How hopeful is too hopeful? Responding to unreasonably optimistic parents

Some parents are unreasonably hopeful, insisting on aggressive therapy for their children even when such treatment would cause additional suffering with little or no chance of success. The various sources of and influences upon such hopes are examined, and suggestions are offered about how to help these parents see the situation more realistically. This discussion covers such issues as religious beliefs, confusions about causation and responsibility, concern about how others see us, and the simple tragedy of children who die. The failure to address these hopes undermines parental decision making, leads to unnecessary tragedies, and can result in costly litigation. Communication is an essential part of dealing with unreasonable hopes, but there is also a place for medical futility judgments and limitation contracts. The goal is not to deprive parents of their hope, but to transform it into something that is both valuable and anchored in reality.