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The Hazards of “Hanging Crepe” or Stating Overly Pessimistic Prognoses

As an intern, I was taught to hang crepe whenever possible. Hanging crepe—intentionally presenting an overly pessimistic prognosis to prepare patients and families for a devastating outcome—was considered to be both sympathetic and practical. It was sympathetic because, if the worst happened, the family had an opportunity to be prepared for it; if the worst did not happen, it was thought that no harm was done. It was practical because it was thought to be less of a legal risk to be wrong about a bad outcome than to be wrong about a good outcome. The etymology of the phrase “hanging crepe” is unclear. The traditional use of the word crepe is the band of black worn as a sign of mourning. Hanging crepe may have referred to placing it on the doorway or windows of homes or public buildings when a person died. Thus, the physical activity of hanging crepe was used to set a somber mood. Others may be familiar with different versions of the phrase such as “sowing crepe” or “sewing crepe.” Sowing may refer to planting seeds of doubt in the mind (such as “to sow a field”) or to lay the difficult groundwork that will prepare the decision maker (as in “reap what you sow”). Sewing may refer to the actual preparing of the black crepe to be worn or hung by mourners. Hanging crepe was not intended to harm and, to the casual observer, it did not. However, changes in the medical environment and increased recognition of the importance of truth-telling now make what appeared to be an innocent technique more morally dubious. Here are two cases in which hanging crepe caused problems with parents’ future decision-making capacity and with the bonding between parents and baby.