Should terminal patients know about their impending deaths? How much should they know? How do we determine “should”?

Medicine constantly holds the tensions of contrasts. Of life and of death. Of fighting and of folding. Of truth and of deceit. Herein lies the art of medicine. Holding the balance of the rational advance of science against the relative world of values and attitudes. This tension, in turn, reflects the human condition, wherein man is both symbolic and physical.

Fear is born of knowledge.

A child will as innocently play with a snake as a teddy bear. A young adult as naively dabble with love as life itself.

Bearing a child is as close as we get to original Creation—something from nothing. Creating a child creates an iredeemable future and changes forever the fabric of life. Procreation can thereby come to symbolize immortality. A symbolic way of cheating our inevitable common-fate, if you like. Love, a mechanism to preserve this symbol, worms its way into the heart and settles there. It flourishes faithfully without fear or doubt, nourishing the parent-child dyad.

Cancer is frequently compared with war. The daily newspapers report on such-and-such a person's battle against cancer. A patient declares, “I will fight it with everything I've got.” One country has called its peak body “The Association of War against Cancer.” In America the National Cancer Act of 1971 “declared war on cancer” (Levy, 2005). Thus is cancer declared the enemy, which must be conquered.

From time immemorial the stars have been solicited to guide us. For mariners using an astrolobe to find their way across the oceans. For philosophers to reflect on the infinite and eternal. For lovers to dream of the future.

There is little convincing agreement in the literature on the definition, measurement, and application of hope. The usual platitude—where there's life, there's hope—does not clarify the confusion, and clinical practice puts paid to a simplistic approach to hope. A 28 year-old man with widespread melanoma is hoping the doctor will offer him a new treatment. He hopes he will marry and have a family. The hopes to us are unrealistic—but for him they are tangible, the stuff of life, the dreams that keep him going. What should clinicians do with this man's hopes? Should we support him medically, for the sake of hope? Does hoping prolong life against death? Should we encourage unproven therapies as elixirs of hope? When hope clashes with reality and causes angst, is it better to jettison hope, or reality? What does acceptance of death mean in terms of hope? What can it mean to live without hope?

His death had been expected for weeks. Just out of his teens he never complained, the girls reminisced later. The leukemic weeds in his blood starved his body of fight and life. His parents stood by his bed as he lay dying. His breathing quickened over a quarter of an hour, then slowed, became irregular and ceased. He died. Death to those inexperienced can be a little surprising in its understatement. Nothing much happens. These parents showed little shock. No hysterics. Numbed, exhausted. In the end all deaths are alike, but no stories the same.