The Oncologist's Duty to Provide Hope: Fact or Fiction?
There are many sources of conflict in oncology. Conflicts arise because there are numerous therapeutic options, each of which is imperfect, and these conflicts produce ethical dilemmas. A recent American Medical Association (AMA) publication outlined the principles of medical ethics for managing conflicts. Common conflicts in oncology include whether to resuscitate, to give more chemotherapy, and how much truth to tell. These conflicts are magnified because of the life and death scenario of advanced cancer. Denial, avoidance, and hope are psychologic mechanisms that enable adaptation to the life-threatening circumstances. Hope is widely written about though poorly understood and defined. Ethical statements regarding its virtue and importance to preserve are frequently given. In an effort to progress the understanding of hope, two critical features are defined: (1) hope as a thought process only exists in the future, and (2) hope is only ever associated with positive and good thoughts. The future is unknown and uncertain; therefore, hoping can be manipulated by presenting statistics in a way to boost hoping. Thus a dilemma and specific ethical responsibility falls on oncologists when discussing conflicts. Furthermore, since hope is a subjective assessment of a possibility that is considered "good" by the hoper, it cannot be perceived as "false." "False hope" is an erroneous assessment. Finally, this article introduces the concept that there might be a role to stop hoping-since hope of the future is also filled with doubt and fear-and instead live in the present and try to find joy and meaning today.
From the Pain and Palliative Care Service, Davidoff Cancer Center, Rabin Medical Center, Petach Tikvah, Israel.
Simon
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Wein