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November 1979, Vol 133, No. 11 >
Article | November 1979

Coping With Poor Prognosis in the Pediatric Intensive Care Unit:  The Cassandra Prophecy FREE

David A. Waller, MD; I. David Todres, MD; Ned H. Cassem, MD; Ande Anderten, MSW
[+] Author Affiliations

Reprint requests to Pediatric Intensive Care Unit, Massachusetts General Hospital, Fruit St, Boston, MA 02114 (Dr Todres).


Am J Dis Child. 1979;133(11):1121-1125. doi:10.1001/archpedi.1979.02130110029002.
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• The intensive-care pediatrician who prophesies to parents that their child's illness is irreversible may encounter denial and hostility. The physician may compare his plight to that of Cassandra—the mythical Greek prophetess of doom, who was cursed to see into the future and not be believed. Four cases are reported in which parents rejected their child's hopeless prognosis, counterprophesied miraculous cures, resolved to obtain exorcism, criticized the care, or accused nurses of neglect. This produced a painful breakdown in the usually harmonious relationships between doctors, nurses, and parents. Parental denial as a coping mechanism is discussed. Guidelines are presented for the prevention and/or early recognition and management of the Cassandra Prophecy phenomenon. A miraculous recovery in one case is a potent reminder to physicians and nurses that they do not have the gift of divine prophecy and cannot see with certainty into the future.

(Am J Dis Child 133:1121-1125, 1979)

REFERENCES

1 +
Richmond JB, Waisman HA:  Psychologic aspects of management of children with malignant diseases . Am J Dis Child 89:42-47, 1955;.
2 +
Weisman AD, Hackett TP:  Predilection to death: Death and dying as a psychiatric problem . Psychosom Med 23:232-256, 1961;.
3 +
Friedman SB, Chodoff P, Mason JW, et al:  Behavioral observations on parents anticipating the death of a child . Pediatrics 32:610-625, 1963;.
4 +
Oken D:  The doctor's job: An update . Psychosom Med 40:449-461, 1978;.
5 +
Siegler M:  Pascal's wager and the hanging of crepe . N Engl J Med 293:853-857, 1975;.
6 +
Solnit AJ, Stark MH:  Mourning and the birth of a defective child . Psychoanal Study Child 16:523-537, 1961;.
7 +
Weisman AD, Hackett TP:  Denial as a social act , in Levin S, Kahana R (eds): Geriatric Psychiatry: Creativity, Reminiscing and Dying . New York, International University Press, 1966;, pp 79-110.
8 +
Superintendent of Belchertown State School vs Saikewicz,—Mass—, 370 NE 2d 417, 1977.
9 +
Caplan G:  Practical steps for the family physician in the prevention of emotional disorder . JAMA 170:1497-1506, 1959;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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References

1 +
Richmond JB, Waisman HA:  Psychologic aspects of management of children with malignant diseases . Am J Dis Child 89:42-47, 1955;.
2 +
Weisman AD, Hackett TP:  Predilection to death: Death and dying as a psychiatric problem . Psychosom Med 23:232-256, 1961;.
3 +
Friedman SB, Chodoff P, Mason JW, et al:  Behavioral observations on parents anticipating the death of a child . Pediatrics 32:610-625, 1963;.
4 +
Oken D:  The doctor's job: An update . Psychosom Med 40:449-461, 1978;.
5 +
Siegler M:  Pascal's wager and the hanging of crepe . N Engl J Med 293:853-857, 1975;.
6 +
Solnit AJ, Stark MH:  Mourning and the birth of a defective child . Psychoanal Study Child 16:523-537, 1961;.
7 +
Weisman AD, Hackett TP:  Denial as a social act , in Levin S, Kahana R (eds): Geriatric Psychiatry: Creativity, Reminiscing and Dying . New York, International University Press, 1966;, pp 79-110.
8 +
Superintendent of Belchertown State School vs Saikewicz,—Mass—, 370 NE 2d 417, 1977.
9 +
Caplan G:  Practical steps for the family physician in the prevention of emotional disorder . JAMA 170:1497-1506, 1959;.

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