Hope to the End

In the book Exploiting Hope: How the Promise of New Medical Interventions Sustains Us-and Makes Us Vulnerable, Jeremy Snyder takes on the dominant theory that exploitation in research ethics involves culpable inequity in transactions between parties. He rightly dismisses that economic explanation as inadequate. His theory of exploitation argues that it happens when those who have a duty of beneficence to someone take advantage of their hope. Exploitation is not just an unfair transaction; it is a betrayal of an obligation owed to the vulnerable, weak, or dependent to protect them. Snyder is persuasive. But only to a point. He helps us understand the betrayal involved in exploiting hope. But much more remains to be debated about hope and exploitation. Exploitation in health care is not just a matter of schemers and ne'er-do-wells playing fast and loose with ever-hopeful patients. Sometimes it involves patient groups looking for the right to try any intervention, no matter how dangerous or outlandish, at government expense.