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This is joint work I've done with Justin Oakley at Monash now,

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many of you have met Justin, you may have read his many contributions to bioethics.

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So to acknowledge him as co-author of the paper.

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So this is a paper about the importance of hope in health care now.

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A lot of people will tell you this,

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they'll say it's really important that patients who are undergoing some kind of medical procedure hope for a successful outcome.

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OK, I hear this, you know, a lot of times and it's bioethicists all

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I never heard someone who's flat out denied it. But people just simply said a lot of health care professionals will say this as well.

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So really important that they hope for a good outcome.

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But it's not clear why this is the case, why it's so important, if indeed it is, and we should be open minded about this.

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Maybe it's not important why you think it is and what we're going to do.

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What just Nyhan do is propose a hitherto unrecognised explanation or as far as we're aware,

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no one else has come up with it, but it's always possible that they come up with it and get it from it, from us.

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It's possible and hit you unrecognised explanation for the importance of patients,

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physician policies, successful treatment and this appeals to prospects.

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So prospect theory for those of you who aren't familiar is a descriptive theory about decision making in situations of risk in uncertainty.

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It's probably the most influential descriptive theory so often contrasted the expected utility theory,

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but expected utility theories often means simply enormous experience.

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What you could do It's prospect theory usually just said to be descriptive of how people make decisions under situations of risk and uncertainty.

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So we're going to keep this theory and I'll go through the basics of it.

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And those of you who are familiar with that already and you just kind of tune out for a few weeks if that's OK.

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Now, this talk is about hope in health care, specifically about patients hope for a successful outcome.

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So it's quite narrowly targeted. However, the analysis we're going to provide might well work in other contexts, so we're just open minded about this.

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There are certainly other context in which people run around saying publicly support.

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So here's a couple that if we make change,

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hopefully military leadership so soft and claimed it's very important that military leaders hope that they're going to be successful.

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Clearly, if they're not hopefully successful, they despairing.

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And that sounds like a very bad thing intuitively. So people keep saying this and also elite athletes so often say, you know,

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you really have to hope that you're going to win when she sees hoping for victory or,

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you know, the sort of reality sets in facing the world champion and that your chances are very slim.

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Then things go wrong. You've got to OK. And there might be other contexts as well where hope is important.

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Completely open minded about that. But we're just focussing on this one context where we think hope is important.

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Other thing to say is we seem to have a sort of a weird sidebar crossing some.

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So my words here, but we're going to assume that and this is really uncontroversial assumption.

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But I need to say this in this paper somewhere else and people kept bringing

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it up is that the point of health care is to restore people to good health.

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It doesn't have some other things. So the health care system is set up to get people back to health.

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It's not for humanity in its summer. And so the very people who keep saying that hope is health is important in health care are the same people

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who say that health care is designed around this uncontroversial assumption of restoring people's security.

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We cannot. Both seem to have a.

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Now we start. Right.

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Now, so that's good. OK.

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So if you start reading the literature on hope in philosophy, there is said to be a standard, so that's going to be the jumping off point here.

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So here's a take on the standard account by Eve Garrard and co-author Hurston hopes for

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statehood of phase three if and only if she desires the believes that it is possible,

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though not certain, that he will come about. So if you're not desiring it, you're not hoping.

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And if you think it's certain to come about how it's, you know, it's in the bag,

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it's not not something you're hopeful that it has to be something less than certainty.

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Thanks. Now. Straightaway, this doesn't seem right to me, it's not there's not enough going on and what's missing,

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and I'm not the first person to point this out is any mention of the S8 affective dimension.

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So think about this. So you've got two patients and thought experiment in the same patient.

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Patient number one, he believes that there's a one per cent chance that a malignant tumours will be successfully treated.

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And this is something she desires. And so she fits the standard definition pretty straightforwardly, and she's hopeful.

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She thinks, Oh, there's a one per cent chance this is great, huh?

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So she hopes she approaches the impending operation with a sense of hope of success in the face of great odds of failure.

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A patient to exact same circumstances believes as one per cent chance that the malignant tumours will be successfully treated.

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But she finds herself in a state of despair because only one per cent chance she abandons hope now intuitively.

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These people are very different. The first one is genuine case of hope.

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The second one is not in this same state. What's the difference?

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It's a different ethic to start different emotional engagement with information that's being presented

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as it presented the exact same information and don't have the exact same outcome they want.

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But they have different emotional reactions, and intuitively, the first one is hope.

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And the second one? Yeah, a different thing.

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Yeah. Here's a definition, which we think is much more plausible, and this comes from Adrian, Martin said.

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She says to look for an outcome is to decide to be attracted to it, assign probability somebody between zero and one.

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I take it she means not, including one percent certainty, and to judge that there are sufficient reasons to engage in certain feelings and attitudes.

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So the judgement is driving an emotional engagement. The margin contrasts her view with the standard view.

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She also contrasted with the view that's dominant in academic psychology.

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So if you're reading to this, there's someone who which Snyder who big hope fubar in psychology like reams of papers about books and things,

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and it's got big school out in the hope theorists.

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And this is a definition for him and some of his co-authors. Hope is a goal oriented cognitive construct these effective and behavioural implications.

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Now Adrian Martin contrasts it means she doesn't like this field, but we think very similar.

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OK, so she's hoping for an outcome.

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Snyder unfolds this as a goal oriented cognitive construct, an outcome of the goal.

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Pretty much the same thing. So we think she shouldn't contrast,

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and she's right to contrast him with the standard account of Rome to make such a big song and dance about the difference between housing,

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psychology and so on.

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So so we don't see what the fuss is about.

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We think you should get these psychologists. OK.

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Now, you might have an objection to this, because not all uses of the term of the word seem to motivate goal oriented behaviour.

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OK, so if I say, look, I hope it's tomorrow thing, just give you like, I hope this even better luck to have a nice day and see where folks in this.

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I'm saying that despite have no understanding, fully understanding, I have no ability to influence the winner whatsoever,

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so it's not possibly a goal for me is not my goal to cause good weather tomorrow.

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OK, so the hope is not going to be in any way whatsoever.

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OK. So as a definition, this doesn't seem to us to do the work that's needed, but we're not interested in giving me injecting definition of heart.

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OK? What we're interested in is a particular form of goal oriented behaviour.

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OK. I actually hope for successful treatments.

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What we think is going on is that when patients hope for successful treatment, they're getting with the programme,

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they're gauging a series of activities that will be part of their perceived treat.

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So they're consenting to the operation they going along with whatever the rehabilitation process is afterwards.

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In the end, a series of exercises trying on some kind of restrictive diet or otherwise restricting their behaviour

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to ensure that you're taking those forms of medication for enough time after the operation and so on.

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And that's the goal oriented behaviour. So we're interested in this subclass of hope, which we think is captured by the psychologists pretty well.

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So we're on board with the psychologists. But we acknowledge that.

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Someone who was more concerned to pin down an exact, you know,

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added definition of necessary and sufficient conditions would need something slightly different from this.

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But that's what happens. OK, now let's get on to just looking at some reasons that are being given, and this is just in literature, one hopes and we.

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So this is some stuff people say. So one of the things they say is that, look, there are psychological benefits of having hope.

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OK. So why is it important for patients to have hope? Well, let's say they have hope they'll get these psychological.

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Now, we don't think this is a good response, and the problem is not that there may not be psychological benefits of hope.

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It's just that it's very difficult to tease them out from the benefits that come along

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with optimism and so hopeful person that is almost invariably an optimistic person.

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Lots of studies that show that optimism has health benefits in various ways.

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And so as far as we can tell, it's optimism that's probably doing the work of providing health benefits.

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It's possible that hope is adding something to it, but it's just very, very difficult to get clear what separates this act.

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So we think this might be something to this explanation, but it's just very difficult to prove.

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OK. A second thing people say is that the company wants to avoid civil rights.

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So there's a recent paper which runs this line,

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and we also name on blanking on draws on this stuff by this guy to Frankel, who survived the concentration camp.

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And according to Frankel, the important thing for him surviving was having hope.

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And he points out in his story that were many members,

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many people who stuck in the concentration camp who fell into a state of despair about their miserable lives and prospects.

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So what happened is when they fell into the state of despair, according to Frankel, they just ceased sort of trying.

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So with the concentration camp guards would be starting to do this, that or the other, and they just would do it.

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And the gods would hit them with their rifles and they'd sort of fall on the ground and do nothing and

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basically just dive into the state of despair that and realise that there's just no good future for them.

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So they figure out what it looks like.

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And, you know, they don't survive very long. So frankly, story is that hope is very important because it helps you avoid despair.

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Now we think that's true. It's just that we also think is a neutral state, which is between hope and despair.

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OK, which is neither hoping for a saviour is successful, more despairing that it's going to be unsuccessful.

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And what we would like is an explanation that picks our hopeful state from the neutral state and smells fantastic.

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So we don't think that pointing out the badness of despair is sufficient to tell you about the goodness of hearts,

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because we also want to know why hope is better than the nutrients that.

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Thank you. That is a sad thing that you said, which we endorse, we don't think the full story,

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but we endorse this hope motivates patients to cooperate with health care professionals to achieve the goal of regaining its health.

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So it's motivation. And we think this is clearly right.

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The patient who is hopeful they're going to be motivated, they're going to try harder to participate in their rehabilitation,

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they'll take the regular exercise, they'll stick to the restrictive diets. We'll take regular medication for longer periods of time.

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The patient who's in despair certainly won't do this. So what's the point?

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The patient is in the neutral state.

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Well, you know, they might do if you think about the benefits, but they're not particularly motivated to do less of a regular exercise and diet.

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You know, alcohol much. Whatever it is, we think you need help.

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You need to be focussed on the goal of restoring yourself to health to get it.

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So we think this motivational disturbance could host this.

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We just think it's not the whole study. Okay, what is the whole story most when I speak to you?

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So this is the we can treat our first, too.

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OK, let's start with the well-known idea disease problem.

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So this weekend in the diverse diversity, imagine that the this is better all study,

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imagine that the US hearing an outbreak of an unusual Asian disease which is expected to kill 600 people,

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two alternative programmes to combat the disease have been proposed.

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Assuming that the exact scientific estimates of the consequences the programmes it was far from Ghana has adopted 200 people will be saved.

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Programmes B is a one third probability that 600 will be saved and two thirds probability that no people saved.

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So that's your choice. Your research subject, given these choices, now turns out that most people prefer programme in these choices.

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So what's going on is that programming is the safest way.

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You you're making a recommendation. This is the safest you will save to hunt programme B, we'll save 200 on average in the risk category.

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So there's a two thirds chance of say No. 600 die.

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But there's a one third chance you'll say, Oh, that's the riskiest. Most people don't take the risk and left this life.

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We can now tell a story slightly differently.

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Same scenario and you saying on this programme say is adopted 600 400 people will die.

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Programme B is adopted one third probability that no one will die and a two thirds probability that 600 people die.

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Now you tell the story this way in the same scenario, but you use the wheel dialling, which will be saved.

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Flip the script around. People have very different choices, so this time 22 per cent of the subjects preferred see which is the safe bet.

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This 400 by 200 was saved and 78 percent take the state programme D now.

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So what's going on is that this sudden switch of wording has switched people most people from being risk averse to risk seeking.

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Thanks. Now the big question is how does this happen?

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How is this little switching language at this extraordinary effect?

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Well. This is this is the explanation, which is so dominant view, and it's again comes from kind of adversity.

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They say this that make frequent claims. This is they've got some prospects.

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We evaluate risk in comparison to a reference point. Outcomes that are not understood as superior to the reference points are regarded as games.

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Outcomes that are understood as being in Syria are regarded as lost weight loss lot of us so losing a psychologically, morally winning benefit.

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So Cameron, in his book, he cites the case of Jemmy Connors, who famously said, I hate to lose more than I love to weep right now.

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Apparently, we're all guilty because you miss me.

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We all feel more than the badness of losing in the goodness of.

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So I think academics can relate to this. You could choose from a journal and you feel much more about acceptance makes you feel good right now.

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The thing is, we experience diminishing sensitivity gains and losses in proportionally relative distance from the records.

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So if it's zero dollars, the reference point first ten dollars,

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we might gain or lose as more psychologically psychological significance in next ten dollars.

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So putting that all together, you get a chart that looks like this.

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And so the key things here to understand is you've got your reference point.

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That's the point in which in your head, you switch from games to lawsuits.

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So again, is what's going on above the line are losses below the line and the curve below the line is steeper.

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So the losses are harming you more your field and the more you benefiting from the gains.

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So you like gains or losses more. That's the idea.

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Now, according to kind of adversity, this is a kind of a hard luck figure feature only human psychology.

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It's not just a few people like this. What's this?

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Just so this is this is the guts of prospects. It's descriptive theory of how we try and evaluate how we make decisions on the society.

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Risking uncertainty is that we way it's intuitive.

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We like this. We try and avoid losses and costs, but we'd like to make some gains.

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Now you use your reference point is the status quo, whatever the current situation is, so suppose you're lucky enough to own one problem.

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And that's your reference point. Now you are going to do a lot more to prevent loss get.

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OK.

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So you might you've got your one property and say you don't have any data which you might be able to take out a big mortgage to buy a second property.

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You. And you might do that if you think, well, I can lock in a low interest rate tool, very safe.

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But you're not going to do it if it's so risky and be risk averse. We got to that decision.

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Think about a threat to the status quo, to your ownership of that one property.

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Suppose I don't have a bank trust foreclose on something like that.

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We've never used the kind. You get the letter saying you're not making the payments.

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You have to do this. So totally. So if you're going to move heaven and Earth to stop this, OK, because that's your status quo, that one province.

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So the idea is that that's your response. So status quo, particularly about what you consider what you own, is often a reference point, should people.

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And from that point, you become loss of this and you risk averse.

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So you receiving a lot of Americans want to try and prevent losses.

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One of the reasons why risk averse and respecting, you know, as we've seen with Asian flu, the reference point can be shifted.

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So what's going on there is it's a kind of a little tricky language.

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So when you used the phrase, let's go back in and I'll show you this will die.

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This this makes people risk seeking because the phrase will die makes you think the reference point is that people are alive.

196
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OK, so you become risk sinking below the reference. You want to prevent those deaths.

197
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However, the language will be saved. What's the reference point for when intuitively that they're going to die if they're not saved?

198
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OK, so the reference point is now that they're as good as dead, so.

199
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So you are just starting to you're not going to be risk thinking in regard to making those statements.

200
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I severe risk sinking, preventing losses and this language shifts the way you think.

201
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But it does it. I mean, 99 or 100 people not going to realise this is going on and it's going on.

202
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OK, so I usually I usually flew reframing that's way of shifting a reference point.

203
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Another example of the way in which I reference point and shift is through acquisition of an extension.

204
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So let's go back to the writing that one thought.

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Now, suppose. Do your parents tell you when we die, we're going to you're going to be carrying a second now?

206
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You think so. That's all very well. You know, my parents are healthy, whatever.

207
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It's still going to happen any time soon. So you don't really think this sounds nice, but you won't lose parents, but you can't have that.

208
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So it's not really doing any work. It suppose now that actually, you know, you hear from a doctor, I should care inside,

209
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and they've lost to a new strain of COVID, and they're not going to be around for long this week.

210
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Well, you you're obviously pretty upset. Another thing that's going on is the silver lining is that you stop, you know, banking that that extra house.

211
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I think my reference point is moot now. So my reference point now based on rational expectation is that I have two properties,

212
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even though it's not quite yours, it's not even the bag you can't get in the bag.

213
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But suppose you know, a estranged cousin comes along and challenges the will.

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They say, look at that, Steve Clarke, the ne'er do well, you know, this thing about the property,

215
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they kind of made this and they produced this opportunity at that point because the reference point is shifted again.

216
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You consider this a loss if you've banked this in your head as as good as yours.

217
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So you're now going to move heaven on Earth. You lawyer up, get the best lawyers to get rid of this, don't you?

218
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It, because this is now a reference.

219
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However, when it was just a sort of distant thought in the back of your head and you weren't sort of banking on the property,

220
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will it didn't play this role? And if you'd heard that the cousin was sort of schmoozing with your parents and you know, you suspected there you are.

221
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That's a bit suspicious. What are they doing? You're not really going to be too fussed about it.

222
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You might sort of flag pops up, but nothing. So expectations can change.

223
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It's another thing that can change reference points is gone now.

224
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So agouti, this is a good example of this is rummy. So suppose you are a keen distance runner.

225
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I'm not talking about operations on two of my knees. I do not do this, but that's not constant.

226
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Use the example. Suppose you're running your regular runner, and if you want to run, you know you've got to go.

227
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You're kind of increasing the distance. You run the military every week or whatever, and you're up to five ks.

228
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You want to run five times. That's a bit of a challenge for.

229
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Well, you do understand that you might try to reach this goal, might incur some kind of injuries there are that there is a danger.

230
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Hamstring. Up your knee or whatever it is, athletes, whatever it is,

231
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you take these risks because you set yourself a goal that's now going to serve as your reference point.

232
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So goal, can you hear that will run five KS? You will take risks if you help get the goal, reach the goal.

233
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However, suppose you meet your goal and you still feeling pretty good about running.

234
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If you actually I could run a little bit further, you might do it,

235
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but you're not going to risk your health doing that because you've already achieved.

236
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You got the goal when your back of your head was a good run five times.

237
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So another K, yeah, you might do it if you're feeling good and you think this is low risk,

238
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but you're not going to be so bad the more you know, I'm not really terrified me.

239
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If I do this, just stop.

240
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So the goal is setting so different ways in which reference points and shift around and very important for how you respond accordingly.

241
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Prospect sequence, which is stop a truck. OK, now is there evidence that goals concerns reference points?

242
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Yes. So this is a well known study by people who Pope and Schweitzer, and they believe it or not.

243
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They examine two point five million golf packs using laser measurements.

244
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Now the reasoning was this a professional golfer? Is expected to get a par round a round of golf, so 18 holes is supposed to get passed.

245
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So for those of you don't know the game, every hole it's in either sluggish to get to the hole three or four shots.

246
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It's par for the hole and perfection must people like me suck.

247
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But a double body needs most times to two extra shots.

248
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Oh, what a professional golfer. This is what makes it.

249
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So that's the goal. I can schmucks a reason.

250
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Now, if that's right, if the professional golfers goal is to get a pass go on a given home,

251
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they are going to take more risks to ensure that only to a loss that they don't get

252
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worse for bogeys in golf and the risks they will take to get a better than pass forward.

253
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If you know your golf, if it's two under par or a an eagle, so, so, so they looked at these pots, these 2.5 million putts.

254
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And indeed, this is what they found that found that there was more of a chance of overshooting the hole when you were going.

255
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When you're really going forward,

256
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when you're faced with the threat of getting an overpass for the losses of then the underpass for the the same bonus got better.

257
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And the reason is that, you know, if you want to make sure to make sure you get the par school that your ball travels, at least as far as the hole.

258
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So you didn't know the danger of a shooting, whereas if you were putting four under par might just be happy just to lay out the ball for the hole.

259
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And so that's if it's a couple of inches short and you can just tap the right now.

260
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Interestingly. Some professional golfers are waiters, and they defend it, so this is probably the only philosophy paid that beat you.

261
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Tiger Woods has been cited, but here is Tiger, who is surely thought to be golf.

262
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He says Any time you make big parts, I think it's more important to make those than birdie putt.

263
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I don't ever want to drop a shot. Psychological difference between dropping shock and making a birdie, I think it's just bigger to make a par pop.

264
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So basically, he's endorsing prospect theory, right? The goal is par, and I really don't want to get below par.

265
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Got to do that. But no birdie. It's kind of bogus.

266
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So it's aware of what's going on. And he's endorsing. Right.

267
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Let's bring this back to medicine itself. In health care and some evidence for this.

268
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By the way, I should have said this quite a lot of evidence about prospect theory and health care.

269
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Lots of people prospect theory is important to health care and the very standards should try and shove it.

270
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It's before is back. Why this?

271
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This is the first one as far as we can hope.

272
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But these people, Treadwell and Lannett, they were interested for other reasons and which the reference point and I think for most people,

273
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reference point is your current state of health. So for most people, you think I'm in this current state of health?

274
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Yeah, I'd like to be in a better state of health. That would be great, but I really don't want to get worse.

275
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So think about white, you know, pretty nice if I've lost a few pounds, but I really don't want a guy in.

276
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OK, that's the worst thing to me. So I'm more motivated to try and prevent myself putting on right and I'm motivated to lose weight.

277
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So that's kind of it a common thing. So for most people, current state of health is your reference point.

278
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Yeah. If you take a quick fix on the goal of returning to their former state of health and their reference point shifts,

279
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they're going to become risk thinking in regard to an outcome that falls short of that goal.

280
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OK, so get the idea. So if a health care professional could persuade them to take on the goal of returning from the state of health,

281
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then that's going to shift the reference point and they're going to be some of more risks and otherwise in regard to getting there.

282
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So we'll be more willing to accept the risks of side effects that might come along with an operation,

283
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but be more willing to risk side effects that might go along with taking medication.

284
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And they'll be more willing to undertake exercises that might backfire because of injuries as part of the rehabilitation,

285
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then they wouldn't be otherwise. So we think this is another thing that's important about health that makes you hope for goal of it.

286
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Better in restoring the self to good health makes you more risk seeking in

287
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ways that ultimately decision that you make makes you more likely to go along.

288
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Health care programme that involves more risks to others.

289
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The hope sets goals, shift reference points, changing attitudes towards Hey.

290
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So that's the other reason we feel totally functional.

291
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But it's also important because it changes your attitude to risk.

292
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OK. Now, having said this, we now think we can pin down what the difference is between the absence of hope and despair.

293
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And so this has been a side issue. It's kind of interesting to do to fix on this.

294
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So a patient who has no particular hope of recovery, but if this recovery is possible,

295
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enough in the studies, but it's not in spite of despair, but just that the status quo,

296
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a reference point is where the health is right now and that patient is in a

297
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state of despair has accepted the fact that the health will further deteriorate.

298
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So the reference point is where in their heads actually the expectation?

299
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I think it's going way down. And so the concentration camp victims despair.

300
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They just assume the reference point is now that they and other people who are in a state of despair about their health,

301
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their reference point is going to be wherever they feel their health is going to end up often.

302
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What is the disease that you have?

303
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So that's the difference, we think, between being in the neutral stand between hope and despair and being in despair.

304
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But that's just the insight. OK, now given that.

305
00:37:45,380 --> 00:37:56,300
Imbuing a patient with hope and change their attitudes to risk this surely concerns about manipulation.

306
00:37:56,300 --> 00:38:00,710
There is already literature about this, but it plays out slightly different.

307
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It's quite a literature about what's known as false hope.

308
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It also is when, say, doctor make stuff on patient gives them sort of very unrealistic assessments of things.

309
00:38:17,210 --> 00:38:22,340
17. So there's no review literature, so we're concerned something slightly different.

310
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We're concerned with this issue about how to manipulate a patient by moving the reference point.

311
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And could you do something appropriately right now?

312
00:38:35,230 --> 00:38:42,910
So. Patients will often say, as we've noted, considering the options,

313
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patients will often use Google's reference, but be more willing to take greater risks to achieve that goal.

314
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Raises concerns about manipulation, particularly if they're led to accept this means that they do not endorse now,

315
00:38:58,750 --> 00:39:05,440
but they're going to be situations where this is absolutely fine and it's not wrongful.

316
00:39:05,440 --> 00:39:18,280
In the average case, to inspire someone to cut, it's so I suppose think about this patient, a doctor.

317
00:39:18,280 --> 00:39:23,590
So his patient, a patient, hey, has an advanced cancer, which is proven resistant.

318
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Most of traits in all the range of drugs, which are very unlikely to cure the cancer.

319
00:39:29,230 --> 00:39:34,160
One highly likely to cause of premature death. So she's in a bad way.

320
00:39:34,160 --> 00:39:39,870
She's no longer has her, but she thinks so a reference point.

321
00:39:39,870 --> 00:39:45,830
She's not in a state of despair. She's just gotten over the reference point status quo.

322
00:39:45,830 --> 00:39:48,320
So come along and say to her, well, you know,

323
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there's this other possible drug therapy you could take out these very high risk side effects, blah blah blah.

324
00:39:55,280 --> 00:39:58,970
Then she's probably going to be unwilling to file, which has been awesome point.

325
00:39:58,970 --> 00:40:02,210
More drugs, more side effects. I don't want to go.

326
00:40:02,210 --> 00:40:13,140
I don't want to do this. Now, suppose the doctor, though from patient day, provides her with access to a promising new drug that's being trialled,

327
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which appears to be far less likely to cause premature death, has some side effects, but they don't seem to be as bad as the others.

328
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That's a different story. So the doctor may be able to infuse patient improvements.

329
00:40:26,900 --> 00:40:31,610
And what we know was drug therapies said to be proven out there market.

330
00:40:31,610 --> 00:40:37,280
They pretty bad. They have these terrible side effects. But this one that's in trial really seems promising.

331
00:40:37,280 --> 00:40:40,930
Yeah, there are some side effects, but we've really seen these trials.

332
00:40:40,930 --> 00:40:50,690
OK, now if the doctor can persuade the patient to take this and that's going to change their attitude to risk, I am more likely to take it.

333
00:40:50,690 --> 00:40:56,600
So this is where the doctor due the question of manipulation lies.

334
00:40:56,600 --> 00:41:01,520
Now we think in most cases this is perfectly fine,

335
00:41:01,520 --> 00:41:10,010
morally acceptable because the doctor just straightforwardly says to the patient, Here are the know.

336
00:41:10,010 --> 00:41:18,470
Here is the risks, the known risks taken to this new drug, the known side effects.

337
00:41:18,470 --> 00:41:27,890
Here's what we know about chances you know might not work a lot and, well, much better than the other therapies.

338
00:41:27,890 --> 00:41:34,370
The patient is, in effect, making a rational decision about what's going to happen if she is inspired,

339
00:41:34,370 --> 00:41:39,770
but hope that she's going to move from risk are risk averse to risk seeking.

340
00:41:39,770 --> 00:41:45,260
But we don't think that's a problem because on the prospect theory,

341
00:41:45,260 --> 00:41:52,040
all of us are already both risk seeking and risk averse, just different circumstances.

342
00:41:52,040 --> 00:41:57,200
So it's not irrational to be risk seeking. It's not irrational to be risk averse.

343
00:41:57,200 --> 00:42:08,660
And this is, you know, this perfectly sort of normal procedure. Every one of us has the experience of acquiring hope and changing our behaviour.

344
00:42:08,660 --> 00:42:18,890
But I do think this is perfectly normal procedure, which can be quite consistent rationality and can be something that she can actually treat.

345
00:42:18,890 --> 00:42:23,660
And so we don't think, you know my advice, this is for the patient.

346
00:42:23,660 --> 00:42:35,430
The key thing is the patient, OK? However, there might be some variations on this which are not good.

347
00:42:35,430 --> 00:42:39,620
Now this is a paper. It's frightening.

348
00:42:39,620 --> 00:42:49,900
Justin Staff is very impressed by this. Someone who would rather know from 1978, I did not find this, that he's not an account of manipulation.

349
00:42:49,900 --> 00:42:55,660
I I attempts to modify their safety on these attempts, the complex motivation of this behaviour.

350
00:42:55,660 --> 00:43:02,950
I mean, it's a fictional claim of supposed weakness that is attempting to motivate someone's

351
00:43:02,950 --> 00:43:10,360
behaviour in a way which presume which fans of all persons Pro-Ject know.

352
00:43:10,360 --> 00:43:17,410
So think about this. So the worry here is this playing on supposed weakness I was.

353
00:43:17,410 --> 00:43:24,490
The doctor finds out that the patient has a tendency to clutching at straws, a plastic straws, anything.

354
00:43:24,490 --> 00:43:31,660
It tells them about a little prospect and they immediately jump on it without sort of feeds them.

355
00:43:31,660 --> 00:43:39,160
So you decided to be patient? Well, you know, you've tried all those main therapies and will produce this bad side effects.

356
00:43:39,160 --> 00:43:43,060
But there's this new driving trial of patients.

357
00:43:43,060 --> 00:43:48,370
Yes, I wanted without thinking it through.

358
00:43:48,370 --> 00:43:57,780
And that's that's his worry, because if the doctor is aware of this and there's a potential to exploit to neglect the statute,

359
00:43:57,780 --> 00:44:07,660
there are tendency to flash at straws. And you could imagine the doctor is prepared to say that they don't really want to cure the patient.

360
00:44:07,660 --> 00:44:20,830
What they want is to have another person take the experimental drug because hundreds of patients publicly follow something.

361
00:44:20,830 --> 00:44:27,910
So there might be some bad motives here. Well, in that case, we think this is a pretty simple distillation.

362
00:44:27,910 --> 00:44:37,210
So the first story where the patient doses, I hope the switch in her attitude to risk we think is acceptable.

363
00:44:37,210 --> 00:44:47,860
We think this influence by way of decision-making weakness is not morally acceptable, so it should be clear.

364
00:44:47,860 --> 00:44:56,230
OK, so. And here's another way this another sort of possibility this patient might just be obsessed

365
00:44:56,230 --> 00:45:04,060
with preventing deaths at all costs and exaggerates the efficacious mass found in any trial.

366
00:45:04,060 --> 00:45:11,590
So, so it might be that, no, they have a patient, and I know the clutching at straws.

367
00:45:11,590 --> 00:45:15,910
The doctor is worried about the ethics of performance record.

368
00:45:15,910 --> 00:45:19,150
They want to try everything. They don't want to be seen as someone who gives up.

369
00:45:19,150 --> 00:45:24,610
Even the patient wants to give up and doesn't want to have all these different side effects.

370
00:45:24,610 --> 00:45:31,600
And so they exploit the see budget straws getting to take these drugs.

371
00:45:31,600 --> 00:45:35,260
So once you imbued with hope,

372
00:45:35,260 --> 00:45:46,150
the reference point shifts load from the state of being unwell with cancer that now the best lusts and wounds take more risks.

373
00:45:46,150 --> 00:45:56,410
And so she's been manipulated wrong. Now this is slightly different from this is another case comes up.

374
00:45:56,410 --> 00:46:04,480
So this is just more of a straightforward section. Tyson's different from the the clutching at straws case.

375
00:46:04,480 --> 00:46:12,710
No information has been withheld from the patient. It's just that a known decision making weakness has been manipulated.

376
00:46:12,710 --> 00:46:17,740
But there are other cases that come up is something to worry about.

377
00:46:17,740 --> 00:46:22,330
Now it's basically a patient. There's no hope, any each way.

378
00:46:22,330 --> 00:46:30,990
And but the doctor pushes their buttons and gets them to hope that there will be a miracle

379
00:46:30,990 --> 00:46:37,150
and just neglects to mention the sort of significant risks of the experimental procedure.

380
00:46:37,150 --> 00:46:41,100
In that case, they could ignore discount rationalise away.

381
00:46:41,100 --> 00:46:48,910
So they're not engaging with risks at all. So again, this is another way of manipulating a patient.

382
00:46:48,910 --> 00:46:53,740
It's not quite as devious as exploiting.

383
00:46:53,740 --> 00:47:02,260
It's more exploiting these circumstances rather than exploiting the he wants, but it's still OK.

384
00:47:02,260 --> 00:47:15,920
But even though there are these wonderful ways of taking advantage of patients propensity to change their attitude to risk as a result of the quality,

385
00:47:15,920 --> 00:47:21,390
though, they're also going to be saving lives and.

386
00:47:21,390 --> 00:47:29,390
OK. So, sir, I've done that already. So, yeah, so that's just a different story.

387
00:47:29,390 --> 00:47:34,860
Actually, the the other case, I'll just finish up it, say in the next I was going to say,

388
00:47:34,860 --> 00:47:42,440
we're going to say something about religion and hope that kind of Dr Typekit Typekit longer and longer.

389
00:47:42,440 --> 00:47:45,830
But the gist of what we want to say is this well,

390
00:47:45,830 --> 00:47:56,930
insofar as and this often comes up if religion religion is a common source of hope and you see to religious and the life to be

391
00:47:56,930 --> 00:48:08,330
hopeful insofar as religion is doing the work of getting patients to hope for an outcome that they rationally endorse anyway,

392
00:48:08,330 --> 00:48:16,940
and which is, I know that they become better, that they return to their previous state of health.

393
00:48:16,940 --> 00:48:23,960
And that's good. If religion is actually pushing you to some other goal, then we think that's bad.

394
00:48:23,960 --> 00:48:29,600
Guns and religion are no longer in line with the goals of culture. And so that's what we can say.

395
00:48:29,600 --> 00:48:35,240
But as I say, that simply dropped out of the pipe, those regions of space.

396
00:48:35,240 --> 00:48:38,746
So I'll leave it there. Thank you. And I look forward to.