Statistical Probabilities and Personal Possibilities in Patient and Pastoral Care

Statistical Probabilities and Personal Possibilities in Patient and Pastoral Care March 13, 2021

“Healing of the Blind Man,” 1871, Carl Bloch; Wikimedia Commons {{PD-US-expired}}

In his work as a medical ethicist, my friend and mentor Dr. Robert Potter (M.D., Ph.D.) would instruct his students that “learning statistics is learning probabilities,” not actualities in each individual instance. The problem all too frequently arises that medical professionals “translate probabilities into individuals. That’s not possible.” They mistakenly turn their rightful pursuit of objectivity and realism into “thinking they know what will happen in each and every individual case. They need to understand that they have statistical knowledge, but not knowledge of any one particular case.” One has no idea what will ultimately happen in an individual situation. “Probabilities only apply to a group of individuals, not an individual patient.”

As my wife Mariko has said in reflecting on our son Christopher’s situation involving his traumatic brain injury and comatose state, life is a mystery. We need to account for life as a mystery in attending to each individual patient. Persons are not numbers or statistics. When we go beyond probabilities to operate as if we have certainty, we are not objective and realistic enough. Objectivity and realism account for complexity and remote possibilities that may end up defying the statistical generalizations.

I fear that in some unintentional way medical professionals can project possible outcomes onto patients and turn them into self-fulfilling prophecies, if and when they operate according to one or both of the following dynamics: focusing only on generalizations based on statistical groupings; failing to account for the mystery and agency of each critical care patient who is a person. Such presumed realism is not objective enough. That is why I have appreciated the realistic exhortation of a respiratory therapist to remain positive and hopeful, the objective evaluation of a neurosurgeon who left open the room for medical miracles, and a perceptive nurse who said we are waiting to see how Christopher will respond. The combined emphasis on hope, mystery, and a patient’s unique personal agency speaks volumes to me.

It is not simply in the arena of medical patient care where we need to guard against forcing generalizations on individual situations. Probabilities are not certainties in personal relationships and pastoral care either. So, even if a group of people, even a family or church community, operates in a certain way, we must account for the possibility of someone being the exception to the rule. The same goes for an individual who has a problematic or disturbing track record. Their life story is still being written. While consistency of a changed state does not come overnight, we should always be hoping for glimpses of reformation, transformation, and growth toward relational and spiritual healing. We should never give up on others, but always hope for their repentance to stick. Jesus is the God who always uses multiplication in detailing statistics on the subject of forgiveness. Take for example his response to Peter recorded in Matthew 18:

Then Peter came to Jesus and asked, “Lord, how many times shall I forgive my brother or sister who sins against me? Up to seven times?”

Jesus answered, “I tell you, not seven times, but seventy-seven times. (Matthew 18:21-22; NIV)

The advanced numbering system Jesus offers can be alternatively rendered “seventy times seven.” Jesus had to apply such advanced numbering in Peter’s case in various instances, including his restoration of Peter following his threefold denial of Jesus during his trial preceding the crucifixion.

In personal relationships and pastoral care, we need to be on guard against being cynical on the one hand and naïve or gullible on the other hand in giving people second, third, and seventy-seven chances. We need to be hopeful, which entails being both innocent as doves and shrewd as serpents, not shrewd as doves and innocent as serpents.

Statistics matter. Track records matter. But may we never approach individual cases or individual encounters in patient and pastoral care as if there is no place for healing and reform.

In closing, I draw attention to one of the most dramatic literary scenes that brings this point home. The scene is found in Victor Hugo’s Les Miserables, where police caught the ex-convict Jean Valjean with the silver he stole from the bishop’s home. Instead of crying out that the police should send Jean Valjean back to a life of hard prison labor, the bishop scolds Jean Valjean for not taking the silver candlesticks, too! After sending the stupefied police away, an even more stupefied Jean Valjean nearly faints. The elderly bishop strengthens and transforms him in that very moment, not with probabilities bound up with the statistics from the ex-convict’s prior and present way of life, or what will happen to most convicts when they return to civilian life. Rather, the bishop perceives Jean Valjean in view of the divine possibility of a changed life bound up with the miraculous mystery of forgiveness:

Jean Valjean was like a man on the point of fainting.

The Bishop drew near to him, and said in a low voice:–

“Do not forget, never forget, that you have promised to use this money in becoming an honest man.”

Jean Valjean, who had no recollection of ever having promised anything, remained speechless. The Bishop had emphasized the words when he uttered them. He resumed with solemnity:–

“Jean Valjean, my brother, you no longer belong to evil, but to good. It is your soul that I buy from you; I withdraw it from black thoughts and the spirit of perdition, and I give it to God.”

Jean Valjean lived the rest of his days as a new man who did not steal from others, but gave his life for their well-being.

In our rightful desire to account for statistical probabilities in patient and pastoral care, may we, like Victor Hugo’s bishop, always make room for the impossible possibility of healing, reformation, and growth.

About Paul Louis Metzger
Paul Louis Metzger, Ph.D., is Professor of Theology & Culture, Multnomah University & Seminary; as well as the Director of The Institute for Cultural Engagement: New Wine, New Wineskins. He is the author and editor of numerous works, including the journal Cultural Encounters: A Journal for the Theology of Culture. You can read more about the author here.

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