Dame Cicely Saunders(1918–2005)

Cicely Mary Strode Saunders was born at Barnet in Hertfordshire on the twenty-second of June 1918, eldest of the three children of Gordon Saunders, an estate-agent and property-owner of the Barnet and Mayfair offices, and Mary Christian Knight of a Sussex farming family. She was schooled at Roedean School in Sussex from 1932, won a scholarship to St Anne's College, Oxford, in 1937 to read Politics, Philosophy and Economics, and on the outbreak of war in September 1939 left Oxford in her second year to train as a nurse at the Nightingale School at St Thomas's Hospital, London. She qualified as a State Registered Nurse in 1944 in her twenty-sixth year, served at St Thomas's through the V-1 and V-2 attacks of 1944 to 1945, suffered a recurrent back injury from the heavy nursing lifting, and on the strength of the back injury was forced to give up nursing in 1945.

She returned to Oxford in 1945 to complete the PPE degree, took the Diploma in Public and Social Administration in 1946 in her twenty-eighth year, and trained from 1947 as a Lady Almoner (the predecessor of the modern medical social worker) at the Almoner's Institute at the Royal Cancer Hospital (later the Royal Marsden) in London. She took the Almoner post at St Thomas's Hospital from 1948 to 1958, and through that decade made the central decision of her life. At St Thomas's she had cared in 1948 for the dying Polish-Jewish patient David Tasma, a refugee from the Warsaw Ghetto with an inoperable cancer, with whom she had long evening conversations about the care of the terminally ill; on his death he left her five hundred pounds with the instruction that I'll be a window in your home. The home and the window became the founding metaphor of St Christopher's.

She decided in 1951 in her thirty-third year that the central problem of end-of-life care in mid-twentieth-century medicine was the absence of a specialised institutional setting in which dying patients could be treated with the combined attention of skilled pain-management, nursing, social work and spiritual care. The medical hospitals of the 1950s discharged dying patients home when active treatment was no longer indicated; the home setting was inadequate to manage the increasingly severe terminal symptoms. She concluded that she needed to be a doctor to make the case from inside the medical profession, returned to St Thomas's Medical School in 1951 at thirty-three, qualified MB BS in 1957 in her thirty-ninth year (the first Almoner ever to retrain as a medical practitioner), and took the post of Research Fellow in Terminal Care at St Mary's Medical School from 1958 to 1965 on the strength of a Halley Stewart Trust grant. She used the research years to develop the systematic Saunders approach to terminal-pain management, particularly the regular round-the-clock administration of opioid analgesia by mouth (the central single technical innovation of modern palliative care, against the existing medical practice of intermittent on-demand opioid administration that left patients in chronic pain) and the multi-disciplinary attention to what she called total pain (physical, emotional, social, spiritual).

She raised through the early 1960s the foundation funding for the dedicated terminal-care hospital that would put her methods into practice, took the lease on the small Sydenham site in south London in 1965, and opened St Christopher's Hospice on the twenty-fourth of July 1967 in her fiftieth year. St Christopher's was the first dedicated terminal-care hospital in the world built on the modern model: it combined the in-patient ward (with the eight thousand books and the chapel that Tasma's bequest had asked for), the medical-research programme on the pharmacology of terminal pain, the academic teaching programme that became the foundational training of the new specialism of palliative medicine, and from 1969 the St Christopher's Home Care Service that took the hospice model out into the patients' own homes. The St Christopher's model has been adopted across the world; there are today over twenty-eight hundred hospices in the United Kingdom alone, and over eight thousand worldwide.

She wrote the foundational medical textbook of the specialism, The Management of Terminal Disease (1967, revised editions to 1984), founded the academic Department of Palliative Care at St Christopher's that became the institutional training-ground of the specialism's first generation, was created DBE in 1980 and admitted to the Order of Merit in 1989. She married the Polish-British painter Marian Bohusz-Szyszko in 1980, and died as a patient in the breast-cancer ward of her own hospice at St Christopher's on the fourteenth of July 2005 in her eighty-eighth year. The Saunders name in modern medicine carries the weight of the opening of St Christopher's on the twenty-fourth of July 1967.