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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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