Tony Hope

University of Otago, Taieri, Otago, New Zealand

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Publications (156)1030.43 Total impact

  • John McMillan · Simon Walker · Tony Hope
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    ABSTRACT: This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it, from three different kinds of hope, or 'hopes for', and then relate these distinctions back to differing accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make.
    No preview · Article · Mar 2014 · Monash bioethics review
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    ABSTRACT: Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that conceptualizing anorexia nervosa as a passion is a promising way forward in both our understanding and treatment of that condition. Building on the theory of the passions elaborated by Théodule Ribot, the founder of scientific psychology in France, we argue that there is convincing empirical evidence in defense of the empirical hypothesis that anorexia nervosa is a passion in Ribot’s specific, technical sense. We then explore the implications of this finding for current approaches to treatment, including cognitive–behavioral therapy, and clinical and ethical issues associated with treatment refusals.
    Full-text · Article · Dec 2013 · Philosophy, Psychiatry & Psychology
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    ABSTRACT: We are grateful for these two insightful commentaries, which both see novelty and value in the manner in which we invoke the hypothesis that anorexia nervosa is a passion, to help explain data from the Anorexia Experiences Study, which provides the basis of our inquiry. In this response, we wish to clarify and elaborate on our hypothesis; in particular, the difference between passions and moods, the manner in which our hypothesis touches on issues of authenticity and identity, and the compelling parallel with addiction. We also wish to emphasize that, in proposing the hypothesis that anorexia nervosa is a passion, our primary aim is not so much to exclude or replace alternative theoretical approaches. Our focus, really, is to argue that the hypothesis that anorexia nervosa is a passion adds something rich and unique to our current understanding of that condition, which is not fully or adequately captured by alternative accounts. Hannah Bowden asks whether the descriptive theoretical virtues we attribute to ‘passion’ might also be accomplished by referring to “Heideggerian mood,” or “a form of Heideggerian mood in combination with certain beliefs” (Bowden 2013, 368). She explicitly asks how passions differ from moods. These are important questions. To begin, note that in her remarks Bowden is inquiring about the descriptive capabilities of the theoretical constructs ‘passion’ and ‘mood.’ Her concern is largely with phenomenological description. Now it is indeed true that we argue that ‘passion’ plays a pivotal role in the description of the clinical course and nature of anorexia nervosa, although admittedly we do not engage in phenomenology per se. However, what must be emphasized is that we also wish to argue that, properly understood, the construct ‘passion’ plays a theoretically irreducible and ineliminable role in the explanation of the clinical course of anorexia nervosa; in particular, the manner in which many of the feelings and emotions in anorexia nervosa succeed one another in apparently rule-governed and even law-like ways. Our contention is that neither the concepts ‘emotion,’ ‘feeling,’ ‘mood,’ ‘belief,’ or any combination of these, can adequately describe or explain the complex progressive syndrome that is anorexia nervosa. Something like the concept of passion we invoke from Ribot is required. Although much work remains to be done, this at least is the essence of our case. We believe that it is an especially important theoretical virtue of the concept of passion that we employ that it helps to describe and explain, both how and why the anorexic syndrome can sometimes take the tragic, progressive, worsening, course it does. Indeed, at one point Ribot likens passions where there is a loss of control of this sort to an ‘avalanche.’ This compelling metaphor suggests a tightly bound, progressive, worsening, affective–intellectual–motivational syndrome that, in our view, cannot credibly be labeled or identified, described or explained, with moods, or simply moods plus certain beliefs. Furthermore, ‘passion’ in our view cannot be accounted for using other preexisting theoretical concepts, or any combination of these. Our claim is that the concept ‘passion’—and not simply the term—must be added (reinstated, to be precise) to our current existing theoretical framework. None of this is to say that moods might not play an important part in the phenomenological and clinical description of the anorexic syndrome, or its explanation. But that is an independent empirical question that we did not attempt to answer in our article. To further clarify, there are in fact quite a few important differences between moods and passions on our account. First, passions may initially be voluntarily chosen, whereas moods, normally, are not. Second, passions are tied to an ‘intentional object’ or fixed idea, whereas moods, normally, are not. Third, passions require the intellectual resources of reason and cognition, whereas moods, normally, do not. Fourth, passions are often tied to specific stereotypical action tendencies, whereas moods, normally, are not. Fifth, passions are stable and may endure for years, whereas moods tend to be more fleeting and temporary, lasting minutes, days, or maybe months, but not (continuously) years or decades. Sixth, passions necessarily move us to action, although this is not necessarily true of moods. Finally, seventh, passions can sometimes be harder to resist than...
    Full-text · Article · Dec 2013 · Philosophy, Psychiatry & Psychology
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    ABSTRACT: The use of charged-particle radiation therapy (CPRT) is an increasingly important development in the treatment of cancer. One of the most pressing controversies about the use of this technology is whether randomised controlled trials are required before this form of treatment can be considered to be the treatment of choice for a wide range of indications. Equipoise is the key ethical concept in determining which research studies are justified. However, there is a good deal of disagreement about how this concept is best understood and applied in the specific case of CPRT. This report is a position statement on these controversies that arises out of a workshop held at Wolfson College, Oxford in August 2011. The workshop brought together international leaders in the relevant fields (radiation oncology, medical physics, radiobiology, research ethics and methodology), including proponents on both sides of the debate, in order to make significant progress on the ethical issues associated with CPRT research. This position statement provides an ethical platform for future research and should enable further work to be done in developing international coordinated programmes of research.
    Full-text · Article · Sep 2013 · Journal of medical ethics

  • No preview · Article · Aug 2013 · Cambridge Quarterly of Healthcare Ethics
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    ABSTRACT: On the basis of detailed interviews of females aged between fifteen and twenty-six years with a diagnosis of anorexia nervosa we argue that the autonomy of people with this condition may be severely compromised in four ways, particularly in relation to eating and weight. First there are problems with agency. Second, affective components, particularly anxiety, can dominate beliefs such that the grounds for making a decision may differ from the reasons given in justification. Third, the interactions between the affective components and the objective evidence lead to substantial inner conflicts with resulting lack of stability in preferences and beliefs. Fourth, this lack of stability leads to concerns around identity and authenticity. We argue that some of the ways in which autonomy is compromised reduce competence to decide on treatment. We suggest that these results may be relevant to other mental disorders and have clinical and policy implications.
    No preview · Article · Mar 2013 · International Journal of Law in Context

  • No preview · Article · Jan 2013 · Cambridge Quarterly of Healthcare Ethics

  • No preview · Article · Jan 2013 · International Journal of Law in Context
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    Full-text · Article · Oct 2012 · Cambridge Quarterly of Healthcare Ethics
  • Mark Sheehan · Tony Hope
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    ABSTRACT: This chapter examines the ethical principles behind just allocation of health care resources in the UK, with particular emphasis on the National Health Service (NHS). These ethical considerations include equality of outcome and equality of persons or equity; the latter can be considered through the principles of fair process, need, and rescue. The chapter analyzes how these ethical principles work in practice on the national, regional, and local levels. The national level is governed by the National Institute for Health and Clinical Excellence, and uses the principles of cost effectiveness and equity in order to make fiscal and clinical recommendations to the lower levels. The chapter also looks at the Oxfordshire Primary Care Trust and how it uses the South Central Ethical Framework to make decisions about why an individual patient should receive a treatment that is not usually covered by the NHS. Finally, it discusses the issue of rescue and Individual Funding Request (IFR) panels.
    No preview · Chapter · Sep 2012
  • Tony Hope · John McMillan
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    ABSTRACT: The non-identity problem arises when an intervention or behavior changes the identity of those affected. Delaying pregnancy is an example of such a behavior. The problem is whether and in what ways such changes in identity affect moral considerations. While a great deal has been written about the non-identity problem, relatively little has been written about the implications for physicians and how they should understand their duties. We argue that the non-identity problem can make a crucial moral difference in some circumstances, and that it has some interesting implications for when it is or is not right for a physician to refuse to accede to a patient's request. If a physician is asked to provide an intervention (identity preserving) that makes a person worse off, then such harm provides a good reason for the physician to refuse to provide the intervention. However, in cases where different (identity-altering) interventions result in different people having a better or worse life, physicians should normally respect patient choice.
    No preview · Article · Aug 2012 · The American Journal of Bioethics
  • Charles Foster · Tony Hope

    No preview · Article · Jul 2012 · Journal of the Royal Society of Medicine
  • Stephen Holland · Tony Hope
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    ABSTRACT: Decisions on which new health technologies to provide are controversial because of the scarcity of healthcare resources, the competing demands of payers, providers and patients and the uncertainty of the evidence base. Given this, additional information about new health technologies is often considered valuable. One response is to make access to a new health technology conditional on further research. Access can be restricted to patients who participate in a research study, such as a randomised controlled trial; alternatively, a new treatment can be made generally available, but only on condition that further evidence is collected (eg, on long-term outcomes and adverse events, in patient registries). The National Institute for Health and Clinical Excellence (NICE), which provides guidance on which new health technologies to make available under the UK's NHS, for example, has made some research conditional recommendations, and the current interest in such options suggests that they are likely to become more prevalent in the future. This paper identifies and discusses the main ethical issues created by this distinctive range of recommendations. We argue that decisions to put research conditions on access to new technologies are compatible with widely accepted values, principles and practices relevant to resource allocation. However, there are important features of these distinctive judgements that must be taken into account by resource allocation decision-making bodies and research ethics committees, and that require new sorts of empirical data.
    No preview · Article · Feb 2012 · Journal of medical ethics
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    ABSTRACT: People with anorexia nervosa struggle with questions of authenticity. More attention should be paid this concept—both how patients think about it, and how clinicians should think about it.
    No preview · Article · Feb 2012 · Hastings Center Report
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    ABSTRACT: Making threats and offers to patients is a strategy used in community mental healthcare to increase treatment adherence. In this paper, an ethical analysis of these types of proposal is presented. It is argued (1) that the primary ethical consideration is to identify the professional duties of care held by those working in community mental health because the nature of these duties will enable a threat to be differentiated from an offer, (2) that threatening to act in a way that would equate with a failure to uphold the requirements of these duties is wrong, irrespective of the benefit accrued through treatment adherence and (3) that making offers to patients raises a number of secondary ethical considerations that need to be judged on their own merit in the context of individual patient care. The paper concludes by considering the implications of these arguments, setting out a pathway designed to assist community mental healthcare practitioners to determine whether making a specific proposal to a patient is right or wrong.
    Full-text · Article · Dec 2011 · Journal of medical ethics
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    ABSTRACT: People with anorexia nervosa struggle with questions of authenticity. They thought about whether they were being their authentic selves, and which of their desires, emotions, and choices were authentic. More attention should be paid this important concept and its role and status--both how patients think about it, and how clinicians should think about it.
    Full-text · Article · Nov 2011 · The Hastings Center Report
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    ABSTRACT: Fall detectors are a form of remote monitoring assistive technology that have the potential to enhance the wellbeing of adults at risk from falling. In this paper, the ethical issues raised by the use of fall detectors are examined. The fall detection devices currently available are outlined, and a summary of how these devices require social-care services, or family carers, to respond in particular ways, is provided. The ethical issues associated with the use of fall detectors are classified under four headings: autonomy, privacy, benefit, and the use of resources. These issues, we argue, arise out of the nature of the technology itself, and the way that this technology is integrated into the day-to-day support package of the person for whom it is provided. It is argued that manufacturers have a duty to provide information about the ‘ethical side-effects’ associated with the use of a particular device, and that the process of making a decision to provide a person with a fall detector should include a checklist of questions that is designed to enable decision makers to work through the ethical issues raised.
    No preview · Article · Oct 2011 · Ageing and Society
  • Tony Hope · John McMillan

    No preview · Article · Jun 2011 · The Lancet
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    ABSTRACT: The "doctrine of double effect" has a pleasing ring to it. It is regarded by some as the cornerstone of any sound approach to end-of-life issues and by others as religious mumbo jumbo. Discussions about "the doctrine" often generate more heat than light. They are often conducted at cross-purposes and laced with footnotes from Leviticus.
    No preview · Article · Jan 2011 · Cambridge Quarterly of Healthcare Ethics
  • Tony Hope · John McMillan · Elaine Hill
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    ABSTRACT: Intensive care units (ICUs) are not always able to admit all patients who would benefit from intensive care. Pressure on ICU beds is likely to be particularly high during times of epidemics such as might arise in the case of swine influenza. In making choices as to which patients to admit, the key US guidelines state that significant priority should be given to the interests of patients who are already in the ICU over the interests of patients who would benefit from intensive care but who have not been admitted. We examine four reasons that in principle might justify such a prioritization rule and conclude that none is convincing. We argue that the current location of patients should not, in principle, affect their priority for intensive care. We show, however, that under some but not all circumstances, maximizing lives saved by intensive care might require continuing to treat in the ICU a patient already admitted rather than transferring that patient out of the unit in order to admit a sicker patient who would also benefit more from intensive care. We conclude that further modelling is required in order to clarify what practical policies would maximize lives saved by intensive care.
    No preview · Article · Dec 2010 · Bioethics

Publication Stats

4k Citations
1,030.43 Total Impact Points


  • 2014
    • University of Otago
      • Centre for Bioethics
      Taieri, Otago, New Zealand
  • 1992-2013
    • University of Oxford
      • • Ethox Centre
      • • Department of Public Health
      • • Department of Psychiatry
      Oxford, England, United Kingdom
  • 2011
    • All Souls College Oxford
      Oxford, England, United Kingdom
  • 2002
    • University College Dublin
      • Institute of Criminology
      Dublin, Leinster, Ireland
  • 1999
    • The Royal Children's Hospital
      Melbourne, Victoria, Australia
  • 1994-1998
    • Oxford University Hospitals NHS Trust
      Oxford, England, United Kingdom