Global perspectives on palliative care.

The modern hospice movement had its formal beginnings in the United Kingdom with the 1967 opening of the St. Christopher's Hospice in London by Dame Cicely Saunders. Global uptake of the hospice principles and, more recently, palliative care, is widespread. However, the movement has shifted from charismatic, charity-based, and independent hospices to routinized and increasingly bureaucratized palliative care. Global differences exist around the degree to which hospice and palliative care are established components of the health care system. Access appears to increase with the integration of services into mainstream health funding. The downside of this is increased regulation, competition, and a potential loss of specificity for those who are dying. This article explores the changing face of palliative care, with particular emphasis on palliative care delivery in the developing world. These issues for developing countries include access to services, access to morphine, and professional access to information and education.