Wednesday, November 5, 2008

Keeping Alive with Hope

Hope has been a consistent theme in Barack Obama's campaign, which thankfully came to a glorious end (many of us can now "hope" to actually get some work done after weeks of checking every ten minutes). His book was titled The Audacity of Hope. In the close of his victory speech, he stated "Let us keep that promise, that American promise, and in the words of scripture hold firmly, without wavering, to the hope that we confess." Newspaper headlines proclaim "Elections Unleash Flood of Hope Worldwide (NYTimes) and "Time to Hope Again" (Washington Post).

Hope is also a central theme in translational research, driving research advocates ("Hope for a Cure"), perseverance at the lab bench, and for better and for worse, the participation of gravely ill patients in trials that offer the slimmest prospect of serious medical benefit. Hope in many settings– particularly in the political– is an unalloyed good. 

But in the context of enrolling patients in early phase trials, hope becomes morally ambiguous.  Or at least, so Penn philosopher Adrienne M. Martin would seem to suggest in her critical analysis of hope ("Hope and Exploitation," Sept / Oct issue of Hastings Center Report).

Martin begins her essay with a set of consensus observations about hope: 1- it involves a desire for an outcome; 2- it involves imaginative engagement with a desired outcome– like praying or fantasy; 3- it often frames how people interpret and use information.  She then goes on to explore the various ways that hope can lead to exploitation in clinical research.

Much has been written about "hope" in bioethics, and much of it is drivel. I have a number of reservations about Martin's article. For my money, however, this is the most compelling analysis of the phenomenon that I know of. I highly recommend this article to anyone who takes seriously the moral dimensions of how translational research engages hope. (photo credit: San Diego Shooter, Tattered Hope, 2008)

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