How do patients, their families, or their caregivers express hope for a miracle in the clinical setting? How can medical professionals respond to these desires for a miracle to occur?
Guests Dr. Devan Stahl, Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and Department of Pediatrics and Human Development at Michigan State University, and Dr. Trevor Bibler, Assistant Professor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine, have written on this topic, with articles published in the American Journal of Bioethics and the Journal of Pain and Symptom Management. In this episode they discuss the framework for categorizing the various ways in which people hope for a miracle, while also drawing from experiences they have had as clinical ethicists. They also discuss the importance of not making assumptions when miracle language is used, emphasizing the need for all religious beliefs to be respected by medical professionals.
Ways to Listen
This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full episode transcript available.
About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Each month Center for Ethics faculty and their collaborators discuss their ongoing work and research across many areas of bioethics—clinical ethics, evidence-based medicine, health policy, medical education, neuroethics, shared decision-making, and more. Episodes are hosted by H-Net: Humanities and Social Sciences Online.
Authors Trevor M. Bibler (Baylor College of Medicine), Myrick C. Shinall, Jr. (Vanderbilt University Medical Center), and Center Assistant Professor Dr. Devan Stahl have a target article in the May 2018 American Journal of Bioethics, on “Responding to Those Who Hope for a Miracle: Practices for Clinical Bioethicists.” Additionally, AJOB published correspondence from the authors, “Response to Open Peer Commentaries on “Responding to Those Who Hope for a Miracle: Practices for Clinical Bioethicists”,” where the three authors discuss significant points of disagreement, clarification, and agreement from the responses to their article.
Abstract: Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, “How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?” We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator’s conceptions of God, community, and self. After the ethicist appreciates how these concepts influence the invocator’s worldview, she can begin responding to this hope with specific practices. We discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle.
The full text as well as the response are available online through Taylor & Francis Online (MSU Library or other institutional access may be required to view these articles).
Center Assistant Professor Dr. Devan Stahl is co-author of an article published in the February 2018 issue of the Journal of Pain and Symptom Management. “Addressing a Patient’s Hope for a Miracle” was written by Myrick C. Shinall Jr. (Vanderbilt University Medical Center Section of Palliative Care), Dr. Stahl, and Trevor M. Bibler (Baylor College of Medicine).
Abstract: Ill patients may make decisions to continue aggressive life-prolonging care based on hope for a miraculous recovery, and clinicians can find goals of care discussions with these patients extremely challenging. Thus, palliative care providers may be asked to help in these discussions. The concept of “miracle” can express a multitude of hopes, fears, and religious commitments. Effective, sensitive engagement requires the palliative care provider to attend to these variegated hopes, fears, and commitments. This case presents a typology of ways patients express hope for a miracle along with analysis of the motivations and beliefs underlying such hopes and suggestions for tailored responses by palliative care providers.
The full text is available online through Elsevier/Journal of Pain and Symptom Management (MSU Library or other institutional access may be required to view this article).
On November 11, Center Assistant Professor Dr. Devan Stahl presented at the Michigan State Medical Society 21st Annual Conference on Bioethics. Held in Ann Arbor, the conference’s theme was “First do no harm: Avoiding Overdiagnosis and Overtreatment in Medicine.” Dr. Stahl gave the talk “Responding to those who Hope for a Miracle.”
Dr. Stahl presented strategies for engaging patients and families who request aggressive care with the hope of obtaining a “miracle.” As discussed in her latest article*, Dr. Stahl laid out a taxonomy of how the term “miracle” is used in the context of health care, as well as tips for healthcare providers responding to those particular invocations. The audience was presented with case studies that highlighted the different ways in which a patient may use miracle language as well as communication strategies that can help further a dialogue about appropriate and inappropriate uses of medical treatments.
* Note: viewing this article may require MSU Library or other institutional access.