Encyclopedia of Global Bioethics

Living Edition
| Editors: Henk ten Have


  • Silviya Aleksandrova-Yankulovska
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-05544-2_228-1


History of hospice development dates back to medieval times, but modern hospice movement started just in 1967 with the establishment of St. Christopher’s Hospice in London by Cicely Saunders. Hospice’s unique features comprise of caring for all dimensions of the “total pain”: physical, spiritual, psychological, and social problems of the patient and the family. Hospice care can be provided in five organizational forms: inpatient hospices, home care, day care, palliative care units, and hospital palliative care teams. Last two forms present the integration of hospice care in the healthcare system. Presentation of ethical dimension of hospice care starts with the application of the four basic principles of bioethics. They have specific expression in the context of hospice care: respect for autonomy is generally associated with the issue of truth-telling and advance directive; beneficence and non-maleficence are focused on the problems of pain control, primarily on the double effect debate; and justice is associated with respect to the rights of terminally ill patients. Justice is discussed also in relation to guaranteeing a minimum of palliative care to everyone in need. Terminally ill patients are seen as vulnerable population in regard to inclusion in clinical research. Euthanasia and palliative care are generally considered as incompatible.


Hospice Palliative care Terminally ill Total pain 
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  1. Callahan, D. (2000). Justice, biomedical progress and palliative care. Progress in Palliative Care, 8, 3–4.Google Scholar
  2. Centeno, C., et al. (2013). EAPC Atlas of palliative care in Europe 2013 (Full edition). Milan: EAPC Press.Google Scholar
  3. Clark, D., et al. (2005). A bit of heaven for the few? An oral history of the modern hospice movement in the United Kingdom. Lancaster: Observatory Publications.Google Scholar
  4. Cohen, J., Deliens, L. (2012). Inequalities at the end of life: Under-served groups. In A Public Health Perspective on End of Life Care. (pp. 151–195). New York: Oxford University Press.CrossRefGoogle Scholar
  5. Foley, K. M. (1991). The relationship of pain and symptom management to patient requests for physician-assisted suicide. Journal of Pain and Symptom Management, 6, 289–297.CrossRefGoogle Scholar
  6. Galloway, P. (1992). Caring for the terminally ill. In Hedberg, J. Kagan, J.E. Osborn, R.E. Rakel (eds), The world book health & medical annual (pp. 354–366). Chicago: World Book.Google Scholar
  7. Ganzini, L., & Block, S. (2002). Physician-assisted death – A last resort? The New England Journal of Medicine, 346(21), 1663–1665.CrossRefGoogle Scholar
  8. Illhardt, F. J., & Ten Have, H. (2002). Research ethics in palliative care. In H. Ten Have & D. Clark (Eds.), The ethics of palliative care (pp. 198–211). Buckingham: Open University Press.Google Scholar
  9. Janssens, M. J. P. A. (2001). Pain management. In H. Ten Have & B. Gordijn (Eds.), Bioethics in a European perspective (pp. 495–509). Dordrecht/Boston/London: Kluwer.Google Scholar
  10. Kubbler-Ross, E. (1969). On death and dying. New York: Touchstone.Google Scholar
  11. Martin-Moreno, J. M., Harris, M., & Clark, D., et al. (2008). Palliative care in the European Union. Study on the request of the European Parliament’s Committee on the Environment, Public Health and Food Safety. European Parliament.Google Scholar
  12. NHPCO. (2013). NHPCO’s facts and figures. Hospice care in America. http://www.nhpco.org/sites/default/files/public/Statistics_Research/2013_Facts_Figures.pdf. Retrieved online 25 June 2014.
  13. Sahm, S. (2000). Palliative care versus euthanasia. The German position: The German General Medical Council’s principles for medical care of the terminally ill. Journal of Medicine and Philosophy, 25, 195–219.CrossRefGoogle Scholar
  14. Saunders, C. (1964). The need for institutional care for the patient with advanced cancer (Anniversary volume, pp. 1–8). Madras: Cancer Institute.Google Scholar
  15. World Medical Association Declaration of Venice on Terminal Illness. (2006). Adopted by the 35th World medical assembly, Venice, October 1983 and revised by the 57th WMA General assembly, Pilanesberg, October 2006. Google Scholar
  16. World Medical Association Declaration on the Rights of the Patient. (2005). Adopted by the 34th World medical assembly, Lisbon, September/October 1981, and amended by the 47th WMA General assembly, Bali, September 1995, and editorially revised at the 171st council session, Santiago, October 2005.Google Scholar

Further Reading

  1. Humphreys, C. (2001). Waiting for the last summons: The establishment of the first hospices in England 1878–1914. Mortality, 6(2),146–166.CrossRefGoogle Scholar
  2. Saunders, C. (1963). The treatment of intractable pain in terminal cancer. Proceedings of the Royal Society of Medicine, 56, 195–197.Google Scholar
  3. Smith, F. and Himmel, S. (2013). Changing the way we die: compassionate end of life care and the hospice movement. Berkeley, United States, Viva Editions.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Department of Medical Ethics, Management of Health Care and Information TechnologiesMedical University of PlevenPlevenBulgaria