Cicely Saunders — trained nurse, social worker, and physician — is the founder of the modern hospice movement. With the founding of St Christopher’s Hospice in London in 1967 she created an institution that in the following decades became the model for more than 8,000 inpatient hospices worldwide. Her main theoretical contribution — the concept of Total Pain — shapes palliative medicine to this day.
Key Contribution
Saunders shows: suffering in dying is not an aggregate of separate forms of pain but an indivisible whole with four interpenetrating dimensions — physical, psychological, social, and spiritual. Whoever treats only the somatic dimension does not treat the person. From this diagnosis followed the hospice answer: interdisciplinary teams, holistic accompaniment, dignity-preserving care to the last breath.
In terms of the ontology of the person, Saunders’s concept has a striking structural parallel to the anthropology of the book: the person, as a bodily-spiritual unity, is not an aggregate but a whole person whose suffering has personal depth.
Life and Career
Saunders passed through three medical professions — an unusual path for her time, which grounded her interdisciplinary view of dying:
- Nurse (qualified 1944) — direct contact with the dying in clinical practice
- Medical social worker — the social dimension of dying
- Physician (licensed 1957, working at St Joseph’s Hospice) — the medical responsibility for pain therapy and care of the dying
Between 1958 and 1967 she developed the concept of Total Pain at St Joseph’s Hospice in London. In 1967 she founded St Christopher’s Hospice in Sydenham (London) — the first modern hospice with integrated pain therapy, research, and teaching. The model spread internationally within a few years.
Motto
“You matter because you are you, and you matter to the end of your life.”
Translated into the ontology of the person: personhood is inalienable; the dignity of the person endures to the last breath. The statement stands in line with the substance-ontological-relational concept of person of the dissertation: personhood is not bound to actual function but remains the same through all phases of life.
Position on Euthanasia
Saunders spoke out against euthanasia throughout her life — not out of dogmatic duty but out of clinical experience. Where Total Pain is taken seriously and treated holistically, the question shifts. It is no longer “how is the suffering to be ended” but “how is the person to be accompanied to the end.”
Saunders thereby created an institutional counterpole to the euthanasia movement. The hospice movement is the structural answer to the practical oblivion of the person in a dying that reduces the person to loss of function.
International Influence
Out of St Christopher’s, within decades, grew a global movement:
- Australia and New Zealand (early 1970s)
- USA (first hospice in 1974 in Connecticut, on the St Christopher’s model)
- Germany (first hospice foundations from the 1980s onward)
- Austria, Switzerland, the Netherlands, other Western countries
- By now also in Eastern and South-Eastern Europe, Latin America, Africa
Saunders was made a Dame Commander of the Order of the British Empire in 1979. In 2001 she received the Conrad N. Hilton Humanitarian Prize. She died in 2005 in St Christopher’s Hospice — in the very institution she herself had founded.
Significance for the Ontology of the Person
Saunders is not a philosopher in the academic sense. Her significance for the ontology of the person developed in this book lies in two points:
First, the Total Pain concept shows empirically what the Spaemann line asserts philosophically: the person cannot be decomposed into functional components. Whoever thinks only somatically in the face of dying overlooks the human being.
Second, the hospice is the institutional embodiment of the position that personhood is not bound to actual function. In every phase of dying — pre-final, terminal, dying — the person remains a person. The First Dimension of personhood is inviolable; the actualization of the Second and Third Dimension is accompanied, not assessed.
Sources
Saunders’s Own Writings (Selection)
- Saunders, Cicely (1958): Dying of cancer. St Thomas’s Hospital Gazette 56(2): 37–47.
- Saunders, Cicely (1964): The need for institutional care for the patient with advanced cancer. In: Anniversary Volume, Madras: Cancer Institute, pp. 1–8.
- Saunders, Cicely (1964): The symptomatic treatment of incurable malignant disease. Prescribers’ Journal 4(4): 68–73.
- Saunders, Cicely (1967): The management of terminal illness. London: Hospital Medicine Publications.
- 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 (1992): Voluntary euthanasia. Palliative Medicine 6(1): 1–5.
- Saunders, Cicely (1996): A personal therapeutic journey. British Medical Journal 313(7072): 1599–1601.
- Saunders, Cicely (2006): Cicely Saunders: Selected Writings 1958–2004. With an introduction by David Clark. Oxford: Oxford University Press.
Biographies and Historical Studies
- Du Boulay, Shirley; Rankin, Marianne (2007): Cicely Saunders: The Founder of the Modern Hospice Movement (rev. ed.). London: SPCK Publishing. The standard biography.
- Clark, David (2018): Cicely Saunders: A life and legacy. Oxford: Oxford University Press. Scholarly biography of her work.
- Clark, David (ed., 2002): Cicely Saunders — Founder of the Hospice Movement: Selected Letters 1959–1999. Oxford: Oxford University Press.
Theoretical Reconstruction of Her Contribution
- 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.
- Clark, David (2007): From margins to centre: A review of the history of palliative care in cancer. The Lancet Oncology 8(5): 430–438.
Tributes and Obituaries
- Richmond, Caroline (2005): Dame Cicely Saunders (obituary). British Medical Journal 331(7510): 238.
- fembio.org: Cicely Saunders — biography. https://www.fembio.org/biographie.php/frau/biographie/cicely-saunders/
On the Ontology of the Person in the Dissertation
- Bexten, Raphael E. (2017): Was ist menschliches Personsein? Der Mensch im Spannungsfeld von Personvergessenheit und unverlierbarer ontologischer Würde (What Is Human Personhood? The Human Being in the Tension between Oblivion of the Person and Inalienable Ontological Dignity). Eichstätt-Ingolstadt: Univ., Diss.
See also
Generated by querying the Personhood ontology.