nected to conventional hospitals or nursing homes, and are on that account considered institutional (Asch-Goodkin, 2000).
Most commentators appear to agree that the contemporary concept of hospice care originated in 1959, when one Cicely Saunders, M.D., began to develop plans for a hospice program in England. St. Christopher's Hospice opened in 1967, and as its director Saunders installed a component of compassionate care that was revolutionary: pain management that permitted patients to live the end of their lives absent the symptoms of profound suffering (Saunders, 1972 & 1978). What that came down to is that painkiller drugs were administered for palliation, not cure.
Saunders developed a palliative, extrainstitutional model that became a hallmark of the St. Christopher's program (Davidson, 1985) and that has become a familiar fixture of hospice care in the US as well. In 1971, the first American hospice reportedly opened in New Haven Connecticut, under direction of Dr. Sylvia Lack, a St. Christopher's veteran (Lack & Buckingham, 1978). Substantially following the English model, it caught attention of legislators, health-service professionals, and the lay population (State of New York Department of Health, 1982). As of 1982, there were some 800 hospice programs in various stages of operation throughout America, serving more than 60,000 patients, 95% of whom were dying of cancer (New York State, 1982). Programs were housed in nursing homes, extended-care facilities, hospitals, free-standing facilities, and are also decentralized, sometimes providing extrainstitutional home care via team efforts.
Since those early days, the American hospice movement has developed as a social-welfare program designed to enhance the health and welfare of the dying patient, family, friends. Some hospice care has been folded into the roster of benefits available in Medicare and other government-funded programs, though the funding was cut back in 1...