock Society. She writes in a letter to Dr. A. Sickel in the Netherlands:

31 May 1972 Thank you for your most interesting paper. I was particularly interested in your comments on loneliness. I am afraid that I do not agree with you at the end where you suggest that we may have come to the place of active euthanasia. . . . Perhaps I could summarize a conversation I had with a patient last week-end. Sister has told me about your conversation...