In medicine our job is not to squelch another person’s hope for a miracle. And while I do not think I have actually seen a miracle, I know that others have – or they believe they have. There is no question that very, very rare things do happen on occasion. That includes spontaneous remissions from cancer and recovery from illnesses that everyone thought was impossible. Are these miracles? I am not sure, but 76 percent of Americans believe in miracles and herein lies the problem.
Do we build a health care system that plans for miracles? How much time and money should we invest in waiting for a medical miracle to occur at the bedside? Medical futility is a term that implies that experts, often from different specialties, agree that there is no reasonable chance of success from a given treatment. While futility does not include a numerical part of the definition, we might agree that something is medically futile if the chance of recovery is, say, more than 1 in a million. So, when a person is in intensive care and the only treatments are those considered “medically futile,” should families be allowed to insist that hospitals continue to provide all life-sustaining therapies because “there is always a chance that a miracle will take place”?
Futile care is not so benign. It often inflicts pain on the patient, takes up valuable space in a crowded ICU and costs the health care system tens or even hundreds of thousands of dollars. And it may not even be what the patient would have wanted at the end of his or her life.
Some scholars have spent their careers arguing that miracles do occur, but right now I am just trying to understand the rules. If a family is waiting and hoping for a miracle to happen, is it less likely that a miracle will occur when we provide no life-sustaining treatment than if we provide aggressive treatments? In other words, does a miracle present itself only to those who are receiving aggressive life-sustaining treatments? When a family pushes for aggressive care waiting for a miraculous cure, they sincerely believe that they are acting in the best interests of the sick person. But in my experience, distraught relatives routinely overestimate the chance that a miracle cure will occur and doctors often hesitate to push back against a family at such a vulnerable time.
In medical school, we are not taught about miracles. This creates difficulty when the medical community sees the world and the chances of recovery very differently than some families. With a new health care system on the horizon, we need to engage in public debates around futility and miracles and hope we can arrive at some clear guidelines around waiting for miracles.
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at firstname.lastname@example.org.