The Evolution of Palliative Care

The development by the second half of the twentieth century of new technologies and effective specific treatments for disease still left much suffering unaddressed. As Professor Patrick Wall wrote in 1986, ‘Symptoms were placed on one side and therapy directed at them was denigrated’1. In the same vein, when Aneurin Bevan introduced the National Health Service Bill to Parliament, he stated that he would ‘rather be kept alive in the efficient if cold altruism of a large hospital than expire in a gush of sympathy in a small one’2. But what if no cure was possible and the end of life was inevitable? Referring particularly to the hospice movement, Wall added that ‘The old methods of care and caring had to be rediscovered and the best of modern medicine had to be turned to the task of new study and therapy specifically directed at pain’. Care, matched with an increasingly sound evidence base, was by then underpinned by the concept of ‘total pain’—defined in 1964 as including not only physical symptoms but also mental distress and social or spiritual problems3. This approach met ready audiences among nursing and medical students during lectures or in articles, as well as social workers and more gradually among senior members of the medical profession.