A Perspective on the End of Life: Hospice Care

Thomas J. Simms, RN, CHPN


Topics in Advanced Practice Nursing eJournal 

In This Article

Origin of Hospice

As life's only certainty, death is never more than one heartbeat away. Death is inevitable and final. Death not only brings an end to all actuality but to all possibility as well. And, whether it comes sooner or later, physical death is the ultimate victor, no matter how hard one battles or how long one seeks to delay arriving at the terminal destination.

The journey, at times, can be difficult and exhausting, making any given day an ordeal. However, acceptance can be achieved by understanding that it takes some preparation, even hard work, to reach the end of life. "Someone who is dying, like the developing child, goes through stages of discovery, insight, and adjustment to constantly changing circumstances in his person and in the ways people react to him," according to Byock.[1] To successfully navigate these potentially turbulent waters requires the interdisciplinary resources best provided through a hospice and/or palliative care program and the team of providers they employ.

The word hospice itself comes from the Latin word "hospis," meaning host and guest. It is the root for words such as hospitality, hospital, hotel, hostel, and hospice in English, as well as in many Romance languages. While the origins of hospice are somewhat unclear, it is thought that the establishment of "safe houses" in Biblical times where travelers could find safety, rest, and refuge from bandits is the earliest evidence of what has grown into the modern hospice concept.

In fourth-century Rome, the concept of hospice as a place to care for the sick and dying first came into being under the direction of Fabiola, a member of the Roman patrician class, who was well-known in her day as a generous provider of care and comfort to the sick and dying. Over the next several centuries, the Roman Catholic Church continued to provide care to the poor and sick, especially to the soldiers returning from the Crusades.

In 1842, the term "hospice" was used for the first time to identify a place to care for the chronically ill and dying in France, where Mme. Jeanne Gamier is credited with establishing an institution dedicated to the care of the dying. Soon after this, an order of nuns known as the Irish Sisters of Charity cared for the terminally ill. They started a hospice in Ireland in 1879. In 1885, the Sisters of Charity expanded their work in hospice to England. In the ensuing years, other homes for the dying were established not only in England but also in several other European countries.


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