Academic journal article The Hastings Center Report

Hope and Exploitation

Academic journal article The Hastings Center Report

Hope and Exploitation

Article excerpt

How do we encourage patients to be hopeful without exploiting their hope? A medical researcher or a pharmaceutical company can take unfair advantage of someone's hope by much subtler means than simply giving misinformation. Hope shapes deliberation, and therefore can make deliberation better or worse, by the deliberator's own standards of deliberation.

On June 18, 2004, the U.S. District Court for the Eastern District of New York sentenced Jason Vale to sixty-three months in prison and three years of supervised release for defying a court order to stop advertising and selling Laetrile to cancer patients. Said Lester M. Crawford, acting commissioner of the Food and Drug Administration at the time, "There is no scientific evidence that Laetrile offers anything but false hope for cancer patients, some of whom have used it instead of conventional treatment until it was too late for that treatment to be effective." (1) Jason Vale, goes the charge, exploited sick people's hopes for cure or prolonged life by lying about Laetrile's curative powers.

It is true that the hope for unlikely cure or prolonged life, which is for the most part highly valued and admired, makes sick people vulnerable to the distinct form of exploitation practiced by hucksters like Vale, and it seems right that we should take action to prevent that exploitation. However, this is not the only form of exploitation we should be concerned about when it comes to taking unfair advantage of sick people's hope. There are other, less readily recognized forms that require remedies quite different from the laws and punishments levied against charlatans.

What Is Hope?

The range of vulnerabilities entailed by the hope for an unlikely cure is most visible through the lens provided by some recent philosophical work that treats hope as an attitude that goes beyond the desire for an uncertain outcome. (2) These accounts contain interesting disagreements about hope's crucial characteristics, but for the purpose of distinguishing the different forms of exploitation to which hope makes sick people vulnerable, we need only three points, upon which there is uniform agreement:

* Hope for an outcome involves the desire for it.

* Hope involves imaginative engagement with the desired outcome, such as prayer, mental imaging, or fantasizing.

* Emotions, including hope, play a framing role in relation to our uptake, interpretation, and deliberative use of information.

I will say more about these points below, as they become relevant to the ways it is possible to exploit the hope for cure. Before moving on to discuss exploitation, however, it is important to see how this three-part conception of hope differs from the two approaches to hope that dominate the medical and bioethics literature.

First, there are theorists--mostly psychologists but also some nurses--who aim to operationalize hope in order to study its relation to mental and physical health and to effectiveness in setting and pursuing goals. To my knowledge, none of these theorists taps the phenomenon that is the focus of the present analysis. For example, the Snyder Hope Scales measure respondents' beliefs about their own abilities to effectively set and pursue goals. (3) The hope I am focused on here is not an attitude or set of beliefs about oneself, however; it is, rather, an attitude toward desired and imagined states of affairs--in particular, unlikely cures.

The second common approach to hope within the medical and bioethics literature seems to be motivated primarily by an apparent dilemma that has long plagued medical providers. On one hand, both the general public and the medical community have the notion that hope is a precious commodity, allowing ailing people and their loved ones to endure hardship and illness, to face terrifying odds, and to find meaning in even the bleakest outcomes. (4) On the other hand, the same groups believe that it can be deceptive to support or offer hope when bleak outcomes are to be expected. …

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