Under the British Roof: The British Contribution to the Development of Hospice and Palliative Care in Poland.

The article focuses on British contribution to the development of palliative and hospice care in Poland in the 1980s and beyond. It is based on archival research in the hospices in Cracow and Poznan and broad-scoped Polish journals' review. The social background of the hospice movement in Poland is described. We explore the role of inspiration and help of Dame Cicely Saunders and other British leaders in the transfer of British hospice philosophy and practice of palliative care to the medical community in Poland. This study demonstrates the importance of institutions for the formal exchange of medical information.

Hospice and Palliative Care in Mainland China: History, Current Status and Challenges.

The concept of End-of-Life Care (EOLC) came into China in the late 1980s. However, hospice and palliative care in medical practice develope slowly. In recent years, profesionals, patients and their families, as well as government begin to attach importance to it. There is a hospice and palliative care movement now in China. This article gives an overview of the progress and the current status in multiple aspects of hospice and palliative care in mainland China, and points out the barriers and challenges for its further development in the future.

[Hospice--an institution of support to the patient]. / Hospicjum jako instytucja wspierajaca czlowieka.

The paper summarises the past and the present of the palliative care. The author describes the developement in the field from the times of antiquity, through the deep Christian vocation of middle ages to alleviate pain and misery, the eigthteenth century's enlighted ideas until the relatively recent developement of the idea of hospice pioneered in 1967by dr Cicely Saunders in England, and in 1964 by Chrzanowska in Poland. The role of hospice and palliative care at large is summarised, with special focus on emotional, affirmative, instrumental and information-centered support. The paradox of hospice is discussed, which rests on caring for the incurable patient and helping them comfortably to pass the terminal stages of their disease and life, with dignity, without pain, depression, negligence and deprivation. The hospice movement, drawing form Christian tradition, affirms life while accepting the inevitability of death, opposes the idea of euthanasia, educates the society about the issues related to dying, rests on a set of autonomous units the organisation of which is adapted to local needs, and, finally, acts in concordance with other agendas of the healthcare system. The Polish system constituted by palliative care reach-out teams and palliative units and hospices should be strongly supported and adequately founded to supply best care available to the dying and distressed.

In the shadow of a rainbow: the history of animal hospice.

This article outlines the young history of animal hospice by first focusing on the history of human hospice, with special emphasis on the last 200 years. It then examines similarities between the two, showing how human hospice has informed its animal counterpart and defined it as specialized comfort care benefiting terminally ill companion animals in their home setting as well as a unique journey wherein the caregiver understands that quality of death is as important as quality of life. The article includes a bibliography and two specialized reading lists-on human hospice and on the growing field of animal hospice.

Banishing death: the disappearance of the appreciation of mortality.

The experience of death and dying is very different in the 21st century than it was in the 19th. A number of societal changes in the latter part of the 19th and early part of the 20th centuries served to remove contact with the dying and the dead from everyday experience. This article examines four of these changes: 1) falling death rates, 2) the rise of hospitals, 3) the rise of funeral directing as a profession, and 4) the rural cemetery movement. It is proposed that these changes produced an unjustified optimism with regard to the prolongation of life.

Journey of struggle: kalothanasia and the hospice way of dying.

The purpose of this article is to characterize the notion of a "good death" both historically and conceptually, grounding the philosophy of the modern hospice movement. This concept encompasses elements originating in ancient societies, such as peasant societies, where death was prepared for and shared socially, with ethical and aesthetic elements originating from Ancient Greece. These Greek elements emerged from a "journey of struggle" and can be recognized in the current day as a journey to cope with illness. From this conceptualization emerged a category of "good death" (kalothanasia), adding to the expertise of advocates of the modern hospice movement, who seek to revive a process of dying that is socially ritualized. However, this is challenging in the setting of a medical practice that is constantly incorporating new technology, in accordance with its present bio-techno-scientific paradigm, and in a medical scenario that identifies itself with the continued and persistent use of new technologies.

Pain control in the African context: the Ugandan introduction of affordable morphine to relieve suffering at the end of life.

Dr Anne Merriman is the founder of Hospice Africa and Hospice Africa Uganda. She is presently Director of Policy and International Programmes. Here she tells the story of how HAU was founded. Dr Richard Harding is an academic researcher working on palliative care in Sub-Saharan Africa. This paper described Dr Merriman's experience in pioneering palliative care provision. In particular it examines the steps to achieving wider availability of opioids for pain management for those with far advanced disease. Hospice Africa Uganda has been a model facility in achieving high quality clinical care embedded in a strategy of advocacy and education, using a multifaceted approach that has addressed logistical, policy and legislative barriers. Until 1990 control of severe pain in Sub-Saharan Africa was non-existent except in Zimbabwe and S Africa. Oral affordable morphine was brought to Kenya through Nairobi Hospice that year, and to Uganda through Hospice Africa Uganda in 1993. This paper offers an example of a highly effective and cost efficient model of care that has transformed the ability to humanely manage the problems of those with terminal illness, and to offer a culturally appropriate "good death". Thus it is now possible to complete the ethical circle of care in resource poor circumstances.

How might Levinas' concept of the other's priority and Derrida's unconditional hospitality contribute to the philosophy of the modern hospice movement?

Hospitality is commonly referred as one of the meanings of hospes, the Latin word which is also the root of hospice. This article explores the semantics of the word hospice - the seal of identity of modern hospice movement - and attempts to integrate the meaning of hospitality into the modern hospice movement, understood as unconditional reception. Therefore, the article analyzes the concept of unconditional hospitality, developed by Jacques Derrida and that of ethical responsibility proposed by Emmanuel Levinas based on the phenomenological experience of the other. From this point of view, these two concepts tie in with the meaning of hospice, bringing substantial grounding elements to the hospice movement for the construction of a protective ethos.

[The hospice movement in Croatia--short review]. / Hospicijski pokret u Hrvatskoj--ukratko.

The hospice movement was launched by the Croatian Society of Hospice and Palliative Care, Croatian Medical Association, founded and headed by the author until 2009. In this article, the author describes the development of the hospice movement in four periods, as follows: first period 1994-1999, the beginnings; second period 2000-2005, a period of great hopes and initial achievement of first goals; third period 2006-2008, a period of stagnation, the 'burn-out' syndrome, looking for new ways and people; and fourth period 2009-? Let us hope it will bring true finding way out, a new period of struggling for acceptable solutions, which has already been accomplished in many countries. The hope dies last, the hope in positive powers among the citizens of Croatia. Only the most important facts are presented, whereas citations from numerous lectures, events held all over Croatia and publications in many books and newspapers are omitted. Descriptions of numerous trips for training, education, for one month, two weeks, one week or several days in the USA, Canada, UK, Poland, Hungary, Austria, Switzerland, Norway, etc., and of visits paid by many guests from the UK, USA, Canada, Italy, Germany, Switzerland, Poland, Hungary, Romania, Bulgaria, Israel, Bosnia and Herzegovina, Serbia, Macedonia, etc. are also omitted. All these facts will be presented in the monograph that has been prepared for publication.

Death, mourning, and medical progress.

A number of changes can be observed in the way people are coming to think about death, mourning, and medical progress. The palliative care movement was initiated some 30 years ago to respond to widespread ignorance or neglect of pain relief for the dying, which was then coming to public attention and becoming a key part of the nascent hospice movement. Yet if an important feature of the latter movement was acceptance of the reality of death, in recent years there has emerged a blending of clinical treatment and hospice care, a kind of compromise with the idea of death as an inevitability. Meanwhile, the combination of real progress in forestalling death and the matching medical and media hype about past and coming victories over mortality mean that death itself is coming to be seen as a biological accident, a contingent event, not a fixed given. People die now because of bad luck, indifference to good living habits, unfortunate genetics, and the like, or because they have the misfortune of dying before a cure for their fatal disease is at hand. Mourning likewise is changing. The old custom of the deceased being laid out in their living rooms, followed by a funeral, has long given way to a movement away from public funerals to private ones followed later by a memorial ceremony. No more dead bodies on display to grieve over, but soothing ceremonies of remembrance.

The Nairobi Hospice--tribute to the late professor Edward George Kasili.

Professor Edward George Kasili is regarded as the father of the hospice movement in Kenya. In 1990, he together with Ruth Wooldridge and Jane Moore founded the Nairobi Hospice which takes care of patients with life limiting illnesses from all walks of life. This was of course not easy since even now the mentality of people towards dying is still the same, where people fear talking about death. The hospice movement tries to help somebody die well, die with dignity. The Nairobi Hospice had the privilege of caring for Professor Kasili in his last days before he passed on due to complications of cancer. This article is a tribute to this great man for his forward thinking and for starting the hospice movement.

Hospice and palliative care development in India: a multimethod review of services and experiences.

Palliative care has been developing in India since the mid-1980s, but there is a dearth of evidence about service provision on which to base national policy and practice. The aim of this study was to assess the current state of palliative care in India, mapping the existence of services state by state, and documenting the perspectives and experiences of those involved. A multimethod review was used, which included synthesis of evidence from published and grey literature, ethnographic field visits, qualitative interviews with 87 individuals from 12 states, and collation of existing public health data. The review identified 138 hospice and palliative care services in 16 states and union territories. These are mostly concentrated in large cities, with the exception of Kerala, where they are much more widespread. Nongovernmental organizations, public and private hospitals, and hospices are the predominant sources of provision. We were unable to identify palliative care services in 19 states/union territories. Development of services is uneven, with greater provision evident in the south than the north, but for the majority of states, coverage is poor. Barriers to the development of palliative care include: poverty, population density, geography, opioid availability, workforce development, and limited national palliative care policy. Successful models exist for the development of affordable, sustainable community-based palliative care services. These have arisen from adapting Western models of hospice and palliative care for implementation in the Indian cultural context. Further work is required to ensure that the growing interest in hospice and palliative care in India is used to increase the momentum of progress.