he Palliative community gets its fair share of bouquets and brickbats, and one frequent jibe is we cannot even decide what to call ourselves. Hospice or Palliative or both? What’s the difference? Naming practice varies from country to country (more about that later), and has been influenced by how palliative care developed, and linguistic and cultural mores.

International bodies like the APHN and WHPCA—the Asia Pacific Hospice Palliative Care Network and Worldwide Hospice Palliative Care Alliance—include both terms. In Singapore, the convention is that “hospice” refers to community-based organisations, and “palliative” to the specialty practice and hospital-based departments and services. We consider the approach to be similar and often use the term interchangeably, but that is not the case in many countries.

In the United States of America for example, “hospice” describes a specific model of care that is Medicare-funded, largely home-based, and requires a doctor to certify that a patient has 90 or fewer days to live. It also requires the cessation of disease-directed treatment, for example, no further chemotherapy for cancer. Therefore, the idea of a hospice in the USA is very much associated with end of life care, so much so that proponents of palliative care have taken pains to distinguish themselves from hospice care.

It gets even more confusing when one considers that different Chinese-speaking dominions have their own terms as shown in the box below.

China

姑息治疗

(this is the term adopted by
the World Health Organization)

Hong Kong

临终关怀

Taiwan

安宁照顾

Singapore

慈怀疗护

Some of these terms have unfortunate meanings, for example 姑息 suggests “withering”, or “do nothing”; and 临终 means “near the end”.

Of course, it will be clear by now that a lot of this is a reaction—and a very normal human one—to the association of words like “hospice” with illness, dying and death.

But first, a brief history lesson on the origins of the terms…

Hospice versus Palliative

The term Hospice derives from hospitium, and the same Latin root, hospes, gave rise to words like hospital, hotel, hostel and hospitality. The earliest hospitals in Middle Ages Europe were run by religious orders and offered refuge to travellers, some of whom were pilgrims who had travelled long distances under arduous conditions. The monks and nuns provided food and lodging, protection and whatever care they could, and this spirit of charitable whole-person care was a strong influence in the development of the hospice services in many countries, including Singapore.

Palliative derives from the terms pallium and palliare, meaning “to cloak”. To understand the origin of this term, we must go back 50 years to 1970’s Canada, where a urology cancer surgeon named Balfour Mount attended a discussion on Elizabeth Kubler-Ross’ seminal book “On Death and Dying”, and after visiting St Christopher’s Hospice in London, returned to the Royal Victoria Hospital in Montreal to set up the first palliative care ward.

He coined the term “palliative care” and is considered the father of the discipline in Canada. Why was a new term needed? This was because in Francophone regions, the term hospice was closely associated with charity poorhouses, where the destitute and indigent would go. It is somewhat ironical then, that over the decades, palliative care or soins palliatif has acquired some negative associations of its own.

A rose by any other name?

So what can we do about ‘branding’ hospice and palliative care so that it is more acceptable? One way is to call it something else. Studies across different countries have shown that patients find the term “supportive care” more acceptable, and an oft-quoted 2011 paper from MD Anderson Cancer Center described how changing the name of the service from Palliative to Supportive Care, resulted in an increase in referrals.