Journal of palliative medicine
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Biography Historical Article
Religion, medicine, and community in the early origins of St. Christopher's Hospice.
Commentators on the history and development of hospice and palliative care can appear inclined toward a revisionist viewpoint that sees something "lost" in recent years from the original concept. The thesis concerning the "secularization of hospice" is one such example. It is suggested that the quality of these debates can be improved by serious scholarly attention to earlier events and circumstances, drawing on contemporary source materials, rather than retrospective viewpoints. ⋯ It shows how Cicely Saunders and her associates created an Aim and Basis for the hospice that sought to reconcile questions about its religious orientation; its relationship to medicine; and its status as a community. We see how tensions between these were resolved, resulting in a model that would be applicable in other contexts. Without this pragmatic turn, it is unlikely that the hospice movement would have spread so quickly and so far in the 1970s and 1980s.
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How do health care consumers, private sector organizations, professionals, and government agencies work toward ensuring quality end-of-life care? This challenge is by no means uniquely Canadian; our approach may thus have applications that extend well beyond our national borders. Raising the profile of palliative care in Canada has occurred on many fronts. Local, provincial, and national efforts in end-of-life care have long been underway. ⋯ Their report, Quality End-of-Life Care: The Right of Every Canadian has seen Canadian palliative care gain unprecedented momentum. The federal government recently took the unprecedented step of creating a new office to represent palliative care within the federal cabinet. In Canada, it would appear that palliative care is an idea whose time has come.
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In order to estimate the prevalence of palliative care programs in academic hospitals in the United States, we surveyed a random sample of 100 hospitals in the Council of Teaching Hospitals and Health Systems directory. Sixty percent of hospitals provided information. At least 26% of hospitals had either a palliative care consultation service or inpatient unit and 7% had both. ⋯ In comparison, almost half of hospitals noted established pain services. In conclusion, palliative care programs, although found in a minority of surveyed hospitals, are becoming an established feature of academic medical centers in the United States. More detailed information is needed about the type and quality of care they provide.
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The Pan American Health Organization (PAHO) is engaged in field demonstration projects in Latin America and the Caribbean to expand the availability and effectiveness of palliative care services. Workshops and calls for proposals address the multiple causes of inadequate palliative care services that are typical for countries in the developing world. These include regulatory barriers and drug interdiction policies that interfere with the medical use of opioids, lack of education among health professionals, and insufficient palliative care infrastructure.