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The Prognosis of Hope
Ernest Rosenbaum, MD

The Philosophy of Caretaking for an Ill Person
Palliative Care and Hope

Hope can be a part of one's upbringing from childhood, depending on family philosophy, or it can be developed and adopted through life experiences, as well as from friends, spiritual or religious philosophy or from examples in life.

A child who has many disappointments as he grows up is less likely to be as hopeful as a person who was better supported, both psychologically and through physical acts of one's family and friends.

A lot depends on development of one's personality and how one has dealt with crises during one's life, as the better one copes with crises, the better chance one has of being more hopeful. In contrast to this, at the end-of- life when one requests euthanasia, it reflects a feeling of severe hopelessness and wishing for peace and the end of whatever suffering is ongoing, both physically and psychologically. Again, a lot of this depends on the cancer stage, physical condition, degree of suffering and the caregiver and the type of care one is receiving, as well as the support from the medical team, family and friends.

It can be said that the goal of the medical and social professions is to promote hope within the concept of a realistic chance that life will continue with some degree of quality and purpose during this final period of life.

An interesting analogy is that of Frankl,2 a survivor of a German concentration camp, who faced death and found that many of his fellow captives continued to have a reason and purpose for living. They often fared better than those who found the concentration camp experience dreadful and overwhelming. He found, in the Buchenwald Concentration Camp, the physician prisoners kept hope alive by preparing and presenting medical papers, often late at night when fellow prisoners had gone to sleep, and even put together a working x-ray machine. It was felt that hopelessness had a significant effect on the human response to illness. 3This has also been shown to be an effective part of treatment for breast cancer patients, as those who were not passive acceptors had increased survival.

>2. Frankl, V. E., "Man's Search for Meaning." Boston: Beacon Press, 1963.
3. Menninger, K., "Hope." Am J Psychiatry, 1959 and Frankl, V., "Man's Search for Meaning." Boston Beacon Press, 1963, and Hinds, P. S., "Adolescent Hopefulness in Illness and Health." Adv Nurs Sci, 1988, April: 79-88.

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