Medical doctors walk a fine line between giving patients false hope and not giving their patients enough hope, which then causes despair. Suppose my patient is diagnosed with a cancer that is usually terminal—even with treatment—in one to two years. How can I encourage her to hope authentically? In a recent publication, I explore what a robust hope might look like in the face of death.

In the late Middle Ages, a genre of literature known as the ars moriendi (or “art of dying”) became very popular and circulated for more than 500 years. The ars moriendi referred to handbooks on the preparation for death, designed to be used by communities of laypeople, even the illiterate, in order to anticipate and make ready for death. Many of the earliest versions focused on discussion of the temptations to dying poorly and the habits that people might cultivate to die well. One of the top-five temptations was to despair, and hope was its associated mitigating habit.

Academic conceptions of hope in medieval Western Europe were often deeply religious. The 13th-century scholar Thomas Aquinas described hope as a God-given virtue to help the faithful obtain the difficult-to-achieve yet possible future good of union with God in heaven—an infinite good. Aquinas said that despair is not only the opposite of hope, it is also the withdrawing from hope. In my article, I acknowledge that as in Aquinas’ day, not everyone today believes in the divine. Yet, then, as now, it is critical that all people cultivate hope and not withdraw toward despair. What, then, are the characteristics of this sort of authentic hope?

First, hope is an orientation toward a future good. This was true for Aquinas as well. We do not hope for that which we presently possess. Patients with cancer hope for healing because they are not at this moment cured. But patients in good health do not hope for good health now, because they have it. Hope must have a fundamental future orientation.

Second, that future good is difficult but possible to achieve. It is foolish to hope for the impossible. A human being cannot hope to sprout wings and fly like a bird, for example. But she could hope to see the world from a new vantage point; that would be possible. Similarly, if a patient with incurable cancer hopes for total cure and doesn’t obtain it, she may very well retreat toward despair. But if her hope is oriented toward some greater future good (e.g., deep legacy work, relational reconciliation, a season of remission from disease), this empowers her against despair. Hope must be for a realistic future good.

Third, that future good is ill-defined. This is a critical component to philosophies of hope. If that future good is too crisply defined, failure to achieve it is grounds for despair, such as when my patient is given two weeks to live but puts all her hope in two years. Again, the point is that this future good is not measurable or definable in detail but rather is the “hunch” of a good toward which one orients oneself.

The philosopher Iris Murdoch offers an image of this sort of hope—hope as orientation toward an ill-defined future good that is difficult but possible to obtain. She describes a painter, who “is obedient to a conception of perfection to which his work is constantly related and re-related in what seems an external manner.” The work of painting stroke after stroke, version after version, in an effort to realize that future good is a practice of hope. The artist knows that it will take work, but ultimately the good of the painted image will come into relief.

Doctors must not deceive their patients by promising impossible cures. Nor should they deliver bad news that is void of any possibility of the good prevailing. As the saying goes, “As long as there is life, there is hope.” Whether doctors or patients, we must all learn to cultivate the sort of hope that works hard toward a possible, if not-altogether-clear, future hope. Anything less is to acquiesce to despair.