Appeals to the miraculous are common in healthcare, and arguments about end-of-life decision-making can quickly become theological. Assessments of hope have been recommended within the biopsychosocialspiritual model of medicine, but these assessments fail to account for the theological dimension of hope. Examples of failed assessments include recent efforts in palliative care and classic works, such as On Death and Dying by Elisabeth Kübler-Ross. To adequately address the patient’s and family members’ hopes without patronizing or harming the patient, assessments must be (...) done by a person trained in theology. (shrink)

The belief in miracle, as a modality of spiritual/religious coping strategy in the face of stress and psychic suffering, has been discussed in psychological literature with regard to its positive or negative role on the health and well-being of patients and family members. In contemporary times, where pseudo-conflicts between religion and science should have been long overcome, there is still some tendency of interpreting belief in miracle – as the possibility of a cure granted by divine intervention, modifying the normal (...) course of events in a bleak medical diagnosis – as having unhealthy impacts in the care and treatment of health. This position seeks to find a base in the three characteristics of hoping in a miracle, frequently pointed out by psychological literature: it would imply a negation of reality instead of its confrontation; it would be a coping strategy focused on emotion instead of the problem; it would imply seeking to modify the supposed desire of God by extra-natural facts. In this study, we shall critically discuss this position and the dangers of its crystallization by the use of SRC scales in which the act of praying for a miracle is previously classified as a negative strategy. We revisit some tendencies in psychological literature about the subject, taking into consideration the various facets of miracle, sociocultural facts, elements of idiographic nature, and their profound outcomes in the lives of people especially in health contexts. We illustrate the dangers of a hasty generalization of the results of nomothetic studies about the role of belief in miracle with two examples of research in the Brazilian context: one carried out with pregnant women with fetal malformation and the other with family members caring for children and adolescents with cancer under chemotherapeutic treatment. In both studies, the results do not confirm the predominance of the negative aspects associated with the act of praying for a miracle, which we discuss and analyze in light of the phenomenological perspective. In this perspective, “pray for a miracle”, as experienced by patients and caregivers, can be recognized as an act of openness to life, bolstering hope, and the resignification of reality in the psyche. (shrink)

As a continuation of the previous paper,Praying for a Miracle – Negative or Positive Impacts on Health Care, published in this research topic, this second paper aims at delving deeper into the same theme, but now from a simultaneously practical and conceptual approach. With that in mind, we revisit three theoretical models based on evidence, through which we can understand the role of a miracle in hospital settings and assess its impact in health contexts. For each of the models described, (...) we seek to illustrate the possible outcomes of belief in miracles as a modality of religious coping in situations of stress and suffering experienced by patients and caregivers in the face of gloomy diagnoses on coming across the limits of medicine to revert certain illnesses (e.g., child cancer) or biological conditions (e.g., fetal malformation). We posit that the judgment about how such a mechanism is healthy or not for each of the people involved (patient, caregiver, and/or health professional) depends on the modulation between the conception of the miracle adopted by the patient and/or caregiver and the concrete outcomes of the way of responding to the situations that accompany the gravity of the illness or condition. To better understand this process of psychological modulation that accompanies belief in miracles, we revisit the concepts of spirituality, religiosity, and religion, pointing out the connections and distinctions between them from a phenomenological perspective. We then present a conceptual model that takes these connections and distinctions into consideration to foster an understanding of miracles, their relations with the diversity of experiences of people who meet in hospital settings (patients, caregivers, and health professionals), and their respective impacts on healthcare. (shrink)

Every clinical ethics consultant, no matter their own spirituality, will meet patients, families, and healthcare professionals whose spiritualities anchor their moral worldviews. How might ethicists respond to those who rely on spirituality when making medical decisions? And further, should ethicists incorporate their own spiritual commitments into their clinical analyses and recommendations? These questions prompt reflection on foundational issues in the philosophy of medicine, political and moral theory, and methods of proper clinical ethics consultation. Rather than attempting to offer definitive answers (...) to these questions, this essay prompts readers to consider their own answers to these questions. Specifically, it offers a taxonomic analysis of six (6) distinct responses: assessment, delegation, examination, translation, incorporation, and assertion. Furthermore, this essay describes the role of the ethicist’s own spiritual commitments during the responses. Each section also names several strengths and weaknesses that ethicists ought to consider when evaluating the purpose and scope of each response. This paper prompts readers to consider circumstances under which they might promote, critique, or incorporate spiritual worldviews—their own and those of their patients—when offering clinical analyses and recommendations. (shrink)