The founding of St. Christopher’s Hospice in South London, in 1967, by Dr. Cicely Saunders is generally credited with having provided the catalyst for the development of the modern hospice movement, with its emphasis on meeting the “total” needs of patients with a life limiting illness. To Dr. Balfour Mount of Canada, is attributed first use of the term “palliative care” to describe the range of professional services needed to provide such care.

Today, palliative care is defined by the World Health Organisation (WHO) as: “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual”.

In other words, palliative care is about reducing suffering and ensuring the best possible quality of life throughout the course of a debilitating and life limiting illness. It is about adding life to days and not days to life.

• affirms life and regards dying as a normal process;
• neither hastens nor postpones death;
• provides relief from pain and other distressing symptoms;
• integrates the psychological and spiritual aspects of patient care;
• offers a support system to help patients live as actively as possible until death;
• offers a support system to help the family cope during the patient’s illness and in their own bereavement.

Palliative care is today taught in medical schools in most developed countries and has emerged as a sub-speciality of general medicine. Based on research, the WHO has developed an analgesic ladder to control pain in which it recommends that opioids such as morphine and codeine be combined with analgesics to ensure that people do not suffer unnecessary pain. Radiotherapy, chemotherapy and surgery also have a place in palliative care, provided that the symptomatic benefits of treatment clearly outweigh the disadvantages. Investigative procedures, it is agreed, are to be kept to a minimum as are futile medical interventions and life support measures.

Palliative care can be provided both in the home and in a facility-based setting. In hospitals, it is usually delivered in out-patient clinics while hospices provide in-patient care.

There has been some discussion regarding at what stage of a patient’s illness palliative care has a role to play. Today, it is generally recognized that palliative care programs that address the physical, psychosocial and spiritual needs and expectations of patients with life-threatening illnesses have a role to play even if life expectancy extends to years. This is because the core issues of relief of suffering and improvement of quality of life are salient throughout the course of an illness such as cancer.