I've seen some very good responses to this "hope" canard over on the PC board, which is fairly distinctive in that nearly everyone posting there either is terminally ill or is the caregiver of someone who is terminally ill. (Lest I scare anyone, I hasten to add that I'm in the small minority.) The idea is not that you are giving up hope, but that what you hope for changes over time. When you're diagnosed, you hope for eligibility for the Whipple (the only procedure which offers an actual chance at a cure); after the Whipple/if you can't have it, you hope that you will respond well to chemo and radiation without many side effects, gaining quality time; when metastasis occurs, you hope it will be slow and in the least painful ways; and, finally, you hope for a death with love and dignity and without pain. The point is, acknowledging the limited options you do have and trying your best to make sure that the best one ensues is just as valid a form of hope as continuing to grab for the brass ring. It's not a betrayal of the sick person at all.

I've made it very, very clear in my health care proxy statement that if I do become terminally ill, pain relief is my highest priority. This led to some uncomfortable conversations with my mom (my health care proxy), but now that I really have experienced honest-to-god 9-on-the-scale pain, I know that I value not feeling that in my last moments far more than I value alleged "lucidity" or "hope" at that point.