Is This a Hopeless Case?


Occasionally, a patient will present to the clinic with a myriad of health complaints so complex and profound that the therapist and/or multidisciplinary team can feel a bit overwhelmed. The equivalent situation in an ITU (Intensive Therapy Unit) setting might be the ultimate decision whether or not to continue resuscitation as the perceived loss of ‘quality of life’ justifies the removal of life-sustaining medical intervention. In the clinic we are not dealing with such stark binary decision-making but with the grey-area algorithms associated with patients who are the ‘walking wounded’, complaining of functional problems. Not considered medically as ‘life or death’ these problems still have an impact, however small or large, on ‘quality of life’.

So how do we define this ‘life quality’? Or, indeed, who defines it? Often, the patient in chronic pain, with relationship issues, work pressures, getting older and with no hope of any improvement, is desperate to ‘get a life’. The therapist cannot give it to them but can help to catalyse attitudinal changes. Hope and positive self-belief are powerful healing agents. Set against this, however, is mass consumerism and societal pressures where self-esteem often seems pegged to what the individual is earning or whether they have the latest gadget/ clothes/ car, etc..Is life worth living if you can’t keep up with this?

As advances in medical technology lead to situations when a person’s vital functions can be artificially maintained beyond our conventional idea of life preserved, we will be confronted more often by moral questions of how best to intervene. This is at a time when infant mortality and death rates from killers such as cancer and heart disease have dramatically declined. Life expectancy is expected to continue increasing. As a result, we are now in a situation when qualitative assessment of life is eclipsing the quantitative. Being kept alive (by machines, drug regimes, teams of professionals and over-stretched carers) is not the same as living.

The saying goes: ‘Where there is life there is hope’. Perhaps that now be changed to: ‘Where there is hope there is life.’

David Propert

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