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“I have met people in Japan, in New Zealand, in Australia, South Africa, Zimbabwe, Bermuda, all over the United States and all over Europe, who regard Cicely as their teacher, the person who originated all that they are doing”

Richard Lamerton, former Medical Director of St Joseph’s Hospice, London, p188, Cicely Saunders: The founder of the Modern Hospice Movement by Shirley du Boulay (originally published 1984, updated and revised in 2007 by Marianne Rankin)

The letters that Cicely received at reflected her reputation as the founder of the modern hospice movement and international expert for the terminally ill. She received a great number of letters from overseas, many of which were from medical professionals wanting to learn how to provide more effective pain management for their patients.

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In a series of letters written between 1980 and 1981, Dr D O’Connell, Mount Miriam Hospital Penang, Malaysia, requested Cicely’s help in lobbying the government for the use of diamorphine (heroin) within the hospital. The issue was both dangerous and politically contentious as the drug or “dadah” was banned by the Malaysian authorities, with a possible death penalty for those convicted of possession.

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The subsequent exchange provides an insight into Saunders’s determined advocacy of strong analgesics, in particular, diamorphine. However, it also reveals her pragmatism in seeking alternatives rather than fighting protracted political battles, for example noting the use of opium in the Indian hospice movement when they faced a similar prohibition.

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Dr O’Connell’s response not only reflected the legal obstacles encountered in providing palliative care, but also the significance of local cultures and customs. The hospital, founded by Franciscan nuns, was originally intended to be a home for the dying, but became instead a cancer treatment centre. This change was due to the enduring Chinese custom of dying in one’s own home and the belief that death elsewhere would result in the spirit of the deceased wandering the Earth.

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