Milestones in Hospice Palliative Care

The Canadian Hospice Palliative Care Association... A History

Hospice (noun) is derived from the Latin word “hospitium,” which means hospitality or hospitable.

Palliative (noun or adjective) or “palliate” (verb) is derived from the Latin “palliare,” which means to cloak.

The first hospices date back as far as the 4th century in when Christians in Europe provided care to the sick and destitute. In the 1960’s, Dame Cicely Saunders revived the hospice tradition in the United Kingdom out of a need to provide terminally ill patients with end-of-life services. St.Christopher’s Hospice, a sixty bed facility for the terminally ill, opened in July 1967 in Sydenham, London, England. With this first modern hospice, the specialty of care for the terminally ill was born.

Historically, in Canada, hospice palliative care has developed to meet local needs. It came about as a result of the rapid expansion of cancer treatment programs in the 1970’s whereby treatment was defined as either curative or palliative. In Canada, the hospice palliative care movement began with the creation of palliative care units in a hospital setting. In 1974, approximately seven years after the implementation of Medicare, the first palliative care unit opened at Winnipeg’s St. Boniface General Hospital. Within a matter of weeks, the second palliative care unit in Canada opened at the Royal Victoria Hospital in Montreal, Quebec. Subsequently, hospice palliative care programs developed as divisions of larger organizations or agencies. Volunteer-based hospice societies and organizations began to develop soon after.

In the mid 1980’s health care systems began using terms such as acute, chronic, geriatric, or palliative to define a category of patient. These new terms mandated specialized needs. Hospice palliative care became quickly and widely accepted as a societal movement reforming health to balance “high tech” acute care with “high touch” palliative care.

In 1981 the Palliative Care Foundation in Toronto, Ontario proposed a definition of palliative care. They stated that “Palliative care is active compassionate care of the terminally ill at a time when they’re no longer responsive to traditional treatment aimed at cure and prolongation of life and when the control of symptoms, physical and emotional is paramount. It is multidisciplinary in its approach and encompasses the patient, the family and the community in its scope.” That same year, Health and Welfare Canada sought to develop national practices in palliative care with the publication of the “Palliative Care Services Guidelines.” The first University Institute for research and education in palliative care was created at the University of Ottawa in 1983.

The groundwork for the creation of a national association began in 1987 at the National Palliative Care Conference held in Ottawa. At that time there were only three provincial organizations, but no national voice for hospice palliative care in Canada. As a result of meetings held during the conference the provincial groups agreed to begin to work towards creating a national association.

In 1990 the first Canadian Palliative Care Directory was developed through an initiative of the Royal Victoria Hospital, Palliative Care Services and financial assistance from Knoll Pharmaceutical Inc. (now Abbott Laboratories). There have been a number of revised versions published over the years and the Directory is now available on-line on the association’s web sites.

The Canadian Palliative Care Association (CPCA) was formally established as a national charitable organization in November 1991 and opened the first office in Ottawa in February 1994. That same month the Special Senate Committee on Euthanasia and Assisted Suicide was announced.

The association’s first newsletter “AVISO” was published in both official languages in June, 1992. In Spanish, “AVISO” means “advice” or “intelligence”. In Latin “AVIS” means “bird”. Both meanings relate nicely to the official logo of the association.

In 1997 the CPCA created the “CPCA Award of Excellence” to recognize outstanding individuals working (in a paid or volunteer capacity) in hospice palliative care in Canada. This award is presented annually and information on the past recipients can be found on the Award of Excellence pages.

In 1998, the CPCA entered into a partnership with the GlaxoWellcome Foundation (now The GlaxoSmithKline Foundation) and created the Living Lessons® public awareness campaign. Highlights of the campaign include pamphlets, brochures, a guide for family physicians and a guide for caregivers. Materials can be obtained through the toll-free information line 1-877-203-INFO (4636) or by sending an e-mail to Contact Us.

In May 1998, the first annual National Hospice Palliative Care Week public awareness event was launched from Ottawa by Her Excellency Mme. Diana Fowler-LeBlanc, C.C.. At the time Her Excellency was the Honorary Patron of the association. The kick-off event was held at Rideau Hall and included a showing of paintings by Robert Pope entitled “Illness and Healing”.

1999 – The Palliative Care Training for Support Workers Project which enabled hundreds of support workers from across Canada to be trained in hospice palliative care.

In June 2000, the Standing Senate Committee on Social Affairs, Science and Technology released a landmark report entitled Quality End-Of-Life Care: The Right of Every Canadian. Under the leadership of Senator Sharon Carstairs, the report examined the federal government’s response to the 1995 report of the Senate Special Committee on Euthanasia and Assisted Suicide entitled “Of Life and Death“. The report released in June 2000 made 14 key recommendations to the federal government to address critical issues in Canada related to end-of-life care for Canadians.

In December 2000, 24 national stakeholders with an interest in end-of-life care met in Toronto, Ontario to discuss ways of working together. The result of the meeting was the creation of the Quality End-of-Life Care Coalition of Canada and the development of a Blueprint for Action to address the current end-of-life care needs in Canada.

In March 2001, Prime Minister Chrétien appointed Senator Carstairs as Minister with Special Responsibility for Palliative Care. In this role she has been assisting the Health Minister in supporting the federal government’s interest in the development of palliative care by working with provinces, territories and non-governmental organizations, to ensure that palliative care is meeting the needs of Canadian patients, families and care givers.

The summer of 2001 also saw the announcement of the creation of the Secretariat on Palliative and End-of-Life Care at Health Canada. The Secretariat was established as the first step in Health Canada’s work to coordinate the development of a Canadian strategy for end-of-life care. The Secretariat facilitates expert collaboration, and works to create greater awareness of the need for quality care at the end of life, including access to appropriate palliative care. The Secretariat is a focal point for end-of-life issues in Health Canada.

At the Annual General Meeting held in Victoria, B.C. on October 21st., 2001 the membership of the then Canadian Palliative Care Association (CPCA) overwhelmingly supported a motion from the Board of Directors to update the logo of the association and change the name of the association to the Canadian Hospice Palliative Care Association (CHPCA). Due to the fluidity of the English language, “hospice care” and “palliative care” are no longer recognized as separate entities. The term that is now widely accepted in Canada is “hospice palliative care”.

In April of 2002, after more than 10 years in development, the CHPCA published A Model to Guide Hospice Palliative Care: Based on the National Principles and Norms of Practice. This guide is recognized as a landmark document providing information on nationally accepted norms of practice for hospice palliative care. The Model has been used extensively throughout Canada since being released and has also attracted attention from the international hospice palliative care community.

In May 2003 the CHPCA introduced a new annual fundraising and awareness event. The first national Hike for Hospice Palliative Care was held on Sunday, May 4th, 2003. The event was a huge success with more than 75 communities across Canada participating in the event. The event was picked up by various media outlets across Canada and more than $300,000 was raised to support local hospice palliative care programs and services with no monies being transferred to the CHPCA.

The summer of 2003 saw the introduction of a new communication tool for the various Interest Groups supported by the CHPCA. Each Interest Group now has an electronic List Serve to facilitate communication. The List Serves provide, at a no-cost, an opportunity to share ideas, concerns, proposals, assessment tools, effective interventions, educational opportunities, etc. with other members who share the same interests.

In 2003 the Government of Canada announced a new type of Employment Insurance benefit, called the “Compassionate Care Benefit“. This benefit will enable Canadians to temporarily leave their jobs to care for a dying family member while being supported by the federal Employment Insurance program.