The Spring 2016 issue of IJFAB is now available via Project Muse. It includes an interesting open access paper by Allison Merrick, “A Paradox of Hope? Toward a Feminist Approach to Palliation.” The paradox of hope arises in cases where a patient’s prognosis is very poor. Because physicians have a duty to respect patient autonomy, they should be sure that a patient receives accurate information about their progress. At the same time, however, receiving this information may cause the patient to lose hope, causing their condition to worsen. Thus, providing accurate information seems contrary to the duty of beneficence.

Merrick’s goal in this paper is to undermine this paradox by developing an alternative model of medicine, one that does not focus solely on cure – on “the eradication of the cause of an illness or disease, [or] the radical interruption of and reversal of the natural history of the disorder” (Pellegrino and Thomasma 1997, 27; quoted in Merrick 2016, 112). Instead, she offers a palliative model, informed by feminist scholarship, that understands hope in terms of the patient’s subjective priorities and experiences. Such a model, she claims, “opens up the space for a plurality of values” (112).
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Merrick closes her paper with a discussion of some of the work in feminist bioethics that parallel her ideas and that could be used to further develop her approach to palliation. In particular, she stresses that we must incorporate a relational dimension to palliation, emphasizing the patient’s relationships with their loved ones and also the ways that power structures operate in the healthcare system. I believe that the model she offers is very promising and would love to see further development of a relational approach to palliation. As questions about end-of-life care become more pressing, it becomes increasingly important to develop frameworks that are adequate to the complexity of the decisions that patients, their families, and health care providers will face. A feminist account such as Merrick’s seems to me to be our best hope of doing so.