Dr. Josefina B. Magno, 83; Pioneer of Hospice Care for Dying Patients in the U.S.

Dr. Josefina B. Magno, an oncologist whose compassion for a dying patient led her to become an early proponent of hospice care in the United States, has died. She was 83.

Magno, a Philippines-born physician who immigrated to the U.S. in the 1960s, died July 27 of congestive heart failure in her native Manila.

She helped found one of the first hospices in the U.S. as well as national and international organizations devoted to promoting humane care for the dying.

Hospice is a concept of care that neither prolongs the life nor hastens the death of the terminally ill but aims to enhance the quality of the time remaining. Magno advocated for hospice care in the 1970s, when dying patients too often were under-medicated for their pain and suffered their fears in isolation.

“She saw a gap between what dying patients needed and how physicians were approaching their care,” said Liliana Delima, executive director of the International Assn. for Hospice and Palliative Care in Houston, who called Magno one of the leaders of the hospice movement in the U.S.

Magno was born in San Fernando, Pampanga, in the Philippines, one of nine children in her family. Her mother died when she was 13, and her father was a lawyer and politician who traveled a lot.

She met her husband, Cesar, in medical school at Santo Tomas University in the Philippines. They were married for 11 years until his death from skin cancer in 1955. She was 36 when he died and had seven children, ages 1 to 10.

One of her sons died of cancer in 1992. She is survived by six children, 16 grandchildren, three great-grandchildren, three sisters, a brother, nieces and nephews.

A few years after her husband’s death, Magno went to work in the Philippine government as assistant to the secretary of health. She served for 10 years, until 1969.

That year, she moved with her family to Washington, D.C., where she had a fellowship to study oncology at Georgetown University. At Georgetown, she developed a pilot hospice program and persuaded officials at Blue Cross Blue Shield to cover hospice care as a benefit for six months. The six months of coverage was later adopted as the standard in the insurance industry.

While at Georgetown, Magno was diagnosed with breast cancer and underwent a radical mastectomy and radiation. The experience enabled her to experience firsthand the fears of patients confronting death.

“It made her see the anguish these people went through,” Pat Pastore, a nurse who met Magno 30 years ago through a church group, said in an interview with The Times late last week.

In 1975, Magno was called to treat a patient in the final stages of pancreatic cancer who had been admitted to Georgetown University Hospital for severe abdominal pain. She controlled his pain with drugs and sent him home, only to face him again a few days later when the pain returned, accompanied by violent nausea and vomiting. Again, Magno medicated him; again, he returned.

“That man was in too much pain to take a sip of water,” she recalled in a 1980 interview with the Independent News Alliance. “And now that the possibilities for a recovery were gone, so were his specialists. He seemed so very alone.”

It was then she decided that what American medicine offered the dying was sorely inadequate.

She spent the next few years in England and Canada, visiting the hospices that existed solely to comfort the dying, alleviate their physical suffering and give them the freedom to shape their last days.

When she returned, she joined with several interested friends, including Pastore, to turn an abandoned elementary school in suburban Washington into a haven for the terminally ill. They persuaded county officials not only to donate the building but provide nearly $1 million to refurbish it. The Hospice of Northern Virginia, in Arlington, opened in 1977, three years after the first U.S. hospice was established in Connecticut. Magno served as medical director for three years.

In 1983, she founded the International Hospice Institute to educate doctors about the management of terminal illness; that group later became the International Assn. for Hospice and Palliative Care. In 1984, she moved to Detroit to establish a home-care program for the city’s first hospice and subsequently started a hospice service for Detroit’s Henry Ford Hospital. She also was the first executive director of the National Hospice Organization.

After moving back to the Philippines a few years ago, she continued to work on hospice issues, developing models for programs in Third World countries.

Pastore, a nurse for 46 years who worked alongside Magno at the Arlington hospice, described her friend and former colleague as a highly accomplished diagnostician. But her greatest gift, according to Pastore, was her ability to intuit the needs of those facing the end of life.

Magno helped patients who wanted to die at home, or those who refused pain medication because it would make them too woozy and erode the quality of their last days with their children.

At times, she found that the best way she could help had nothing to do with drugs or physical comforts.

One time, Magno recounted, she received frantic calls from the family of a 42-year-old woman named Florence who was dying of lung cancer. Although Magno had given her strong drugs to relieve her physical pain, the woman was still moaning and screaming.

Sensing that Florence feared facing God for something she had done in her past, Magno, a devout Roman Catholic, asked her, “Do you want me to pray with you?”

The woman soon calmed down.

On a subsequent visit, the doctor prayed with Florence for God’s forgiveness. When she finished praying, the woman grew very quiet; she died peacefully half an hour later. Magno told a reporter later that Florence gave her her first glimpse of a dying person’s spiritual pain.

“She has been, in my mind, one of the most talented bedside physicians I have ever seen,” Pastore said of Magno.

“When she went to the bedside of a patient, you could see the difference immediately. She had such warmth and such compassion and so much common sense. This truly was an extraordinary woman.”