Coping with Poor Prognosis in the Pediatric Intensive Care Unit

The Cassandra Prophecy
  • David A. Waller
  • I. David Todres
  • Ned H. Cassem
  • Ande Anderten


When the pediatrician in a hospital intensive care unit (ICU) predicts to parents that a poor outcome is likely, he may sometimes encounter disbelief and even animosity. “We’ve told the parents their child’s chances for a healthy recovery are extremely poor, but they don’t appear to understand—they seem to be totally unrealistic” was a comment not infrequently made by pediatric medical staff and nursing staff in our pediatric intensive care unit. 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. The purpose of this report is to describe the Cassandra prophecy phenomenon and to present our hypotheses about its meaning and how it might be dealt with effectively.


Nursing Staff Pediatric Intensive Care Unit Biliary Atresia Hospital Environment Hospital Intensive Care Unit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Richmond, J. B., & Waisman, H. A. Psychologic aspects of management of children with malignant diseases. American Journal of Diseases of Children, 1955, 89, 42–47.PubMedGoogle Scholar
  2. 2.
    Weisman, A. D., & Hackett, T. P. Predilection to death: Death and dying as a psychiatric problem. Psychosomatic Medicine, 1961, 23, 232—256.PubMedGoogle Scholar
  3. 3.
    Friedman, S. B., Chodoff, P., Mason, J. W., & Hamburg, D. A. Behavioral observations on parents anticipating the death of a child. Pediatrics, 1963, 32, 610–625.PubMedGoogle Scholar
  4. 4.
    Oken, D. The doctor’s job: An update. Psychosomatic Medicine, 1978, 40, 449—461.PubMedGoogle Scholar
  5. 5.
    Siegler, M. Pascal’s wager and the hanging of crepe. New England Journal of Medicine, 1975, 295, 853–857.CrossRefGoogle Scholar
  6. 6.
    Solnit, A. J., & Stark, M. H. Mourning and the birth of a defective child. Psychoanalytic Study of the Child, 1961, 16, 523–537.Google Scholar
  7. 7.
    Weisman, A. D., & Hackett, T. P. Denial as a social act. In S. Levin & R. Kahana (Eds.), Geriatric psychiatry: Creativity, reminiscing and dying.New York: International University Press, 1966.Google Scholar
  8. 8.
    Superintendent of Belchertown State School vs. Saikewicz,—M:BS—, 370 NE 2d 417, 1977.Google Scholar
  9. 9.
    Caplan, G. Practical steps for the family physician in the prevention of emotional disorder. JAMA, 1959, 170, 1497–1506.CrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1984

Authors and Affiliations

  • David A. Waller
    • 1
  • I. David Todres
    • 2
  • Ned H. Cassem
    • 3
  • Ande Anderten
    • 4
  1. 1.Child and Adolescent Psychiatry, Department of PsychiatryUniversity of Texas Health Science CenterDallasUSA
  2. 2.Joseph S. Barr Pediatric Intensive Care Unit, Children’s ServiceMassachusetts General HospitalBostonUSA
  3. 3.Department of PsychiatryMassachusetts General HospitalBostonUSA
  4. 4.Department of Social ServicesMassachusetts General HospitalBostonUSA

Personalised recommendations