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BMJ. Sep 27, 2003; 327(7417): 753.
PMCID: PMC200824

Josefina Bautista Magno

Short abstract

A leader of the hospice movement in the United States and internationally

Josefina Bautista Magno broke ground in getting the medical profession to understand the need for pain relief and palliative care for terminally ill patients. She envisioned an environment where dying patients could get comfort, care, and spiritual counselling. Magno developed some of the first hospices in the United States. More recently, she developed programmes to spread hospice care internationally.internationally.

Figure 1

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Credit: IAHPC

Born and raised in the Philippines, she completed her medical training at the University of Santo Tomas, the Philippines, in 1943. She trained as a haematologist and oncologist at Georgetown University in Washington DC.

Magno was not a stranger to cancer, death, and dying, according to Bill Farr, vice chairman of the International Association for Hospice and Palliative Care (IAHPC). Her husband, a sister, and a son died from cancer. Magno also developed breast cancer, and underwent a radical mastectomy and chemotherapy. In a tribute to her on the IAHPC website (www.hospicecare.org), Farr writes that these experiences undoubtedly influenced her decision to promote hospice care. She went to study in the United Kingdom, where Cicely Saunders had pioneered the hospice movement, setting up the world's first hospice, St Christopher's in south east London, in 1967.

Magno's earliest efforts to promote hospice care were in the United States. In 1976 she convinced the president of Georgetown University to set up a pilot hospice-training project, known as the Hospice of Northern Virginia. Many more hospice demonstration projects were established, several through the Medicare programme.

Yet even as the hospice movement grew, Magno thought it lacked a scientific and research base. “Jo started the first organised group of hospice healthcare professionals in the United States, the American Academy of Hospice and Palliative Care,” said Eduardo Bruera, chairman of the International Association for Hospice and Palliative Care. Now, it is the main academic group interested in hospice and palliative care in the United States, said Professor Bruera. “She recognised the importance of disciplined professional work, research, education, quality control, and in a sense she was visionary in that respect,” he told the BMJ. Professor Bruera said that Magno's main contribution was to be able to work well in identifying people whom she could cajole into working in hospices.

By the 1970s in the United States, public demand for more compassionate ways of dying was strong. Debates over Medicare and Medicaid coverage for hospices flared in the US Congress. Data from the Hospice of Northern Virginia proved instrumental in letting government officials evaluate the merits and cost-effectiveness of hospices. After more than eight years of wrangling over reimbursement for hospice care, Congress finally made the Medicare Hospice Benefit permanent and left Medicaid benefits to the states. Magno also persuaded Blue Cross-Blue Shield, one of the leading medical insurers in the United States, to reimburse for hospice care.

Jay Mahoney, past executive director of the National Hospice Organization, a position that Magno held in 1980, told the BMJ that her contribution was broad. “She helped people throughout the country see the benefits of hospices and also was close to hospice people themselves and galvanised them into action.” In her many roles, she served as an inspiration to hospice founders and workers, said Mahoney.

Once she felt that the growth of hospices in the United States was assured, Magno turned her attention to poor countries that had no resources for hospice care. “She was a missionary in every sense of the word,” says Derek Doyle from Edinburgh on the IAHPC website. Dr Doyle, vice president of the National Council and Specialist Care Services and president emeritus of the International Association for Hospice and Palliative Care, worked with Magno on the global development of hospices. “She would enthuse about hospice care becoming available and accessible in every country of the world. That vision, fuelled by her drive and gritty determination, led to the International Hospice Institute, soon to metamorphose into the International Hospice Institute and College as the need for education and training became recognised, and finally into today's International Association for Hospice and Palliative Care.”

Dr Doyle says that Magno saw more than 8000 hospice and palliative services established in more than 100 countries.

Josefina Bautista Magno, palliative care physician (b San Fernando, Pampanga, Luzon, the Philippines, 1919; q University of Santo Tomas, the Philippines, 1943), died in Manila from heart failure on 27 July 2003.


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