The Cancer of Optimism

Jason Micheli —  May 7, 2013 — 2 Comments

05OPTIMISM-articleLargeOne thing pastors get good at over time is assessing what doctors tell their patients. Sitting next to congregants’ bedsides I often glean more than they or their families do from what the round-making doctor has said about their condition, about the next steps, about what they can expect hope for next.

Very often, patients and their families don’t learn what they ought from their doctors because they don’t know what questions to ask. And how could they? For many in that situation it’s their first time in that situation.

Another thing pastors get good at over time is noticing how often spouses and children and family realize that their loved one is about to die, how seldom doctors come out with it and tell their patients ‘there’s nothing we can do, anything else we try will only prolong the inevitable (and the suffering), there’s no hope.’

And I don’t mean by this to beat up on doctors.

By and large, I think doctors have better bedside skills than most clergy.

Nevertheless, over time as a minister I’ve noticed that many doctors are simply not good at helping their patients to die.

And again, I’m not blaming doctors.

I think their reluctance owes to the fact that we don’t want them to help us die.

We want them to help us live- at all costs- because when you get down to the bitter truth, we don’t really believe there’s any living to be done after we’re dead.

The eternal optimism patients crave is but a symptom of our pessimism regarding eternal life.

Optimism is almost by definition not the same thing as faith.

I bring this up having read HAIDER JAVED WARRAICH’s piece in the NY Times, The Cancer of Optimism. Here’s the heart of the reflection:

I have come to believe that I was a victim of irrational optimism, a condition running rampant in both doctors and patients, particularly in end-of-life care.

Physicians are thought to be the harbingers of bad tidings, the people who use cold words like “prognosis.” But studies show that they are just as capable of emotions as their patients are. According to a study published in 2000 in the British medical journal BMJ, about two-thirds of doctors overestimate the survival of terminally ill patients.

This optimism is far from harmless. It drives doctors to endorse treatments that most likely won’t save patients’ lives, but may cause them unnecessary suffering and inch their families toward medical bankruptcy.

One source of this optimism is pop culture, which frequently depicts heroic recoveries from seemingly life-threatening situations. Another is the medical school experience. What motivates weary medical students is the hope that one day interventions they perform will save lives, heal families and enact cosmic good.

Later, our judgment becomes clouded as we build relationships with patients, share their fears and anxieties, cherish their small victories and celebrations and hope that there may still be a way, however unlikely, they can make it to their grandson’s bar mitzvah.

And yet studies have shown that patients almost universally prefer to be told the truth.

The article called to mind one particular death I was privileged to be a part of years ago.

I was present with a family as they stood vigil at the passing of a loved one. The dying man was elderly and at the end of a long, difficult decline.

The family knew they were at the point where the faithful thing to do was to let go of life. He was joined in the room by his wife, his sons, his two daughters-in-law, and grand-daughter. The man’s grand-son was present, too, through a cell phone connection.

As the man’s death approached, at the request of the family, we read scripture and then shared together in the sacrament of the eucharist. After praying as a group, the family took turns telling the man how thankful they were for his life, expressing gratitude for what his life had meant to and contributed to their own.

He died while we worshipped in this way. And when the family realized his passing, they all kissed him and embraced one another and concluded by singing the doxology: “Praise God from whom all blessings flow, praise Him all creatures here below…” 

That such a ‘good’ death has been rare in my ministry is unfortunate.

That so much of our cultural expectation of medicine makes that rarity a reality is tragic.


Jason Micheli


2 responses to The Cancer of Optimism

  1. Is the next post on euthanasia? The last 2 posts lay a foundation for that topic.

  2. I really like this reflections, Jason. It is very important to recognize that no matter how long we live, and how much we are able to extend life with medical interventions, that we all eventually must pass from this world. I too don’t wish to seem to be criticizing doctors. I also do recognize that confronting one’s mortality is not easy. But, to delay telling a patient of the inevitable, and its likely closeness, also precludes the person from gaining closure on issues they might have with others. Sometimes its forgiving – other times its seeking forgiveness. Possibly its just having an opportunity to say good bye and thanks to others. But to overly manage a person’s movement into recognizing the inevitable, may preclude that person’s bringing closure to important issues. At the end of the day, we must just be certain to remember that we do have a loving God, that through Jesus Christ we are saved, to live each day like he wants us to live in doing the work of His Kingdom, to be thankful for the lives that we have been given and to live the day like it might be your last – with joy and thankfulness. One day will be that day – live so you do not have regrets when it does arrive.

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