Living with a life-threatening illness is challenging. It is not uncommon for patients and caregivers facing medical uncertainties to utilize religious coping as a tool to foster adjustment to changes along an illness trajectory. Religious coping can promote a sense of meaning, emotional well-being, and hope. This article explores requests for aggressive treatment stemming from strongly held religious beliefs and overarching hope for a miracle. A case example highlights the complexities of religious coping, belief in miracles, and requests for life-prolonging treatment at the end of life. The article closes with a discussion of the ethical considerations and strategies for best communicating with and caring for patients who request life-prolonging medical care in advanced illness.