Hope Less: How a Healthy Dose of Realism Can Help in the ICU

The author’s father died recently after a sudden heart attack. This essay discusses how the family’s experiences in the cardiac intensive care unit surprised her, even though she is a member of the Ethics Committee and the Ethics Consult Team at her local hospital, and how this led her to reconsider the ways in which families and hospital physicians communicate about the process of dying. How should doctors balance their messages of hope and realism when the situation is grim? Important judgment calls needed to be made, yet the family did not fully understand what they needed to know to make good decisions, especially the importance of the timing of their decisions. A conversation early on about what would happen if the patient became physically stable—no matter how impaired—while all options remained on the table might usefully (and mercifully) transform hope at the end.