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Until not so long ago, in this country and throughout the West, religious voices were deemed an essential element in the public square. Indeed, as difficult as it may be for those born after 1960 to believe, the opinions of people motivated by religious values were once at the forefront of public-policy formation. What "the churches" thought often made the difference between failure and success for those seeking to get a particular idea enacted into law.

Today, while most religious organizations still offer their opinions on a wide range of issues, they generally have limited impact. The primary reason for this is the widespread acceptance of the attitude succinctly summarized by the prominent philosopher Dan Brock in the Hastings Center Report: "In a pluralistic society like our own, with a strong commitment to freedom of religion, public policy should not be grounded in religious beliefs which many in that society reject."

At the very least this attitude is undemocratic, for it silences the many to protect the sensitivities of the few, transforming the public square into a virtual private enclave. As James W. Walters, professor of Ethical Studies at Loma Linda University, puts it, "Society's most fundamental moral views are rooted in religion .... Ninety percent of the population identifies with the Judeo-Christian tradition." More significantly, however, religious values have been an essential part of the motivation behind the most important social movements in our country's history: abolition, the civil rights movement, and the effort to end child labor, to mention just a few. To remove religious values from the recipe of public policy is akin to leaving most of the ingredients out of what should be a thick, hearty soup: Not only does it ruin the taste, but it strips the broth of much of its nutrition.

One case in point, in which an instance of religious belief influenced secular ethics and public policy in a way that few people could object to, is the development of the modern hospice movement. Hospice care is now recognized as valid by Medicare, Medicaid, and most health-insurance providers. It is a tale rarely told, but the hospice movement owes its existence to the deeply held religious values of its British founder, Dame Cicely Saunders.

Dame Cicely was a medical social worker in a London hospital in the years immediately following World War II. She was also a devout Anglican. In the course of her duties, Saunders met a Jewish emigre named David Tasma, who had escaped the Warsaw ghetto, only to lie dying at the age of 40 in a London hospital. Believing she had a religious duty to visit the sick and knowing that Tasma was alone in the world, Saunders made a special point to spend time with him every day. Their friendship changed our world.

Saunders was already well aware that a nearly universal problem in care for the dying was uneven pain control, causing much unnecessary misery. As she spoke with Tasma about his impending death, she had an epiphany. As she told me when I met her fifty years later, "I realized that we needed not only better pain control but better overall care. People needed the space to be themselves. I coined the term `total pain' from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated. I have been working on that ever since." (Tasma left Saunders L500 to begin her work, telling her, "I will be a window in your home." Saunders told me, her eyes filling with tears, "It took me 19 years to build the home around that window.")

Saunders's epiphany was not rational or secular, but spiritual. Her work was a "personal calling, underpinned by a powerful religious commitment," wrote David Clark, an English medical school professor of palliative care and Saunders's biographer, to whom she has entrusted the organization of her archives. So strong was Saunders's faith in what she perceived as her divine call that she began volunteering after work as a nurse at homes for the dying. Urged on by her experiences at these homes, she went to medical school -- this at the ripe old age of 33, and at a time when there were few women doctors.

After becoming a doctor, Saunders continued to focus on alleviating the pain of people who were dying. She obtained a fellowship for research in palliative care and began to work in a hospice run by nuns. Her first initiative was to put patients on a regular pain-control schedule, which, in her words, "was like waving a wand over the situation."

Before long she was impelled to found her own hospice, St. Christopher's; "I have thought for a number of years," she wrote to a correspondent at the time, "that God was calling me to try to found a home for patients dying of cancer." Clark has written that Saunders's certainty that "the St. Christopher's project [was] divinely guided and inspired" led her to become an activist, energetically raising money for the new project and, in the process, raising the consciousness of the medical establishment about end-of-life care. Saunders's initial idea was for St. Christopher's hospice to be a "sequestered religious community solely concerned with caring for the dying." But the idea soon expanded from a strictly religious vision into, in Clark's works, a "full-blown medical project acting in the world."

Saunders succeeded beyond even her own wildest hopes. Today, St. Christopher's is a four-story glass and brick structure located in a beautiful, tree-lined London suburb. There "the Dame," as the St. Christopher's staff affectionately calls her, continues to work energetically and devotedly. Although physically slowed by her 80-plus years and no longer actively practicing medicine-she turned that aspect of her work over to others several years ago-she meets daily with people from all over the world who make pilgrimages to St. Christopher's to learn how care for the dying can be improved and to be inspired by her indomitable spirit. Indeed, as I entered Dame Cicely's second-floor office, a large group of smiling Japanese physicians, reluctant to leave, were warmly repeating their appreciative goodbyes.

As the Japanese physicians left, Saunders, a dignified, gray-haired woman with a truly English face, turned her full attention upon me. As we were introduced by her assistant, the awe I felt at being in the presence of greatness must have shown, for Dame Cicely smiled broadly, her eyes twinkling, and began to put me at ease by asking me about myself and my work. As we talked, she moved with some difficulty back to her large desk covered with papers and books. Behind her was a large bookcase filled with books on death, dying, and palliative care. She is clearly as devoted to the dying today as she was when she almost singlehandedly started the hospice movement.

Finally Dame Cicely allowed the conversation to be directed toward herself and her work. "We opened our doors in 1967," she told me, "and we started in-home care in 1969. The majority of our work is out in the community. In 1971, we sent one of our team doctors to New Haven, Connecticut, to help found the first modernhospice in the United States." From there, the hospice movement gradually spread throughout our country.

As I spoke with Dame Cicely, I reflected upon the death of my father in 1984. Dad had been fighting colon cancer for about two years. Then one day he was sitting on his hospital bed contemplating a bile-drainage tube the doctors had inserted to prevent the tumor from blocking his bile duct. Dad looked at the drainage bag taped to his inner thigh. He sighed deeply, his shoulders sagged, and he looked up at me with an expression I had never seen before. Dad had made a momentous decision: His fight to stay alive was over.

As a society, we too often mistake dying for dead; we transform the end of life into a shameful thing, something to be hidden away in a dark corner. Mom and I were determined not to let that happen to Dad; just because he was no longer seeking to prolong his life, that did not mean his life was over. We shifted emphasis from cure to comfort, dignity, and peace. That meant hospice care, which at that time was still a relatively novel concept here in the United States.

Thanks to that decision, Dad's last several months were peacefully pain-free. He was richly nurtured by my mother and by dedicated hospice professionals. He would spend hours sitting on a bench in the back yard overlooking his beloved cactus garden, contemplating his life and the ultimate issues raised by human mortality. As an only child, I bore a heavy burden, caring not only for my father but also for my mother, who was devastated by her impending loss. The hospice professionals provided me with grief counseling-even before Dad died-an invaluable aid in helping me help him and Mom. Dad died in a Veterans' Hospital hospice unit in Los Angeles, and in his passing he taught me how to die with dignity, grace, and fortitude.

I also reflected upon Frank's death. Frank was my childhood best friend's father and my "second dad." He died in 1997, also of colon cancer. Unfortunately, unlike my father's doctor, Frank's doctor did not readily agree to hospice care, causing him much unnecessary suffering. But once admitted to a hospice program, Frank left behind the intense pain and suffering he had been enduring and entered a world of peace.

"Hospice was so wonderful," his wife, Jean, recalls. "I will never forget the depth of care showed by the doctor and the nurses, particularly Jill, who came every day to visit. They showed Frank such tremendous compassion. It is hard to believe that there are people in the world who are so deep-down compassionate to strangers. But there are. They are sincere and wonderful about it." Frank's last words to me were spoken quietly and with great dignity just three days before his passing: "I am ready to die."

None of this would have happened without the religious values which entered the secular milieu of medicine through Dame Cicely Saunders: specifically, the belief that no matter what our state of health, no matter what our age, no matter how much help we need, no matter how we look or smell-- our lives are sanctified; we are all worthy of compassion and care. I noted to Saunders the direct line of succor and love that led from David Tasma in 1948, to my father in 1984, to Frank in 1997, to the millions of others who have benefited from hospice care since 1967. She smiled and agreed.

This is not theocracy. This is not dividing a pluralistic society by imposing religion on an unwilling public. There is nothing narrow or sectarian about Dame Cicely's recognition that being classified as "terminal" does not cancel a person's claim on us. A secularism that is not enriched by values such as these will be stunted and incapable of fully reflecting the potential of the human condition.

Wesley J. Smith is the author of Culture of Death: The Assault on Medical Ethics in America (Encounter Books), in which some of this material originally appeared.

Copyright Human Life Foundation, Incorporated Fall 2001
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