The “Hope Capacity” in the Care Process and the Patient-Physician Relationship

Especially in serious pathologies, in which there is a real risk of dying, the capacity of the sick person of keeping alive the will of living and participating actively in the care process, is intimately linked to what Fornari calls “hope capacity”. Such capacity is often reduced and inhibited by the kind of arguments developed in the patient-physician communication due to a misunderstanding or a wrong use of the concept of “probability”. In the context of the actual biomedical model, inspired on a narrow conception of the living beings, we currently use, in the patient-physician communication, the statistical and probabilistic evaluations referred to clinical/epidemiological data as predictive of the possible evolution of the pathology in the single person. When that happens — for a misunderstanding of the concept of “probability” or a semantic one — the “hope capacity” of the sick person fades away until it definitely disappears. This work shows how, in a systemic conception of health problems — where the barycentre of our attention is shifted from the illness to the sick person — new and fertile spaces for the discussion in the patient-physician communication about his/her possible futures can be opened, referring on one hand to the logistic concept of probability developed in the XX century by Wittgenstein and Keynes and on the concept of subjective probability developed more recently by De Finetti, on the other hand to the objective interpretation of the probability theory proposed by Popper, which defines probability as “propensity”, that is as a physical reality analogous to forces or forces field.