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September 1963

The "Hopeless" Case

Arch Intern Med. 1963;112(3):314-326. doi:10.1001/archinte.1963.03860030068004

Introduction  When, in a given patient, there has been established a firm diagnosis of a relatively chronic condition that may be expected to terminate fatally because curative treatment is either not known or not applicable, the case may properly be considered "hopeless." Under these circumstances medicomoral problems are almost inevitable; they are accentuated when the pathogenesis is obscure, when remission is rare, and when the general health of the patient is apparently good. Almost by common acceptance the prototype "hopeless case" is the patient with incurable malignancy. Unfortunately there are many other diseases, such as central nervous system neuropathies, that may readily be included in this baleful category. It is evident, but nevertheless of considerable significance, that the term "hopeless" in this context is relative—its limits are defined by the current state of medical knowledge. Scientific progress has narrowed these boundaries in some areas and expanded them in others. Pernicious