This series entitled History and Origins of Palliative Medicine attempts to revisit foundational texts and figures in the discipline, critiquing their ideas in the context of contemporary institutional practices and the author’s ideological leanings in order to identify what was anticipated, what has been achieved, and what continues to remain unfinished.

In his essay entitled The Joy of Death, published in the Lancet in 1997, Twycross acknowledges a paradox in describing palliative care: the presence of life and joy in the midst of death and distress. He talks about expressions of respect for the patient which take the form of ordinary activities such as skilled nursing care, good symptom management and sensitive psychological support. He uses the term “human compassion in action” to describe the activities that comprise palliation. He describes the House of Hospice model with its foundation stone of acceptance (non-abandonment) and affirmation (recognition of dignity in dying). He goes on to describe hope, openness, and honesty as the cement that binds it all together.

The latter part of the essay focuses on the importance of openness and honesty vis-à-vis prognostic disclosure and the assertion that lying and evasion (provision of false hope) isolate the patient and prevent them from sharing their anxieties and, quite possibly, obtaining a sense of closure. In his view, Creative arts are expected to play a central role in giving shape to the idea of finding meaning in suffering. He describes these activities as ones that facilitate crossing from the surface to deeper levels of experience, perhaps signifying improved comprehension and also perhaps insight into their condition. This development of newfound insight enables the patient to contemplate how a certain event maps to the trajectory of their illness. He warns that acceptance by the establishment might stifle the very personality of palliative care and cautions against entanglement with bureaucratic narratives, perhaps rightfully recognizing their ability to interfere with patient care.

Editor’s take
This essay provides important insights into the challenges facing the integration of palliative care into the modern hospital setting. There might be a growing realisation that specialist palliative care has been unable to create a favourable environment for its sustenance and propagation outside the purely academic narrative. While provision of training can be used to justify the existence of a speciality to a certain extent, it might not be able to meet standardised outcomes (as might be expected from a sub-speciality). The integration of processes, and formulation of pathways, howsoever challenging (given the emphasis on favorable economic outcomes) might be the fuel that is required to ignite various thought-engines for further development and self-sustenance. For this engagement with a mostly hostile bureaucratic narrative and nuanced understanding of country-specific legal and administrative processes might prove to be crucial.
There might be a need to provide much more than a mere hint of medicine to the foundational idea of these everyday processes that he refers to (such as symptom management and psychological support), which form the very basis of specialist palliation, in order for them to resonate with the educated patient and their equally well-informed families.

With reference to the role that art as therapy might play, my own observations about its place in training might provide some meaningful insight (for enthusiasts). While surrounded by patients with advanced illness, and families overwhelmed by sadness, I took recourse to socializing and visiting the most relevant places around me, as a means of achieving a sense of catharsis. These were cultural landmarks of mammoth significance, which left a palpable impression, and when the time came to justify my applications to an organization whose handling of the discipline I had had big differences in the past, my retort was steadfast and constant. I wish to work there because of the kind of life that the place offers. Looking back at the impact that cities have had on famous auteurs and their work, that idealistic answer seems to make some sense.

Even closer to home, my own writing has been heavily influenced by art. In fact, my recent satirical take on systemic critique (E2) shares its name with a movie directed by the late Rob Reiner, whose life was lost to a mindless act of unprovoked violence. The tone borrows from Emma Thompson’s speech after winning the best adapted screenplay award for Sense and Sensibility at the Golden Globes, oops, Golden Globes.

So in effect, myriad influences from art have been able to percolate into my writing to a greater extent than I might be willing to acknowledge (a nod to Twycross’s prophecy here!!).
Art has been able to corrupt my mind and convolute the temperament expected of me. Paraphrasing the devil who still wears Prada, once again. That’s all.

*The original title – A prophetic visit to the “House of Hospice” with Sir R Dot Twycross, the disgruntled ghost of Reiner, spirits of Thompkinson and Priestley has been foreshortened owing to creeping editorial compulsions (which seem to be catching up on me).

References
Twycross R. (1997). Palliative care. The joy of death. Lancet (London, England), 350 Suppl 3, SIII20. https://doi.org/10.1016/s0140-6736(97)90053-2

Dalton, A., & Weber, C. (2025, December 16). Prosecutors charge Rob Reiner’s son Nick with 2 counts of murder in the killing of his parents. Associated Press.

Cooney, J. (2022, December 14). 1996: Emma Thompson channels Jane Austen. Golden Globes.
https://goldenglobes.com/articles/1996-emma-thompson-channels-jane-austen/

Frankel, D. (Director). (2006). The Devil Wears Prada [Film]. 20th Century Fox.

Disclaimer
Artificial intelligence tools, primarily Claude (Anthropic), have been employed for language refinement. They do not replace critical scholarship, clinical experience, or editorial judgment. Final responsibility for all interpretations, factual accuracy, originality of synthesis, and the quality of the published material rests entirely with the Founder and Editor.

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