The advent of the hospice movement and the growth of palliative care have played a major part in changing the disablist situation where having a life-threatening illness5 and becoming terminally ill were accepted as necessarily accompanied by a decline in the quality of life. The evolution of palliative care has made more effective pain relief available (Working Party on Clinical Guidelines in Palliative Care (WPCGPC) 1998) and stimulated the development of better relief of other distressing symptoms such as unremitting nausea, vomiting and muscle spasms (Williams and Corcoran 1996). The influence of the ‘hospice model’ has also produced improved responses to the psychosocial requirements of people living with life-threatening illness. For example, the generalised conspiracy of silence in the health care system which condemned people who were dying to be unapprised of the fact of their own imminent death – leaving them powerless to take informed decisions about the remainder of their life – has largely been breached (Scale 1989; Sheldon 1997). Recognition that people with life-threatening illness and those close to them may be grappling with ‘total pain’ (‘a complex of physical, emotional, social and spiritual elements’, Saunders 1996: 1600) has informed the development of palliative care, moving it beyond a narrow ‘medical model’.