Clinical Challenges in Parental Expression of Hope and Miracles

The concepts of hope and the medical miracle are ubiquitous in modern medical practice and can often become central aspects of a critically ill patient’s or his family’s hospital experience.1–3 Cases where these beliefs are especially strong even make their way into mainstream media, as in the 2013 case of the California teen who became brain dead after a complication from a tonsillectomy. In this case, her family fought a widely publicized court battle to be able to keep her on mechanical support and move her out of state to another facility. They believed that, despite what was explained to them regarding the diagnosis of brain death, their daughter would one day recover.4 A high prevalence of spirituality within the American population serves as a foundation for expectations in miracles5 and pediatricians may frequently encounter similar ideas in conversations with families. Despite all of the limitations in contemporary practice, physicians are acutely aware of the popular confidence in medical technology and the tendency for families to hope for outcomes that are medically unattainable. The unprecedented explosion of rapid medical advancement through the 20th century has helped to perpetuate the belief that technology has the ability to repair any affliction. With the advent of the mechanical ventilator and proliferation in its use from the 1960s to 1970s, it was suddenly possible to even prevent death. The new technology mandated the medical community to outline technical definitions of cardiac death and brain death, which is a debate that continues … Address correspondence to Bonnie H. Arzuaga, MD, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Rose-3, Boston, MA 02215. E-mail: barzuaga{at}bidmc.harvard.edu