When seriously ill patients reach the end of the standard treatment trajectory for their condition, they may qualify for the use of unapproved, investigational drugs regulated via expanded access programs. In medical-ethical discourse, it is often argued that expanded access to investigational drugs raises ‘false hope’ among patients and is therefore undesirable. We set out to investigate what is meant by the false hope argument in this discourse. In this paper, we identify and analyze five versions of the (...) false hope argument which we call: (1) the limited chance at benefit argument, (2) the side effects outweighing benefits argument, (3) the opportunity costs argument, (4) the impossibility of making informed decisions argument, and (5) the difficulty of gaining access argument. We argue that the majority of these five versions do not provide normative ground for disqualifying patients’ hopes as false. Only when hope is rooted in a mistaken belief, for example, about the likelihood of benefits or chances on medical risks, or when hope is directed at something that cannot possibly be obtained, should it be considered false. If patients are adequately informed about their odds of obtaining medical benefit, however small, and about the risks associated with an investigational treatment, it is unjustified to consider patients’ hopes to be false, and hence, to deny them access to investigational drug based on that argument. (shrink)

After Hume, attempts to forge an empiricist epistemology have taken three forms, which I shall call the First, Middle, and Third Way. The First still attempts an a priori demonstration that our cognitive methods satisfy some criterion of adequacy. The Middle Way is pursued under the banners of naturalism and scientific realism, and aims at the same conclusion on non-apriori grounds. After arguing that both fail, I shall describe the general characteristics of the Third Way, an alternative epistemology suitable for (...) empiricism. (shrink)

Despite the frequent invocation of ‘false hope’ and possible related moral concerns in the context of assisted reproduction technologies, a focused ethical and conceptual problematisation of this concept seems to be lacking. We argue that an invocation of ‘false hope’ only makes sense if the fulfilment of a desired outcome (eg, a successful fertility treatment) is impossible, and if it is attributed from an external perspective. The evaluation incurred by this third party may foreclose a given perspective from (...) being an object of hope. However, this evaluation is not a mere statistical calculation or observation based on probabilities but is dependent on several factors that should be acknowledgeable as morally relevant. This is important because it allows room for, and encourages, reasoned disagreement and moral negotiation. Accordingly, the object of hope itself, whether or not based on socially embedded desires or practices, can be a topic of debate. (shrink)

This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it from three different kinds of hope, or ‘hopes for’, and then relate these distinctions back (...) to differing accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make. (shrink)

The goal of this paper is to introduce the false hope harms (FHH) argument, as a new concept in healthcare. The FHH argument embodies a conglomerate of specific harms that have not convinced providers to stop endorsing false hope. In this paper, it is submitted that the healthcare profession has an obligation to avoid collaborating or participating in, propagating or augmenting false hope in medicine. Although hope serves important functions—it can be ‘therapeutic’ and important for patients’ ‘self-identity (...) as active agents’— the presentation of false hope along the hope continuum entails a misconstrued balancing act. By not speaking up against unrealistic patient and family requests—including some requests for rights to try, resuscitative efforts in terminally ill patients, or other demands for non-beneficial treatments—healthcare providers precipitate harms, i.e., the FHH. These harms arise on both individual and communal levels and cannot be ignored. The goal of this paper is not to offer a definition of false hope, because the phenomenon of false hope is too complex for any simple definition. Instead, this paper seeks to make four points while outlining the FHH argument: consumer medicine and false hope are connected; providers and patients are very vulnerable in the system of consumer medicine; providers have a responsibility to stand up against false hope; and how the FHH argument could perhaps offer a footing to resist giving in to false hope. (shrink)

Sustaining hope in patients is an important element of health care, allowing improvement in patient welfare and quality of life. However in the palliative care context, with patients who are terminally ill, it might seem that in order to maintain hope the palliative care practitioner would sometimes have to deceive the patient about the full nature or prospects of their condition by providing a ‘false hope’. This possibility creates an ethical tension in palliative practice, where the beneficent desire to (...) improve patient welfare through sustaining hope appears to be in conflict with an autonomy-based requirement not to deceive patients about their condition. In order to resolve this ethical tension, we provide an analysis of the concept of hope and argue that there is at least one conception – the ‘absolute’ conception of hope – which when properly understood allows practitioners to foster hope in terminally-ill patients while avoiding any need to deceive them about their condition. Practitioners therefore do not need to shy away from using the language of hope in the palliative setting, as on this understanding of hope it can be used in a way that both promotes patient welfare and respects patient autonomy. (shrink)

Author Daniel Callahan discusses what he thinks is the cause of the health care crisis in the United States, and gives an alternative solution to the problem.

Accelerated approval of aducanumab for mild Alzheimer's by the U.S. Food and Drug Administration on June 7, 2021, has generated substantial medical, scientific, and ethical controversy. That approval was contrary to the nearly unanimous judgment of the FDA's Advisory Committee that little reliable evidence existed of significant benefit, even though the drug did reduce β‐amyloid. Three major ethical problems were created by this approval: (1) Medicare resources would be unjustly squandered, given the drug's $56,000 annual price and the 3.1 million (...) older potential American patients needing the drug; (2) physicians will feel ethically compelled to provide the drug to desperate, insistent patients, given FDA approval and in spite of side effects of brain bleeds and brain swelling; (3) and false hopes are generated for patients. A needed corrective by the federal government would reduce reimbursement to the bare cost of producing the drug (plus only a modest profit) until a phase IV trial has been successfully completed. (shrink)

Universal basic income is increasingly proposed as a simple answer to the problem of domination at work—one policy whose knock-on effects will transform the balance of power between workers and employers. I argue against such ‘UBI-first’ approaches. Compared to UBI proposals for other purposes, a UBI sufficient or near-sufficient for minimising domination at work would be especially demanding in two ways. First, the level of the grant would be more demanding compared to UBIs suitable for other purposes, in order for (...) workers to be able to credibly threaten to leave their jobs. Secondly, the maintenance of the grant must also meet strict criteria. The demanding level of the grant must be effectively secured against reduction, allowing workers to plan on its long-term acceptability; and in order to avoid increased state domination it must assume the status of an entitlement rather than a gift that may be withdrawn, through stabilisation against political change or some other means. These difficulties render UBI-first approaches doubtful at best, and an unhelpful distraction from other, more fruitful strategies at worst. (shrink)

This article offers a general discussion of the concept of false hope. Its ultimate aim is to clarify the meaning and the relevance of that concept for medicine and medical research. In the first part, the concept of hope is discussed. I argue that hope is more than a combination of a desire and a belief about the probability that the desire will be fulfilled. Imagination and anticipation are as well components of hope. I also discuss if hope implies (...) orientation to action. In the second part, I examine the concept of false hope. I show that hope is false if it cannot be justified epistemically. There is, I argue, an intimate relation between false hope and ignorance. Hope is justified—“realistic”—when the hoping person knows and accepts experts’ judgement about the probability of hope fulfillment. I then argue that what matters for evaluating a person’s hope is not only whether it is realistic, but also whether it is reasonable in the light of the aim and goals that a person strives for in his life. Part three goes into the question of what is morally wrong about having or causing false hope. In the fourth part, the relevance is shown of the insights from the previous parts for the debate on false hope in medicine and clinical research. (shrink)

Marleen Eijkholt presents a new argument in healthcare ethics, the false hope harms (FHH) argument. In brief, false hope promotes a host of individual harms (e.g., financial, physical, and psychological harms) and system‐level harms (e.g., distrust of medical practitioners, increased complexity of care and the associated costs), all of which provide reason for healthcare providers to stop promoting false hope in medicine. The goal of this paper is to show that the FHH argument is unsuccessful.

The precise application of the term ‘heroic measures’ in the discourse of medicine and medical ethics is somewhat uncertain. What counts and what does not is, at the margins, a perpetually contentious issue. Basically, though, we can say that the term refers to the deployment of unusual (rare, experimental, expensive, non-standard) technologies or treatment regimes, or of ordinary technologies or treatment regimes beyond their usual limits.

The precise application of the term ‘heroic measures’ in the discourse of medicine and medical ethics is somewhat uncertain. What counts and what does not is, at the margins, a perpetually contentious issue. Basically, though, we can say that the term refers to the deployment of unusual (rare, experimental, expensive, non-standard) technologies or treatment regimes, or of ordinary technologies or treatment regimes beyond their usual limits.

It is suggested that wittgenstein's picture theory of meaning is, In part a synthesis and resolution of the early metaphysics of moore and the theory of judgment held by russell about 1910. Moore's theory of the objective existence of concepts and their propositional role is considered. Russell's unsuccessful attempt at the problem of the false proposition is discussed. The ptm offers a more successful solution, Through the concept of logical form, Akin to the russellian concept of order. But this (...) solution still fails because it does not hold for ordinary language. (shrink)

In the original published article, in discussing Paul Cobley’s work, I made an unclear statement and one that was actually false. I mentioned that Cobley is critical of “otherness” as it has been explored in sex and gender studies.

As a growing number of faculty use constructivist and constructionist approaches to teaching in SL, little research exists on the many ethical considerations and legal implications that affect course development. Following the experiences of the instructor and five students, their 12-week journey is documented through interviews, journals, blogs, weekly course activities, SL class dialogs, and in-world assignments. Additionally, five faculty and staff experts who taught or trained in SL at this university were also interviewed and consulted. Ethical considerations in constructivist (...) and constructionist teaching were time, appearance, skills, scaffolded instruction, playful exploration, vicarious experience, self-directed project development, construction of objects, constructivism and constructionism balance, social networking and collaboration, harassment and griefing, false identities and alternate avatars, chat log sharing, and copyright and trademark violations. Lessons learned included developing scaffolded pedagogical approaches that moved from direct teaching to constructivism and constructionism, and required faculty and student adherence to the SL TOS, Community Standards, and Intellectual Property policy. (shrink)

This work studies hope as a phenomenon that both reveals and belongs to our status of being human. To understand that status, we must understand what it means to hope, which profoundly surpasses both psychological wish or desire and the "merely religious" belief in salvation. The author looks at hope in all its concrete manifestation: He examines works of art, some of which depict hope in unflattering terms as delusional, while others see it as dangerous and elusive; he examines (...) class='Hi'>false hope as that which confuses intensity of desire for a specific boon as an actual cause of the boon; he points to the metaphors of hope (light and darkness as congruents of revealing/concealing; or the two forms of light itself: illumination, or hope for, vs. radiation, or hope in (to trust). (shrink)

Abstract.The United Kingdom Department of Health initiative on “The Expert Patient” (2001) reflects recent trends in political philosophy, ethics and health services research. The overall objective of the initiative is to encourage patients, particularly those suffering from chronic conditions to become more actively involved in decisions concerning their treatment. In doing so there would be (perhaps) an expectation of better patient compliance and (arguably) a resultant improvement in quality of life. Despite these anticipated beneficial influences on health outcomes, there may (...) be a danger that such initiatives are being carried along by the general swell of enthusiasm for recognising and facilitating the claims of disadvantaged or discriminated against groups. What more attractive than that patients should be “liberated” from what might be seen as the oppression of medical paternalism? To a great extent the potential for success of the Expert Patient venture turns on:(a) whether and to what extent a patient can be considered truly to be an expert and (b) full acceptance by the medical and heath care professions of allowing patients a more equitable and positive role.Whilst clearly the patient is an expert in the hermeneutic sense – it is they and they alone who experience their illness – there is nevertheless a risk of confusing experience with expertise. Experience limited to an individual does not of itself give rise to the generalisations that underlie reliable clinical treatment. Neither do the vast majority of patients possess the physiological and pharmacological knowledge to fully appreciate the biological nature of their illness nor the basis, risks or limitations of therapeutic measures. Might the notion of “The Expert Patient” as informed co-decision maker become a well-meaning but rather vacuous aspiration similar to that of informed consent? Even worse, could patient “empowerment” have a deleterious effect? The paper reviews some of the major issues and concludes that the expert patient initiative could have benefits for both patients and health professionals if operated on the basis of concordance: an informed collaborative alliance that optimises the potential benefits of medical care. (shrink)

The knowability paradox derives from a proof by Frederic Fitch in 1963. The proof purportedly shows that if all truths are knowable, it follows that all truths are known. Antirealists, wed as they are to the idea that truth is epistemic, feel threatened by the proof. For what better way to express the epistemic character of truth than to insist that all truths are knowable? Yet, if that insistence logically compels similar assent to some omniscience claim, antirealism is in jeopardy. (...) Response to the paradox has drifted toward a common theme, a theme I will argue is a non-starter in resolving the paradox. Seeing this point will also make clear the philosophical inadequacy of simply viewing the paradox as a refutation of a wide range of antirealisms. (shrink)

The purpose of this study is to identify if gender differences exist with respect to conviction of university students for academic dishonesty. To investigate this phenomenon, data from the Swedish National Agency for Higher Education (SNAHE) and from disciplinary boards of several Swedish universities were evaluated from a gender perspective. To identify whether the penalty severity for academic dishonesty is gender biased, the ratio of suspensions/warnings for male and female students was calculated. It was identified that female students are less (...) prevalent in disciplinary matters and that there was no systematic gender bias in penalty severities (warnings or suspensions). In addition, female students deny academic dishonest behaviors more than male students, indicating a possibly higher false conviction rate. (shrink)

At times of general malaise and social breakdown, it is not uncommon for millenarian movements to arise to replace lost hopes by idle dreams: dreams of a savior who will lead us from bondage, or of the return of the great ships with their bounty, as in the cargo cults of South Sea islanders. Some may yearn for a lost golden age, or succumb to the blandishments of the new Messiahs who come to the fore at such moments. Those (...) more cognizant of the institutional causes of discontent may be attracted to an image of hope destroyed by dark and powerful forces that stole from us the leader who sought a better future. The temptation to seek solace, or salvation, is particularly strong when the means to become engaged in a constructive way in determining one's fate have largely dissolved and disappeared. (shrink)

Ever since the U.S. Attorney General named health care fraud as the government's second highest priority after violent crime, the government has cracked down on health care fraud and abuse. Some of this crackdown has been needed. The General Accounting Office estimates that as much as 10 percent of all government expenditures on health care are being siphoned out of the system because of fraud or abuse.The extreme measures taken to curb health care abuse have raised eyebrows, however. The American (...) Medical Association and the American Hospital Association both have been vocal in their disapproval, describing the current enforcement initiative as “absolutely out of control.” The associations even went so far as to file suit to enjoin the government's actions. (shrink)

Ever since the U.S. Attorney General named health care fraud as the government's second highest priority after violent crime, the government has cracked down on health care fraud and abuse. Some of this crackdown has been needed. The General Accounting Office estimates that as much as 10 percent of all government expenditures on health care are being siphoned out of the system because of fraud or abuse.The extreme measures taken to curb health care abuse have raised eyebrows, however. The American (...) Medical Association and the American Hospital Association both have been vocal in their disapproval, describing the current enforcement initiative as “absolutely out of control.” The associations even went so far as to file suit to enjoin the government's actions. (shrink)

ABSTRACT When hope is discussed in bioethics’ literature, it is most often in the context of ‘false hopes’ and/or how to maintain hope while breaking bad news to patients. Little or no time is generally devoted to the description of hope that supports these analyses. In this paper, I present a detailed description of hope, one designed primarily for the healthcare context. Noting that hope is an emotional attitude, four key aspects are explored. In particular, the function of (...) imagination in hope is discussed in depth. Through an examination of the relationship between hope and vulnerability, I demonstrate how adequately describing hope can broaden the normative inquiry into the role of hope in healthcare. Three ways in which persons with hope can be vulnerable are illustrated, and the challenge of how healthcare providers can attend in moral ways to the hopes of patients is identified. (shrink)

Hope, in its propositional construction "I hope that p," is compatible with a stated chance for the speaker that not-p. On fallibilist construals of knowledge, knowledge is compatible with a chance of being wrong, such that one can know that p even though there is an epistemic chance for one that not-p. But self-ascriptions of propositional hope that p seem to be incompatible, in some sense, with self-ascriptions of knowing whether p. Data from conjoining hope self-ascription with outright assertions, with (...) first- and third-person knowledge ascriptions, and with factive predicates suggest a problem: when combined with a plausible principle on the rationality of hope, they suggest that fallibilism is false. By contrast, the infallibilist about knowledge can straightforwardly explain why knowledge would be incompatible with hope, and can offer a simple and unified explanation of all the linguistic data introduced here. This suggests that fallibilists bear an explanatory burden which has been hitherto overlooked. (shrink)

This paper examines expressed hopelessness among environmental activists in Extinction Rebellion. While activists claim that they have lost all hope for a future without global warming and species extinction, through despair emerges a new hope for saving what can still be saved—a hope for what is left. This radical hope, emerging from despair, may make Extinction Rebellion even more effective. Drawing from personal interviews with 25 Extinction Rebellion activists in the United Kingdom and the published work of other Extinction Rebellion (...) activists, this paper identifies signs of radical hope. While activists have cast off false hope and passive hope, a new hope for what is still possible remains. This hope is based on virtue ethics: doing what is right in the moment, rather than being attached to a desired outcome. This drives forward activism despite the results. Through their principle of regenerative culture, Extinction Rebellion activists learn to support each other and be prepared for a more turbulent and challenging future. Through a regenerative culture they can salvage and repair what is left and sustain radical hope. (shrink)

The aim of this paper is to explore a pragmatic approach to hope and the ethics of belief that allows rational hope against hope. Hope against hope is hope that goes beyond what the evidence supports by hoping for something that is both highly unlikely and highly valuable. However, this could take different forms. One could either hope against the evidence or merely go beyond it; the evidence could be inconclusive or conclusive, conflicting or clear, misleading or plain, absent or (...) neutral. Hope against hope then covers everything from hoping for something that appears unlikely to hoping for something that appears impossible, judging by the available evidence. However, there is a very long tradition of criticizing hope for being false or irrational. But hope can only be false or irrational if it is subject to rational assessment. This presupposes that it is appropriate to ask for a reason or a justification for hoping, since one can be answerable or responsible for hoping. Moreover, this typically assumes that hopes can be changed in response to reasons. False hopes, notably, should be given up (if possible). However, if hope is subject to rational assessment, it is also possible for hope to be rational or justified. Indeed, I will explore how practical reasons or pragmatic considerations may justify hope against hope, sketching criteria for rational hope that allow hope against hope. Section I introduces evidentialism and pragmatism regarding belief. Sections II and III discuss whether or not rational hope against hope is compatible with evidentialism, favoring a pragmatist approach to hope and belief. Section IV discusses evidentialism and pragmatism, whereas sections V-VII sketch constraints on pragmatism and rational hope. (shrink)

The paper attempts to show that Christian hope is not a product of religious fantasy. It finds today an ally in the dialogue with the natural sciences which started in recent years on the topic of the ultimate destiny of the world. The natural sciences have confirmed that the universe is doomed to physical annihilation. Humanity with its cultural riches, scientists say, is only an episode in universal history and doomed to perish. Hence, if the Earth is nothing more than (...) an island of rationality in a cosmic void, then the only thing we can do is to keep up a heroic attitude worthy of human beings towards our own fragile existence. Contemporary science’s visions of the future are pessimistic: abundant, though short-lived, evolution culminating in a sense of final futility and the ultimate destruction of all life in the universe. Such forecasts question religion’s claims for the eschatological transformation of all creation. Christian eschatology does not accept, however, reductionist presuppositions about the very nature of reality. The universe contains levels of meaning far richer than what we have been able to discover sofar. Theology’s task is not to provide easy consolation, or generate false hopes. It has a good reason to avoid catastrophism, and maintain calm in its strivings to keep up our faith in God’s concern for the destiny of all His creatures. Theologians have to take a serious stand on the very concept of finitude, furthered by natural and social sciences. This, in turn, will require critical review of such concepts as the world’s future in God, hope and new creation. This effort must be undertaken in dialogue with the scientific views of the world’s finitude. Both sides are prone to stereotype judgements and shallow answers which must be corrected in consideration of the complexity of the issue at hand. Christian theology has to justify its claim to truth, but certainly not by launching battles with science. Christian hope shows the new creation not as annihilation and destruction of the old but as its ultimate transfiguration and salvific transformation. It speaks about the paradox of continuity/discontinuity in this new universe’s emergence. Special attention is paid in the paper to the “logical” structure of matter. If the world ofultimate events is, in fact, to be a new world of the resurrection, created by transition into new reality, then certain scientific suggestions and data on the present world’s processes could prove helpful in grasping the truly cosmic dimensions of Christian hope. Crucial here will not so much be particular data but rather a sort of meta-science allowing the deduction of general concepts from the detailed achievements of scientific research. Such generalized insights include today the following elements: 1) the dynamic concept of physical reality, 2) the relationality of its processes and, 3) a deeper understanding of the complexity of matter/energy as carriers of a specific information-bearing pattern. It appears that there are some similarities in science’s and theology’s strivings for a deeper understanding of the truth of reality, which continues to evade our theories and teaches us modesty. Neither method nor concept has yet managed to explaineverything. There exists no universal key to a comprehensive interpretation. The postulate to avoid reductionism in approaching the manifold richness of reality is addressed to scientists and theologians alike. (shrink)

The election of Donald Trump has exposed American society’s profound crisis of hope. By 2016 a generation of shrinking employment, rising inequality, the attack on public education, and the shredding of the social safety net, had set the stage for stunning insurgencies at opposite ends of the political spectrum. Against this dire background, Ronald Aronson offers an answer. He argues for a unique conception of social hope, one with the power for understanding and acting upon the present situation. Hope, he (...) argues, is far more than a mood or feeling—it is the very basis of social will and political action. It is this kind of hope that Aronson sees brewing in the supporters of Bernie Sanders, who advocated the tough-minded and inspired disposition to act collectively to make the world more equal, more democratic, more peaceful, and more just. And it was directly contrasted by Trump’s supporters who showed a cynical and nostalgic faith in an authoritarian strongman replete with bigotry and misogyny. Beneath today’s crisis Aronson examines our heartbreaking story: a century of catastrophic violence and the bewildering ambiguity of progress—all of which have contributed to the evaporation of social hope. As he shows, we are now in a time when hope is increasingly privatized, when—despite all the ways we are connected to each other—we are desperately alone, struggling to weather the maelstrom around us, demoralized by the cynicism that permeates our culture and politics, and burdened with finding personal solutions to social problems. Yet, Aronson argues, even at a time when false hopes are rife, social hope still persists. Carefully exploring what we mean when we say we “hope” and teasing hope apart from its dangerously misconstrued sibling, “progress,” he locates seeds of real change. He argues that always underlying our experience—even if we completely ignore it—is the fact of our social belonging, and that this can be reactivated into a powerful collective force, an active we. He looks to various political movements, from the massive collective force of environmentalists to the movements around Sanders and Jeremy Corbyn, as powerful examples of socially energized, politically determined, and actionably engaged forms of hope. Even in this age of Donald Trump, the result is an illuminating and inspiring call that anyone can clearly hear: we can still create a better future for everyone, but only if we resist false hopes and act together. (shrink)

-/- Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. -/- Research objectives: The purpose of this inquiry was to explore nurses’ moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social–moral space of nurses’ work in order to (...) capture how competencies may reflect an adaptation to a less than ideal work environment. -/- Research design: A critical qualitative approach was used. -/- Participants: Fifteen graduate nursing students from various practice areas participated. -/- Ethical considerations: After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed. -/- Findings: One overarching theme ‘Mediating the tension between providing false hope and destroying hope within biomedicine’ along with three subthemes, including ‘Reimagining hopeful possibilities’, ‘Exercising caution within the social–moral space of nursing’ and ‘Maintaining nurses’ own hope’, was identified, which represents specific aspects of this moral competency. -/- Discussion: This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope. -/- Conclusion: The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings. (shrink)

Hope takes on a particularly important role in end of life situations. Sustaining hope can have considerable benefits for the quality of life and any prospect of a good death for the dying. However, it has proved difficult to adequately account for hope when dying, particularly in some of the more extreme end of life situations. Standard secular accounts of hope struggle to establish how the fostering of hope may be possible in such situations. This leads to a practical ethical (...) dilemma for those caring for the dying, the ‘paradox of hope’, whereby one can either help maintain the welfare of the dying by generating a misleading ‘false hope’ or maintain truthfulness and concede that hope is not possible. These two problems combine to leave individuals the prospect of dying in terrible circumstances facing only despair. To address this, I argue that we should look beyond standard intentional or dispositional accounts of hope in such cases and treat hope as a cluster concept. Rather than appeal to a unitary conception, what we precisely mean by ‘hope’ may therefore vary depending on the context of use. I outline an account of hope based on Marcel’s account of ‘absolute’ hope but offering an alternative, secular foundation based on solidarity that can explain how hope when dying in extreme circumstances is possible. Hence, where the more familiar accounts break-down in these circumstances, ‘hope talk’ may still be possible if it is seen as relying on this conception of hope. (shrink)

The paper attempts to show that Christian hope is not a product of religious fantasy. It finds today an ally in the dialogue with the natural sciences which started in recent years on the topic of the ultimate destiny of the world. The natural sciences have confirmed that the universe is doomed to physical annihilation. Humanity with its cultural riches, scientists say, is only an episode in universal history and doomed to perish. Hence, if the Earth is nothing more than (...) an island of rationality in a cosmic void, then the only thing we can do is to keep up a heroic attitude worthy of human beings towards our own fragile existence. Contemporary science’s visions of the future are pessimistic: abundant, though short-lived, evolution culminating in a sense of final futility and the ultimate destruction of all life in the universe. Such forecasts question religion’s claims for the eschatological transformation of all creation. Christian eschatology does not accept, however, reductionist presuppositions about the very nature of reality. The universe contains levels of meaning far richer than what we have been able to discover sofar. Theology’s task is not to provide easy consolation, or generate false hopes. It has a good reason to avoid catastrophism, and maintain calm in its strivings to keep up our faith in God’s concern for the destiny of all His creatures. Theologians have to take a serious stand on the very concept of finitude, furthered by natural and social sciences. This, in turn, will require critical review of such concepts as the world’s future in God, hope and new creation. This effort must be undertaken in dialogue with the scientific views of the world’s finitude. Both sides are prone to stereotype judgements and shallow answers which must be corrected in consideration of the complexity of the issue at hand. Christian theology has to justify its claim to truth, but certainly not by launching battles with science. Christian hope shows the new creation not as annihilation and destruction of the old but as its ultimate transfiguration and salvific transformation. It speaks about the paradox of continuity/discontinuity in this new universe’s emergence. Special attention is paid in the paper to the “logical” structure of matter. If the world ofultimate events is, in fact, to be a new world of the resurrection, created by transition into new reality, then certain scientific suggestions and data on the present world’s processes could prove helpful in grasping the truly cosmic dimensions of Christian hope. Crucial here will not so much be particular data but rather a sort of meta-science allowing the deduction of general concepts from the detailed achievements of scientific research. Such generalized insights include today the following elements: 1) the dynamic concept of physical reality, 2) the relationality of its processes and, 3) a deeper understanding of the complexity of matter/energy as carriers of a specific information-bearing pattern. It appears that there are some similarities in science’s and theology’s strivings for a deeper understanding of the truth of reality, which continues to evade our theories and teaches us modesty. Neither method nor concept has yet managed to explaineverything. There exists no universal key to a comprehensive interpretation. The postulate to avoid reductionism in approaching the manifold richness of reality is addressed to scientists and theologians alike. (shrink)

The paper attempts to show that Christian hope is not a product of religious fantasy. It finds today an ally in the dialogue with the natural sciences which started in recent years on the topic of the ultimate destiny of the world. The natural sciences have confirmed that the universe is doomed to physical annihilation. Humanity with its cultural riches, scientists say, is only an episode in universal history and doomed to perish. Hence, if the Earth is nothing more than (...) an island of rationality in a cosmic void, then the only thing we can do is to keep up a heroic attitude worthy of human beings towards our own fragile existence. Contemporary science’s visions of the future are pessimistic: abundant, though short-lived, evolution culminating in a sense of final futility and the ultimate destruction of all life in the universe. Such forecasts question religion’s claims for the eschatological transformation of all creation. Christian eschatology does not accept, however, reductionist presuppositions about the very nature of reality. The universe contains levels of meaning far richer than what we have been able to discover sofar. Theology’s task is not to provide easy consolation, or generate false hopes. It has a good reason to avoid catastrophism, and maintain calm in its strivings to keep up our faith in God’s concern for the destiny of all His creatures. Theologians have to take a serious stand on the very concept of finitude, furthered by natural and social sciences. This, in turn, will require critical review of such concepts as the world’s future in God, hope and new creation. This effort must be undertaken in dialogue with the scientific views of the world’s finitude. Both sides are prone to stereotype judgements and shallow answers which must be corrected in consideration of the complexity of the issue at hand. Christian theology has to justify its claim to truth, but certainly not by launching battles with science. Christian hope shows the new creation not as annihilation and destruction of the old but as its ultimate transfiguration and salvific transformation. It speaks about the paradox of continuity/discontinuity in this new universe’s emergence. Special attention is paid in the paper to the “logical” structure of matter. If the world ofultimate events is, in fact, to be a new world of the resurrection, created by transition into new reality, then certain scientific suggestions and data on the present world’s processes could prove helpful in grasping the truly cosmic dimensions of Christian hope. Crucial here will not so much be particular data but rather a sort of meta-science allowing the deduction of general concepts from the detailed achievements of scientific research. Such generalized insights include today the following elements: 1) the dynamic concept of physical reality, 2) the relationality of its processes and, 3) a deeper understanding of the complexity of matter/energy as carriers of a specific information-bearing pattern. It appears that there are some similarities in science’s and theology’s strivings for a deeper understanding of the truth of reality, which continues to evade our theories and teaches us modesty. Neither method nor concept has yet managed to explaineverything. There exists no universal key to a comprehensive interpretation. The postulate to avoid reductionism in approaching the manifold richness of reality is addressed to scientists and theologians alike. (shrink)

The paper attempts to show that Christian hope is not a product of religious fantasy. It finds today an ally in the dialogue with the natural sciences which started in recent years on the topic of the ultimate destiny of the world. The natural sciences have confirmed that the universe is doomed to physical annihilation. Humanity with its cultural riches, scientists say, is only an episode in universal history and doomed to perish. Hence, if the Earth is nothing more than (...) an island of rationality in a cosmic void, then the only thing we can do is to keep up a heroic attitude worthy of human beings towards our own fragile existence. Contemporary science’s visions of the future are pessimistic: abundant, though short-lived, evolution culminating in a sense of final futility and the ultimate destruction of all life in the universe. Such forecasts question religion’s claims for the eschatological transformation of all creation. Christian eschatology does not accept, however, reductionist presuppositions about the very nature of reality. The universe contains levels of meaning far richer than what we have been able to discover sofar. Theology’s task is not to provide easy consolation, or generate false hopes. It has a good reason to avoid catastrophism, and maintain calm in its strivings to keep up our faith in God’s concern for the destiny of all His creatures. Theologians have to take a serious stand on the very concept of finitude, furthered by natural and social sciences. This, in turn, will require critical review of such concepts as the world’s future in God, hope and new creation. This effort must be undertaken in dialogue with the scientific views of the world’s finitude. Both sides are prone to stereotype judgements and shallow answers which must be corrected in consideration of the complexity of the issue at hand. Christian theology has to justify its claim to truth, but certainly not by launching battles with science. Christian hope shows the new creation not as annihilation and destruction of the old but as its ultimate transfiguration and salvific transformation. It speaks about the paradox of continuity/discontinuity in this new universe’s emergence. Special attention is paid in the paper to the “logical” structure of matter. If the world ofultimate events is, in fact, to be a new world of the resurrection, created by transition into new reality, then certain scientific suggestions and data on the present world’s processes could prove helpful in grasping the truly cosmic dimensions of Christian hope. Crucial here will not so much be particular data but rather a sort of meta-science allowing the deduction of general concepts from the detailed achievements of scientific research. Such generalized insights include today the following elements: 1) the dynamic concept of physical reality, 2) the relationality of its processes and, 3) a deeper understanding of the complexity of matter/energy as carriers of a specific information-bearing pattern. It appears that there are some similarities in science’s and theology’s strivings for a deeper understanding of the truth of reality, which continues to evade our theories and teaches us modesty. Neither method nor concept has yet managed to explaineverything. There exists no universal key to a comprehensive interpretation. The postulate to avoid reductionism in approaching the manifold richness of reality is addressed to scientists and theologians alike. (shrink)

IntroductionDeep brain stimulation (DBS) is utilized to treat pediatric refractory dystonia and its use in pediatric patients is expected to grow. One important question concerns the impact of hope and unrealistic optimism on decision-making, especially in “last resort” intervention scenarios such as DBS for refractory conditions.ObjectiveThis study examined stakeholder experiences and perspectives on hope and unrealistic optimism in the context of decision-making about DBS for childhood dystonia and provides insights for clinicians seeking to implement effective communication strategies.Materials and MethodsSemi-structured interviews (...) with clinicians (n = 29) and caregivers (n = 44) were conducted, transcribed, and coded.ResultsUsing thematic content analysis, four major themes from clinician interviews and five major themes from caregiver interviews related to hopes and expectations were identified. Clinicians expressed concerns about caregiver false hopes (86%, 25/29) and desperation (68.9%, 20/29) in light of DBS being a last resort. As a result, 68.9% of clinicians (20/29) expressed that they intentionally tried to lower caregiver expectations about DBS outcomes. Clinicians also expressed concern that, on the flip side, unrealistic pessimism drives away some patients who might otherwise benefit from DBS (34.5%, 10/29). Caregivers viewed DBS as the last option that they had to try (61.3%, 27/44), and 73% of caregivers (32/44) viewed themselves as having high hopes but reasonable expectations. Fewer than half (43%, 19/44) expressed that they struggled setting outcome expectations due to the uncertainty of DBS, and 50% of post-DBS caregivers (14/28) expressed some negative feelings post treatment due to unmet expectations. 43% of caregivers (19/44) had experiences with clinicians who tried to set low expectations about the potential benefits of DBS.ConclusionThoughtful clinician-stakeholder discussion is needed to ensure realistic outcome expectations. (shrink)

ABSTRACT When hope is discussed in bioethics’ literature, it is most often in the context of ‘false hopes’ and/or how to maintain hope while breaking bad news to patients. Little or no time is generally devoted to the description of hope that supports these analyses. In this paper, I present a detailed description of hope, one designed primarily for the healthcare context. Noting that hope is an emotional attitude, four key aspects are explored. In particular, the function of (...) imagination in hope is discussed in depth. Through an examination of the relationship between hope and vulnerability, I demonstrate how adequately describing hope can broaden the normative inquiry into the role of hope in healthcare. Three ways in which persons with hope can be vulnerable are illustrated, and the challenge of how healthcare providers can attend in moral ways to the hopes of patients is identified. (shrink)

The orthodox definition of hope suffers from an exclusion problem: it is unable to exclude subjects without hope. In fact, the orthodox definition even allows for despair to be falsely classified as hope. This problem suggests two basic desiderata for a successful analysis of hope: it should solve the exclusion problem, and it should have the resources to explain why, in a given situation, a subject does or does not form a hope. Bearing these desiderata in mind, I assess two (...) recent hope‐accounts offered by Jack M. C. Kwong and Cheshire Calhoun. I then offer my own view, which is based on the Jamesian notion of a “live possibility”. I suggest that a possibility needs to reach a certain probability threshold in order to count as live, and according to my account, to hope is to desire the truth of such a live possibility. This view is well‐equipped to solve the exclusion problem, and it can explain why a subject does or does not hope. (shrink)

There are, I thinks too many morally significant exceptions to accept the physician's rationales or the bioethicist's criticisms, stated siveepingly. Physicians need to take account of the harms caused by loss of hopes, especially false hopes due to deception, as Ivell, as of the harms of successfully maintained deceptive hopes. As for autonomy, hopes even..

Thomas Aquinas has argued that the passion of hope is the movement of the sensitive appetite and the first of the irascible passion. The first part of the article aims to explore the cause and the mechanism of the passion of hope, and tries to clarify the relationship between the passion of hope and the perception. In human beings, it is possible that the passion of hope is caused by false judgement of the perception, which will lead to the (...) result of false hope. In Aquinas’s argument, the problem of false hope could be solved through the moral virtue and the prudence. In the second part of this article, the aim is to analyse how the virtue of magnanimity, humility and the prudence work impact on the passion of hope and perfect it.Contribution: This research concentrates on the topic of the passion of hope of Thomas Aquinas, and provides a new perspective on the understanding of the relationship between the passion and the virtue. (shrink)

there are two lines of influence of David Hume on the history of classical American pragmatism: the familiar atomist-nominalist-associationist of empirical psychology reviled by Kantian and idealist critics, on the one side, and the conjectural historian and early developmentalist, or evolutionary, philosopher who was important to Darwin, on the other. The classical pragmatists received the first most directly through the work of Thomas Hill Green, in his edition of the Treatise of Human Nature—with its long critical introduction—that appeared in the (...) 1870s. In this essay I argue that the atomist of the traditional reading is a false Hume, with the hope that identification of the error will make way for a better... (shrink)