Hinohara Lecture at the 12th Asia Pacific Hospice Conference, Singapore
3rd August 2017
Hinohara Lecture 2017
In July 2017 Professor Higginson gave the Hinohara Lecture at the 12th Asia Pacific Hospice Conference in Singapore. The Hinohara Lecture is named in honour of the physician Shigeaki Hinohara who died in July 2017 at the age of 105. Professor Higginson met Dr Hinohara in 1996.
Professor Higginson’s lecture Greater than the Sum of Its Parts looked ahead to the development of palliative care in the next 50 years. Professor Higginson described the philosophical roots of palliative care, the multi-professional nature of modern palliative care, and the multi-dimensional nature of the specialty, incorporating Mind and Body, as described by the founder of the modern hospice movement, Dame Cicely Saunders. Here is a summary of the lecture.
Greater than the sum of its parts: its relevance to modern palliative care for the next 50 years?
The birth of modern palliative care is often attributed to the opening by Dame Cicely Saunders of St Christopher’s Hospice in 1967. Her vision included an amalgamation that made the whole greater than the sum of the parts.
First, and perhaps the most radical, was to integrate research for new knowledge, with education and the best clinical care. Cicely Saunders had been a fellow in department of Pharmacology, St Mary’s Hospital Medical School, conducting research supported by Sir Halley Stewart Trust. For 5½ years she studied pain management in 1100 patients receiving terminal care at St Joseph’s Hospice. She learned much from the nuns in pain assessment and management, but wanted to extend and translate this into best in practice.
Arising from this work she developed a theoretical underpinning for clinical management – a second integration being sound theory, integrated with practical application.
A third integration is the concept of ‘total pain’, of the whole person, with physical, emotional, social, spiritual and other components.
A fourth integration is of nursing, medicine, social work, physiotherapy and other disciplines to better address individual needs. Cicely Saunders was a multiprofessional team herself. There are integrations of setting, with hospice (with a focus on welcoming environment), home and hospital; hospice included a nursery for the staff of children and a nursing home, as well as care and respite for the dying. There is the integration of patient and family as the unit of care.
How relevant are these integrations today? Are there new ones we should consider? Worldwide there are 56 million people who die each year, over 100 every minute. The annual number of deaths is growing in many countries, as a consequence of earlier extensions in life. While this growth will occur globally, more than half of the new cases and two thirds of the deaths are predicted to occur in the less developed regions of the world.
The patterns of diseases experienced today have changed considerably since 1967, and will alter more in the future. People are living longer with many chronic diseases, treatments extend later into the course of the disease and multimorbidity is escalating; resulting in longer periods in which suffering needs alleviation. New diseases, such as dementia, are emerging; the relationships between those affected by progressive illness are changing. The urgent need for better care and treatment of physical symptoms, and of emotional, social, spiritual and quality of care concerns, to add quality to life, has never been greater. Especially as health and social systems struggle with constrained resources. Cicely Saunders International is continuing to campaign for changes that will address these concerns and funds research and education and policy changes that will make change happen.