What does someone have to do to make a miracle occur? Is hoping for a miracle enough? Is there a certain number or quality of prayers that need to be said? Or, a certain amount of time that has to pass?
These may sound like questions related to faith, but we encounter patients and family members who disavow religion and yet hope and wait for a miracle. What is our role as health care providers in addressing a spiritual issue that impacts health care decisions?
Sometimes in the face of what seems obvious, a patient with poor performance status who is unable to undergo additional chemo, a weak and cachectic patient, someone with widespread disease that has spread in spite of treatment, we hear the same rationale for continuing to refuse any discussion of Goals of Care: “We are praying for a miracle.”
This is one of the most perplexing statements. Such a declaration is a conversation stopper, one that blocks continued discussion or counterpoint. It makes me uncomfortable, and puts me immediately on the defensive because the idea of waiting for a miracle implies that if a patient/family accepts the patient’s condition that is tantamount to giving up not just the physical fight, but the spiritual one. From there, I can infer that any effort to explain the reality of the situation reflects on me as someone who is pushing them to give up, therefore, somewhat violating their autonomy.
In a situation such as this, my goal is to facilitate and open discussion. Yet I am left feeling like the bearer of bad news and someone who dismisses their beliefs. Instead of creating an atmosphere of understanding, I feel like I am promoting a loss of faith. Many of us, myself included, incorrectly believe if we can just figure out the “right” explanation, patients and families will understand we are not negating their desire for a miracle but are trying to prepare them for what will likely happen.
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Is an unrealistic idea of hope something you need to talk someone out of, or is it something you can yield to?
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