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Deep hope: A song without words

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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.

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Notes

  1. Shorter Oxford English Dictionary, 1993 ed., s.v. “hope.”

  2. Meta-analyses by Asjborn Hrobjartsson and Peter Gotzsche question the overall clinical importance of the placebo effect [56, 57]. Miller et al. respond to these claims based on additional information provided by Hrobjartsson and Gotzsche [53].

  3. Classical conditioning may also play a role in placebo responses, but the extent of its effect and its relationship to conscious expectancy are unknown.

  4. 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].

  5. This is not a claim that all mystical traditions are the same but merely that mystical experience appears to share many characteristics across religions.

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Coulehan, J. Deep hope: A song without words. Theor Med Bioeth 32, 143–160 (2011). https://doi.org/10.1007/s11017-011-9172-2

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