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Cicely’s inspiration

· ​Cicely Saunders ·

Not long ago a group of about 20 Italian experts in palliative treatment, from different professions and with different ethical convictions, gathered to reflect on the figure of Cicely Saunders and to take part in a series of questions. “Sul sentiero di Cicely” [On Cicely’s path] was the title chosen by the working group which first tackled the question of how the experience of the foundress of the Hospice Movement can still be meaningful to those involved in treating patients with incurable diseases. It resulted in a manifesto, “Il sentiero di Cicely: la bellezza delle cure palliative” [Cicely’s path: the beauty of palliative treatment”], which reaffirms and promotes the principles and ways in which this young discipline is put into practice in accordance with Saunders’ vision.

But who was this woman who died just over 10 years ago? Officer of the Order of the British Empire, Dame Commander and Member of the Order of Merit of the United Kingdom with 25 honorary degrees: Cicely Saunders was first and foremost a nurse, a social worker and a physician. Born in 1918, she lived through the dark years of the Second World War: “It often happened that we ran out of everything”, she wrote, “medicines, bandages, water... we had nothing left, we had nothing to offer except ourselves”. Life forged her on the road of sacrifice, sobriety and action. The Manifesto begins with a quotation of David Clark who knew Cicely Saunders very well and who emphasizes the deep bond “between the personal biography, the spiritual life and the ethics of treatment” which characterized her. Saunders obtained a nursing diploma in 1944 at the very demanding Nightingale School of Nursing. An Anglican Christian since 1947, she quickly completed her university studies to become a social worker after she had various back problems which prevented her from working as a nurse. At St Thomas’ Hospital in London she met a patient who changed her life: David Tasma, a Jew who had escaped from the Warsaw Ghetto and was now suffering from terminal cancer. She had lengthy discussions with him and envisaged a specific place providing assistance to the sick nearing the end of their lives. And she received a gift. David left her a legacy of £500 sterling: “I shall be a window in your house”, he told her.

“It took me 19 years to build that house around the window”, Cicely Saunders once confided. That house, St Christopher’s Hospice, still exists today. It opened in 1967 and was the precursor of a great many other similar institutions throughout the world. As a nurse in those years she would have risked being listened to by no one. However, a thoracic surgeon for whom she was working advised her to enrol in medical studies and at the age of 39 Saunders obtained a degree and qualified as a physician. It was once again a patient who inspired her with the name St Christopher’s: “A place of passage for travellers: it absolutely has to be called St Christopher’s”, Mrs Galton said to her.

What made this woman such an extraordinary figure that she is still a guide for professionals in palliative treatment today? The “sentiero di Cicely” explains it clearly. “A holistic vision of illness and treatment [...], the discovery of the efficacy of the regular treatment of pain and suffering, the recogition of the ‘total pain’ of the dying, to the point of understanding the therapeutic potential of relationships in the treatment given at the end of life […], Cicely Saunders marked a turning point”. The Manifesto is structured in five points, highlighting the reality of a most vivid experience. The spiritual dimension of treatment stems from the concept of “total pain”: those nearing the end of their lives suffer not only physically but also spiritually, psychologically and on the social and cultural levels. “The direction pointed out by Cicely”, we read, “is certainly that of the encounter with every authentic expression of human spirituality, considered as both a need and a resource […]”. Secondly we confront the topic of palliative sedation, already described by Saunders: this process is “coherent with the protection of the person’s dignity” and is an intervention “well founded in certain conditions on the principle of holistic treatment [...]”, in perfect harmony “with Cicely’s inspiration” and in stark opposition to the logic of euthanasia. “What should the characteristics of the advance directive and the planning of treatment in advance be in order to correspond with the centrality of the individual expressed in Saunder’s thought [...]?”, the authors ask in their third point. The answer lies in the reference to relational autonomy rather than to a principle of absolute self-determination, and in respect for patients who, Cicely wrote, “are facing adversity”. “The result of the treatment”, she added, “must be for them, not for us”.

The fourth point of the document emphasizes that the foundress’ opposition to euthanasia was always extremely firm: still today Saunders teaches people to keep solutions that cut life short outside the horizons of palliative treament, trusting in the fact that a human and competent approach to the patient can find unexpected solutions in the therapeutic relationship. Lastly, “since its foundation the modern hospice has been a place of training and research”, not only “exclusively of acceptance and compassionate treatment”: an intuition, a “true innovation” which still today guides those who want to nurse dying patients and is an incentive towards new goals. “Once again”, the Manifesto continues, “it is confirmed that in Cicely Saunders’ founding intuitions palliative treatment finds not only roots and reference points to which it continues to adhere firmly but also notable elements of modernity and starting points for growth and innovation, yet to be completely realized”. 

Ferdinando Cancelli




St. Peter’s Square

March 24, 2018