Sherwin Nuland held a post as a surgeon and lecturer at the Yale School of Medicine for over three decades. In 1994, he published the groundbreaking book How We Die: Reflections on Life’s Final Chapter. His stated goal with the book was to demystify the process of dying.
From How We Die:
A young doctor learns no more important lesson than the admonition that he must never allow his patients to lose hope, even when they are obviously dying.
Scanning my Webster’s Unabridged, I find five separate interpretations of the meaning of the noun hope, and that doesn’t include the synonyms. The meanings listed range from ‘the highest degree of well-founded expectations’ to expectation that is ‘at least slight.’ In a separate entry is to be found an example of usage for hope as an intransitive verb, and herein may lie the crux of the matter for many patients suffering with terminal cancer: ‘to hope against hope,’ which the lexicographers describe as ‘having hope thought it seems to be baseless.’ A physician has no greater obligation than to be sure that no hope is baseless if he has given his patient reason to believe in it.
Too often, physicians misunderstand the ingredients of hope, thinking it refers only to cure or remission. They feel it necessary to transmit to a cancer-ridden patient, by inference if not by actual statement, the erroneous message that it is still possible to attain months or years of symptom-free life. When an otherwise totally honest and beneficent physician is asked why he does this, his answer is likely to be some variation of, ‘Because I didn’t want to take away his only hope.’ This is done with the best of intentions, but the hell whose access road is paved with those good intentions becomes too often the hell of suffering through which a misled person must pass before he succumbs to inevitable death.
A physician must offer treatments to keep the patient alive. As well a physician must prevent further harm to the patient, which can be caused by futile treatments. There seems to be a whole lot of grey area between these two responsibilities and, quite often nowadays, there seems to be a whole lot of silence.