By Keith Block, MD
Hope is believing in spite of the evidence, and then watching the evidence change.
– Jim Wallis, editor of Sojourners magazine
Physicians who offer cancer patients innovative but “unproven” therapies are often criticized for providing false hope. The basic line of reasoning here is that, without definitive evidence from randomized clinical trials to support the use of a therapy, there are no grounds for hope. Some might even consider it cruel to offer such therapy to individuals who will eventually have their expectations shattered should the treatment fail.
Now, for people touched by cancer, the term hope can mean different things. At a basic level, of course, you hope to get rid of your cancer and then stay free of the disease. Hope in this context is simply a form of wish fulfillment: You desire, and to some degree, expect a full-fledged recovery. Implicit in this brand of hope is a very human attachment to the outcome. If you don’t achieve the outcome, your hope is lost, or at least greatly injured. If you experience a relapse or recurrence, such hope invariably will suffer a devastating blow.
Whenever hope is rooted in expectations, I believe that it may be hard to bounce back without having an alternate source of inner strength to draw from. That inner strength could also be called authentic hope, faith, even the will to live. Rather than being a form of expectation, authentic hope is more primarily a feeling or sense of possibility. Authentic hope is the feeling that what is desired is also possible, or that somehow life will unfold for the best. Hope is not a tangible, measurable state of mind, but an activity of the spirit that is ever changing. Nonetheless, it can be reinforced by the practical actions one takes toward reaching for a better outcome.
Over the years, through their struggles to survive, my patients have taught me that authentic hope is a highly adaptive response to the profound stress of cancer. Instead of grasping for certainty, this more realistic form of hope accepts the uncertainty of life as part of the territory of having cancer—and then moves toward possible avenues for living more fully, even if this means living with cancer for much of that time.
Given that hope itself is an intrinsically positive healing force, is there ever a time when doctors should not communicate to patients in a hopeful manner, in a manner that encourages patients to embrace the possibility of extending life, whether it be for hours, days, weeks or months? Do doctors have a right to tell people when they should stop hoping?
I believe the answer to both questions is a resounding “no.” To say that a person should stop hoping for a cure is one thing. That cure may certainly be beyond reach, or the statistics themselves may be too dismal to say that any cure exists. Unrealistic expectations of this kind certainly could be considered “false hope.” Even so, I believe the true, dynamic function of hope is to help propel the person forward in the belief that life is still worth living.
The often-heard phrase “false hope” is used when we fear the possibility of failure. In truth, I worry far more about patients receiving “false hopelessness” than “false hope.” False hope runs the risk of a communication of exaggerated expectations. But false hopelessness runs the risk of leaving a patient with excessive despair. Terrifying words from a medical authority the patient has come to respect can lead to a patient unintentionally fulfilling that prophecy. For example, if told “you only have 6 months to live,” a patient may inadvertently develop the psychophysiology needed to fulfill the prediction. This can hasten a dying process and actually increase the odds of a terminal outcome! Therefore, I urge my patients to resist fatalistic communications, as their attitude and will-to-win can have a profound influence on their ability to overcome disease. Additionally, I believe it is incumbent on all healthcare providers to reinforce and enhance whatever recuperative powers and emotional vigor a patient possesses. What this means is that the physician must walk a fine line in presenting the diagnosis and prognosis. It is essential to be direct and honest without misleading the patient. This can require great sensitivity, tact, and finesse, and, I believe, lies within the fabric of excellent clinical care.
Quite simply, to offer hope is to nurture the human spirit; to steal hope is to pilfer the human spirit. If giving hope is done to encourage and nourish the human spirit, then hope can only be viewed as a positive and beneficial influence on one’s life and healing process.
Rather than shun uncertainty and insecurity, we need to learn to move through them. In doing so, we relieve ourselves of a great deal of suffering. In this way, the cancer experience becomes a mixed blessing: a terrible shock to the spirit, and a surprising opportunity for enhancing our sense of engagement with life itself. Cancer becomes an opportunity for slowing down and more fully savoring the gift of being alive, and of our existence, for cultivating a hope and faith far deeper, for more enduring, than anything we had experienced before.
The challenge of cancer will very likely push you beyond your personal limits. Perhaps you cannot expect a cure, but you can hope to heal. Perhaps you cannot expect to fulfill all of your therapeutic aspirations, but you can choose to overcome defeatism and fatalism, open your heart, and discover parts of yourself that have long been neglected. You can make the best of your life in the time you have remaining. Preparing for the worst while living for the best will certainly enhance your wellness and peace of mind. Whether you face a mild diagnosis or a life-threatening one, you can write your own script, and bring about an unexpected, life-affirming conclusion. You can take the hero’s journey — a journey of blessing, of possibility and of life!