Abstract
Hope helps alleviate suffering. In the case of terminal illness, recent experience in palliative medicine has taught physicians that hope is durable and often thrives even in the face of imminent death. In this article, I examine the perspectives of philosophers, theologians, psychologists, clinicians, neuroscientists, and poets, and provide a series of observations, connections, and gestures about hope, particularly about what I call “deep hope.” I end with some proposals about how such hope can be sustained and enhanced at the end of life. Studies of terminally ill patients have revealed clusters of personal and situational factors associated with enhancement or suppression of hope at the end of life. Interpersonal connectedness, attainable goals, spiritual beliefs and practices, personal attributes of determination, courage, and serenity, lightheartedness, uplifting memories, and affirmation of personal worth enhance hope, while uncontrollable pain and discomfort, abandonment and isolation, and devaluation of personhood suppress hope. I suggest that most of these factors can be modulated by good medical care, utilizing basic interpersonal techniques that demonstrate kindness, humanity, and respect.
Similar content being viewed by others
Notes
Shorter Oxford English Dictionary, 1993 ed., s.v. “hope.”
Classical conditioning may also play a role in placebo responses, but the extent of its effect and its relationship to conscious expectancy are unknown.
It should be noted that the American Medical Association borrowed this quotation virtually intact from Thomas Percival’s Medical Ethics, which was first published in 1803 [63].
This is not a claim that all mystical traditions are the same but merely that mystical experience appears to share many characteristics across religions.
References
Ober, K.P. 2003. Mark Twain and medicine: "Any mummery will cure.” Columbia, MO: University of Missouri Press.
Groopman, Jerome. 2004. The anatomy of hope: How people prevail in the face of illness. New York: Random House.
Shakespeare, William. 1952. Measure for measure. In Shakespeare—the complete works, ed. George B. Harrison, 1103–1135. New York: Harcourt Brace.
Hertzler, Arthur E. 1940. The horse and buggy doctor. Garden City: Blue Ribbon Books.
Oken, Donald. 1961. What to tell cancer patients: A study of medical attitudes. JAMA 175: 1120–1128.
Novack, Dennis H., Robin Plumer, Raymond L. Smith, Herbert Ochitill, Gary R. Morrow, and John M. Bennett. 1979. Changes in physician attitudes toward telling the cancer patient. JAMA 241: 897–900.
Kodish, Eric, and Stephen G. Post. 1995. Oncology and hope. Journal of Clinical Oncology 13(7): 1817–1822.
Saunders, Cicely. 1984. The philosophy of terminal care. In The management of terminal malignant disease, ed. C. Saunders. London: Edward Arnold.
Cherny, Nathan. 2004. The challenge of palliative medicine: The problem of suffering. In Oxford textbook of palliative medicine, ed. Derek Doyle, Geoffrey W.C. Hanks, Nathan Cherny, and Kenneth Calman, 7–14. Oxford: Oxford University Press.
Warr, Thomas. 1999. The physician’s role in maintaining hope and spirituality. Bioethics Forum 15(1): 31–37.
Von Roenn, Jamie H., and Charles F. von Gunten. 2003. Setting goals to maintain hope. Journal of Clinical Oncology 21(3): 570–574.
Beck, Anthony L., Robert M. Arnold, and Timothy E. Quill. 2003. Hope for the best, and prepare for the worst. Annals of Internal Medicine 138(3): 439–443.
McCormick, Thomas R., and Becky J. Conley. 1995. Patient perspectives on dying and on the care of dying patients. Western Journal of Medicine 163: 236–243.
Helwick, Caroline. 2010. Fostering hope in hopeless situations. MedConnect March 23. http://medconnect.com.my/tabid/92/s19/Psychiatry/ct1/c36049/Fostering-Hope-in-Hopeless-Situations/Default.aspx. Accessed 29 Dec 2010.
Pellegrino, Edmund D., and David C. Thomasma. 1996. The Christian virtues in medical practice. Washington, DC: Georgetown University Press.
Johnson, Thomas H. (ed.). 1960. The complete poems of Emily Dickinson. Boston: Little, Brown and Company.
Marcel, Gabriel. 1960. Fresh Hope in the world. London: Longmans.
Tillich, Paul. 1990. The right to hope. Sermon given in 1965, Christian Century Nov. 14: 1064–1067.
Frankl, Viktor. 2006. Man’s search for meaning. Boston: Beacon Press.
Miller, Judith F. 1985. Inspiring hope. American Journal of Nursing 85: 23–25.
DuFault, Karin, and Benita C. Martoocchio. 1985. Hope: Its spheres and dimensions. Nursing Clinics of North America 20: 379–391.
Herth, Kaye. 1990. Fostering hope in terminally ill people. Journal of Advanced Nursing 15: 1250–1259.
Benzein, Eva, Astrid Norberg, and Britt-Inger Saveman. 2001. The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine 15: 117–126.
Steinbock, Anthony J. 2004. Hoping against hope. In The phenomenology of hope: The 21st annual symposium of the Simon Silverman Phenomenology Center, ed. D.J. Martino, 1–18. Pittsburgh: The Simon Silverman Phenomenology Center.
Snyder, C.Richard. 2003. Hope theory: Rainbows in the mind. Psychological Inquiry 13(4): 249–275.
Farina, Carol J., Kaye A. Herth, and Judith Popovich. 1995. Hope and hopelessness: Critical clinical constructs. Thousand Oaks, CA: Sage.
Feldman, David B., and C. Richard Snyder. 2005. Hope and the meaningful life: Theoretical and empirical associations between goal-directed thinking and life meaning. Journal of Social and Clinical Psychology 24: 401–421.
Nekolaichuk, Cheryl L., Ronna F. Jevne, and Thomas O. Maguire. 1999. Structuring the meaning of hope. Social Science and Medicine 48: 591–605.
Cutcliffe, John R., and Kaye Herth. 2002. The concept of hope in nursing 1: Its origins, background, and nature. British Journal of Nursing 11(12): 832–840.
Morse, Janice M., and B. Doberneck. 1995. Delineating the concept of hope. Image 27: 277–285.
Scheier, Michael F., and Charles S. Carver. 1985. Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology 4(3): 219–247.
Snyder, C.Richard. 1995. Conceptualizing, measuring, and nurturing hope. Journal of Counseling and Development 73: 355–360.
Averill, James R., George Catlin, and Kyum K. Chon. 1990. Rules of hope. New York: Springer-Verlag.
Bryant, Fred B., and Jamie A. Cvengros. 2004. Distinguishing hope and optimism: Two sides of a coin, or two separate coins? Journal of Social and Clinical Psychology 23: 273–302.
Tindle, Hillary A., Yue-Fang Chang, Lewis H. Kuller, et al. 2009. Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women’s Health Initiative. Circulation 120: 656–662.
Tinker, Leslie F., Milagros C. Rosal, Anne F. Young, et al. 2007. Predictors of dietary change and maintenance in the Women’s Health Initiative Dietary Modification Trial. Journal of the American Dietetic Association 107: 1155–1166.
Raikkonen, Katri, Karen A. Matthews, Janine D. Flory, Jane F. Owens, and Brooks B. Gump. 1999. Effects of optimism, pessimism, and trait anxiety on ambulatory blood pressure and mood during everyday life. Journal of Personality and Social Psychology 76: 104–113.
Matthews, Karen A., Katri Raikkonen, Kaye Sutton-Tyrrell, and Lewis H. Kuller. 2004. Optimistic attitudes protect against progression of carotid atherosclerosis in healthy middle-aged women. Psychosomatic Medicine 66: 640–644.
Pope, A. 1994. An essay on man and other poems. Mineola, NY: Dover Publications.
Hall, Stephen S. 2010. Wisdom: From philosophy to neuroscience. New York: Alfred A. Knopf.
Meeks, Thomas W., and Dilip V. Jeste. 2009. Neurobiology of wisdom: A literature review. Archives of General Psychiatry 66: 355–365.
Seybold, Kevin S. 2007. Physiological mechanisms involved in religiosity/spirituality and health. Journal of Behavioral Medicine 30: 303–309.
Colloca, Luana, Fabrizio Benedetti, and Carlo Adolfo Porro. 2008. Experimental designs and brain mapping approaches for studying the placebo analgesic effect. European Journal of Applied Physiology 102: 371–380.
Faria, Vanda, Mats Fredrikson, and Tomas Furmark. 2008. Imagining the placebo response: A neurofunctional review. European Neuropsychopharmacology 18: 473–485.
Diederich, Nico J., and Christopher G. Goetz. 2008. The placebo treatments in neurosciences: New insights from clinical and neuroimaging studies. Neurology 71: 677–684.
Shamay-Tsoory, Simone G., Judith Aharon-Peretz, and Daniella Perry. 2009. Two systems for empathy: A double dissociation between emotional and cognitive empathy in inferior frontal gyrus versus ventromedial prefrontal lesions. Brain 132: 617–627.
Carr, Laurie, Marco Iacoboni, Marie-Charlotte Dubeau, John C. Mazziotta, and Gian Luigi Lenzi. 2003. Neural mechanisms of empathy in humans: A relay from neural systems for imitation to limbic areas. Proceedings of the National Academy of Sciences 100: 5497–5502.
Farrow, Tom F., Ying Zheng, Iain D. Wilkinson, et al. 2001. Investigating the functional anatomy of empathy and forgiveness. Neuroreport 12: 2433–2438.
Benedetti, Fabrizio. 2008. Mechanisms of placebo and placebo-related effects across diseases and treatments. Annual Review of Pharmacology and Toxicology 48: 33–60.
Zubieta, Jon-Kar, and Christian S. Stohler. 2009. Neurobiological mechanisms of placebo responses. Annals of the New York Academy of Sciences 1156: 198–210.
Enck, Paul, Fabrizio Benedetti, and Manfred Schedlowski. 2008. New insights into the placebo and nocebo responses. Neuron 59: 195–206.
Finniss, Damien G., Ted J. Kaptchuk, Franklin Miller, and Fabrizio Benedetti. 2010. Biological, clinical, and ethical advances of placebo effects. Lancet 375: 686–695.
Miller, Franklin G., Luana Colloca, and Ted J. Kaptchuck. 2009. The placebo effect: Illness and interpersonal healing. Perspectives in Biology and Medicine 52: 518–539.
Benedetti, Fabrizio, Elisa Carlino, and Antonella Pollo. 2011. How placebos change the patient’s brain. Neuropsychopharmacology 36(1): 339–354.
Wager, Tor D., and Jack B. Nitschke. 2005. Placebo effects in the brain: Linking mental and physiological processes. Brain, Behavior, and Immunity 19: 281–282.
Hrobjartsson, Asjborn, and Peter C. Gotzsche. 2001. Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. New England Journal of Medicine 344: 1594–1602.
Hrobjartsson, Asjnorn. 2002. What are the main methodological problems in estimation of placebo effects. Journal of Clinical Epidemiology 55: 430–435.
Friedman, Joseph H., and Richard Dubinsky. 2008. The placebo effect. Neurology 71: e25–e26.
Kaptchuk, Ted J., William B. Stason, Roger B. Davis, et al. 2006. Sham device v. inert pill: Randomized controlled trial of two placebo treatments. BMJ 332: 391–397.
Klosterhalfen, Sibylle, and Paul Enck. 2008. Neurophysiology and psychobiology of the placebo response. Current Opinion in Psychiatry 21: 189–195.
Moerman, Margaret. 2002. Meaning, medicine and the “placebo” effect. New York: Cambridge University Press.
American Medical Association. 1847. Code of Medical Ethics. http://www.ama-assn.org/ama1/pub/upload/mm/369/1847code.pdf. Accessed 16 Nov 2010.
Percival, Thomas. 1975. In Percival’s medical ethics, ed. C. D. Leake. Huntington, NY: Robert E. Krieger.
Post-White, Janice, Lyn Ceronsky, and M. Kreitzer. 1996. Hope, spirituality, sense of coherence, and quality of life in patients with cancer. Oncology Nursing Forum 23: 1571–1579.
Herth, Kaye. 1993. Hope in older adults in community and institutional settings. Issues Mental Health Nursing 14: 139–156.
Herth, Kaye A., and John R. Cutcliffe. 2002. The concept of hope in nursing 3: Hope and palliative care nursing. British Journal of Nursing 11: 977–983.
Chochinov, Harvey Max, Thomas Hack, Thomas Hassard, Linda J. Kristjanson, Susan McClement, and Mike Harlos. 2005. Dignity therapy: A novel psychotherapeutic intervention for patients near the end-of-life. Journal of Clinical Oncology 23: 5520–5524.
Chochinov, Harvey Max, Thomas Hack, Susan McClement, Linda Kristjanson, and Mike Harlos. 2002. Dignity in the terminally ill: A developing empirical model. Social Science and Medicine 54: 433–443.
Chochinov, Harvey Max. 2007. Dignity and the essence of medicine: The A, B, C, and D of dignity conserving care. BMJ 135: 184–187.
James, William. 1982 [1902]. The varieties of religious experience. New York: Penguin Books.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coulehan, J. Deep hope: A song without words. Theor Med Bioeth 32, 143–160 (2011). https://doi.org/10.1007/s11017-011-9172-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11017-011-9172-2