CAN THE HOSPICE MOVEMENT take hold in America? The question is being asked by what appears to be a growing number of citizens, including many who read the recent article by Victor and Rosemary Zorza in The Post's Outlook section on the care given their dying daughter in a British hospice. Few families are without memories of relatives whose deaths were marked by unnecessary suffering or by the bleak isolation that characterizes so many hospitals and nursing homes. These institutions are less often places of willful neglect than reflections of our tendency to deny death and to push the dying from our consciousness. A hospice - from the medieval term meaning "way station" and from the custom of religious orders in the Middle Ages of providing shelter and care to the dying - offers a positive alternative to the anguish of impersonal and excruciatingly painful dying.
The hospice movement in America is new. A national association in New Haven, Conn., is providing ideas and guidance to some 100 local hospice groups around the country that want to respond to the need. The Washington Hospice Society, established last year with offices at 1511 K St. NW, is part of the network. In addition, the Zorzas are forming Hospice Action Committee to deal with questions about them and how to start them.
In an interview in The Christian Century, Edward Dobihal, a chaplain at the Yale-New Haven Hospital and chairman of the baord of directors of a hospice now under construction in Branford, Conn., said that "the hospice is first of all a program and a team of persons: physicians, nurses, social workers and clergy . . . . The important thing is to create an environment in which terminally ill people can spend their last days and hours in a painless, meaningful, pleasant way - with dignity and as much joy as possible . . . The hospice is a ministry and not merely another institution." The goal is to understand " that the dying can be made comfortable by palliative treatment in many instances, and that they can be loved in a way that can enrich the end of their lives."
Much of what we know about the methods and the philosophy of ministry needed to operate a successful hospice comes from the British model, as developed in the past 10 years by Dr. Cecily Saunders, who founded the internationally respected St. Christopher's Hospice in London. But an exact duplication of that particular operation probably is not practical. Instead, the goal should be for the medical community, volunteer groups, religious organizations, social workers, families and government agencies to work together to provide a missing service in the American context.
To pull together these forces will require some extraordinary doing, not to mention a willingness by some of them to change some attitudes. In recent testimony at hearings on national health insurance, Canon Michael P. Hamilton of the Washington National Cathedral noted that although hospices might benefit from close contact with a hospital, "not all doctors, nurses and social workers have the necessary vocation and talent to be as good in looking after the dying as hospice standards require."
Other issues also need to be explored: the availability of heroin as a painkiller; the acceptance of a hospice facility by neightborhood residents; the willingness of the family of a terminally ill person to alter their daily routines to let him spend his last days at home, if that seems right; the improvement by seminaries of the study of death and dying in order to train priests, ministers and rabbis in the art of counseling the dying and the bereaved; and the role that should be played - if any - by the federal government. On this last point, it is worth noting that at ground-breaking ceremonies for the Branford hospice, Dr. Michael McGinnis, deputy assistant secretary for health at the Department of Health, Education and Welfare, noted that "the event today is of national significance. We at HEW expect to learn a great deal from it about how special provision for the needs of the terminally ill and their families can fill the gaps in the federal health-care-delivery system."
The importance of the present moment is that by whatever name - a groundswell, a rising tide, a surge of interest - more than a few communities are ready to act. In Washington, a recent $15,000 grant from the American Cancer Society has enabled the Washington Hsopice Society to begin making the effort to learn what services areneeded, how and where to provide them, and who should be involved. That group is still in the stage of asking questions. But that is progress, however modest. Only a short time ago, the questions weren't even being asked.