Was den Menschen zum Menschen macht

Hospice

5 Min. Lesezeit

🇩🇪 Deutsche Version: Hospiz

The hospice is an institution that takes in and cares for dying people, with the goal of preserving their dignity until the last breath. Cicely Saunders founded St Christopher’s Hospice in Sydenham (London) in 1967 — the first modern hospice with integrated pain therapy, research, and teaching. By 2005 more than 8000 inpatient hospices following this model had emerged worldwide.

Significance for Personal Ontology

The hospice is more than a care facility. It is the institutional embodiment of an ontological position: the human person remains fully a person until death and does not lose their dignity through loss of function. Whoever is admitted to a hospice is not “beyond treatment” or “functionally incapacitated” — they are a person in a final phase of life, whose personhood is affirmed in every dimension.

This position stands in sharp contrast to empirical functionalism, which binds personhood to actual capacities (cf. empirical-functionalist concept of person) and therefore tends to see, in dying, a personhood held “on call.” The hospice instead works out of the substance-ontological-relational concept of person: the person is always whole, in every phase.

Cicely Saunders and the Total Pain Concept

Between 1958 and 1967 Saunders developed the concept of Total Pain — suffering in dying as an indivisible whole with physical, psychological, social, and spiritual dimensions. From this diagnosis followed the hospice answer: no single profession can treat Total Pain alone. Hospices therefore work with interdisciplinary teams of physicians, nurses, social workers, chaplains, and psychologists.

Saunders’ motto — “You matter because you are you, and you matter to the end of your life” — has become the motto of the worldwide hospice movement.

Places of Dying in Comparison

The hospice is one of four possible places of dying, which are weighted differently within personal ontology.

Hospice — a specialized place of dying, designed for Total Pain treatment and holistic accompaniment. Structurally the most direct embodiment of the affirmation of personhood in dying.

Hospital — an acute-care place of dying. Ambivalent within personal ontology: the acute-care orientation can come into conflict with the dying phase, because it is geared toward cure and the prolongation of life. Palliative consultations can soften this, but they do not fundamentally change the institutional logic.

Intensive care unit — the place of dying of highest technical intensity. Here the sharpest tension appears between technical life-sustaining technology and the affirmation of personhood as a whole. The withdrawal of treatment is here often the last decision before death; the controlled practice of organ donation after circulatory death typically takes place here.

Home — the domestic place of dying, as a rule with outpatient palliative accompaniment (in Germany SAPV — Specialized Outpatient Palliative Care). It preserves personal embeddedness in the family most immediately.

The Hospice Movement Worldwide

Within a few decades St Christopher’s grew into a global movement. It carries the idea of holistic accompaniment in dying into practice and policy. Within personal ontology it is the institutional answer to the practical oblivion of the person of a dying that reduces the person to loss of function.

In many countries the movement has shifted the euthanasia debate: where hospices are available, the question of euthanasia is often posed differently — not “how is the suffering ended,” but “how is the person accompanied to the end.” Saunders herself spoke out against euthanasia throughout her life, precisely because she knew the hospice alternative.

Ontological Classification

Superordinate concepts: state of affairs (institution, movement)

Ontological relations:

Chapter assignment: Chapter 4: What Is Human Personhood? (German), Chapter 5: Oblivion of the Person (German)

Sources

Founding and Philosophy of St Christopher’s Hospice

  • Saunders, Cicely (1981): The founding philosophy. In: Saunders, Cicely; Summers, Dorothy H.; Teller, Neville (eds.): Hospice: The Living Idea. London: Edward Arnold, pp. 4—6.
  • Saunders, Cicely (1996): A personal therapeutic journey. British Medical Journal 313(7072): 1599—1601.
  • Du Boulay, Shirley; Rankin, Marianne (2007): Cicely Saunders: The Founder of the Modern Hospice Movement (rev. ed.). London: SPCK Publishing.

History and Spread of the Hospice Movement

The Total Pain Concept and Practice

  • Saunders, Cicely (1964): The symptomatic treatment of incurable malignant disease. Prescribers’ Journal 4(4): 68—73.
  • Clark, David (1999): “Total pain”, disciplinary power and the body in the work of Cicely Saunders, 1958—1967. Social Science & Medicine 49(6): 727—736.

Places of Dying and Palliative Structures

Position on Euthanasia

  • Saunders, Cicely (1992): Voluntary euthanasia. Palliative Medicine 6(1): 1—5. Saunders’ own statement from hospice practice.

See also

Generated by querying the Personhood ontology.

Graphansicht

Backlinks