Dr. Saul Ebema

Note: In 1986, Rev. Edward F. Dobihal, Jr. and his wife Shirley Dobihal were recognized by the National Hospice Organization (NHO) with the Founder’s Award for his significant role in the founding of the first hospice in the United States.

Born in June 1927 in Baltimore, The Rev. Dr. Edward F. Dobihal Jr. grew to become one of the pioneers of the hospice movement in the United States.

During Dobihal’s childhood, the American healthcare system that he would later be part of to reform, was being hit hard by the great depression. Patients and philanthropic organizations could no longer afford to make donations to voluntary hospitals and those hospitals struggled to stay afloat. John Gabriel states that, “Approximately 20,000 beds and 418 hospitals were withdrawn from use during that time, and private institutions were forced to take on some of the burden to care for sick patients.”[1]

This difficult period led to a social consciousness that called for action to help improve the care for people with tuberculosis, cancer, and those with terminally illness.

In an article that appeared in Hospitals: A Magazine for the Hospitals of the United States and Canada in 1936, the system for care of the terminally ill was described as being in the “almshouse stage,” and was categorized as inadequate or nonexistent care.[2] With the exception of the government creating the National Cancer Institute in 1937, little progress was made in caring for the terminally ill until after the great depression ended in 1942.

When Rev. Dobihal was in his teen years in the early 1940s, there was a lot of scientific discovery and a growing faith in medical authority. That faith in medicine was even strengthened by the development of injectable penicillin in 1941 and streptomycin in 1945. These new developments showed promise in medical progress and the treatment of dangerous diseases.

“The advancement of these drugs excited the public and upheld the authority of medical science, which was able to boast of rapidly diminishing rates of infectious and parasitic diseases, with 1950 death rates from these conditions falling to 1/3 of what they had been a decade earlier.”[3]

These medical advancements also led to the development of more anti-tuberculosis therapies that enabled the disease to be controlled. Not long after that, sanatoriums for tuberculosis patients were no longer necessary.

In 1946, the Hill-Burton Act was passed and with it the campaign to build more hospitals. About one third of hospitals in the united states were build around that time by the Hill Burton Act. Soon, hospital care for the sick became the norm instead of home care. This led to a new turn of events because more people started dying in the hospitals instead of at home. While the establishment of many large hospitals by 1950 was a big accomplishment for the country, for the dying, it resulted in a difficult and painful journey.

Where once families gathered around the deathbed at home, dying patients now found themselves alone in ICUs tethered to machines. The denial of mortality also reinforced the most gruesome features of death and dying. Unable to face their own anxieties, doctors prolonged life long after the hope of recovery had ended and failed to communicate honestly with the dying. Families hid behind falsely cheerful demeanors or withdrew entirely, thus heightening patient’s sense of isolation. In addition, ICUs regulations at the time severely restricted the presence of relatives who wished to keep deathbed vigils.

Although there was plenty of space for the dying in those hospitals, the hospital administrators did not demand the delivery of adequate care for the dying. Within the medical staff, there was this attitude that death signaled a physician’s failure. This led to terminally ill patients being largely ignored by the medical staff.

Around that time in 1950, The Rev. Dr. Edward F. Dobihal who would champion the cause of the dying was sensing a call to ministry. The following year, he began his pastoral service in the Baltimore Conference of the United Methodist Church. There, he was ordained as a deacon and probationary member.[4] Soon, he applied to study for his Master of Divinity degree. In addition to his divinity degree, Dobihal trained as a therapist and in hospital chaplaincy. He wanted to provide spiritual guidance and help to patients, their families, and the hospital staff.[5]

He began his first ministry as a chaplain in 1955 at St. Elizabeth Hospital in Washington, D.C. Around that time, the topic of death and dying had taken on a new relevance to the society. This was probably because of the 50,000,000 people who had died during the second world war.[6]

In the late 1950s, articles in both national and state medical journals began to urge physicians to restore dignity to the dying. A major way was to focus less on prolonging life and more on improving its quality.

In 1959, McGraw-Hill released the book, The Meaning of Death, which later went on to receive international acclaim and became a big inspiration for the modern hospice movement. The Meaning of Death finally called attention to the problem that had plagued the medical profession for over half a century, and demonstrated that, by the second half of the twentieth century, at least some medical professionals had come to acknowledge the denial of death as a detriment to quality care and many agreed that U.S. physicians rarely devoted full attention to care of the terminally ill.[7] They often turned away from their patients after realizing that they could not cure them. Patients felt isolated, abandoned by their doctors, and able to see family only during rigidly enforced visiting hours.

The 1960s in the United States is well-recognized as the era of civil rights. The climate was ripe for assessing the boundaries around human rights. According to Mauss (1975), the social justice atmosphere that existed during the 1960s resulted in more social movements than any other time in the history of the United States.[8]

There was the civil rights movement, the women’s movement, the movement against the Vietnam war and gay rights movement. The patient rights movement that led to the emergence of hospice was among these collective activities, and its cause to ameliorate the plight of the dying was consistent with increased efforts to improve conditions for all members of society.

The assassination of John F. Kennedy in 1963 propelled the topic of death, dying, and grief to the national spotlight. This created great public and scientific interest in death, dying and grief. The Vietnam war, known as the living room war for being the first to enter people’s homes daily on television, also brought death to the public’s attention.[9] Popular interest in death, dying and grief was a necessary condition for the emergence of the hospice movement. That was when Rev. Dobihal was introduced to the hospice movement that he would champion here in the United States. It was a time of protest and change.

It was also a time of personal change for Rev. Dobihal as he was offered a new position to work as the first fulltime chaplain at Yale-New Haven Hospital by Dr. Albert Snoke who was the president of the hospital then. The mandate given to him by Dr. Snoke was to make the hospital more humane. He took that mandate seriously and began to advocate for quality care and patient rights.

Prior to patient-rights discussions, cancer care in the hospital involved secrecy, with cancer diagnoses often being kept from patients. Patients were commonly placated and told something akin to, “We had to remove a breast because we found a few bad cells, but this doesn’t mean you have cancer.”[10]

Curative treatment was then pursued at all costs, even if the patient’s condition was worsening. Dying pain-free and with dignity was never an option in the early 1960s. Seeing this happen in the hospital was tough for Rev. Dobihal and he wanted to find ways to honor the rights and dignity of these patients.

An awaking to the total suffering of dying patients and their families was not only taking place in Rev. Dobihal’s heart, but it was also taking place in the United Kingdom under the leadership of Cicely Saunders. “She was a nurse, a social worker, and a physician who studied pain relief in all its manifestations and created a hospice setting where physical comfort, respect, and spiritual and psychological support were there for those who were facing death.”[11]

In 1963, as plans for St. Christopher’s Hospice in the UK were advancing, Cicely came to the United States in search of others with similar interests in palliative and hospice care.

She was invited by a Yale urologist Bernard Lytton to speak to medical students about her ideas.

Photographer and hospital historian Grace Goldin, after attending Cicely Saunders’ first lecture at Yale in 1963, wrote a powerful account to a friend in which she divulged that the talk was “the first time [she] heard anybody in the medical field describe what pain contributes to human life (both to the afflicted and to those who serve them, and simultaneously of death as the dignified culmination of mortality).

When the lights were dimmed for Cicely to show and comment on the slides, at least in my row there were several faces with tears. Cicely’s matter-of-fact tone of voice gave her message an eloquence no public relations rhetoric could equal.” Continuing, Goldin excitedly mentioned that she was surprised to see a number of doctors who were not only present, but who seemed to be emotionally affected by the presentation.[12]

Another person in attendance was Virginia Henderson who had read Cicely’s first publication. After the event, Virginia told Florence Wald of the standing ovation Cicely had received from the students and doctors and described what she had heard as “the essence of nursing.”^[13]

Florence then invited Dr. Saunders to speak at the School of Nursing. Dr. Saunder’s presentation touched Florence deeply and she described that moment as a “professional epiphany.”

Florence was particularly moved by Cicely’s grasp of what was in the patient’s heart and mind. “It was the epitome of nursing,” Florence said. Cicely articulated in one lecture what Florence had been seeking for her entire career. She walked away from the discussion knowing that hospice care was here to stay.

Not long after that, Florence Wald invited two pediatricians and Rev. Edward Dobihal to join her and explore ways to start a hospice program in New Haven. That meeting triggered the start of the hospice movement in the United States.

After St. Christopher’s hospice was opened in England in 1967, Dobihal and his wife Shirley went to England for seven months to get to know Saunders and see the hospice process at first hand.

When Rev. Edward Dobihal was getting ready to return to the United States, a hospice patient at St. Christopher’s hospice gave him this mandate; “ “Go back to America and provide places like this, where I have found a place to belong, if you don’t have them there.”[14]

He returned with a wind in his sails!

Sources

---

[1]The New York Conference of United Methodists Church website.

[2] Making an Impact: Supporting the mission of Yale New Haven Hospital, Summer 2009

[3] William M. Lamers Jr., “Classics Revisited: Herman Feifel, The Meaning of Death,” Mortality 17, no. 1 (2012): 64.

[4] McCarley, “Psychological Aspects of Pain in Patients with Terminal Cancer,” 16.

[5] Beth Houser and Kathy Player, “Pivotal Moments in Nursing: Leaders who Changed the Path of a Profession.”2017

[6] Beth Houser and Kathy Player, “Pivotal Moments in Nursing: Leaders who Changed the Path of a Profession.”2017

[7] Sarah Pajka,“Doctors, Death, and Denial: The Origins of Hospice Care in 20th Century America.” 2017

(8) Cathy Siebold,”The Hospice Movement: Easing Death’s Pains.”(Twayne Publishers- New York, 1992)

(8) Cathy Siebold,”The Hospice Movement: Easing Death’s Pains.”(Twayne Publishers- New York, 1992)

[10] Beth Houser and Kathy Player,  “Pivotal Moments in Nursing: Leaders who Changed the Path of a Profession.”2017

[11] Death with dignity hearings before the special committee on aging United States Senate, 1972

[12] Robert D. Grove and Alice M. Hetzel, “Vital Statistics Rates in the United States: 1940-1960.” U.S. Department of Health, Education, and Welfare, (Public Health Service Publication No. 1677, Washington D.C., 1968): 580-590.

[13] John Gabriel. “The Hospital and the Changing Social Order,” 17.

[14] Ernst P. Boas, “A Community Program for the Care of the Chronic Sick,” Hospitals: A Magazine for the Hospitals of the United States and Canada February (1936): 18-19.

Note: This research piece is part of Dr. Saul Ebema’s research on; “The Hospice Legacy of The Rev. Dr. Edward F. Dobihal, Jr: An Intersection Between Spirituality, Healthcare and Social Justice.”