ABSTRACT
In Australia, as in most other places, palli at ive care had its origins in the grass roots com mun ity hospice movement. This movement took shape and gathered momentum as local com munit ies in various parts of the world responded to the demonstration pro ject Cicely Saunders set up at St Christopher’s Hospice in London in 1967. The St Christopher’s hospice philo sophy asserted that it is pos sible to pursue health even in the final days of life: the ex peri ence of dying was seen as giving dying people an oppor tun ity to ‘make their journey toward their ultimate goals’ (Saunders 1996, p. 319). For hospice practitioners symptom control was a means to a wider end: phys ical comfort should allow dying people and their fam il ies to attend to relationships, life review, and spiritual nurture. Throughout the 1970s in the UK and the USA, and the 1980s in Australia, com mun ity networks estab lished and promoted hospice care as a preferred al tern ative to death in the hos pital. By the 1990s, how ever, the momentum was dissipating, funding pressures were growing, and the community based hospice programs began to seek a place within mainstream funded health systems. In Australia at least mainstreaming shifted the holistic hospice approach towards clinical care, a more orless inev it able con sequence of participating in the funding and account ability structures of the health ser vices. Mainstreaming also weakened hospices’ alignment with their local com munit ies by amalgamating local hospice groups to increase the catchment areas of the resultant new palli at ive care ser vices (Rumbold 1998). Certainly mainstreaming resulted in sustain ability and improved access to palli at ive care; but it has also tended to emphasise clinical care, placing allied health in a support role.
