The hospice movement in Austria is a fairly recent phenomenon. It was only in the middle of the seventies that a first group of Austrian nurses who were committed to the concept went to England in order to learn more about it from the founder of the hospice movement, Dame Cicely Saunders (a physician and nurse who had created the first hospice in London).

Subsequently, the German Association for Final Care and Bereavement Support (IGSL - Internationale Gesellschaft für Sterbebegleitung und Lebensbeistand) established a subsidiary in Vienna/Austria that organized discussion groups and workshops and promoted the idea of a "living will".

The hospice idea was also taken up by SECO, an initiative of the Evangelical Church, and by other institutions which, in 1993, jointly created the umbrella organization "MENSCHENWÜRDE BIS ZULETZT" (Death with Dignity). This association was later renamed HOSPIZ ÖSTERRREICH (Hospice Austria) and can be considered as the nucleus of the first nation-wide activity in this field.

In the following years, with the help of public relations specialists and politicians, the hospice idea was widely publicized. This often gave rise to negative reactions, especially within the medical community, where quite a few doctors clearly spoke up against the idea of "death wards" and "euthanasia".

Today, in 2001, there are 6 hospices in Austria, one mobile hospice team (in Vienna) as well as nearly 50 micro-initiatives in all of Austria's 9 provinces.

Austria's first permanent hospice was founded in 1995 ("Hospiz St. Raphael" in Vienna). Six months later, another hospice was opened in the framework of a geriatric facility ("Geriatriezentrum Wienerwald - GZW"), initially seen as a pilot project for two years. It was, however, decided that this hospice should continue to operate, and with its 19 beds it is still Austria's biggest, the other hospices offering only 9 to 12 beds (except the mobile hospice that cares for many more patients, but with the help of "flying" care teams using a whole fleet of vehicles). The third hospice created in Austria was the "Hospiz-Station der Caritas Socialis" (Vienna, Rennweg).

A specific feature of the Austrian Hospice Movement is to be seen in the fact that it is deeply rooted in the churches. All the hospices are indeed managed and financed by religious communities, with the exception of the "GZW", that is owned by the City of Vienna. This is also true for the 3 others that are already operating (one in the province of Tyrol and two in Upper Austria) as well as for those that will open soon.

Equally typical is their integration in Austria's existing hospital structures. The "classic" hospice model is geared to maximize nursing care, if necessary at the expense of sophisticated or high-tech medical interventions. It encompasses also care by volunteers (relatives, friends, or other helpers with a purely idealistic motivation) who are considered to be major pillars of the hospice movement. In the context of support for the terminally ill, sophisticated medical care is needed, mainly in the form of palliative treatment. This is a specialty for which two advanced training courses are available in Austria since 1999.

It must be noted, however, that in Austria's Medical Schools there is still no chair in palliative medicine. This deplorable state of affairs is due to be changed soon.

The fact that nearly all of Austria's hospices are integrated in the ordinary hospital environment has brought about a medicalization of terminal care that goes against a tradition still very much alive in the English-speaking countries, namely the idea that the dying should be taken care of by the community and in the midst of their loved ones. This raises the question of whether this kind of institutionalization is consistent with the true roots of the hospice movement.

A third typical feature of the Austrian Hospice Movement is to be seen in its financing. There is only one hospice - St. Raphael in Vienna - that does not charge fees. This has been made possible by a special arrangement with the Statutory Health Insurance Scheme. All other hospices are considered nursing homes for which the patients have to pay fees - often very high ones. It is true that public welfare institutions will step in if a terminally ill patient is completely impecunious, but in the first place the institution will try to reimburse itself by drawing on the persons assets (real estate, bank deposits, etc.) and by charging the fees to the relatives. Although most of the dying will not stay very long in those institutions, this can become a very heavy financial burden and is considered as an unfair treatment. This is why HOSPIZ ÖSTERREICH has started negotiations with the aim of obtaining relief in cases of hardship.

Today euthanasia is a very topical subject in Austria. The hospices themselves are unanimous in rejecting this idea because they are convinced that, in most of the cases where it is declared that the suffering of a terminally ill patient must be shortened, one has, in fact, not fully utilized the modern methods of pain control.

One has to admit, however, that when it comes to pain management many doctors are not fully aware of the new methods at their disposal. But this evident knowledge gap cannot be taken as an excuse for solving the problem by taking the patient's life. The full range of palliative measures must always be applied first. Experience has shown that patients, who at the end of their life have asked to be "released once for all from their pain", have nearly always changed their mind after receiving palliative care and psychological support.

The Austrian hospice movement has therefore come to the following conclusion: If you are against euthanasia, you must be for hospice care!