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Some parents are unreasonably hopeful, insisting on aggressive therapy for their children even when such treatment would cause additional suffering with little or no chance of success. The various sources of and influences upon such hopes are examined, and suggestions are offered about how to help these parents see the situation more realistically. This discussion covers such issues as religious beliefs, confusions about causation and responsibility, concern about how others see us, and the simple tragedy of children who die. The failure to address these hopes undermines parental decision making, leads to unnecessary tragedies, and can result in costly litigation. Communication is an essential part of dealing with unreasonable hopes, but there is also a place for medical futility judgments and limitation contracts. The goal is not to deprive parents of their hope, but to transform it into something that is both valuable and anchored in reality.
The child is gravely ill and there is no real chance of recovery. The treatment is doing the child more harm than good, but the parents insist that it be continued. They haven't lost hope, they say, but what are we to make of hope when it is so detached from medical reality? Although the parents of sick children are often told to hope for the best, there is a point at which such hopes are unreasonable. Why are some parents overly optimistic, and how should we respond to them?
Sources of Hope
Hope springs from many sources and is influenced by many factors. Examining these is essential to understanding how best to handle such situations. We often refer to medical treatment as medical care, so treating and caring become linked in people's minds. Some parents then think that halting treatment means they no longer care for their child. Clearly, most parents care deeply for their children and will avoid anything that might seem to indicate abandonment. The result is that they often insist on continued aggressive treatment, feeling that anything less would make them bad parents. Explaining that halting aggressive therapy does not mean a cessation of care may help some parents to see their choices in a new light.
This is magnified by parents' concern with how their decisions will be viewed by the medical...