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8/14/2019 Thank you to the organizing commi2ee for asking me to
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Thankyoutotheorganizingcommi2eeforaskingmetospeakonthetopicofHOPE
fromtheperspec:veofamedicaloncologist.Anunderstandingofhopeisan
importantaspectofunderstandingthewholepersonandinpar:culartheprocessofdealingwithterminalillness.Researchindicatesthathopeisasubstan:veissuefor
almostallpa:entswithcancer.
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HavingsaidthisImustconfessthataerthinkingaboutthistopicforsome:meI
ratherhopedthatIcouldescapethecommitment.Itsmysenseisthathopeisoneof
thoseconceptsthateverybodyintui:velyunderstandsandyetfinds,terriblydifficulttoexplain.
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Notonlyishopedifficulttoexplainbutresearchinghopeisdifficultbecauseithasnt
fitinaboxsincethe:mePandoraletitout.
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Theproblemoffinghopeintoaboxiscompoundedbythefactthatitcanbe
studiedfrommanyperspec:vesincludingtheology,philosophy,psychology,
psychiatry,andsurelyahostofotherologies.
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Soletmestartwithadefini:on.Hopereferstoanindividualhavingawish,
expecta:onoraspira:onforsomethingtohappen,thatwouldbe,fromtheir
perspec:veagoodoutcomeoranimprovementoftheircurrentsitua:on.Inotethatonecanhavepersonalhopesorhopesforotherindividuals.
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Inotethatitisnotunreasonableforanindividualtohopefordeath,whetherornot
societywouldviewitasadesirableoutcome,andespeciallywhenthewishfordeath
isgenuinelyahopetemperedbyafulfilledlifeandnotduetoitsan:thesisdespair.
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Thisdefini:on,however,isnoten:relysa:sfactorybecauseitdoesnotaddressthe
ques:onofthepurposeofhope.Iftheabilitytohaveasenseofhopeisessen:ally
universalthenbiologicallyitpresumablyservesapurpose.Giventheincreasingevidencethatemo:onsandmoralityevolvedthenhopeshouldbenodifferent.From
anevolu:onaryperspec:vehopeisanadap:vestrategythatisconsistentwiththe
fright-flightreflex.
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Personally,asaclinician,whenconfrontedbytheques:onisthereanyhope?Id
ratherbesomewhereelse.Ithinkthatthishopen-endedques:onisperhapsatrap.
Herearesomethoughtsthatmightrunthroughyourmindaerbeingaskedthisques:on
Whatdoesthispersonmeanbyhope?
Whatexactlyaretheyhopingfor?
Whatistheirreferencepointforhavingthehope?
Whatistheirworldview?
Ifthehopeisabletobear:culatedisitarealis:chope?
Ifthenon-realiza:onofahopeconflictswiththeirpar:cularworldviewwillthe
pa:entexperiencedespair?
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Whatdoesanindividualmeanbyhope?Wellclearlythiswillvaryfrompersonto
personbutanimmediateobserva:onisthathopeisasingularity.My4-year-oldson
wouldlikealotofthingstrains,balls,icecream,lollies,andsoon.ButIdontthinkyouwouldreallycallthishope.Ithinkwhenpeoplespeakofhopethenitisa
singularity.Whenpushedtheymaybreakitdownintocomponentsbut
fundamentallyhopeisexpressedasasingularitisthewaytheywouldlikethingsto
be.Mysenseisthathopeisanexpressionthatlifeshouldturnoutinacertainway.
Thatpersonshouldlive,shouldbecured,shouldlivealong:me,withoutpain,with
certainpeoplearoundthem,andsoon.
Anyself-respec:ngsocialscien:stwouldstatethathopeisamul:-dimensional
conceptbutIchallengethatgeneraliza:on.Yes,hopecanhavedifferentaspectsbut
wemustbecarefultoseparateouthopefromotheremo:ons.Forexample,inthe
caseofafamilythatisreluctanttomakeadecisionaboutresuscita:onstatusisthis
familyreallyexpressinghopefortherecoveryoftheirlovedoneoraretheyavoiding
guiltassociatedwiththeresponsibilityofdecisionmaking.
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Sonowletmeproposethathopenotonlypertainstoasingularoutcomebutan
outcomethatisconcordantwithanindividualsworld-viewi.e.howthingsshould
be.Therealproblemwiththedenialofhope,therecogni:onthatahopewillnotberealized,isthatitfundamentallychallengesanindividualsviewoftheworld.
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Eveninitssimplestformaworld-viewispowerfulstuff.Tosaytomethat40isno
longerthenew30buttheendofmylifewouldbeacogni:vechallengetosaythe
least.Butnothingiseverassimpleasthis.Personalviewsoftheworld,whether
unconsciousorconsciouslybuilt,haveextra-ordinarydepth.World-viewsarenotjust
aboutthepersonbuttherela:onshipofthepersontotheworld.Whenhopeis
challengeditisachallengetotherela:onshipofapersonwiththeirworld.
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Inasense,itisunavoidable,whenconsideringworld-views,thatwealsodiscuss
religion.ThisisnoteasyterritoryformeasIamclearlyunqualifiedtodiscuss
theology.CertainlyIwasraisedinaProtestantenvironmentbuttodayIiden:fymyselfasabright,apersonwhofostersanaturalis:cworld-view,freefromthe
supernatural.Maybethisdisqualifiesmefromhavingthisdiscussion.Ormaybeit
doesnt,becauseanatheistcans:llhavehope.
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Sowheredoesreligion,asabasisforaworldview,fitinthediscussionofhope?The
interes:ngthingaboutreligionasthebasisofworldviewisthattheperceiveddenial
ofhopecanbeconcordantordiscordantwithonesworld-view.Formanypeople,thetransi:ontodeathisen:relyconcordantwiththeirworldview.Nowtheymaynotbe
inastateofnirvana,theymaynothaveaccepteddeathandmays:llhopefora
turnaroundintheirsitua:onbutatleasttheirsitua:onisconcordantwiththeir
expecta:ons.Wemustrememberdeathisanaturaloutcomeforallmenandthereis
li2leelsethatwouldsuggestotherwise.
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Unfortunatelythesamereligiousframeworkcan,inmyopinion,bedetrimental.For
someindividualsthedenialofhopeisextremelydiscordantwiththeirworldview.In
fact,thedenialofhopemaybesodiscordantthatitmightleadtosuchextremecogni:vedissonancethattheworldviewisactuallychallenged.Wenowhave
ques:onsemerginglikedoesGodreallyexist?orifso,thenwhatisGoddoing
aboutmysitua:on?.Whenhopeisdeniedworldviewscanbechallenged,forthe
religiousindividualfaithcanbechallenged.Or,indeedtheconversecanoccurandfor
somefaithcanbeacquired.
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Soletscomebacktomypa:entsques:onsothereisnohopedoc?Nowmy
immediatethoughtisthatImustbeextremelycarefulwhatIsaybecauseIlacka
fundamentalpieceofinforma:onwhatismypa:entsworldview?Inthecontextofgenerallybriefconsulta:onsIsuspectthereisnoen:relysa:sfactoryresponsetothe
ques:on.
Possibleresponsescouldbe
Well,hopecanmeandifferentthings.Some:mes,hopesneedtobereviewedand
seenintheinthecontextofwhatismostlikelytoactuallyhappen.
or
Well,ifbyhopeyoumeanamiraclethatwillleadtorecovery,thenIdhavetosay
thatmiraclesareexcep:onallyrare.Thereisachance,butitisvery,verylow.Ifyou
areareligiouspersonIthinkyoullfindthatyourreligionoffershopeevenwhen
deathoccurs.Perhapsyouwouldliketotalktoapriestorsomebodyelseaboutthis.
or
Tellhowyouexpectthingstoturnout
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Itiscommonlysaid,wherethereislifethereishope.Althoughthisstatementcould
beinterpretedinanumberofways,inmyexperiencepeoplewhoadheretothis
aphorismmeanwhilstIamaliveormylovedoneisalivethereisachancethattherecouldbeamiracle.Thisassump:on,evenforthereligiousbelievermustbe
incorrect.Eveninreligioustextstheoccurrenceofmiraclesisexcep:onaland
uncommon,theyare,aer-all,miraculous.Thismeansinprac:cethateitherthe
hopeisfalseorthefundamentalbasisofthehopehasbeenmisconstrued.By
misconstruedImeanthatthestatementwherethereislifethereishopeis
fundamentallyamisinterpreta:on.Whatshouldreallybestatedisthat despite
death,thereishope.Tomethisasser:onwouldbecommontomanyreligions.
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Soinsitua:onswhereapa:entortheirfamilyhas(fromourperspec:ve)anunrealis:chopetheremustbea-stepprocesstoleadtorealis:chope.Firstly,adiagnos:cassessmentmustbeperformed.Theworldviewmustbeappraised.Indeedtheworldviewsofallofthestakeholdersmightneedtobeappraisedasfrequentlyproblemsarisebecauseofvariableworldviewsbetweenpa:entandfamily,orindividualfamilymembers.Oncetheworldviewisestablishediden:fyinghowthatworldviewmightbediscordantwiththehopeisimportantor,inthecaseofmytheologicalexample,iden:fyingmisunderstandingsoftheworldmaybeimportant.Finally,oncethesediagnos:csarecarriedoutthenundertakingtore-alignthehopestomakethemmoregroundedinrealityyetsimultaneouslyconcordantwithworldviewshouldbeheaim.Ineffectthetherapeu:cgoalistoreducethediscordancebetweenthepa:entsrealityandtheirhope/worldviewbyaligningthesetwoconcepts.
Soinprac:cewhatshould(do)Idoforthepa:entorfamilyexperiencingareality/hopediscord(crisis).Thefollowingstepsshouldbetaken1.Carefuleduca:onandcommunica:onastowhythesitua:onisthewayitis..Reassurancethateverythingappropriate(butnoteverythingpossible)isbeingdonetomanagethesitua:on.3Counseltorealignhopes.Thismayrequireobtainingconsulta:onfromtherelevantreligiousmember,socialworker,etc.4.Trytoalignexpecta:onsofbothpa:entandfamily.5.Reassessexpecta:ons
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Buthangon,isntthisacopouthereissomebodywhoisaself-professedatheist
givinginstruc:onabouttheology.Ivedealtwiththesupernaturalbutnotthenatural
worldandsurelyeventhosewithanaturalis:cworldviewmusthavehope.
Well,IthinkthishastobetruebutIamnotconvincedthatIhavetrulyobserveda
secularexisten:alcrisisofhope.Inmyexperience,ra:onalexplana:ontrumps
unrealis:chope.Ithinkwealsoneedtomakeacleardis:nc:onbetween
expecta:onsoftheindividualandexpecta:onsofanindividualsfamilyandloved
ones.Forexample,acommonscenarioisthatfamilymembersinsistthateverything
bedonetokeepafamilymemberalive.Therearemul:plereasonswhythismightbe
thecaseafamilymembermaybecentraltoapersonsworldviewandsointhis
circumstancethehopeisappropriate.Butanotheraspectofthescenarioisthe
perceivedresponsibilitythatafamilymembermighthavefortheirlovedonethey
dontwanttheresponsibilityofmakingthedecisionaboutpallia:vecare,for
example.
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Nowonefundamentalproblemwiththeac:onplanoutlinedaboveisthatitismore
thanlikelythatbythe:methecrisisofhopeisrecognizeditisactuallytoolateto
effec:velymanagetheproblem.Forthisreason,inthecontextofwholepersoncare,theprocessofins:llingrealis:chopemustbeginwiththeini:alconsulta:ons,notat
thepointwheretheterminalphaseoflifehasalreadybegun.Beingveryclearabout
thepossiblejourneysandtheiroutcomesshouldstartfromthebeginningofthe
therapeu:crela:onship.
Indeedforgingrealt\is:chopeshouldstartmuchearlier.Itisfashionabletosupport
preventa:vemedicineasthepanaceaforhealthcare.Ifthisisthetruethenitshould
alsobethecasethatimbuingindividualswithasetofvaluesthatserveasa
frameworkforalifegroundedinrealis:chopesiscri:caltooveralllifesa:sfac:on.As
VaclavHavelsuggests,everythingmustmakesenseandofcourse,wemustfeelthat
ourlifehasnotbeenwasted.Themostsa:sfyinginterac:onsIhavearewiththe
peoplewhocansayIvelivedmylifewellandamhappywithwhatIvedone,Iam
preparedtodie
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