12.2 - Hope

What does it mean to hope in medicine and for medicine? How do we foster hope in our patients? What is the object of hope when clinical improvement does not seem feasible? Join John and Michael as they discuss the virtue of hope in medicine, addressing these questions and much more. This discussion previews some of the topics that will be covered at the Hippocratic Society National Conference in Houston, June 5-7. Check out the website to find out more. Did you know the Hippocratic Society podcast is a video podcast? Check out our Youtube channel for our video podcast episodes and more!

23 minutes • Published Apr 01, 2026 • Download • Transcript

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[Intro music]

Hi, and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.

In the podcast, we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.

Thank you for joining us and we look forward to engaging with you through this podcast.

Hi, and welcome back to the Hippocratic Society Podcast.

This podcast we are following an episode from Sofia Carozza where we talked about neuroscience and the soul today. Following up on that, we wanted to talk about the virtue of hope,

which I think is very fitting and a great choice. Thank you. To myself,

this is also very fitting because it is a prelude to our upcoming summer conference whose theme is hope.

And John will not be talking at that conference, so he felt that he wanted a space to talk about his thoughts, and so we gave that to him. Thank you, John, for being back so he can hear your thoughts.

You're welcome, Michael.

You really appreciate it.

Anyway, so speaking of hope, hope is as. As we've brought up in meetings and in Hippocratic Society discussions before, hope seems to be a fairly unique virtue where it's a little bit hard to put your finger on it.

It's not so much like temperance, where it's sometimes just more obvious, where things are intemperate or just a little bit more practical and maybe just easily graspable.

So for hope, maybe we could just start out talking about what it is,

what sort of conceptions come to mind in hope specifically and in religious context, hope is considered theological. Clearly, it also has very practical and secular applications. So, John, what would your thoughts be about hope?

Thanks, Michael.

As you were just mentioning, I think today we could talk about hope in perhaps two different categories.

From a traditional virtue standpoint,

hope would be considered a theological virtue. So Aquinas would mention hope along with faith and love as one of the three theological virtues. And the theological virtues have an end that is directly God.

And so where faith informs the intellect and charity informs the will,

hope informs the desire. So the desire for eternal life or the desire to be united to God.

Now, that's in the traditional virtue sense, but I think as we talk about it in medicine,

the reason why I mentioned that is that we also want to distinguish that there is a type of hope that the patient is talking about,

which actually may be more theologically oriented for many patients.

But then, then there's hope, as maybe one could say, like a moral virtue,

a way in which hope In a maybe more secular or non religious sense,

is this desire still. Still a desire? Right. It's based in this desire for the fact that something may improve or something may get better,

or that there may be a change in the current situation that a person is in,

but always directed towards the sense in which hope is also an aspect in which the person is reflecting interiorly towards like that which is good and the desire towards achieving that good.

Yeah, okay, a lot of questions come up, but maybe we can continue to parse that out about the good and desire.

Ben Freshen, Brewer Eberly have this article on hope in clinical practice and they,

I think, drawing on other sources,

pull apart four aspects of hope where there's seeing the good,

sort of recognizing it as good, having a forward looking out, a forward looking perspective. So you're always pursuing that good and not sort of just remaining in the present moment in despair and then being able to take action towards that good.

So maybe we could examine that good a little bit. As you were saying that from the theological perspective, it's God. From a clinical perspective, maybe an improvement in the situation,

but just getting into it, for example, what would it look like for a patient who's terminal or who doesn't have reasonable hope of a clinical improvement, even though there's always some chance?

What would hope look like for them? What is the good that they're pursuing?

Yeah,

yeah. I think especially maybe we could even bring that to a more extreme question of a patient who is at the end of life and still retains a sense of hope.

Right. I find that in my colleagues, they struggle a lot with this particular virtue because from a clinician standpoint point,

they see a patient as having hope, as somehow not understanding the situation that they're in.

And I think if we were to take a very strict definition of seeing hope as this desire towards like what we may see as a clinician as an unrealistic outcome,

if we see that as the only basis of hope, then I could see why my colleagues may say like the patient doesn't get it or they're not really understanding how dire the situation is.

And at the same time it's always interesting to me where when I've gotten these consults before,

where a team may say, oh, the patient's like not really getting at the end of life when you really delve into asking patient about both illness, understanding from their own words, but also what they hope for.

We've talked about this before in the setting of miracles, right. That they also hope for miracles, that oftentimes they are talking about hope, especially if they're somebody of a religious background with this hope in a cure or hope that is in some sense more directed towards God, in the sense that they're hoping for God's direct intervention.

And I often find that in clinical care, the patient who does the best is the patient who's also able to both maintain a sense of hope while at the same time understanding what situation that they're in.

You know, that they may actually be at the end of life, but still retain the sense of hope that is directed towards something maybe beyond us, like beyond this life.

Right. Or beyond the current suffering.

And this sense of hope, I actually think is important to continue to cultivate in patience. Right, right.

Whether the doctor doesn't share that same religious sense or not.

Because,

you know, we could make. Maybe make an analogy to our own personal situation. One could even say that the Hippocratic Society was born out of a desire to live hope better.

Because there are many physicians,

I would say that. Or I've heard this from a lot of trainees, that there have been physicians who basically say, like,

you shouldn't go into medicine. Like, medicine's like, in a really bad place. Like, it's basically hopeless.

Or as I've mentored a lot of students over the years,

including mentored them not just in terms of professional, but also in personal circumstances where maybe somebody is trying to kind of overcome a weakness but has been failing for a long period of time.

I find that the person who then doesn't make progress is the person who actually becomes hopeless about their situation,

rather than the fact that even if they fail, they continue to struggle and hope that this will improve and that they will be able to, at some point, make small steps towards overcoming their weakness.

We might even see this in relationships when you're trying to help a friend through a particular struggle or a friend overcome some addiction, let's say.

I think the worst thing is when we lose hope in them, because then we no longer try with them. Like, we no longer are there to try to help them take next steps.

It's actually only when we maintain a sense of hope in them as well, that they will be able to get over this, that we continue to struggle alongside them.

And so I think this is the same in medicine and also in the same in which we care for our patients.

Like when we also become hopeless. It is reflected also to the patient, too,

that we also have to keep cultivating, in some sense, the sense of hope, but also at the same time doing our duties as a clinician to inform the patient, make sure that they understand, have good illness understanding,

but that the hope is oftentimes their ongoing struggle and desire for something more. And that's not some fantastical or improbable things. I mean, it's not my place here to discuss theology and what's like, possible and not possible after death.

And at the same time, there's also many interesting scientific hypotheses and theories of near death experience, et cetera, that still point towards, like maybe they're actually something,

maybe transphysical here.

Again, not to go into this topic too much because we're focusing on hope, but that it is not.

It is not, I think something crazy to think that there may be something there and to also help the patient because the sense of hope is what's helping them also get through the day to day and that it is not always equated with them not understanding their illness or their situation.

Okay, yeah, so a lot of examples there. But it seems like hope in all cases is helping,

as you said in that last point, live the day to day, actually move forward practically, even if.

Even if that means that the patient is just a little bit happier with their struggle and, you know, not being able to. Or being able to follow their treatment a little bit better or being able to respond to the clinical team in a positive way.

So very practical as well as being a virtue good in itself, as we talk about.

Interesting. Yeah. And so how, in this case,

I know you talked about how clinicians sometimes are the ones without hope and.

Or don't recognize the goodness of the hope in patients that see something beyond death,

but in the other case, where patients are really struggling with their illness or is really burdensome for themselves and their families, where they might be lacking hope,

what is the role and how can physicians and clinicians in general be a model for hope and foster hope in the patients?

Yeah,

I personally, and this is also,

in some sense, maybe a podcast on its own, is around miracle language. But sometimes a patient will bring up this sense of like, I hope in a miracle,

and I go alongside them there. I say, I also hope in a miracle for you. I mean, genuinely, that is what I hope for you. Right.

I desire that for you. It's a desire that I wish that you were also. Well, right.

That I could affirm their sense of hope. And at the same time saying, asking them about, like, what do miracles mean for you? What does this particular hope mean for you?

And then within that context, then being able to also counsel them in terms of I still hope for you.

And let's practically make some considerations,

if things were not to turn out the way that we hoped for,

that I want you to maintain your sense of hope. And like, let's also do some practical planning right now, because I often explain this to my patients too. That practical planning,

just to make it clear,

doesn't somehow create some voodoo bad luck.

And I think sometimes, like actually saying that out loud is important too, because there might be this subtle sense of the planning being equated with giving up. And I think that sometimes patients also can equate those two things or associate those two things.

And so sometimes I like directly address it and say planning doesn't mean giving up.

I want you to still maintain a sense of hope and in that way share that hope with them while also saying,

and if things don't turn out in the way that we hope.

Right.

That we are making the preparations for the people that you love,

whether that's legacy work, whether that's caring for leaving some type of memories for their family.

Right. And the sense of giving of self to others.

I would say the large majority, if not all patients respond very well to explaining this balance of maintaining hope and also preparing.

Hmm,

okay, I see.

Yeah. So it's not.

So even patients where there is hope, not sort of just allowing that to be the only thing and still focusing on the clinical care where there is practical progress to be made or even just practical preparation to be made in the case of.

In the worst case scenario.

Great. And then back to the clinician side, I guess being able to foster hope I think requires hope ourselves,

at least in my experience,

and I'm sure in patient. Patients experience as well, it seems that hope sometimes has sort of a physical component to it as well, where if you're tired and if you're sick,

I think sometimes it's just harder to actually live hope. You know, if you're really healthy and it's a Sunny Day, it's 70 degrees here in Boston. I think it's a lot easier to feel upbeat.

And there's sort of a mood component to it. So I guess how do we. And this is the whole thing with virtues is,

is getting over the letting feelings and emotions control you and integrating the emotions with the intellect, but specifically with hope. How.

How does one live hope without feeling

hope, if that makes sense.

Yeah.

I think it's important to clarify here that none of the virtues are about feelings. And so hope is not an exception here that we do want to still identify, like what the good Is and to unite our intellect with the will.

Now, this is not to say that we discount any of our emotions,

but that maybe we also want to recognize things that are maybe based on feelings that are directed towards the good.

So emotions in which it helps us to live the good better or inspires us better to live the good.

And the emotions that take us away from the good, usually those are,

if we think about it from an Aristotelian point of view,

things that may direct us to a good that is not a good that is the most fulfilling end.

And therefore the idea of virtues is to try to live this life of flourishing or eudaimonia, right? And so to distinguish the types of emotions that bring us towards the good and therefore to grow those feelings as well.

A sensitivity to those feelings that help us direct our will towards the good, and then also recognizing with a mindful awareness the feelings that may be making us more anxious about it or whatever it might be.

Right. That may misdirect us from the good.

So I think it's the same in hope to distinguish those factors where we can identify, like what is the hope,

the good that I'm trying to direct my will towards in this particular situation now, I mean, that's kind of theoretical, so maybe better to give an example. So going back to when I made this extreme statement about Hippocratic Society being all about hope,

but in some sense I think it is.

You know, I've talked about,

in different circumstances, this podcast in our places, the birth of the Hippocratic Society.

And it was born from an experience of hopelessness.

The sense where I woke up one evening and felt like I just didn't want to go in because it maybe didn't matter anymore, like what I was doing in the hospital.

And I think that there are physicians out there who actually also give up medicine because of the sense of hopelessness.

I think the important thing is that we don't completely disengage in it.

And hopelessness leads us to this feeling of despair,

where we then allow that feeling of despair to overwhelm our intellect,

to allow that to say that this is an unsolvable problem.

But I think that that's also looking at it from a level of despair, because we are looking at it from preps, like an outcome only mindset.

So if we're thinking about things as just outcomes, which virtues are actually not about outcomes, they're about these processes. Right?

And so if we have hope in each patient interaction, how I could help particular patient grow,

or how I can grow a deeper Bond with them or have them take the next step in their own personal life.

There's a lot to be hopeful for,

actually, I think, in every medical encounter in medicine.

But if we only see it as outcomes and system level, then we become disenfranchised. We think that we have no ability to affect this current situation. And then we kind of have this, like, approach where we let go of everything and say, there's nothing else that I could do other than leaving this particular situation.

Right.

It goes back to the sense of that friendship where if we give up on somebody, then we're just basically saying there's nothing else that could be done.

But the right thing to do, I think, is to recognize with our intellect that actually in every particular situation, I can still live a sense of hope,

help patients to live each day with that sense of hopefulness, but also to live a sense of hope for medicine, too, that we can reroute this profession of medicine, that each of that starts with every one of us trying to live more virtuously as a physician in each and every circumstance that he or she is in.

I mean, again, I always say this disclaimer that we talk about these things theoretically. And then, of course, in practice,

there are times where we fail at that. There are particular patient interactions that we fail at that. Right.

And that we are not always the best version of ourselves, especially when we're tired, hungry,

did a shift that was 28 hours, and we're coming out of that,

or just at times accused wrongly by patients, too,

whatever that might be.

Right.

There's many things that may play kind of a sense of.

Into our feelings of hopelessness,

but to recognize, even in those places, with my full awareness, that,

okay, like, I feel really hopeless right now, but is that because I need to re. Engage with my sense of, like, wonder, beauty, and what this hope means for the practice of medicine, which is such a privilege to practice and be with others.

Right. In their sense of suffering and to uplift them in their lives.

Right.

Whether that is accompanying them and lessening the burden a little bit of their suffering.

Right.

Or whether then I kind of, like,

have this approach where I'm like, okay, it's like,

nothing. Nothing's possible.

And recognizing that sometimes, like with mindfulness, like,

when I'm feeling hopeless about something,

just also, like,

kind of being, like, okay with it.

Because,

you know, I've definitely had times where I'm like, oh, I feel terrible right now.

And then I just, like, have a moment of mindfulness,

and then it's like, oh, yeah, it's because, like,

I didn't sleep well last night,

so it's okay. And I'm just gonna. I know that this is actually gonna pass,

so it's not like something that I have to, like, pay so much attention to.

Just be mindfully aware and recognize that that's, like, also a normal process that will be affected by the daily things and rhythms and circumstances of life, and that's also a normal part of life.

Yeah.

I really love that you really laid out a beautiful vision of hope for medicine and the hope that we can bring into each clinical encounter. And there's.

I really love that. And also something I've been thinking about recently in my bioethics program with structural problems in medicine and issues around financial incentives and insurance. And I think.

Yeah, I just love the positive view of hope, that even just starting from our own individual action,

we can make progress. We can help that individual patient, even when it seems like there's no hope.

Yeah.

I think there's a really interesting idea here that if you've ever read Man's Search for Meaning by Viktor Frankl,

where he talks about this idea of hope even existing in a concentration camp,

and that the people who survived actually were the people who maintained a sense of hope. So he writes about this in the book. Right.

And I think that that's a powerful statement,

that hope does allow us to keep going. It does allow us to have this sense for the future, whether it's for us or. Or whether it's for,

you know, future generations of physicians, medical students, that maintaining that sense of hope is, in some sense, I think, even a duty of our profession as a physician,

that we together can figure this out. Like, let's. But we have to be together as a community.

And the Hippocratic Society, I think, is really about that through community,

to rediscover the sense of hopefulness that there is, even when all external circumstances seem totally against us.

And, you know, how could you be worse than a concentration camp? Right. But even there, Viktor Frankl says that those who maintained a sense of hope were the ones who were able to live.

Right.

Live in the sense of. Kind of have the desire to. And continued strength to not give up. Right.

And so even in this circumstance of medicine, which can be very messy at times,

the focus of the Hippocratic Society is to say, like, where is this internal locus of control where I decide that I will still positively hope because I see the good in medicine, and I will make that decision to hope even when all of the external structures seem hard and in that way,

I will be that small light that makes the change little by little,

by bringing that light to those around me, helping them also sense of sense, have this feeling or desire for hope. And with that, keep expanding that sense of hope for our profession to, I hope,

an eventual degree where we do reroute a sense of what it means to practice good medicine.

Yeah, I love that. I don't think I can add anything else. I think that's the perfect place to end and also a perfect lead up into our conference.

So on that note, thank you so much, John. I think this was a really beautiful, fruitful and also very practical discussion that

we talked about, hopefully. Thank you. Yeah, thanks, Michael.

We'll see you next time on the Hippocratic Society Podcast.

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