As a hospice professional I have observed the "death denial" behavior of health care professionals for some time now.
In my opinion, families and patients often accept the terminal prognosis sooner than the physician does. It is not at all uncommon for a family member or the patient themselves to request hospice services only to have the PCP or medical specialist balk at identifying the patient as "terminal". I will also simply refer folks to the stats that indicate the average length of stay in the USA for a hospice patient...the late referral of terminal patients speaks more to the inability of the managing medical provider to even acknowledge evidence of decline toward death of their patients than it does of death denial in the families. Most families and patients trust their doctors and respect their opinions and recommendations. Families will demand fewer futile interventions when the medical community is honest with them and does not offer them futile options. MDs should not be surprised when their patients with CHF, Diabetes, COPD, etc begin the process of decline! These are chronic debilitating diseases that will contribute to or result in their death at some point.
The traditional medical community is very well educated in diagnosing and treating disease states. They are not so well educated in identifying chronic terminal disease states and then educating the patient toward a "good outcome" that does not include cure but rather focuses on palliation of symptoms. I am accustomed to having medical residents rotate through our hospice program to learn about end of life issues. Among other things, they learn how to speak to people about death, and dying, and end of life goals. I wish I could say that my initiation of these discussions during hospice informational visits was not the first time that these people have heard such language...but it OFTEN is. Too many people have commented to me that I was the first health professional to actually use words such as death and dying. Generally those folks are relieved (not all, but many).
The removal of nurses from the primary care setting has reduced the amount of ongoing education people get about their health status and the goals associated with their needs. WE are the professionals trained to educate and advocate for the patient. IMHO, the education of the patient and family relative to their disease state should be ongoing in the primary care setting...NOT in just the acute care setting (although it should occur there also).
There certainly are cultural and religious foundations to the decisions that people make relative to their end of life or that of a loved one. It is important that we discover what the perspective of the patient and family are and then attempt to reconcile that with excellent, compassionate, ethical care. I find that many times family are making decisions based in fear and misunderstanding. When a patient daughter recently expressed to me her goals for her mother's end of life care I listened intently and then asked her what she thought her mother would want. I followed that by asking her if she was developing this goal to improve her mother's quality of life or to diminish her fears and anxieties about losing her mom. Granted it was a very blunt question, but it made her think, and over the next couple of weeks her opinion evolved as she continued interaction with her mom and the hospice team. She was not offended by my question and actually expressed to the MSW that she appreciated my honesty.
Having said that, I have one family who will want a feeding tube and IVs for their father because the priest advised them that to do otherwise would be counter to their religion. Another who refuses all opiates for a similar reason. Another family doesn't get to make the choices at all, the spiritual leader or eldest male in the religious group makes the decisions. These, however, are the minority of cases in my view.
In terms of miracles, most folks who are hoping for a miracle at end of life are not encouraged to abandon that hope. Miracles do not require intensive intervention on the part of health care staff, they require intervention by God and can occur at anytime...even post mortem.