Hope and deception

Convinced of hope's therapeutic benefits, physicians routinely support patients' false hopes, often with family collusion and vague, euphemistic diagnoses and prognoses, if not overt lies. Bioethicists charge them with paternalistic violations of Patient Autonomy.
There are, I think, too many morally significant exceptions to accept the physician's rationales or the bioethicist's criticisms, stated sweepingly. Physicians need to take account of the harms caused by loss of hopes, especially false hopes due to deception, as well, as of the harms of successfully maintained deceptive hopes. As for autonomy, hopes – even if based on deception – can protect and enhance autonomy, understood broadly as the capacity to lead a chosen or embraced life.
Deception aside, patients' hopes often rest on beliefs about possible rather than probable outcomes – beliefs themselves supported by optimism, 'denial', or self-deception. Such 'possibility-hopes' may conflict with physicians' often more fact-sensitive 'probability-hopes.' To resolve such conflicts physicians may try to 'down-shift' patients' or parents' hopes to lesser, more realistic hopes. Alternatively, physicians may alter or enlarge their own professional hopes to include the 'vital hopes' that define the lives of patients or parents, as well as 'survival hopes' needed to face and bear the loss of loved ones, especially children.
A principle of Hope-giving might help guide such sympathetic hope-accommodations. More generally, it would give Hope a distinct place among Beneficence, Autonomy, and the other moral factors already high-lighted by canonical principles of Medical Ethics. To formulate such a principle, however, we will need a collective Project Hope to pursue deeper philosophical and psychological studies.     

Choices in neuroscience careers

How do I choose a mentor? How do I decide what field of neuroscience to work in? Should I consider doing research in industry? Most students and postdoctoral researchers aiming for a successful career in neuroscience ask themselves these questions. In this article, Nature Reviews Neuroscience asks four successful neuroscientists for their thoughts on the factors one should consider when making these decisions. We hope that this Viewpoint will serve as a useful resource for junior neuroscientists who have to make important and sometimes difficult decisions that might have long-lasting consequences for their careers.     

Hope against hope: changing emotions in the Burundian crisis

Through the lens of Burundians who have been displaced by the recent crisis in Burundi and their anticipations of possible futures for themselves and their country, expressed in the emotions of hope, anxiety, and despair, this article explores the shift from a situation characterized by upheaval towards the crystallization of authoritarian rule in Burundi. Drawing on ethnographic research amongst Burundian refugees in Rwanda, I examine how these individuals negotiate such uncertain and unpredictable circumstances as well as how emotions of hope, anxiety, and despair change accordingly. I argue that the political closure in Burundi has produced a gradual shift from productive anxiety in the Kierkegaardian sense towards despair and a feeling of existential closure. In such situations, when uncertainty gives way to a certainty that there are no futures, the present becomes detached from the flow of time and decisions become impossible to make. The Burundians in Rwanda can only live for the moment and hope against hope, often evoking a distinction between their hopelessness as human beings and the hope that they are compelled to have as Christians.     

Conflict in Protected Areas: Who Says Co-Management Does Not Work?

Natural resource-related conflicts can be extremely destructive and undermine environmental protection. Since the 1990s co-management schemes, whereby the management of resources is shared by public and/or private sector stakeholders, have been a main strategy for reducing these conflicts worldwide. Despite initial high hopes, in recent years co-management has been perceived as falling short of expectations. However, systematic assessments of its role in conflict prevention or mitigation are non-existent. Interviews with 584 residents from ten protected areas in Colombia revealed that co-management can be successful in reducing conflict at grassroots level, as long as some critical enabling conditions, such as effective participation in the co-management process, are fulfilled not only on paper but also by praxis. We hope these findings will re-incentivize global efforts to make co-management work in protected areas and other common pool resource contexts, such as fisheries, agriculture, forestry and water management.     

Restoration ecology: the study of applied optimism

As a young trainee in the field of restoration ecology in the modern age, it is difficult to feel optimistic about our future. As many environmental protections are de‐regulated and the climate crisis heightens, I turned to restoration to find hope in a changing world. Restoration ecologists are the optimists of biology. We work every day to make the world a better place and our passion and forward thinking spurred the United Nation's “decade of restoration.” Learning about the successes of the hardworking members of this field gives me hope. As the earth moves toward an unimaginable future, we should continue to try to make the world a better place and encourage those around us to act and restore the environments they value, whether it be large‐scale restoration or preserving garden pollinator habitat. I am forever thankful to restoration ecology and the optimism the field provides.     

The Temporalities of the Market

Social theorists' recent interest in global capitalism is partially driven by their sense of "being behind" in a changed and changing world. It is also part of their larger efforts to critique the present. In this article, I seek to find analogues of this sense of temporal incongruity between knowledge and its objects in the Tokyo financial markets. My focus is on the anxieties and hopes animating some Japanese securities traders' life choices. I argue that these traders' differing anxieties and hopes resulted from their divergent senses of the temporal incongruity among trading strategies, workplaces, and Japan's national location vis–a–vis the United States. Drawing on a parallel between social theorists' and traders' efforts to generate prospective momentum in their work, I propose that anthropologists investigate the work of temporal incongruity in knowledge formation more generally. [Keywords: time, Utopian vision, knowledge formation, financial markets, Japan]     

Prevalence and Associated Positive Psychological Variables of Depression and Anxiety among Chinese Cervical Cancer Patients: A Cross-Sectional Study

Background

The prevalence of depression and anxiety and its associated factors in cervical cancer are not well evaluated in China. Meanwhile, with increasing attention given to positive psychological variables in oncology field, there is a need to conduct a study to explore the integrative effects of positive psychological variables on depression/anxiety so as to provide patients a more holistic cancer care. The aim of this study was to assess the prevalence of depression/anxiety as well as the integrative effects of hope, optimism and general self-efficacy on depression/anxiety among Chinese cervical cancer patients.

Methods

A multi-centre, cross-sectional study was conducted of consecutive inpatients at the Liaoning Cancer Hospital & Institute and the Shengjing Hospital of China Medical University in Liaoning Province, northeast China. A total of 224 cervical cancer patients eligible for this study completed questionnaires on demographic and clinic variables, Hospital Anxiety and Depression Scale, Herth Hope Index, Life Orientation Scale-Revised, and General Self-Efficacy Scale during February and August 2013.

Results

The prevalence of depression and anxiety was 52.2% and 65.6% in cervical cancer patients. The anxiety score was significantly higher in patients at the period of 4–6 months after diagnose and at cancer stage II. Hierarchical regression analyses indicated that hope, optimism and general self-efficacy as a whole accounted for 31.3% variance of depression and 35.6% variance of anxiety. Under standardized estimate (β) sequence, hope, optimism and general self-efficacy significantly associated with depression, respectively; hope and optimism were also significant individual predictors of anxiety.

Conclusions

The high prevalence of depression and anxiety among cervical cancer patients should receive more attention in Chinese medical settings. More importantly, efforts to develop the integrated psychosocial interventions are effective and necessary to alleviate depression/anxiety in cervical cancer patients by synthesizing and integrating the individual protective effects of hope, optimism and general self-efficacy.     

On pessimism in Australian ecology

In the face of massive human impacts upon the environment, a prevailing attitude among Australian ecologists seems to have become one of pessimism. The essay explores the consequences of this stance. Pessimism arises understandably from personal values favouring care for the natural world under conditions of rapid global change. Expression of such values is in no way illegitimate; pessimism is as justifiable a perspective as is optimism when interpreting ecology. Examples are mentioned of areas of Australian ecology where pessimism does not predominate, and where the ecological changes being wrought by the Anthropocene are accepted. But, the predominance of gloom can cause ecologists to flirt with exaggeration and with misanthropy, and perversely it can cause them to strive to prevent ecological change even though the discipline is rooted in the reality of flux. Most profoundly, it causes many citizens to switch off: gloom has limited capacity to motivate, whereas hope is the elixir of action. Because of predominant negativity, we risk losing the confidence of society. The solution is for the discipline to develop more diverse strands of interpretation, characterized by more equal doses of acceptance and hope. By balancing dejection, ecology may achieve the efficacy in debate and decision‐making that it warrants in these challenging times.     

Instilling hope and respecting patient autonomy: reconciling apparently conflicting duties

In contemporary American medical practice, certain physicians are critical and wary of the current emphasis on patient autonomy in medicine, questioning whether it really serves the complex needs of severely ill patients. Physicians such as Eric Cassell and Thomas Duffy argue that the duty of beneficence should override the duty to respect autonomy when conflicts arise in clinical situations. After evaluating their claim that severe illness robs patients of their autonomy, I will argue that this perceived conflict between beneficence and autonomy is ill-conceived, resting on misperceptions about both the capacity for autonomy and the meaning of hope. Considering insights on hope from phenomenologist Gabriel Marcel and theologian William Lynch, as well as drawing upon a case study involving a bone marrow patient, I claim that respecting and nurturing patients' capacity for autonomy is a necessary condition for acting beneficently and fostering authentic hope.     

Make me a test and I will save the world: towards an anthropology of the possible in global health

What is deemed possible in the wake of failure? The global biotech industry's failure to develop affordable diagnostic devices for use in low- and middle-income countries (LMICs) has inspired a generation of humanitarian entrepreneurs to launch their own diagnostic start-up companies. This essay traces the rise and fall of one such start-up in Boston in the United States, Daktari, which developed a portable HIV testing device in the 2010s. I show how the alignment of humanitarian and economic valuations in a single diagnostic device depended on the ability of the start-up's founders and employees to synchronize the distinct tempos of financial capital, humanitarian design, and global health standards. Yet their failure to achieve this synchronization does not simply offer another story of biotech hype and speculation, the generation of promissory value at the expense of actual things. Instead, the essay examines the hopes and expectations that the firm's employees invested in the device's material qualities, manufacture, and distribution. What, I ask, is the meaning of failure, and its material remains, when it is measured against humanitarian rather than solely commercial expectations? The essay concludes with some reflections on the aftermath of failure in humanitarian entrepreneurship, examining the questions that Daktari's demise poses for understandings of what is possible and desirable in global health.     

Looking back, looking beyond: revisiting the ethics of genome generation

This paper will explore some of the ethical imperatives that have shaped strategic and policy frameworks for the use of new genetic technologies and how these play a role in shaping the nature of research and changing attitudes; with an attempt to conceptualize some theories of genetic determinism. I analyse why there is a need to put bioethical principles within a theoretical framework in the context of new technologies, and how, by doing so, their practical applications for agriculture, environment medicine and health care can be legitimized. There are several theories in favour of and against the use of genetic technologies that focus on genes and their role in our existence. In particular the theory of geneticisation is commonly debated. It highlights the conflicting interests of science, society and industry in harnessing genetic knowledge when the use of such knowledge could challenge ethical principles. Critics call it a ‘reductionist’ approach, based on arguments that are narrowed down to genes, often ignoring other factors including biological, social and moral ones. A parallel theory is that there is something special about genes, and it is this “genetic exceptionalism” that creates hopes and myths. Either way, the challenging task is to develop a common ground for understanding the importance of ethical sensitivities. As research agendas become more complex, ethical paradigms will need to be more influential. New principles are needed to answer the complexities of ethical issues as complex technologies develop. This paper reflects on global ethical principles and the tensions between ethical principles in legitimizing genetic technologies at the social and governance level.     

Porter Physiology Development Program 1967-2001: a retrospective study

The Porter Physiology Development Program Fellowships have supported the predoctoral and postdoctoral studies of numerous minority students. All of the Fellows responding to the current survey continue to be involved in life sciences-related work, primarily as physiologists-in-training or as physiologists working in academia, government, or industry. Following receipt of their degree, the large majority of Fellows completed a single postdoctoral fellowship and entered their first professional position. Most employed past-Fellows spent at least part of their time engaged in research and were also involved in teaching, management, and administration. Respondents felt strongly that the Porter Fellowship had contributed to the quality of their pre/postdoctoral training. They felt it gave them intellectual freedom to select research advisors and topics or postdoctoral positions. They also felt the financial freedom provided by the Fellowship allowed them to concentrate on their research, contributing both to the quality of their work and to their overall career commitment. Fellows strongly recommended continuation of the program and offered suggestions for expansion and increased communication. Finally, one of the most powerful benefits of the program is in its longitudinal impact. Past Fellows now serve as role models for a new generation of minority students aspiring to careers in biomedical research. Some have their own graduate students who have received the Porter Fellowship. One such Fellow emphasized the importance of this aspect of the program: I was always told by my colleagues that I would be a good role model to minority students. Having Fellowships like the Porter Development Fellowship insures the training of minority professionals. Young minority students have hope of becoming scientists when they see those of us who have made it. I have graduate students who tell me that they want a laboratory and to do research like I am doing which makes me feel that I have accomplished something [important]. As stated earlier, the goal of the Porter Physiology Fellowship Program is to encourage diversity among students pursuing full-time studies toward the PhD (or DSc) in the physiological sciences, and to encourage their participation in the APS. The findings of this retrospective study suggest that the program has been highly successful in both of these aspects.     

Human Rights and Broken Cisterns: Counterpublic Christianity and Rights-based Discourse in Contemporary England

Although human rights are often framed as the result of centuries of Western Christian thought, many English evangelicals are wary of the U.K.’s recent embrace of rights-based law. Yet this wariness does not preclude their use of human rights instruments in the courts. Drawing upon fieldwork with Christian lobbyists and lawyers in London, I argue that evangelical activists instrumentalise rights-based law so as to undermine the universalist claims on which they rest. By constructing themselves as a marginalised counterpublic whose rights are frequently ‘trumped’ by the competing claims of others, they hope to convince their fellow Britons that a society built upon the logic of equal rights cannot hope to deliver the human flourishing it promises. Given the salience of contemporary political conservatism, I call for further ethnographic research into counterpublic movements, and offer my interlocutors’ instrumentalisation of human rights as a critique of the inconsistencies of secular law.     

英国生物技术产业创新创业生态系统的构建与启示

生物技术产业是各大经济体在21世纪优先发展的战略性产业,逐步成为世界经济的主导产业.英国生物技术产业规模在欧洲排名第一,创新创业文化浓厚.通过孵化器运营案例详细阐述英国生物技术产业发展的生态系统构建.针对我国生物技术产业创新环境提出相应建议,以期对我国生物医药产业的创新创业发展提供借鉴.     

Soaking in tapes: the haptic voice of global Pentecostal pedagogy in Ghana

Can a voice touch? This possibility is indeed what underlies ‘soaking in tapes’, a devotional practice performed in Anagkazo Bible and Ministry Training Center, a Pentecostal seminary based in Accra, Ghana. Soaking in tapes is a form of impartation, or grace transmission, homologous to the biblical method of laying on of hands. In this article, I explore the conditions of possibility of this transposition of touch into speaking and hearing, arguing that the haptic voice of soaking in tapes is predicated upon a cultivated receptivity and a specific bond connecting addresser and addressee. I situate the practice in the school's broader pedagogical apparatus, where it operates simultaneously as a spiritual exercise, a method of discipleship, and a technology of church government. I conclude by showing how soaking in tapes gives a pedagogical inflection to the general tactility and flow‐orientated materiality of global Pentecostal power.     

Fostering hope in the clinical setting

Investigators agree that hope is an important coping skill for patients. Hope is stronger than optimism and influences one's physical well being. Suggestions and strategies that can be used in the clinical setting to increase hope begin with an admission of its important role.     

The Mediating Role of Coping Style in the Relationship between Psychological Capital and Burnout among Chinese Nurses

Background

Burnout is recognized as an occupational hazard, and nursing has a high risk of burnout. This study aims to explore the relationship between psychological capital (PsyCap) and burnout among Chinese nurses and the mediating role of coping style in this relationship.

Methods

A total of 1,496 nurses (effective response rate: 80.11%) from two large general hospitals in Daqing City of China were selected as participants. Data were collected via the Chinese Maslach Burnout Inventory (CMBI), the psychological capital questionnaire (PCQ-24), the Chinese Trait Coping Style Questionnaire (TCSQ) and demographic and caregiver-patient relationship. Hierarchical linear regression analyses were performed to explore the mediating role of positive coping and negative coping, and we used the Bootstrap method to confirm the mediating effect.

Results

Self-efficacy, hope, resilience and optimism of nurses were all negatively related with emotional exhaustion, depersonalization and reduced personal accomplishment among Chinese nurses. Positive coping partially mediated the relationship between hope/optimism and emotional exhaustion and between self-efficacy/optimism and reduced personal accomplishment. Negative coping fully mediated the relationship between self-efficacy and emotional exhaustion, and in the regression model self-efficacy was positively correlated with emotional exhaustion. And negative coping also partially mediated the relationship between hope/optimism and emotional exhaustion and between optimism and depersonalization.

Conclusion

PsyCap had effects on burnout and coping style was a mediator in this relationship among Chinese nurses. Nurses who had a strong sense of self-efficacy adopted more negative coping style, which in turn would lead to higher levels of emotional exhaustion. These findings shed light on the influence of negative coping on burnout, and positive coping was a positive resource for fighting against nurses’ burnout. Hence, in order to avoid negative coping style, improve skill of coping and enhance PsyCap of nurses, active interventions should be developed in the future.     

Narrative ARTifice and women's agency

The choice to pursue fertility treatments is a complex one. In this paper I explore the issues of choice, agency, and gender as they relate to assisted reproductive technologies (ARTs). I argue that narrative approaches to bioethics such as those by Arthur Frank and Hilde Lindemann Nelson clarify judgments about autonomy and fertility medicine. More specifically, I propose two broad narrative categories that help capture the experience of encounters with fertility medicine: narratives of hope and narratives of resistance. This narrative typology captures the inevitable conflict that women feel when they become subjects of fertility medicine. On the one hand, they must remain hopeful; on the other, they must not surrender themselves completely. Nelson's account of counterstories as narratives of resistance helps us see how women can reconcile the experience of a strong desire to have children with the desire to remain authentic and whole.