Abstract

While there is evidence in theory and in practice that hope makes a difference to patients' experiences of illness or injury, the ethical aspects of attending to patients' hope have been largely ignored in philosophy and bioethics. In this project, I investigate the role of hope in health care and argue that health care providers have a responsibility to foster conditions within which patients can discover and continue to have hope. Stories from patients in four clinical contexts assist in identifying important, and often overlooked, features of hope such as the role of imagination and the vulnerabilities of patients connected with having hope. The new definition of hope I develop demonstrates that hope is salience-determining and action-directing. Hope also has strong relational features; the relationships patients have and the context within which these relationships are formed and played out can substantially influence what they hope for as well as whether they are able to hope. On this basis, I argue that the responsibility of health care providers is best situated within a feminist care ethics approach. This approach lends itself well to demonstrating what can go wrong with certain practices of care and assumptions about what are "reasonable" hopes for patients to have and generally provides a framework for understanding the role of hope in health care. Finally, I explore the normative implications of the responsibility to foster conditions within which patients can discover and continue to hope demonstrating that there are actions health care providers can take within current structures to address patients' hopes. Moreover, the structural barriers to performing well the required caring hope work can form part of a larger critique of the health care system