The word "hospice" comes from the Latin root for "hospitality" and "hospitable." In the Middle Ages, hospices were way stations for pilgrims going to the Holy Lands, and were usually run by religious orders. Travelers found their bodies, minds, and spirits refreshed by the nourishment and kindness they found there. The Irish Sisters of Charity opened hospices in Dublin in 1879, and in London in 1905. They viewed death as one stage of a journey, and their hospices provided a haven for dying people who could no longer be managed at home.

This view of death as an important stage of life remains central to our practice today. The monks and nuns learned about the outside world from these travelers. They helped in any way they could, realizing that someday they too would make that same pilgrimage. They also realized that ultimately every traveler has to find his own way.

In the late 1940's, a nurse who was retrained as a social worker was sitting at the bedside of a dying patient in a London hospital. This patient, a Jewish immigrant from Warsaw, told her what kind of place he'd like to die in-what would really help now. The social worker was Cicely Saunders. She was moved by his requests for what was "in your mind and heart." He made a contribution, E500, for "a window in your home" -the special "home" for the dying that was taking shape in Cicely Saunders' mind. She went to medical school, and worked in St. Joseph's Hospice in London from 1958 to 1965. There she discovered that skillful nursing, patient and family counseling, and spiritual support could do a lot to ease the suffering of the terminally ill. She also found that opioids, taken orally every four hours, could ease much of the pain and dyspnea. She discovered that "co-analgesics" like anti-inflammatory drugs and antidepressants were also very useful in pain control.

In 1967, Dr. Cicely Saunders opened St. Christopher's House in South London. She taught physicians, nurses, counselors, chaplains, and physical therapists how to work together to really help with the problems at the end of life, especially with advanced cancer. The care these patients received and their level of comfort was totally new. The modern hospice movement was born.

Inspired by Dr. Saunders, hospices soon opened in other parts of Britain, in Montreal, in Connecticut (1974), and then across the United States and around the world. In 1979 the National Hospice organization was formed in the U.S. and the Medicare Hospice Benefit was passed by Congress in 1983. By 1987 Palliative Medicine was a recognized specialty in Britain and in 1988 the International Hospice Institute helped form the Academy of Hospice Physicians (later to become the American Academy of Hospice and Palliative Medicine).