Body of Work: The Science of Hoping for a Miracle

Why are we as humans inclined to believe in miracles? Does “miracle” mean something different to each patient? Are there practices in place to teach healthcare providers how to react to patients waiting for a miracle? Assistant professor of medicine in the Center for Medical Ethics and Health Policy Dr. Trevor Bibler explains.

Trevor M. Bibler, Ph.D. is a clinical bioethicist with a background in religious studies and philosophy. Dr. Bibler performs clinical ethics consultations at Houston Methodist Hospital. He teaches a variety of audiences and conducts research in clinical bioethics, religion and medicine, and philosophical ethics. His current research focuses on the ways religious worldviews—especially worldviews that include ideas related to miracles—influence clinical medicine.

See below for more of Dr. Bibler’s research:

• Addressing a Patient’s Hope for a Miracle
• Responding to Those Who Hope for a Miracle: Practices for Clinical Bioethicists
• Why I no longer say "withdrawal of care" or "life sustaining technology"

Welcome to Body of Work, an exploration of health topics in the news and important issues facing science with experts from Baylor College of Medicine. I'm Erin Blair and this is part two of our interview with Clinical Bioethicist Dr. Trevor Bibler. If you haven't listened to part one yet, we suggest you go back and start there. This is also the final episode of season one of Body of Work. 

Erin: We often think about the worlds of science and faith being distinctly separate. What is it about health that inevitably raises questions about faith?

Dr. Bibler: Well I think that one of when we feel quite healthy we're able to take our bodies for granted. There's a philosopher a German philosopher named Gadamer who talks about the role of medicine as kind of getting us back to this spot where we can take our bodies for granted again. And when we when we end up feeling quite sick whether it's just like a common cold where we have to miss work and are kind of stuffed up so we can't enjoy food in the way if we always have or whether we just we know a family member who had a stroke or we've been diagnosed with a terminal illness or something that's completely irreversible or we might be a candidate for a kidney transplant, all of these issues can end up making us question what it means to live in this world, what it means to die in this world. And oftentimes faith is a way of trying to understand and really reconcile what the type of suffering either we or the people we love are actually going through at this moment as especially when people get near death. Some people I think of science and faith as completely distinct. There's a philosopher and scientist who talks about faith and science as being uses this technical phrase of “non-overlapping magisterial” and what he means by that is that well, from his perspective science is about facts things you can validate based on empirical evidence based on the evidence that's right in front of our eyes and then faith and religion are more about value and science can't touch it and can't touch the other side. And I think that's a little bit too extreme of a view; I think we have enough reason to think that faith reacts to, let's stick to medicine, faith reacts to the ways in which medicine moves forward, and science also has its own set of values that are often part of what they do, even if it's so basic as, “Well, we value answering this question,” it’s still a value. In science while there are definitely objective elements to it, we're still humans who have subjective experiences, our own individual experience who are we're the ones doing the science. I think that strict view ends up not being able to really be fleshed out but I think your question is a good one because we do often think of these two areas as distinct, but it's really to my mind when we get sick that we really have to try to reconcile with both aspects of how we try to think through what's important for us and for most people, many people at least. That involves faith and religion and spirituality. We try to reconcile that with the fact that there are these incredible medical technologies that have something to say about how we can get better. It ends up being a really valuable relationship that I think we as ethicists and we in the healthcare field really need to consider because it's so complex.

Erin: Do you make a distinction between religion and spirituality?

Dr. Bibler: Yeah I think that there's a couple ways of unpacking that. In general I think many scholars, and since their scholars there's a lot of disagreement about it, but I think many of us think about spirituality as this general individual impetus towards trying to get answers to our biggest questions about what it means to be alive, and often time there's some type of an appeal to the divine, whether that's a god or many gods or something even more general, there is that type of impetus to try to wrestle with these questions and precisely get at that but that's the spiritual side of things. And then often I at least think of religion as kind of being a cultural and institutional and organizational really response to this impetus lots of people have. And so to my mind you can always have a spirituality with one person but there can't really be a religion with one person because the religious aspect of it is really about a organizational response to trying to figure out what's sacred and how we better understand what's sacred and how often we try to live in alignment with what we view to be important based on what the sacred has to say.

Erin: Why as human beings are we inclined to believe in miracles?

Dr. Bibler: Yeah well yeah that's a hard question to answer. So there are quite a few scholars, both anthropologists and scholars of religious studies and evolutionary biologists, who argue that to some degree some type of spirituality or faith is hardwired, and some actually argue that there's an evolutionary advantage to having this predilection towards seeing things as being animated. So if we can imagine putting ourselves back a couple millennia and to the polytheistic folk religions of various places across the world, there might be an evolutionary benefit to when you see that bush rustle you pay attention to it because it might be a predator or if nothing's there then maybe that was the divine trying to say something to me, or if you see a very rare bird fly by and then turns out there's a rainstorm maybe that was some type of God giving you a signal of some sort. So that there's a sense that being hardwired to believe in this can have some type of evolutionary advantage because you're ascribing meaning to natural events that might not otherwise have meaning, so you might be more likely to pay attention to these other areas of life. To the point about miracles themselves, yeah I'm not sure. I think that many people are inclined to hope for rare events that might not happen but our to our benefit. And there might be this one in a million chance that some fortuitous event would happen but then different people would ascribe whether or not that means that has to do with God or the divine or many gods they would have different answers to that portion of it, but I think that in general there is a general push towards wanting to find meaning in things and to kind of be hoping against hope that something good will happen even in the worst situations.

Erin: The hope for a miracle is a very complex idea. Does miracle mean something different to every patient?

Dr. Bibler: It certainly can mean quite a few different things. Part of part of my research is really trying to pay attention to the complexity of what this belief might mean while also recognizing that to some degree we can think of people who hope for a miracle in different ways and it can be a helpful way, especially in the clinical setting, to think through them in terms of groups. So I'll just give you a few examples that I think are especially helpful; I think some people hope for a miracle and it's in a way o, “Well my babies a miracle,” or “Every day is a miracle,” or “My healthcare workers are miracle workers,” and it’s a way of thinking about the possibility of a miracle that doesn't really have a direct effect on your medical decisions because the miracle is going to happen either way. But not everybody's like that; some people who I've met they've been very shaken by their experiences by either themselves or their loved ones and then they still hope for a miracle but they themselves actually aren't sure what they mean by miracle. It can mean many different things it can evolve over time. They're just very shaken by the illness and they view the hope for a miracle as something that they can justifiably I think latch on to. But as I very well also learned, not everybody who hopes for a miracle is shaken or thinking through things. Some people are very clear as to what the miracle is what it has to be and how we get there, primarily through lots of praying an additional time for God to work a miracle. Those people in our work we've sometimes called them integrated invocators; their sense of who they are and what's going on and the suffering that they might see, that's all integrated into a framework. Primarily when I hear healthcare professionals say they're in denial, well they're probably not in denial. They just have a very concrete idea as to what sickness is what health looks like and how we get better and that's through hoping for a miracle. Other folks sometimes use it in a more individualized spiritual way of hoping for a miracle. So they might not have a religious community to rely upon, they might be a person who at one time was part of our religious community and now rejects it, or they might think that, “Well no I've never been part of a religious community and when I go and think about these religious communities their idea of miracle doesn't quite overlap with mine, so I'm going to continue thinking about it in my own way.” And then I think what's also quite common are people who are part of a religious community and they're seeking a miracle of some sort but they're also kind of at ease with the possibility of if the miracle doesn't happen in the way that they think it should happen. So I've met folks who thought that at the beginning of their care a miracle would be if my cancer went into complete remission, and then that doesn't happen so they say, “Okay well I guess now my miracle is something else. My miracle might be that my family got to say goodbye to me, or that my family got to reconcile about this issue, or the miracle the whole time was in the life I lived before getting this sick.” So they themselves negotiate what the miracle might be while all the time they're trying to seek it, but unlike those first people I mentioned who are really shaken by it, their faith in their own faith commitments end up staying quite strong; they have it to bounce they have it to anchor how they think about things, but their idea of what a miracle might be just fluctuates over time.

Erin: Can a medical procedure or treatment be a miracle?

Dr. Bibler: Oh I definitely think that quite a few people, and especially health care professionals, they definitely view medical procedures as miracles, everything from routine medical treatments to life-sustaining treatments to very high-risk ones, they can all be viewed as miracles depending on what the health care professionals think.  For example, I was once in a meeting with a cardiologist where he tried to convey to the family that it would be most appropriate to concentrate on the patient's comfort and allow him to die rather than continue to add additional life-sustaining interventions and the language that he used was “We're all out of miracles.” And with that he meant, “Well we've gone through all of these processes we've gone through all of these interventions and there's just nothing else that will get us to the point where he's going to recover, there's nothing else that can cure.” So yeah I think miracle can end up being a lot of different things, especially on the healthcare professional side.

Erin: Are there practices in place to teach clinicians how to react to patients who are hoping for a miracle?

Dr Bibler: Part of my research is precisely on that topic. My colleagues and I, we've suggested practices for clinical ethicists, for palliative care professionals, for chaplains, and now we're writing about pediatricians, trying to help trying to give them tools for precisely that. And it does really involve trying to understand patients and families where they're at and ask this radical question of, “What do you mean by a miracle?” and then listening to the answer, because in those instances that I mentioned earlier, for example, a family or a patient who whose life is completely integrated into their spiritual community and they have no question about a miracle would what that would mean, it might be a good idea to invite their spiritual authorities into the conversation, which would be very different than somebody who is completely shaken and the last thing that they want to see is anybody who has any religious affiliation; their miracle is what they think it is right? So there is there is a little bit of education out there from our group on that. But luckily over time, I just read a statistic recently that around 80% of medical schools have some type of spiritual care aspect that's in some part of their teaching in their curricula. Not every medical school that meets that 80% has a full course dedicated to it or anything like that, but there are specific actions and specific classes that are being taught across medical schools, and I believe the number is somewhere similar for nursing schools as well. There is quite a bit of education around these issues about religion and medicine, but it's primarily under this this guys this concept cultural competency. So what happens if I as a person who does or doesn't believe in God and caring for a patient from Saudi Arabia, right, or they're simply a patient who wouldn't share my faith if I have no faith or doesn't share my faith even if I do have one? And oftentimes getting at the religious aspects is part of this broader idea of cultural competency, getting a sense of other people's culture and I think that's always a good place to start but there are differences between culture and religion. There's also quite a few what are called spiritual assessment tools where it's kind of like, you know, we've done a good job of training doctors to do a clinical history, why not try to get them to do a spiritual history? And so they have a number of prompting questions about previous relationships to the divine, if you're going to your church or synagogue or mosque or your house of worship. And so there's quite a bit of education along that side as well, but for the most part it occurs in medical school and there is still most hospitals have quite a bit of support with chaplaincy services and the health care professionals I meet rely quit heavily upon Hospital chaplains to try to address those issues.

Erin: Are there certain diagnoses or situations where seeking a miracle is more common?

Dr. Bibler: I think so I think so, especially when people hear of a terminal diagnosis I think that's quite common, or generally if there's been a devastating event, like somebody has a neurologically devastating stroke and they're never expected to be able to talk with the people they love again, I found that quite a few family members then try to try to reorient their hope around a miracle because the medical professionals have said this isn't going to happen so then there's this kind of appeal to this one-in-a-million shot or to the possibility of the divine having a direct effect on your loved one. That said I have seen when I've met with patients and families it does tend to be the case that families are especially those who hope for a miracle, I think as part of just the psychological trauma that goes along with acting as a surrogate or seeing your loved one extremely sick. And it's also kind of interesting that recent studies have started to demonstrate and show that people who are part of religious communities, whether they're the big three monotheism like Judaism, Christianity, or Islam, they have a tendency to request additional life-sustaining interventions toward the end of life, additional medical care rather than less, but that that research is still kind of in its infancy, but that does seem to be where it's pointing right now is that those people from those groups do tend to request additional life-sustaining interventions rather than less interesting.

Erin: Interesting, almost like they want a little bit more time for that miracle to work out.

Dr. Bibler: Exactly yeah, that's the hypothesis that researchers have right now is that's precisely right is that; since they're people of faith and many people of faith hope for a miracle then they're waiting for God to perform that miracle. I've met many families who say, “God needs more time to perform the miracle,” and I think that's definitely part of it.

Erin: Have you witnessed any bedside miracles in your profession?

Dr. Bibler: I'm a person who doesn't really believe in miracles. I definitely have seen rare events that were beneficial to patients and families and others that were completely unexpected, but I myself don't really believe in that possibility, so I would say no if that's what we mean. But if we mean an event that was completely unexpected but was fantastic for the patient then yes I've definitely seen those.

Erin: Would you mind sharing an example of what you've seen?

Dr. Bibler: Sure sure definitely. The one that pops to mind right now is there was recently a patient for whom he was on a bunch of cardiac supports and a left ventricular assist device a right ventricular assist device and there was talk about him maybe even needing a total artificial heart when he was waiting for his heart transplant, but it turned out with a type of minimal support that they were offering that the main problem that he had just kind of went away and no one could explain it. I talked with a couple surgeons, I talked with the heart failure doctors, I did a literature search on my own, and there was just no real accounting for how the problem that he had could have been resolved with the drugs that he was on with, the interventions he was on, and in the amount of time that it took to resolve the issue. So that was that was definitely close to a miracle. It was definitely completely unexpected by everybody who was at the bedside.

Erin: On a more general note, can faith or spirituality affect your overall health?

Dr. Bibler: Yeah well there's an entire field of study called Religion and Health that precisely tries to answer that question. This has been a question that scholars have thought about. I think Émile Durkheim and his famous work about the Protestant Work Ethic in the late 19th century. He was trying to answer that question to some degree. And then Sigmund Freud after him. And it's been an area of controversy over the last 30 to 40 years or so. It's become a burgeoning field that ends up being very, it's very interesting to me. There is a lot of bad research out there on it, and the current scholars in the field recognize that. A lot of the research doesn't really meet the gold standard of good research so then it's very hard to replicate but in general there are a couple themes that have come out. One is that there does seem to be some type of association between participation in religious services and a decrease in mortality, so a little bit of that, a decrease in depression, and a decrease in suicide. There's quite a bit of other research related to heart disease and specific psychological disorders but part of the challenge of the entire field is trying to explain that mechanism right. Why is this the case? And that's what's extremely hard to actually sort out; is it the beliefs that the people have, is it the intensity of the beliefs? That's one hypothesis. Is it the fact that they're just out and about and talking to people, they're going to their synagogue, they're going to their church, are going to their mosque, they’re going to their temple? Is it because they're actually doing something? Is it because they have strong social support, like post-op care? One of the most important things after you have a big surgery is post-op support, whether it's people coming by to say a quick hello or people go to Walgreens to try to help alleviate the load of getting out in your car and so on. There's some question if that confers any type of social support, but it's just really tough to disentangle because there's the question of well if it's this social support aspect of it could feasibly somebody could really robust atheist book club offer the same type of benefits if somebody was a part of it for their entire lives? Because it is it about just getting up and getting going and keeping active? It’s a really hard issue to sort through. The field has moved a little bit away from some of the more, how should I put it, some of the more headline-grabbing areas. Like for example there were some studies done decade or two ago about the relationship between intercessory prayer so prayer where you ask God to help heal somebody quicker or make it through their surgery, and there seem to be benefits related to intercessory prayer where there happened before or after, but luckily we've gotten the field, I should say has gotten, a little away from that because there are there's so many variables that you just can't address. Like okay well what happens if the synagogue down the street has a prayer for everybody who's in the hospital right now did I just ruin the entire experiment? Well yeah, probably, because if you're talking about intercessory prayer in the way that people pray for this then. It's really hard to quantify what that means it's very different than a drug X and placebo Y; it's about the nature of prayer. So there's been quite a bit of I think justified pushback about that type of study but the types of studies where they're really trying to account for how it is that participation in services can your mortality. There's also quite a bit of research that says people who attend services more often are more likely to report being happy and having better overall well-being, but again is that divine favor, is that because they're out and about talking to the people they trust? It's really hard to disentangle.

Erin: What does the future of faith and medicine look like? Is the clinical world shifting to being more proactive and addressing patient spiritual needs?

Dr. Bibler: It seems to be. I think that healthcare professionals and hospitals and many other medical institutions are recognizing that if you really want to take this claim that you care for patients and you care about their overall well-being rather than just their bodies, if the way that many people think about their wellbeing and how they function in the world and what their life best lived would look like, then you have to start taking into account the spiritual aspects of it. Organized religion in the United States, there does tend to be a waning at this point in organized religion. There's up to 20% of people across America don't really identify as part of any specific religious group. So while 80 percent do 20 percent of the population is still a still a very significant number, is there's a question of how to incorporate people like this into medical care. I do think there's been a little bit of a push to have those who are hoping for a miracle, or just in general they value their faith, to have them be incorporated into the conversation a little bit more, because again if we're gonna say that we care about people and not just individual patients and the bodies that are in front of us then that means talking with them about what's most important to them because that's the way that they make their medical decisions, as incorporating these big idea.

Erin: Do you find it ironic that your last name is Bibler and your life's work is focused on faith?

Dr. Bibler: I don't know. When I went to Divinity School at first I was planning on doing biblical studies and at that time it was a constant, so every time I would introduce myself they would people would either roll their eyes and say that it was expected or some variation of that. So my family who has done a little bit of research to the nature of the name itself, it does seem like there's it could be the B-I-B could be like bibliography the book side of things, or more related to the imbibe like the drinking of alcoholic drinks side of things. And I don't think it's I think both could make a whole lot of sense. And I don't know where my family comes from in German Bavaria there was definitely the case that monks brewed their own beer and so on so it could be a combination of both but I have the feeling I would probably have ended up doing similar research even if my last name was Smith. So I don't know, t might have had some influence but if it did have an influence it was more subtle than I recognized.

Erin: I see

Erin: Thank you for tuning in to our inaugural season Body of Work by Baylor College of Medicine. If you enjoyed this episode be sure to subscribe, give us a five star review, and tell your friends to listen. We're available on Spotify, Apple Podcast and Stitcher, as well as at BCM.edu/podcast. There you can also find the episode notes including information about the experts featured on the show. A quick note about the medical advice and opinions stated in this podcast; each individual's health profile is unique so please see a health care professional about any questions you may have. Until next time take care.