‘Urgent. Is there a doctor on the plane?’ I clambered reluctantly to my feet, hoping it would be a febrile child. It was an anxious middle-aged man. ‘I've gone blind, doc’, he moaned. A quick history elicited that he had been fine until the day before when he had been prescribed eye ointment for a nasty conjunctivitis. I requested a warm towel and unglued his eyelashes. ‘I can see’, he shouted. ‘It's a miracle’. I slunk shamefacedly back to my seat, and even a free bottle of wine could not relieve my embarrassment.
‘Miracle’ is a term used in general to describe a divine or supernatural event that cannot be explained readily by human activity or natural phenomena. However, the term is sometimes used to describe a statistically improbable, natural phenomenon.
Recently, our infectious disease team cared for a previously healthy teenager who lived on a tropical island and became desperately ill from disseminated infection with a rare fungus. Many times we thought he was likely to die. Multiple specialists were involved. Every day his deeply religious mother read a copy of the Bible translated into their native dialect. Just before he was discharged home well, after 4 months of intensive therapy and risky interventions, a journalist came to write his story. The boy's mother told the journalist the doctors and nurses had been wonderful but ascribed his recovery to God. ‘A miracle, then?’ asked the journalist.
I am an atheist but have no problem with people who give the credit for medical or surgical cures to God, especially if they acknowledge that God worked through the medium of the dedicated care of hospital staff. However, calling this boy's recovery a miracle presents problems. His father asked me repeatedly if I could cure his son and I promised that if the situation became hopeless, I would send his son home to die. If families want to hold out for a miracle, there may be no room for palliative care; no ability to let a child have a peaceful and dignified death.
Some medical events have been accepted by the Catholic Church as miracles. For example, very rarely a patient has spontaneous remission or regression of malignancy in the absence of specific therapy. If a Servant of God, for example, a dedicated nun or priest, prayed assiduously for the patient, it may be deemed by the Church to be a miracle, although a Cochrane review of 10 randomised controlled trials found no convincing evidence that prayer improves outcome. A Servant of God needs to perform one miracle to qualify for beatification and a second miracle to qualify to be a saint. However, spontaneous remission or regression of malignancy also occurs in the absence of prayer. While such events are incredibly rare, we should always seek a scientific explanation. Either the initial diagnosis was wrong or the host immune response was responsible for the ‘cure’ and the nature of this immune response may be highly informative. Some types of infantile disseminated neuroblastoma frequently regress spontaneously, which implies a natural rather than a supernatural phenomenon, and the reasons for spontaneous regression are increasingly being informed by genotyping of cancers.
Similarly, although early data suggested untreated human immunodeficiency virus (HIV) infection was a rapid death sentence, some HIV-infected persons remain asymptomatic with no detectable HIV in their bloodstream for many years. There have even been reports of spontaneous clearance of HIV and HIV antibodies. The scientific explanation for such events, including the role of specific cytotoxic T-cells, may help inform vaccine development. Calling the events miracles risks neglecting helpful scientific enquiry.
Diseases that used to be almost invariably fatal, such as hypoplastic left heart syndrome (HLHS), are now potentially amenable to surgery. However, the benefits of surgery and the difficulty in obtaining fully informed consent may be questioned. Referring to surgery for HLHS as a miracle would mislead parents and might put extra pressure on them to make a decision for surgery as opposed to non-surgical palliation. Who would turn down an offer of a miracle?
Palliative care is indicated for most patients with an active, progressive disease with a limited prognosis for which quality of life is the prime consideration. Acceptance of palliative care involves accepting that not all patients can be cured. For many children and their families, palliative care is a great release from the trauma of a long illness. Families and their physicians who pursue miracles may deprive children of the benefits of palliative care. This is why it would have been wrong for the journalist to refer to our boy's survival as a miracle and why doctors and hospitals should not claim to perform miracles. Miracle is a word that should be banished from the medical lexicon.