Dame Cicely Saunders earned worldwide admiration and gratitude for her pioneering work on the care of the dying, which resulted in the foundation of the hospice movement and the specialty of palliative medicine. In an area of care that often emphasises the importance of the multiprofessional team, Dame Cicely was a multiprofessional team in one person. In response to the outbreak of the second world war she moved from reading PPE at Oxford to train as a nurse at St Thomas's Hospital in London. Back trouble forced her out of nursing to train as an almoner (the equivalent of today's social worker). It was while working in this capacity that she met a young Polish refugee, David Tasma, who was dying of cancer in a London hospital, far from home and family. It was through their conversations together that the idea of a hospice was born, and Tasma left money in his will towards the building of such a place.

Now with a firm ambition to improve the care of the dying, she was advised to read medicine "because it is doctors who desert the dying". Dame Cicely Saunders qualified as a doctor in 1957 at the age of 39. She obtained a research fellowship in the study of pain and elected to pursue it at St Joseph's Hospice in Hackney. At that time St Joseph's had no doctor on its staff and Dame Cicely's demonstration of the pain control that could be achieved by the regular giving of oral morphine (a practice she had come across in the pre-war writings of Dr Barratt at St Luke's Hospital, Bayswater) was a revelation. She also tape-recorded her conversations with hundreds of patients at the end of their lives, laying the foundation for her concept of 'total pain' - the recognition that pain and other symptoms are not simply a reflection of physical disorder, but are also shaped by the sufferer's prevailing emotional, social and spiritual experiences.

However, the full expression of her ideas required the foundation of her own organization. After nearly 20 years of planning and fundraising, St Christopher's was opened in 1967 in south east London as the first care, research and teaching hospice. Shortly after the in-patient unit was opened, she set up the UK's first specialist team to provide hospice care at home. In the years that followed, St Christopher's hosted foundational research in symptom control and bereavement care and became a model that attracted increasing numbers of observers from many countries. Dame Cicely Saunders' work, and that of the colleagues she gathered around her, led directly to the founding of many other hospices, both at home and abroad, resulting ultimately in the 8,000 services spread across over 90 countries that exist today.

With the lessening of her clinical involvement, Dame Cicely made the transition from medical director of St Christopher's to its chairman and, from 2000 until her death, founder president. As the select list at the head of this entry shows, she was extensively honoured, both nationally and internationally. To the end of her life her advice continued to be sought by individuals at home and internationally who were inspired by her example and teaching to improve end of life care in their locality. It was her conviction that palliative care, as hospice care came to be known more generally, should be built on a sound academic footing and should become an integral part of healthcare systems. Towards the end of her life she was involved with the Cicely Saunders Foundation, based at King's College, London, which aims to further international research in palliative care. She was keen to see the NHS take on palliative care, but at the time of her death nearly 80 per cent of specialist palliative care beds in the UK were still provided by hospice charities.

A fundamental motivating factor in her commitment to the dying was her strong Christian faith and this remained the underpinning of her life. She was an avid reader of books on theology and spirituality, but she was always clear that the hospice she had set up was for people of all faiths or of none. The spiritual needs of people were not necessarily to be defined by religion.

Dame Cicely was a longstanding opponent of the legalization of euthanasia. In 1961 the then chairman of the Voluntary Euthanasia Society told her on a visit to St Joseph's Hospice: "I feel there would be little or no problem of euthanasia if all the terminally ill could end their lives in the atmosphere you have done so much to create." As palliative care spread, the grounds for introducing euthanasia moved away from suffering towards the rights of autonomous individuals. Courteously and persistently she continued to point out the threat that euthanasia would pose to the vulnerable majority in the interests of a small but determined minority.

In 1980 she married Marian Bohusz-Szyszko, a Polish artist and mathematician whom she had known for many years since she was inspired to buy one of his paintings for the new hospice. He subsequently became 'artist in residence' to St Christopher's and kept a studio there. The relationship was a happy and devoted one until Marian's death in 1995, at the age of 93.

To the end of her life Dame Cicely retained a clarity of mind and an interest in others that captivated visitors, whom she continued to see until two days before her death. She had a presence that could be intimidating, but beyond this was an ability to communicate a deep concern not only for those who are dying but also for their families and others close to them. A gifted teller of stories, her facility with words, together with the profound humanity that lay behind them, provided a lasting inspiration to audiences all over the world.

Dame Cicely never relinquished her connection with St Christopher's and it was there, in the hospice she had founded, that she died from metastatic breast cancer.

Nigel Sykes

[Brit.med.J.,2005,331,238; The Times 15 July 2005; The Independent 15 July 2005; The Daily Telegraph 15 July 2005; The Guardian 16 July 2005; The Lancet 2005,366,628]