Hope for the Best, and Prepare for the Worst

Medical Writings4 March 2003Hope for the Best, and Prepare for the WorstAnthony L. Back, MD, Robert M. Arnold, MD, and Timothy E. Quill, MDAnthony L. Back, MDFrom Veterans Administration Puget Sound Health Care System, University of Washington, Seattle, Washington; University of Pittsburgh, Pittsburgh, Pennsylvania; University of Rochester, Rochester, New York., Robert M. Arnold, MDFrom Veterans Administration Puget Sound Health Care System, University of Washington, Seattle, Washington; University of Pittsburgh, Pittsburgh, Pennsylvania; University of Rochester, Rochester, New York., and Timothy E. Quill, MDFrom Veterans Administration Puget Sound Health Care System, University of Washington, Seattle, Washington; University of Pittsburgh, Pittsburgh, Pennsylvania; University of Rochester, Rochester, New York.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-5-200303040-00028 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Mr. J., a 40-year-old father of two young children, has metastatic non–small-cell lung cancer that has not responded to two different chemotherapy regimens. His physician, Dr. B., explains that the cancer is progressing. Mr. J. says, Isn't there something you can do? Please don't give up on me. Dr. B. pauses and says, Well, there is an experimental protocol we could try.When faced with life-threatening illness, patients and physicians often feel that they must choose between hoping for disease remission and preparing for death. Mr. J. wants to fight the cancer in hope of living longer, and his physician ...References1. Delvecchio Good MJ, Good BJ, Schaffer C, Lind SE. American oncology and the discourse on hope. Cult Med Psychiatry. 1990;14:59-79. PMID: 2340733 CrossrefMedlineGoogle Scholar2. The AM, Hak T, Koter G, van Der Wal G. Collusion in doctor-patient communication about imminent death: an ethnographic study. BMJ. 2000;321:1376-81. PMID: 11099281 CrossrefMedlineGoogle Scholar3. Ersek M, Kraybill BM, Pen AD. Factors hindering patients' use of medications for cancer pain. Cancer Pract. 1999;7:226-32. PMID: 10687591 CrossrefMedlineGoogle Scholar4. Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, . Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994;330:592-6. PMID: 7508092 CrossrefMedlineGoogle Scholar5. Byock IR. The nature of suffering and the nature of opportunity at the end of life. Clin Geriatr Med. 1996;12:237-52. 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PMID: 11154646 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Veterans Administration Puget Sound Health Care System, University of Washington, Seattle, Washington; University of Pittsburgh, Pittsburgh, Pennsylvania; University of Rochester, Rochester, New York.Acknowledgments: The authors thank Dr. Susan Block for her helpful suggestions about the role of ambivalence.Grant Support: Drs. Back and Arnold are Faculty Scholars of the Project on Death in America. Dr. Arnold was also supported by the Greenwall Foundation, Ladies Hospital Aid Society of Western Pennsylvania, and the LAS Trust Foundation.Corresponding Author: Anthony Back, MD, Veterans Administration Puget Sound Health Care System, 1660 South Columbian Way S111, Seattle, WA 98108; e-mail, email protectedwashington.edu.Current Author Addresses: Dr. Back: Veterans Administration Puget Sound Health Care System, 1660 South Columbian Way S111, Seattle, WA 98108.Dr. Arnold: Section of Palliative Care and Medical Ethics, MUH 200 Lothrop Street 932, Pittsburgh, PA 15213.Dr. Quill: Palliative Care Program, University of Rochester School of Medicine, Box 601, 601 Elmwood Avenue, Rochester, NY 14642. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHope for the Best, and Prepare for the Worst James D. 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