PEDIATRICS Vol. 32 No. 4 October 1963, pp. 610-625
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BEHAVIORAL OBSERVATIONS ON PARENTS ANTICIPATING THE DEATH OF A CHILD

Stanford B. Friedman M.D.1, Paul Chodoff M.D.1, John W. Mason M.D.1, and David A. Hamburg M.D.1

1 Adult Psychiatry Branch, Clinical Investigations, National Institute of Mental Health, United States Public Health Service, Department of Health, Education and Welfare, Bethesda, Maryland, and Department of Neuroendocrinology, Division of Neuropsychiatry, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, Washington, D.C.

There are few tasks in the practice of medicine as difficult as trying to help the parents of a child afflicted with a disease which is invariably fatal. Since the physician cannot change the reality of the tragic situation, he frequently feels totally unable to lessen the parental suffering. However, understanding the nature of the stress as experienced by the parents, and appreciating that there are characteristic ways in which they cope with the situation, should enable the physician to offer helpful support in a majority of cases.

Forty-six parents of children with neoplastic disease were involved at the National Institutes of Health (NIH) in a study of the adrenal cortical response under conditions of chronic psychological stress and this work has been reported elsewhere.1 The present paper is concerned with the clinical impressions gained over a 2-year period while this study was in progress and the implication of these findings to physicians caring for children with similar diseases, adding to what is presently in the litenature.2-8

SUBJECTS AND GENERAL METHOD OF STUDY

The 46 subjects represented one or both parents of 27 children, all of whom had been referred for treatment with chemotherapeutic agents to the Medicine Branch of the National Cancer Institute. In all cases, the child had previously been hospitalized elsewhere for clinical evaluation, and the suggestion for referral was most frequently made by a physician at the time he communicated the diagnosis to the parents. In a minority of cases, the matter of referral was initiated at a time later in the child's clinical course.

Accepted on June 18, 1963




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