Whole person care: the legacy of Balfour Mount

The term “palliative care” was first coined by Canadian physician, Balfour Mount in the mid-1970’s. Inspired by the work of Dame Cicely Saunders in the UK, Mount set up the hospital-based palliative care unit at Royal Victoria Hospital in Montreal. Prior to opening the ward, he found the treatments for terminally ill patients abysmally inadequate. He set out to change that and was awarded the Order of Canada for his efforts.

There have been a plethora of articles written about palliative or hospice care recently, usually linked to the rising cost of health care and the aging global population. While Balfour found hospital-based palliative care more affordable than home-care in 1975, the tables may now have turned. What hasn’t changed however, is the perception that palliative care is given at the end of life, when all medical interventions have failed. A recent New York Times and New Yorker article suggest that this accepted assumption is misplaced.

My understanding of palliative care has always been to ease the suffering of those with terminal illness, but a recent study published by the The New England Journal of Medicine has found it can also extend the life expectancy of those that receive it at the time of diagnosis. The New York Times covered these findings last week. In addition to life extension, a 2008 Coping with Cancer project in the United States found that the quality of life for those that receive palliative care is significantly higher than those that continue to receive medically invasive treatment only.

In Atul Gawande’s New Yorker article, “Letting Go” he writes that patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. “Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives. Hospice has tried to offer a new ideal for how we die. Although not everyone has embraced its rituals, those who have are helping to negotiate an ars moriendi for our age. But doing so represents a struggle—not only against suffering but also against the seemingly unstoppable momentum of medical treatment.”

Looking for solutions to health care funding must happen, but we should never lose sight of the fact that the recipients of care are our loved ones, and inevitably ourselves. We can take heart in the centuries-long development of the hospice and palliative care movements, and embrace the knowledge that providing quality of life is not at odds with extending it.

I’m looking forward to the 2010 Business of Aging Summit in December, hosted at the MaRS Discovery District and co-presented by SiG@MaRS. Attendees will be looking at aging challenges through the lens of the non-profit sector, and how this sector can champion ideas for change. Stay tuned for more on this topic as the Summit draws near.

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Geraldine Cahill About Geraldine Cahill

Manager, Programs and Partnerships, SiG National


  1. The Canadian Virtual Hospice would certainly qualify as a social innovation – being the first website in Canada to connect patients, families and helath care providers directly with pallaitive care specialists online. The site also hosts three 7 minute videos featuring Dr. Balfour Mount speaking about palliative care and his experience facing his own life-limiting illness.

  2. Geraldine Cahill Geraldine Cahill says

    Thanks so much Shelly. I’ll certainly look at the site and will notify colleagues who are developing the Business of Aging Summit. It sounds like a terrific resource.

  3. That’s great Geraldine. Thanks! FYI – we recently won a silver medal at the Health and Science Communication Association Media Festival in Boston and the Cdn Association of Health Libraries ranked us as one of the best health websites in Canada. The information and services on the site are just as relevant for someone with an elderly family member as for those with life-threatening illnesses.

  4. Great, I never knew this, thanks.

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