Very soon Dame Barbara Monroe will retire after a tremendous term of office as Chief Executive at St Christopher’s Hospice in South London – and many years there before that as a practising social worker. The event set me thinking about the early origins of St Christopher’s and some of the factors that shaped its pre-operational development over 50 years ago. I am writing about this in a chapter of my forthcoming book To Comfort Always: A History of Palliative Medicine from the Nineteenth Century. I describe here some of the deep reflection undertaken by Cicely Saunders as she sought to determine the precise institutional character of her new hospice venture, in the years leading up to its opening in 1967.
By the late 1950s Cicely Saunders was well established in the intention of dedicating the rest of her life to developing a modern approach to the care of the dying. She viewed this work as a matter of personal calling. She had studied medicine as a third profession (after nursing and social work) specifically to do something about the problem of pain in patients dying of cancer. In 1959 she was 40 years old and a committed Christian whose evangelical orientation was beginning to broaden. One year earlier she had published the first of what would become many papers setting out her ideas on care at the end of life in a careful analysis of the complete spectrum of challenges in caring for the dying, illustrated through a series of case studies (1). She had gained experience in the care of the dying as a nurse, an almoner, as a volunteer, a doctor and as a researcher.
But in the late 1950s we see Cicely Saunders still seeking to clarify her initial ideas, striving to create a programme for action and labouring to realise her vision (2). Absolutely central to this process was the question of the religious and spiritual foundation of the institution she was to establish. The issue had come early on to the agenda. She had first raised it in 1959 whilst on a retreat at the Mother House of the Church of England order of St Mary the Virgin, at Wantage, Berkshire in Southern England. Subsequently as she pulled around her a group of friends and associates who might help in her quest to found a new home for dying people, she tackled them in turn on the question of religious priorities.
Throughout the early part of 1960 there were numerous meetings and extended correspondence with a clutch of evangelically inclined Anglican friends. By the end of 1960 a certain clarity had emerged which was sufficient to take the project forward. Though the protagonists were likely unaware of it, their deliberations were also to have a profound influence upon the later development of what became known as the hospice movement.
The first clear evidence of Cicely Saunders’ strategic intentions about the formation of a hospice had come in the second half of 1959 when over the space of a few months she circulated to several associates a ten page document, seeking their reaction. It was entitled The Scheme and it set out de novo the structure and organisation of a modern terminal care home containing 60 beds, together with staffing levels, capital and revenue costs, and contractual arrangements. By the end of the year the ‘home’ in question had a name: St Christopher’s Hospice. The patron saint of travellers would thus accompany those making their final earthly journey.
Soon a small but enthusiastic group of supporters had been formed, including: Dr Glyn Hughes (author of a recent report on the state of terminal care in Britain); Betty Read (head almoner at St Thomas’s Hospital); and Jack Wallace (an evangelical friend and lawyer). It was then joined by Evered Lunt (Anglican Bishop of Stepney); Sir Kenneth Grubb (of the Church Missionary Society); and, very significantly, Dame Albertine Winner (Deputy Chief Medical Officer). Led by their enthusiasms and the inspiration and energy of Cicely Saunders herself, they set about raising funds to bring the enterprise to realisation.
Shirley du Boulay (3) in her biography of Cicely Saunders correctly argues that it was the connection with Dr Olive Wyon, then a retired theologian living in Cambridge, which did much to clarify the issue with which Cicely Saunders was grappling at this time – the precise character of the proposed venture, as a community, and in particular the relationship between religious orientation and medical practice. Among Olive Wyon’s interests were the new religious movements and communities that had developed post World War two across Western Europe and it was her knowledge of these which was to prove so helpful (4). Cicely Saunders first wrote to Olive Wyon on 4 March 1960, at the suggestion of Sister Penelope at Wantage. Her letter set out some of the background:
‘The problem about which I wrote to Sister Penelope, is the question of the ‘Community’ which some people seem to see envisaged in my plan. I am tremendously impressed by the love and care with which the Irish Sisters give to our patients, – something more than an ordinary group of professional women could ever give, I think. But I was not really thinking of anything nearly so definite as a real new Community, I think I was using the term in a much less technical way. I asked Sister Penelope if I was attempting the impossible to hope that a secular group of people without any kind of rule would be able to hold together and give the feeling of security, which I want so much to help our patients. … So I am really faced with two problems. On the spiritual side, I know that the spiritual work is of paramount importance and while it goes hand in hand all the time with our medical work, it is the only lasting help that we can give to our people … I feel that the work should be a definitely Church of England one rather than interdenominational and that it must be widely based in the Church, and not just in one wing. Then the other problem is this question of a Community of those who work there. I think myself that this matter should be held in abeyance; I may have adumbrated it in my scheme, but I had not been thinking of going any further than pray for the right people to come, and wait for the leading of the Spirit should He want us to draw together more definitely’ (5).
In just over a week Cicely Saunders had visited Olive Wyon, and came away feeling helped. She had been encouraged to make contact with the Sisters of Commaunaté, at Grandchamp in Switzerland and wrote there soon afterwards to the foundress, Sister Genéviève, who replied with information about the community and an invitation to attend a retreat in the summer. The relationship with Grandchamp is an interesting one, but it does not seem to have strengthened Cicely Saunders’ convictions about establishing her hospice as a form of new religious community. Initial attempts to make a connection with Grandchamp were surrounded with difficulties. In July 1960 a visit was postponed as she felt unable to leave Antoni Michniewicz, a patient for whom she had been caring over the past seven months at St Joseph’s Hospice and who was now nearing death. In June of the following year, despite hesitation due to her father being unwell, it was possible to make a retreat there, but during this she received the news that her father had died. Nevertheless, her links with the sisters at Grandchamp, who undertook to offer prayers for St Christopher’s, continued for many years thereafter.
Religion and Community
But in 1960 two issues required resolution. The first was dealt with straightforwardly. The second remained unclear, and continued so, even as St Christopher’s moved towards its opening day.
First was the question of the precise religious character of the hospice. The debate was initially about in which theological wing of the Church of England it should be located, but quickly ecumenical ideas and the influence of wider discussions about Christian unity became apparent. This was the extent of interfaith considerations; Britain in these years was still some way from addressing multi-cultural issues and the question of non-Christian religions was not given any acknowledgement – that would come later. To a considerable extent the issue was resolved pragmatically; a major source of charitable funds, the City Parochial Foundation, was showing an interest in the project, but the Foundation was unable under its terms of trust to give to a purely Anglican venture. As Cicely Saunders noted in a letter to her brother on 30 August 1960: ‘I very much prefer something that is “inter” rather than “un-”’ (6) , referring here to the question of the denominational character of St Christopher’s. Betty West, the mother of a friend from medical school, had captured this months earlier in a letter encouraging her not to be too dismayed by the apparent diversity of Christian influences which were helping to form St Christopher’s: ‘could it be do you think, that in heaven our ways don’t seem quite so different as they appear to us – and who knows that the edges might well melt away or not matter so much’ (7) . By the end of 1960 the issue was settled and Cicely Saunders could write to Olive Wyon on 6 December:
‘We have decided that it shall be an interdenominational foundation, although we will have something in the documents stating as firmly as possible that it must be carried out as a Christian work as well as a medical one … I found that I just couldn’t think it was right to be exclusive. First of all, I could not be exclusively evangelical and thought that perhaps it would therefore have to be Anglican to keep it safe from heresy or secularisation. But then it didn’t seem right to be that either, and in our legal Memorandum stands the statement: “there shall be a chapel available for Christian worship”, and I do not think that really we could be much broader than that!’ (8)
On the second question however, that of St Christopher’s as some form of community, no such categorical statement appeared. Indeed there was a sense that this issue remained something to be explored and encountered, even as the work of the hospice got under way. Whereas on the question of denominational identity, Cicely Saunders had felt that her supporters and collaborators were taking a broader view than her own, on this second issue it was as if some held her back from the possibility of a more strongly communal orientation. The almoner Rosetta Burch expressed this clearly in a letter of 16 June 1960:
‘To the outside world you must be first and foremost a medical concern … You are a Christian doctor not a spiritual leader with a medical vision. You have lots of experience of working with others on a professional basis but God has never given you the experience of being a member of a Community. Don’t you think he would if that were to loom large in his plan’? (9)
So it was that Cicely Saunders was able to write to Olive Wyon at the end of 1960: ‘It does not seem to have been right to think much more along the lines of a Community for this Home at the moment. I think that if we are to be drawn together in this work, that it will happen when we get there’ (10).
It is now clear that 1960 was an intensely formative year for Cicely Saunders. It was a year of deep reflection and consultation with others on the precise nature of her vision for St Christopher’s Hospice. It was also the year in which the death of one particular patient, Antoni Michniewicz, created in her a powerful and abiding sense of loss, for a relationship which never came to fruition, yet at the same time made her feel that she had experienced something capable of giving a true authenticity and imperative to her subsequent work. The issues which she had explored at such length with her friends and associates during that year would continue to tax her imagination and energy, but a clear and pragmatic turn had occurred which enabled the purposes of St Christopher’s to be explained succinctly to the wider public, including potential donors. Indeed it was to the latter that energies now turned as Cicely Saunders in the following months actively engaged in the communication of her ideas to those who had the material wherewithal to turn them into reality.
The way forward
A few years later, the supporters of St Christopher’s, who had been meeting from 1962 under the guidance of the Bishop of Stepney (in what they came to call ‘a community of the unalike’) sought to clarify and set down in a statement the basic principles of their work. It was at one of these meetings in June 1964 that Olive Wyon shaped the discussion. The result was a document which was to have currency at the hospice for many years in the future, entitled, Aim and Basis (11) . Within it St Christopher’s Hospice was defined as a religious foundation based on the full Christian faith in God. Five underlying convictions were listed: 1) all persons who serve in the hospice will give their own contribution in their own way 2) dying people must find peace and be found by God, without being subjected to special pressures 3) ‘love is the way through’, given in care, thoughtfulness, prayer and silence 4) such service must be group work, led by the Holy Spirit, perhaps in unexpected ways 5) the foundation must give patients a sense of security and support, which will come through a faith radiating out from the chapel into every aspect of the corporate life. The Aim and Basis therefore provided St Christopher’s with a statement of underpinning motivation, which has been reviewed from time to time in the intervening years. The discussions which preceded it however were to shape the work of the hospice for many years to come. They reveal a profound sense of purpose coupled with a rigorous approach to debate and discussion, which were essential in establishing the dominant themes in the life and work of the world’s first modern hospice.
Photograph: Cicely Saunders c1960 outside Our Lady’s Wing at St Joseph’s Hospice – the source of much of her inspiration for St Christopher’s.
(1) Saunders, C. (1958) Dying of cancer, St Thomas’s Hospital Gazette, 56(2): 37-47.
(2) Clark D: Originating a movement: Cicely Saunders and the development of St Christopher’s Hospice, 1957-67. Mortality 1998;3(1):43-63; Clark D (2001) Religion, medicine, and community in the early origins of St Christopher’s Hospice. Journal of Palliative Medicine 4(3): 353-360.
(3) Du Boulay S: Cicely Saunders: The founder of the modern hospice movement. London: Hodder and Stoughton, revised edition, 1994.
(4) Wyon O: Living Springs: New religious movements in Western Europe. London: SCM Press, 1963.
(5) Cicely Saunders letter to Olive Wyon 4 March 1960.
(6) Cicely Saunders letter to Christopher Saunders 30 August 1960.
(7) Betty West letter to Cicely Saunders S 11 February 1960.
(8) Cicely Saunders letter to Olive Wyon 6 December 1960
(9) Rosetta Burch letter to Cicely Saunders 16 June 1960.
(10) Cicely Saundersletter to Olive Wyon 6 December 1960
(11) St Christopher’s Hospice Aim and Basis, mimeograph, revised 1964.