A recent post of mine entitled: “The Case Against Hope,” elicited some thoughtful comments from a reader. My piece argued that it is best to give up hope in hopeless situations. The reader, a former student of mine who works in a major urban hospital, basically agreed. She argues that false hope is counterproductive, that grieving is not a disease, patients should be respected as autonomous agents. The full comments can be found in the comments section of that post but here is a sampling of her thoughts.
I don’t know exactly why, but there seems to be a very thin line between being hopeful in grim circumstances and being realistic and accepting that our power is sometimes limited. For example, I used to work very closely with very sick cancer patients. Some of them I got to know pretty well, over a long time. I also lost my best friend to cancer, and walked with him through that journey. What struck me over and over is the strong-arming that occurs with patients who are terminally ill/in the very late stages of disease–strong-arming them into projecting this perfect portrayal of hope for survival. Do not misunderstand me—I am not saying that positive outlook and motivation and openness is not important when one is facing a serious illness …I am talking about the cases where the patients involved were in a dire situation, and had certainly maintained hope and effort up until the point the situation became so dire.
It was not uncommon to see this happen: Doctor tells patient that their illness has progressed, that their prognosis was not good, that their estimated time remaining was X. Then the very next thing they would do is say that they were writing a prescription for antidepressants, since patients “have a hard time dealing with this”… I still remember when my dear friend was in this situation–he said to the physician, “I am not depressed. I am upset. Am I not allowed to be upset?”
many times these patients who expressed a wish to cease further treatment were offered major surgeries, really radical treatments that were held out as a “last ditch effort.” … Some of them consented to radical surgeries that did not extend their lives at all, and they ended up expressing regret afterwards. It was unsettling to see this play out again and again … And what I saw was people who were being sold so much hope that they never got to move on to acceptance, and that was very unfortunate.
In my next post I would like to expand on the idea of death with dignity.