Hope and exploitation

Hastings Center Report

Volumn 38, Issue 5, 2008, Pages 49-55

  Martin, Adrienne M ^a  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ATTITUDE TO DEATH; CLINICAL TRIAL; ETHICS; HUMAN; HUMAN RELATION; INFORMED CONSENT; PATIENT PARTICIPATION; PSYCHOLOGICAL ASPECT; REVIEW;

ATTITUDE TO DEATH; CLINICAL TRIALS AS TOPIC; HUMANS; INFORMED CONSENT; PATIENT PARTICIPATION; PROFESSIONAL-PATIENT RELATIONS;

EID: 54149084744     PISSN: 00930334     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (27)

1. Food and Drug Administration, "Lengthy Jail Sentence for Vendor of Laetrile - A Quack Medication to Treat Cancer Patients," press release, June 22, 2004; http://www.fda.gov/bbs/topics/news/2004/NEW01080.html; emphasis added.
2. See especially V. McGeer, "The An of Good Hope," and P. Pettit, "Hope and Its Place in Mind," both in The Annals of the American Academy of Political and Social Science 592 (March 2004).
3. Although I do not argue for it in this paper, I believe the Snyder Scales measure one's "sense of agency," which may stand in interesting causal relations to hope, the distinctive attitude. This is because imaginative engagement with the object of hope may affect one's beliefs about one's ability to bring about that object.
4. Many people also believe that hope for a cure causes a cure to be more likely. However, no one has yet developed an instrument to measure hope for a particular outcome, and the data is mixed on the correlation between medical outcomes and generalized optimism and/or positive illusion (both of which are distinct from, but conceivably related to, hope for a particular outcome).
5. See J. Beste, "Instilling Hope and Respecting Patient Autonomy: Reconciling Apparently Conflicting Duties," Bioethics 19, no. 3 (2005): 215-31;
6. M. Links and J. Kramer, "Breaking Bad News: Realistic versus Unrealistic Hopes," Supportive Care in Cancer 2.2 (1994): 91-93;
7. R.F. McGee, "Hope: A Factor Influencing Crisis Resolution," Advances in Nursing Science 6.4 (1984): 34-44;
8. L.J. Schneiderman, "The Perils of Hope," Cambridge Quarterly of Healthcare Ethics 14, no. 2 (2005): 235-39.
9. Another is C. Simpson, "When Hope Makes Us Vulnerable: A Discussion of Patient-Health Careprovider Interactions in the Context of Hope," Bioethics 18, no. 5 (2004): 428-47.
10. J. Groopman, The Anatomy of Hope: How People Prevail in the Face of Illness (New York: Random House, 2003).
11. A. Wertheimer, Exploitation (Princeton, N.J.: Princeton University Press, 1999), 26.
12. See 21CFR50, http://www.gpoaccess.gov/cfr/index.html.
13. See R. Solomon, The Passions (New York: Doubleday, 1976)
14. and "Emotions, Thoughts and Feelings: Emotions as Engagements with the World," in Thinking About Feeling, ed. R. Solomon (Oxford, U.K.: Oxford University Press, 2004), 76-90;
15. C. Calhoun, "Cognitive Emotions?" in What Is an Emotion? second ed., ed. R. Solomon (New York: Oxford University Press, 2002), 236-47;
16. M. Nussbaum, Upheavals of Thought: The Intelligence of Emotions (Cambridge, U.K.: Cambridge University Press, 2003), especially chapters 1 and 2.
17. See A. Damasio, Descartes' Error (New York: Penguin, 1994),
18. and J. Prinz, Gut Reactions (Oxford, U.K.: Oxford University Press, 2004).
19. There is interesting data on the cognitive and behavioral effects of "positive illusion," "dispositional optimism," and "hopelessness," but each of these is a distinct phenomenon from hope for a particular outcome.
20. In relation to the philosophical literature, this conception of autonomy is more like Harry Frankfurt's than Kant's and Kantians'. The latter hold autonomous decisions to an objective standard of rationality that includes the universalizability of the rational beings' maxims and the priceless value of all rational beings, while Frankfurt takes autonomy to be a matter of the wholehearted endorsement of one's own motives.
21. P.S. Appelbaum et al., "False Hopes and Best Data: Consent to Research and the Therapeutic Misconception," Hastings Center Report 17, no. 2 (1987): 20-24;
22. P.S. Appelbaum et al., "Therapeutic Misconception in Clinical Research: Frequency and Risk Factors," IRB: Ethics & Human Research 26, no. 2 (2004): 1-8.
23. Strictly speaking, the therapeutic misconception reduces most participants' autonomy because most are committed to making their decisions on the basis of an accurate understanding of the nature of the research. Conceivably, someone might value deliberating in such a way that reasoning under the therapeutic misconception would be autonomous. There might nevertheless be other, nonautonomy-based reasons to try to eliminate the therapeutic misconception in such a person.
24. Avastin received FDA approval as a combination therapy for breast cancer in February 2008 in spite of the Oncology Drug Advisory Committee's contrary recommendation in December 2007. The latter's report is available at http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4332b1-01-FDA.pdf.
25. It is important to note a complication that I do not take into account in the present analysis. The transactions I will evaluate here are between drug manufacturers and individuals with cancer, and my concern is with whether the prices are unfair to the latter. Yet one of the most pressing concerns about the cost of new cancer drugs is that it is for the most part not individual consumers paying. Rather, private and public insurers, at least for the time being, usually cover the bulk of the cost. These drugs thus have the potential to have a significant impact on the national economy.
26. Wertheimer, Exploitation, 232.
27. A. Berenson, "Cancer Drugs Offer Hope, but at a Huge Expense," New York Times, July 12, 2005.