problems like who will look after the children, or an elderly parent, and whether a spouse can cope on his or her own. A patient may grieve over the losses that he is undergoing, the loss of strength, the loss of appetite, maybe the loss of a limb, or a breast, or hair loss with chemotherapy, or just the drastic change in his whole body image with a serious illness. He mourns over the loss of his job, and of being a useful member contributing to society and to his family. He may be appalled to have to depend on others for such simple needs as eating, or going to the toilet, and the indignity of having to wear diapers.
There may also be spiritual fears, about what is going to happen to him after death. Would there be terrible punishment for all the bad deeds he has done in this life? Would he be re-incarnated into a much lower form of being? Will he be banished to hell - all the different kinds of hell according to the religious beliefs of the patient? Spiritual worries include the sense of self-worth, whether one is loved or valued by others, either by family members or by strangers; whether his life has been worthwhile, whether he has made a difference for having walked on this earth.
Hospice care tries to cater to all of these needs and yearnings of a human being. It does not try to solve all the problems, knowing that it would be impossible to do so, but it acknowledges that all of these needs exist and tries to provide companionship along the road for those who have to tread it.
The outworkings of the concept of hospice care differs with every team that provides hospice care. Each team has its strengths and its weaknesses, according to the make-up of the team members. Some may be excellent in symptom control, others with emotional support, still others with spiritual care. But common to the philosophy of all these teams, anywhere in the world, is the value we put on the person, every human being, be they patient or care-giver, family or palliative care team member. The philosophy affirms the value of each human being and each moment of their lives.
Development of in-patient palliative care
The UK leads the world in the development of palliative care services. In 1997, there are a total of 223 in-patient hospices, providing a total of 3,253 beds. St Christopher's Hospice is an exceptionally large in-patient hospice with 62 beds, and it has in addition a small number of elderly residents (currently 8) in an adjoining wing
