EASTERN ORTHODOX CHRISTIANITY, BIOETHICS IN

The Eastern Orthodox church considers itself identical with the Church established by Jesus Christ and believes itself to be guided by the Holy Spirit, continuing that ecclesial reality into the present age as an organic historical, theological, liturgical continuity and unity with the apostolic Church of the first century. Historically, it sees itself as identical with the "One, Holy, Catholic, and Apostolic Church" that suffered the "Great Schism" in 1054 that led to the division of Christendom into Eastern and Western Christianity.

The Orthodox church is organized hierarchically, with an ordained clergy and bishops. A number of national and ethnic Orthodox churches, under the leadership of patriarchs, are united by tradition, doctrine, and spirit rather than by authority, although the Ecumenical Patriarch of Constantinople is accorded a primacy of honor. The church's identity is rooted in the experience of the Holy Spirit in all aspects of its life and in a doctrinal perspective that serves as a matrix for its ethical teachings (Ware; Pelikan). In the sphere of bioethics, this theological matrix forms a coherent source of values for bioethical decision making. At its center is the view that life is a gift of God that should be protected, transmitted, cultivated, cared for, fulfilled in God, and considered a sacred reality. Consequently, there is a high regard for the concerns usually identified with the field of bioethics.

Doctrine and Ethics

In Orthodox belief, the teaching of the church is found in the Old and New Testaments, the writings of the church fathers, and all aspects of the synodical, canonical, liturgical, and spiritual tradition of faith as lived, experienced, and reflected upon in the consciousness of the church, for which the general name "holy tradition" is used.

The Eastern Orthodox church understands ultimate reality to be the Holy Trinity, or God who is a triune unity of persons: the Father, source of the other two fully divine persons; the Son, forever born of the Father; and the Holy Spirit, forever proceeding from the Father. Thus, ultimate uncreated and uncontingent reality is a community of divine persons living in perpetual love and unity.

This divine reality created all else that exists, visible and invisible, as contingent reality. Human beings are created as a composite of body and spirit, as well as in the "image and likeness" of the Holy Trinity. "Image" refers to those characteristics that distinguish humanity from the rest of the created world: intelligence, creativity, the ability to love, self-determination, and moral perceptivity. "Likeness" refers to the potential open to such a creature to become "God-like." This potential for deification, or theosis, has been lost through the choice of human beings to separate themselves from communion with God and their fellow human beings; that is to say, sin is a part of the human condition. Though weakened and distorted, the "image" remains and differentiates human existence from the rest of creation.

The work of redemption and salvation is accomplished by God through the Son, the second person of the Holy Trinity who took on human nature (except for sin) in the person of Jesus Christ. He taught, healed, gave direction, and offered himself upon the cross for the sins of humanity, and conquered the powers of death, sin, and evil through his resurrection from the dead. This saving work, accomplished for all humanity and all creation, is appropriated by each human person through faith and baptism, and manifested in continuous acts of self-determination in communion with the Holy Spirit. This cooperation between the human and divine in the process of growth toward the fulfillment of God-likeness is referred to as synergy.

The locus for this appropriation is the Church—specifically, its sacramental and spiritual life. The sacraments, or "mysteries," use both material and spiritual elements, as does the life of spiritual discipline known as "struggle" and "asceticism" (agona and askesis). Both foster a communion of love between the Holy Trinity and the human being, among human beings, and between humans and the nonhuman creation, making possible continuous growth toward God-likeness, which is full human existence.

Though in this earthly life growth toward Godlikeness can be continuous, it is never completed. In the Eastern Orthodox worldview, the eternal Kingdom of God provides a transcendent referent for everything. The Kingdom is not only yet to come in the "last days," but is now a present reality through Christ's resurrection and the presence of the Holy Spirit. Within this spiritual reality, the goal of human life is understood to be an ongoing process of increasing communion with God, other persons, and creation. This forms the matrix for Orthodox Christian ethics and provides it with the materials and perspectives for articulating the "ought" dimensions of the church's teaching (Mantzaridis).

Among the more important aspects of these teachings for bioethics are (1) the supreme value of love for God and neighbor; (2) an understanding that sees nature fallen but also capable of providing basic norms for living through a foundational and elementary natural moral law; (3) the close relationship of material and spiritual dimensions of human existence and their appropriate relationship and integration;(4) the capacity for self-determination by human beings to make moral decisions and act on them; and (5) the criterion of movement toward God-likeness—all within a framework that is both this and other-world focused.

In practice, ethical norms are arrived at in holy tradition and by contemporary Orthodox ethicists by defining moral questions within this context of faith in a search for ethical guidelines that embody the good, the right, and the fitting (Harakas, 1983).

Bodily Health

Concern for the health of the body, though not central, has a significant place in Eastern Orthodox ethics (Harakas, 1986a). Orthodox Christian ethics calls for "a healthy mind and a healthy spirit with a healthy body." The body is neither merely an instrument nor simply a dwelling place of the spirit. It is a constituent part of human existence, and requires attention for the sake of the whole human being. Thus, in its sinful condition, the body can also be a source of destructive tendencies that need to be controlled and channeled. This is one of the works of asceticism, which seeks to place the body under control of the mind and the spirit. But asceticism is never understood as a dualistic condemnation of the body. As a good creation, under the direction of the proper values, the body is seen as worthy of nurturing care. Thus, everything that contributes to the well-being of the body should be practiced in proper measure, and whatever is harmful to the health of the body ought to be avoided. The Eastern Christian patristic tradition is consistent in this concern (Constantelos; Darling).

Practices that contribute to bodily health and wellbeing are ethically required. Adequate nourishment, proper exercise, and other good health habits are fitting and appropriate, while practices that harm the body are considered not simply unhealthful, but also immoral. Abuse of the body is morally inappropriate. Both body and mind are abused through overindulgence of alcohol and the use of narcotics for nontherapeutic purposes. Orthodox teaching holds that persons who might be attracted to these passions need to exercise their ethical powers in a form of ascetic practice to overcome their dependence upon them as part of their growth toward God-likeness.

Healing Illness

When illness occurs, Orthodox Christianity affirms an ethical duty to struggle against sickness, which if unaddressed can lead to death. The moral requirement to care for the health of the body indicates it is appropriate to use healing methods that will enhance health and maintain life. Two means are used concurrently: spiritual healing and different forms of medicine. The first is embodied in nearly all services of the church, in particular, the sacrament of healing, or holy unction. There is also a continuing tradition of multiple forms of prayer and saintly intercessions for the healing of body and soul.

The church does not see spiritual healing as exclusive nor as competitive with scientific medicine. In the fourth century, Saint John Chrysostom, one of the great church fathers, frequently referred to his need for medical attention and medications. In his letters to Olympias, he not only speaks of his own use of medications but advises others to use them as well. Saint Basil, another great fourth-century church father, underwent various forms of therapy for his illnesses. In fact, both of these church fathers had studied medicine. Basil offers a classic Christian appreciation of the physician and the medical profession:

Truly, humanity is the concern of all of you who follow the profession of medicine. And it seems to me that he who would prefer your profession to all other life pursuits would make a proper choice, not straying from the right, if really the most precious of all things, life, is painful and undesirable unless it can be possessed with health. And your profession is the supply vein of health. (Epistle 189, To Eustathius, the Court Physician fourth century, p. 228)

Recent studies have highlighted the Eastern Orthodox church's concern with healing, both in its medical and spiritual dimensions. Orthodox monks established the hospital as a place of healing, a tradition maintained by Orthodox monasticism for almost a thousand years, until it was taken over by the medical establishment (Miller; Scarborough; Harakas, 1990).

Bioethical Concerns and Methods

Bioethics as a distinct discipline is only a few decades old, but some topics included in the discipline, such as abortion, have been addressed by the Christian tradition over the centuries. Many bioethical issues are new, however, and the Orthodox church's views concerning them have yet to be officially stated. The method contemporary Orthodox ethicists use to determine Eastern Orthodox perspectives on bioethical questions is the same as the general method used to make ethical decisions. The general doctrinal stance and ethos of the church form the larger context, delineating basic perspectives. The church requires further study, however, to assess the moral dimensions of newly created bioethical questions.

The ethicist concerned with bioethical questions then consults the tradition, which embodies the mind of the church: Scripture, patristic writings, decisions of the ecumenical councils and other synods, the received doctrinal teachings of the church, canon law, ascetical writings, monastic typika (constitutions of monastic establishments), liturgical texts and traditions, exomologetaria (penitential books), the exercises of economia (a process of judgment that allows for consideration of circumstances in a particular case, but without setting precedents for future normative decision making), and theological studies, for specific references that exhibit the mind of the church in concrete ethical situations. The "mind of the church" is understood as the consciousness of the people of God, together with the formulation of theological opinion, in conjunction with the decisions of the church in local, regional, and ecumenical synods, conceived and experienced as arising from the guidance of the Holy Spirit. It is a mindset, rather than a set of rules or propositions. The purpose of examining these sources is to determine whether these sources speak either directly, or indirectly, or by analogy, to new questions of bioethics. The historical contexts of these specific sources are kept in mind, and will serve to condition contemporary judgments.

Both general and specific applications can then be made and expressed as theological opinion on topics in bioethics. These views, however, are tentative, until the mind of the church specifically decides. Wherever this has already occurred, it will be noted below. Otherwise, what follows should be understood as thoughtfully considered theological opinion, subject to correction by the mind of the church (Harakas, 1980, 1986b).

The Protection of Life

Orthodox thought holds that life is a gift from God, given to creation and to human beings as a trust to be preserved and protected. Just as the care for one's health is a moral duty for the individual, society's concern for public health is also a moral imperative. The first large division of concern is that existing life be protected. This can be expressed in a number of ethical positions characteristic of an Orthodox perspective.

The protection of life has been a value pursued throughout history by the church. During the early days of the rise and spread of Christianity, abortion was widely practiced in the Roman Empire. The Church, based on its respect for life, condemned this practice in its canon law as a form of murder. The Church considered abortion particularly heinous because of the defenseless and innocent condition of the victim (Kowalczyk). Of course, no moral stance is absolute. In Orthodox traditional teaching, however, abortion is nearly always judged to be wrong. There can be unusual circumstances, such as an ectopic pregnancy that threatens the life of the mother, that might be judged prudentially as calling for an abortion, but such situations are rare.

Historically related to the rejection of abortion was a condemnation of the exposure of infants, that is, their abandonment, a practice that caused their death or led to their exploitation by unscrupulous persons who profited from forcing children into prostitution or begging. These are severe examples of child abuse that unfortunately have continued into the modern age. Every such case, historic or contemporary, violates the moral requirement that adults care for children in a loving and supportive manner.

Modern Medical Technology and Ethics

The development of medical science and technology has raised many new issues, however. Studying these issues from within the mind of the church has produced a body of positions that are expressive of the church's commitment to the protection of life. Some of these follow.

ALLOCATION OF MEDICAL RESOURCES. A bioethical question that finds a response in the concern for the protection of life is the issue of the allocation of scarce medical resources. A healthcare system that fosters the widest possible distribution of healthcare opportunities is the most morally responsible, since it reflects the common human situation before God.

PROFESSIONAL-PATIENT RELATIONSHIPS. In the area of the relationships of providers and recipients of healthcare, the church affirms the existence of patients' rights and requires that the medical profession honor them. The full human dignity of every person under treatment should be among the controlling values of healthcare providers, manifested in their concern to maintain the patient's privacy, obtain informed consent for medical procedures, develop wholesome personal contacts between the patient and the medical team members, and treat the patient as a total human being rather than an object of medical procedures.

HUMAN EXPERIMENTATION. Because of the role it plays in the development of medical therapies and the possible cure of individual persons, human experimentation must be conducted and is morally justified by an appeal to the value of the protection of life. Wherever possible, however, such experimentation should fulfill the following minimal conditions: The patient should be informed of the risks involved and should accept participation in the experiment freely and without coercion, and the experiment should have potential benefit for the patient. Increased knowledge should be secondary to the welfare of the patient.

ORGAN TRANSPLANTATION. Protection of life finds intense application in the area of organ transplantation. This topic may serve as a somewhat more extensive example of Orthodox bioethical reflection. Organ transplantation was unknown in the ancient world. Some Orthodox Christians consider it wrong, a violation of the integrity of the body. Significant as this consideration is, it does not outweigh the value of concern for the welfare of the neighbor, especially since organs for transplants are generally donated by persons who are philanthropically motivated for the protection of life. The sale of organs is seen as commercializing human body parts and therefore unworthy, and is prohibited by a concern for the protection of life and its dignity.

There are two categories of potential donors: the living and the dead. Usually, the potential living donor of a duplicated organ is a relative. In such cases, concern for the well-being of the patient may place undue pressure upon the potential donor. No one has an absolute moral duty to give an organ. Healthcare professionals must respect the integrity of the potential donor as well as the potential recipient. Yet it is certainly an expression of God-likeness for a person to give an organ when motivated by caring concern and love for the potential recipient. Ethical consideration must be given to the physical and emotional consequences upon both donor and recipient and weighed in conjunction with all other factors. When these are generally positive, the option for organ donation by a living person has much to commend it.

In the case of donation of organs from the dead, some of the same considerations hold, while several new issues arise. Organs can be donated in anticipation of death. Some states, for example, encourage people to declare their donation of particular organs (liver, kidney, cornea) in conjunction with the issuance of auto licenses. There do not appear to be serious objections to this practice; many Orthodox consider it praiseworthy. When no expressed wish is known, permission of donation should be sought from relatives. Their refusal should be respected.

Persons may donate organs through bequests associated with their wills. This choice should be made known to responsible survivors before death. In 1989, for example, the Greek Orthodox Archbishop of Athens announced in the press that he had made provision for the donation of his eyes after his death.

BODY DONATION TO SCIENCE. Similarly connected with the protection of life is the issue of donating one's body to science. Much of the answer from an Orthodox Christian perspective has to do with what the representatives of science will do with it. Giving one's body to science means, in nearly all cases, that it will be used for the education of medical students. There has been a bias against this practice in many countries because at the same time that the personal identity of the body is destroyed, the body itself is treated without respect. The alternative to using donated bodies for medical education, however, is that medical students and young physicians will learn surgical skills on living patients. The concern for the protection of life could not, thus, totally disapprove of the practice of body donation. In principle, then, giving one's body for medical education cannot be ethically prohibited. But medical schools should strive to create an atmosphere of reverence and respect for the bodily remains of persons given for this purpose. In some medical schools, this already takes place; in most, it has not. Potential donors of their bodies should inquire about procedures and refuse to donate their bodies to schools that do not show adequate respect for the body. Usually this means making arrangements for ecclesial burial of the remains after their educational use.

THE AGED. The protection of life covers the whole life span. The Orthodox church has always had a special respect and appreciation for the aged. Industrial society, with its smaller, nuclear families, has tended to isolate the aged from the rest of society. The aging themselves ought not to accept such marginalization passively. They should continue to live active and fulfilling lives, with as much independence of movement and self-directed activity as possible. Spiritually, growth in the life of Christ continues to be important. Repentance, prayer, communion with God, service to others, and loving care for others are important in this and every age bracket.

Children and relatives should do everything possible to enhance the quality of life for their aging parents and relatives. But in cases of debilitating conditions and illnesses, it may be necessary to institutionalize them. Many Orthodox Christians feel that this is an abandonment of their moral responsibilities to their parents. If institutionalization is a way of abdicating one's responsibilities to parents for the sake of convenience, then it is wrong. However, it is often the best solution. Even when it is morally indicated, the important values remain; in a nursing home or outside of it, children still have the obligation to express love, care, and respect for their parents.

DEATH. Concern for the protection of life is also present at the end of life. Death should come of itself, without human intervention. God gives us life; God should be allowed to take it away. Proponents of so-called euthanasia hold that persons should be allowed and may even be obliged to end their earthly lives when "life is not worth living." In the church's judgment, this is a form of suicide, which the church condemns. If one does this to another person, it is a case of murder. Orthodox Christian ethics rejects euthanasia as morally wrong.

Modern medical practice has raised some related issues, however. The possibility that vital signs can be maintained artificially, even after death has occurred, raises the complex question of turning off "life-sustaining" machines after brain death is diagnosed. The tradition has never supported heroic intervention in situations where death is imminent and no further therapies exist. It has been Eastern Orthodox practice not only to allow a person to die but also to actively pray for it when, according to the best medical judgment available, a person is struggling to die. If a person is clinically dead but his or her vital organs are kept functioning by mechanical means, turning off the machines is not considered euthanasia. Until the determination of clinical death, both physician and family should seek to maintain the comfort of the patient. Spiritually, all should provide the dying person opportunities for repentance and reconciliation with God and with his or her fellows (Breck, 1989).

SUFFERING. In all serious medical situations, suffering should be relieved as much as possible; this is especially true for the Orthodox patient who has participated in the sacraments of Holy Confession and Holy Communion. Pain that cannot be relieved should be accepted in as redemptive a way as possible. For the church, a "good death" (in Greek, euthanasia) is one in which the human being accepts death with hope and confidence in God, in communion with him, as a member of his kingdom, and with a conscience that is at peace. Genuine humanity is achievable even on the deathbed.

The Transmission of Life

The Eastern Orthodox approach to marriage provides the context for discussing procreative and sexual issues. The church sees marriage as a sacramental dimension of human life, with ecclesial and interpersonal dimensions and purposes (Guroian). The Orthodox church sees both men and women as equal before God as human beings and as persons called to grow toward God-likeness. Both men and women are persons in their own right before God and may be endowed with many potentialities that ought to be developed as part of their human growth. Yet the special sacramental relationship of marriage, procreation, and child rearing gives to women, in the mind of the church, a special role. Accompanying it is the role of husband and father in constituting a marriage and creating a family. Most of the bioethical issues regarding the transmission of life arise out of this marital and familial perspective in Orthodox thought.

REPRODUCTIVE TECHNOLOGIES. Artificial insemination assists spouses to procreate when they cannot conceive through normal sexual intercourse. In such cases, the sperm of the husband is artificially introduced into the wife's childbearing organs. There are differences of opinion in the Orthodox church regarding this procedure. A major objection is that this is a totally unnatural practice. But since other "unnatural practices" such as cooking food, wearing clothes, using technical devices such as eye-glasses and hearing aids, and performing or undergoing surgery are considered morally acceptable, this argument loses much of its force.

More cogent is the argument that artificial insemination separates "baby-making" from "love-making," which is a way of emphasizing the unity of the spiritual and bodily dimensions of marriage. In the case of artificial insemination by husband (AIH), the personal, social, and spiritual context seems to indicate that AIH is morally acceptable. The opposite holds true when the semen of a donor is used (AID). The intrusion of a third party in providing the semen violates the psychosomatic unity of the marital couple.

The same pattern of ethical reflection applies to other procedures, such as artificial inovulation and in vitro fertilization. If the sperm and ovum come from the spouses themselves, and the wife bears the child to term, ethical objections to these procedures are lessened. Often, however, fertilized ova are discarded in the procedures. The majority of Orthodox consider this a form of abortion. Others hold that for abortion to take place, implantation in the womb must have previously occurred. Nevertheless, surrogate mothers, egg donation, and sperm donation from parties outside the marriage find no place in an ethical approach that places heavy emphasis on the wholeness and unity of the bodily and spiritual aspects of human life, and of the marital relationship in particular.

STERILIZATION. Where sterilization is intended to encourage promiscuous sexual living, Orthodox Christianity disapproves. A strong ethical case can be made for it when there are medical indications that a pregnancy would be life-threatening to the wife. An as yet unexplored ethical area is the case of almost all older, yet still fertile, married couples, for whom there is a significant likelihood that the children of their mature love would be bearers of serious genetic diseases.

GENETICS. Genetic counseling seeks to provide information to a couple before they conceive children so that potentially serious conditions in newborns can be foreknown. Genetic counseling is also related to genetic screening of population groups that might be carriers of particular genetic illnesses. Genetic screening refines and makes more accurate the earlier practices of the church and of society that sought to reduce the incidence of deformed and deficient children, through the restriction of marriages between persons closely related genetically.

As a procedure that would reduce the number of persons entering into marriages with dangerously high chances for the transmission of genetic illnesses, these procedures ought to be strongly encouraged. Premarital genetic screening of young people with Mediterranean backgrounds, where there is a relatively high incidence of thalessemia B and Tay-Sachs disease, might guide them in the selection of spouses. Once a child is conceived and growing in the womb, however, the church could not consider the termination of the pregnancy as anything other than abortion. An impaired child is still the image of God with a right to life (Harakas, 1982). Since the church strenuously opposes abortion, prenatal diagnostic information indicating the prospective birth of a genetically deformed child cannot justify ending the life of the baby in the womb. Instead, this information serves to prepare the parents to receive their child with the love, acceptance, and courage required to care for such an exceptional baby.

GENETIC ENGINEERING. Concern with genetic engineering as an aspect of the transmission of life provokes a conflicting reaction among Orthodox Christian ethicists. Some Orthodox ethicists value the potential therapeutic possibilities of genetic engineering. In this case, the treatment of the genome to correct deficiencies is looked at positively, as a form of medical therapy. Nevertheless, there is concern when these same techniques are thought of as means for eugenic goals. The potential for misuse and abuse make Orthodox Christian reactions very cautious (Breck, 1991).

Conclusion

The common denominator in all these issues is the high regard and concern of the church for human life as a gift of God. Eastern Orthodox Christianity takes a conservative approach to these issues, seeing in them a dimension of the holy and relating them to transcendent values and concerns. Only an intense respect for human life can curb the modern tendencies to destroy human life both before birth and as it approaches its end. The human person, from the very moment of conception and implantation in the womb, is dependent upon others for life and sustenance. It is in the community of the living—especially as it relates to the source of life, God in Trinity—that life is conceived, nurtured, developed, and fulfilled in communion with God. The trust that each person has in others for the continued well-being of his or her own life forms a basis for generalization. Eastern Orthodox ethics, consequently, functions with a pro-life bias that honors and respects the life of each person as a divine gift that requires protection, transmission, development, and enhancement.

stanley s. harakas (1995)

SEE ALSO: African Religions; Buddhism, Bioethics in; Christianity, Bioethics in; Daoism, Bioethics in; Eugenics and Religious Law;Islam, Bioethics in; Jainism, Bioethics in; Judaism, Bioethics in; Medical Ethics, History of: Europe; Mormonism, Bioethics in; Native American Religions, Bioethics in; Reproductive Technologies; Sikhism, Bioethics in; Transhumanism and Posthumanism

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