Waiting for a Miracle?
Angelika Zollfrank, MDiv, Yale New Haven Hospital
Guy Maytal, MD, Massachusetts General Hospital
The workshop will focus on understanding the phenomenon of miracle beliefs. When is it wise to engage such beliefs and when is it appropriate not to? Theological, philosophical, and psychological understandings can guide providers as they are working to improve the quality of end of life care as well as the quality of conflict in medical decision making.
Miracle stories in the Hebrew Bible, the Old Testament show that Divine actions and the events of nature were seen as one. Narrations of supra-natural events contain the belief that God is the source of every event in the created world. The New Testament stories of miraculous healing aim to proclaim Jesus as the Messiah. This primary theological meaning can get lost in receptions of miracle stories as accounts of medical cases and their positive, miraculous outcomes. The apostle Paul views the event of the cross as miracle, in which God breaks into the reality of human suffering and changes such suffering into an event of life-giving closeness between God and God’s people. Augustine emphasizes the miraculous character of daily life and its plethora of the unexplainable, which ultimately points to the inexhaustible creativity of God versus the experience of limitation that all created beings share. While Luther understands the biblical accounts of miracles as supra-natural, he emphasizes the inner experience of faith as the real miracle, which to him is more important than the miracle of healing.
The Roman Catholic teaching sees healing miracles as surpassing natural processes, which are in keeping with the body’s natural capacity for health. The primary purpose of miracles is the glorification of God and the calling of people to salvation. A primary ends of a healing miracle is that it gives glory to God and manifests His saving mercy. The beneficiary is given a temporal grace (secondary to eternal salvation) of better health.
The thesis building on this brief overview is that different understandings of miracles can be seen clinically. Providers need to know what kind of miracle belief a family or surrogate decision-maker holds. In simple cases miracle beliefs are a way into a journey of grief. In complex, longstanding cases, miracle beliefs can be evidence of a complex or even conflicted, relationship between medicine and religion. Owing enlightenment’s separation of faith and science providers may see the same separation of faith and science clinically. In its consequence such separation can either lead to or be evidence of a power struggle between medical team and family, as representatives of science and faith.
We argue that the exclusive reliance of medicine on itself and its curative powers as well as the religious insistence on miraculous healing, lead to a self-reliance, attempts to control clinical outcomes with demands for “unreasonable” care, and use religious beliefs to cope with helplessness in devastating circumstances. In such cases, engagement of miracle beliefs may be contraindicated. However, if the term “miracle” is understood by providers and families as a name for an event, in which the relationship to the Transcendent becomes perceivable, new pathways towards healing may be found, which include the affirmation of God’s efficacy in the clinical course.
Definitions:
Clinical cases: Three cases show how miracle beliefs (in their diversity) challenge the separation of medicine (science) and the life of faith (religion). The selected cases will also show a progression: For example, miracles belief as a way into acceptance of “bad news” and grief, versus miracle beliefs as a way to defend against clinical realities coupled with demands for treatment to entering into a power struggle with the medical team. The cases will elucidate the following questions:
Does the miracle belief:
What are the emotional meanings of Miracle Beliefs? A way of
Reflective questions and progressive clinical approaches to beliefs in miracles will be offered:
Skill training:
Based on a progressive understanding of miracle beliefs in the clinical context, participants will have the opportunity to experiment with known and new strategies to engage miracle beliefs.
Using an inner circle for a group of volunteers to role play a family meeting, workshop participants are invited to experiment with ways of engaging miracle beliefs or deciding not to engage such beliefs. Workshop participants witnessing the role play will track observations and discuss the value of clinical interventions.
Guy Maytal, MD, Massachusetts General Hospital
The workshop will focus on understanding the phenomenon of miracle beliefs. When is it wise to engage such beliefs and when is it appropriate not to? Theological, philosophical, and psychological understandings can guide providers as they are working to improve the quality of end of life care as well as the quality of conflict in medical decision making.
Miracle stories in the Hebrew Bible, the Old Testament show that Divine actions and the events of nature were seen as one. Narrations of supra-natural events contain the belief that God is the source of every event in the created world. The New Testament stories of miraculous healing aim to proclaim Jesus as the Messiah. This primary theological meaning can get lost in receptions of miracle stories as accounts of medical cases and their positive, miraculous outcomes. The apostle Paul views the event of the cross as miracle, in which God breaks into the reality of human suffering and changes such suffering into an event of life-giving closeness between God and God’s people. Augustine emphasizes the miraculous character of daily life and its plethora of the unexplainable, which ultimately points to the inexhaustible creativity of God versus the experience of limitation that all created beings share. While Luther understands the biblical accounts of miracles as supra-natural, he emphasizes the inner experience of faith as the real miracle, which to him is more important than the miracle of healing.
The Roman Catholic teaching sees healing miracles as surpassing natural processes, which are in keeping with the body’s natural capacity for health. The primary purpose of miracles is the glorification of God and the calling of people to salvation. A primary ends of a healing miracle is that it gives glory to God and manifests His saving mercy. The beneficiary is given a temporal grace (secondary to eternal salvation) of better health.
The thesis building on this brief overview is that different understandings of miracles can be seen clinically. Providers need to know what kind of miracle belief a family or surrogate decision-maker holds. In simple cases miracle beliefs are a way into a journey of grief. In complex, longstanding cases, miracle beliefs can be evidence of a complex or even conflicted, relationship between medicine and religion. Owing enlightenment’s separation of faith and science providers may see the same separation of faith and science clinically. In its consequence such separation can either lead to or be evidence of a power struggle between medical team and family, as representatives of science and faith.
We argue that the exclusive reliance of medicine on itself and its curative powers as well as the religious insistence on miraculous healing, lead to a self-reliance, attempts to control clinical outcomes with demands for “unreasonable” care, and use religious beliefs to cope with helplessness in devastating circumstances. In such cases, engagement of miracle beliefs may be contraindicated. However, if the term “miracle” is understood by providers and families as a name for an event, in which the relationship to the Transcendent becomes perceivable, new pathways towards healing may be found, which include the affirmation of God’s efficacy in the clinical course.
Definitions:
- Medically unexplainable events
- Violation or exception to the laws of nature
- Unpredictable interference with nature by a supranatural power
- An unexpected, extraordinary, wonderful event
- Insistence that there is more to life than medicine
- Special divine intervention - Deus ex machina
- Defiance to medical expertise
- An emotional struggle - a power struggle
Clinical cases: Three cases show how miracle beliefs (in their diversity) challenge the separation of medicine (science) and the life of faith (religion). The selected cases will also show a progression: For example, miracles belief as a way into acceptance of “bad news” and grief, versus miracle beliefs as a way to defend against clinical realities coupled with demands for treatment to entering into a power struggle with the medical team. The cases will elucidate the following questions:
Does the miracle belief:
- conflict with quality of care?
- conflict with the conscience of those providing care?
- claim a positive or negative right?
What are the emotional meanings of Miracle Beliefs? A way of
- denying/defying reality
- entering into the grieving process
- expressing that the loss is unbearable
- expressing a “culturally appropriate” belief
- resisting to adjust to a different role/vocation
- asserting some control when feeling helpless
- expressing guilt feelings
- coping that recruits maximal supports
Reflective questions and progressive clinical approaches to beliefs in miracles will be offered:
- Is the miracle belief an expression of positive coping?
- Respectful exploration
- Inquiry into previous experiences
- Listen to underlying feelings
- Reframing miracles
- Probe for inconsistencies
- Figure out how to step out of a power struggle
- Do not proselytize
- What would the patient want? Best interest?
- Involve chaplains and community clergy
- If there is no ethical dilemma, than miracle belief can be understood as an attempt to create a conflict where is none
- Accept that some surrogate decision makers do not feel they have the authority to decide
- Support the medical team in setting limits compassionately
- Understanding the miracle belief as a psychological phenomenon, which maybe best addressed by not engaging
Skill training:
Based on a progressive understanding of miracle beliefs in the clinical context, participants will have the opportunity to experiment with known and new strategies to engage miracle beliefs.
Using an inner circle for a group of volunteers to role play a family meeting, workshop participants are invited to experiment with ways of engaging miracle beliefs or deciding not to engage such beliefs. Workshop participants witnessing the role play will track observations and discuss the value of clinical interventions.