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Two concepts of therapeutic optimism
  1. Lynn A Jansen
  1. Correspondence to Lynn A Jansen, Associate Research Professor (Prov), Madeline Brill Nelson Chair in Ethics Education and Associate Director, Center for Ethics in Health Care, Oregon Health and Science University, 3181 SW, Sam Jackson Park, RD (UHN-86) Portland, OR 97239, USA; ljhomes{at}


Researchers and ethicists have long been concerned about the expectations for direct medical benefit expressed by participants in early phase clinical trials. Early work on the issue considered the possibility that participants misunderstand the purpose of clinical research or that they are misinformed about the prospects for medical benefit from these trials. Recently, however, attention has turned to the possibility that research participants are simply expressing optimism or hope about their participation in these trials. The ethical significance of this therapeutic optimism remains unclear. This paper argues that there are two distinct phenomena that can be associated with the term ‘therapeutic optimism’—one is ethically benign and the other is potentially worrisome. Distinguishing these two phenomena is crucial for understanding the nature and ethical significance of therapeutic optimism. The failure to draw a distinction between these phenomena also helps to explain why different writers on the topic often speak past one another.

  • Hope
  • unrealistic optimism
  • therapeutic misconception
  • informed consent

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  • Funding Work on this paper was supported by an NIH-NCI grant # R21CA131601-01A1, Understanding Optimism in Clinical Research.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.