Orthodox America


  Ethics and Medical Technology


Priestmonk Leonty Durkit 

      America's rising affluence in the postwar years nurtured seeds of hedonism which, as they grew, began to displace traditional philosophies and value systems as no longer fashionable or relevant. Today the mature fruit of this process is being reaped from many fields in our society. Politicians, lawyers, stock brokers, businessmen, church leaders, doctars--have all contributed in recent times to fill the scandal sheets with mounting evidence of what is now widely conceded to be a national ethical and moral crisis.

      Last year, a cover story in Time magazine, "What Ever Happened to Ethics" (May 25, 1987), analyzed various manifestations of this crisis and the search for solutions. Professionals agree that an "obsession with self and image" has wreaked havoc in families and in society at large, and that there must be a turn in emphasis from self to society. But as one student in an ethics course at Harvard Business School argued: "It is difficult to say that human behavior is driven by anything other than self-interest." Indeed, how is it possible to grapple successfully with fallen nature outside the context of an absolute truth? As Dostoevsky so perceptively wrote: "Without God, everything is permitted." Legislation can serve to regulate behavior to some extent, but the choice to comply lies with the individual, and legislation is ultimately no substitute for a personal value system. 

“The thing people fear most is non-being, so when medicine is at the brink of posing being or non-being for us. it has tremendous power. This is one reason why ethical dilemmas have become such an important part of medicine.” Rabbi Terry Bard in “Time”, May 25, 1987

      Nowhere is the present ethical crisis more dramatically exposed than in the medical field. This is not to say that doctors are less ethical than other professionals. While some accusations of careless, money-hungry physicians and "knife-happy" surgeons may be justified, the rising incidence of malpractice suits rests heavily upon the new medical technology which has fuelled unrealistic expectations among patients. It is this new technology which lies at the crux of the ethical dilemma facing the medical profession today.

     Advances in medical science have always been extolled as benefiting mankind, but the effects of these advances--relief of suffering, improved health, longer life--are positive only if they are contained within a right perspective, i.e., an understanding of the purpose of life, the purpose of suffering and the proper relationship of soul and body. With the erosion of Christian values, the meaning of life has been redefined; the focus has become the 'here and now,' with a corresponding emphasis on health and fitness. Medical science is consequently called upon to deliver perfect bodies and perfect babies, to outsmart 'Mother Nature' and arrest the biological time-clock, and, ultimately, to defy death.

    The obsession with "self" and the physical image has popularized cosmetic surgery which has been with us for some years. Now, a new method of weight loss, called "Liposuction'' has been developed. It is a violent surgical technique whereby excess fat is removed by the insertion of a tube that literally sucks out the fat like a powerful vacuum cleaner. Others have now devised a way to take this same fat and insert it into other body areas, such as the breasts. This is called "body sculpting."

     This is one of the more innocent examples of how science and the new technology have come to the service of today's hedonism. There are other developments in the field of medical science whose ethical ramifications doctors and scientists themselves view with considerable apprehension.

     The "New York Times" reports that doctors have begun experimenting with keeping alive babies born without brains (anencephalic) so that their organs can be salvaged (or "harvested" for transplant operations. This "opens the possibilities for hundreds of more transplant operations and raises difficult moral decisions for parents and physicians," the "Times" said.

     The recent announcement that doctors are now using fetal brain cells in the treatment of Alzheimer's Disease raises the legitimate fear that our nation-wide, tax-supported abortion system is being turned into a vast network of tissue and organ "farms" for the living.

     The demand for 'perfect' babies, together with the legalization of abortion, has contributed to an increase in pre-natal testing. The still experimental "chorionic villi-biopsy" test for genetic disorders can be performed in the ninth week of pregnancy, much earlier than the amniocentesis, and is therefore expected to become more common because "it is easier--physically as well as emotionally-for a woman to terminate her pregnancy at a relatively early stage."

    Peoplewant not only healthy babies, they want to pick the sex of their offspring as well. An editorial writer comments:

    "Now modern science seems close to being able to deliver on this promise .... [One expert] has reported a success rate of close to 100% in using a new technique of sperm selection to produce girls. [Another doctor has] developed a method that already is widely used with 85% success in producing boys.

    "These developments are fraught with ethical implications, of course .... If we ever get to the point where we can determine the sex of our children simply by swallowing a blue or pink pill, we will need to be prepared to deal with the consequences." ("Denver Post," Oct. 4, 1987)

    In an article titled "The New Human Genetics: Mapping Inherited Diseases" (Princeton Alumni Weekly, March 25, 1987), author Eric Lander says it is now possible "in principle, to locate the gene for almost any simple hereditary disorder"--an accomplishment which has "revolutionary implications."

    This process, called "chromosome walking," has already been able to locate the gene responsible for a particular form of Muscular Dystrophy; it's probable that scientists will soon find the genes that carry a predisposition to epilepsy, certain cancers, heart disease, arthritis, allergies, and even some mental illnesses. On the surface, this seems to be a wonderful medical advance.

    However, as the author observes, "our ability to foretell the future [by means of genetic mapping] is unmatched as yet by the power to change it." In other words, a doctor can now "tell a healthy young woman that she has inherited the gene for Huntington's [and] will die before her children go to college."

    Scientists are looking forward to the day when they can change a person's genetic map. When that happens "genetic screening will pose ethical dilemmas for which clear touchstones seem hard to find in philosophy, religion, and law." The author concludes that by the year 2000 our society will be overwhelmed by a number of serious if not catastrophic ethical dilemmas.

    Many of these new developments reflect man's compulsion to be "in control" of all human function s and processes, a compulsion which attests to the absence of faith in li f e after death. This was illustrated a few years age in a television documentary on heart transplants. A heart surgeon was asked if he would undergo a transplant if his heart were dying. He said, "No, because I believe in a life after death." One of his transplant patients, however, a well-known journalist, said that he had chosen to have a transplant 'because I don't believe in life after death!"

     Where there is no faith in God and an after life, no acknowledgment of Divine Providence, where man takes it upon himself to create a more 'perfect' world, the door is open to the nightmarish possibility of an Orwellian future. Although some of the new scientific developments leading in this direction offer options which, from an Orthodox perspective can be rejected outright on the basis of Christian common sense and theological precedent, others require very sensitive and careful discernment. Indeed, one can say that the time of "catastrophic ethical dilemmas" has already arrived.

   The ability of medical science to control and manipulate human life is growing at a pace that seems to overwhelm the ability of Orthodox pastors and theologians to analyze and understand what their flocks are encountering every day in hospitals, nursing homes, doctors’ offices and pharmacies. No easy, quick answers can be given to some of the situations that arise. But there are two critical things every pastor should be doing: first, giving his flock frequent and detailed instruction about Divine Providence--how it works in our lives, the purpose of life itself, and the meaning of death and how to prepare for it. This means that priests themselves must be deeply believing, well-read and aware of what is going on in the medical field, and theologically well-grounded. Secondly, priests must strongly encourage the laity not to leave their major medical problems and "solutions" only in the hands of doctors, but also to consult spiritual fathers.

  There is, of course, an ever growing number of issues in the field of medical ethics which should be addressed from an Orthodox perspective. Below is an article which was submitted to "Orthodox America" concerning one of these issues which is bound to confront many of our readers at some point in their lives.

 

The Question of Life-Preserving Intervention

     The most frequent medical-moral question today has to do with what is called "life preserving intervention"--commonly known as "heroic" or “extraordinary” attempts to either revive or keep a dying person alive. This is an area in which priests are seldom consulted by family or doctors; yet, because it has to do with the passage from this life to eternity, priests must be involved.

     When medical personal speak of life preserving intervention, they usually mean one of two things: either omission or affirmative action. For example, should we allow a respirator to breathe for our patient, or not? Should we allow for continued artificial hydration and nutrition, or not? In theological terms the same questions can be phrased thusly: is the patient's life being medically prolonged in order to restore the patient to health? or in order to try to defy the natural order? This question applies to even simple and commonplace methods as well as what are considered "extraordinary" methods of intervention.

     Three tests are now in use for deciding upon either omission or affirmative action in prolonging life: (1) the "subject objective test," when either the patient can act as his own entity or someone with a power of attorney can act for him; (2) the "limited objective test," where there is trustworthy evidence of the patient's own will and testament. (Some states now permit a "Right to Death" contract, but since each state's laws are different, pastors should be aware of what the law allows in their home state and whether or not any of their spiritual children have drawn up such a contract.)

    Another medical/legal way of looking at this is what is called "Best Interest." It may take on various meanings--for instance, what is called "medical good": can a cure be achieved, or is intervention only prolonging the inevitable? Or, "Best Interest" can mean that there is a patient preference about what is being done to him medically; this, however, is often so subjective that it usually isn't considered to be "admissible best interest."

    "Human as human" is still another way of looking at the question of what should be done to and for a dying patient. This means that one must know the value system of a patient. For example, if a doctor knows that his critically, perhaps terminally ill patient is an atheist who sees absolutely no value, no "quality,' in pain or suffering of any kind, he may decide not to artificially prolong that person's life. (On the other hand, a believing Christian usually sees some purifying and refining qualities in a certain amount of suffering.) Professionals believe that this is an important way of preserving the capacity that we, as humans, have.

    Sadly, a priest is often brought to a patient's bedside when all of these questions have already been answered-.usually only by the medical personal without even consulting the family, much less a clergyman. The priest arrives only just in time to give the Last Sacraments, if indeed he is even notified in time for this. This is not always the fault of a doctor or hospital, however. Often the family does not ask questions, does not want to be involved in decision-making at this time, because they are either emotionally paralyzed at the realization that Mother or Father may now be dying, and/or so spiritually illiterate that they simply "don't know what to do."

     The point is: someone is going to make the decisions; better that it be a concert between medical staff, family, patient (if possible), and priest. And of these, the priest should be the most important advisor, for usually only he can give the vital spiritual theological input; only he will know if the patient is properly prepared for death and eternity-and if he is not yet prepared, it may indeed be appropriate for "extraordinary" measures to be taken, if only to insure the repentance of the dying patient before death occurs.

     What are some spiritual guidelines about health, sickness, medicine, and dying that pastors should be teaching their flocks while they are in good health?

     We read in the Epistle of St. James these words, which are also repeated at the end of the Divine Liturgies of St. John Chrysostom and St. Basil: "Every good gift and every perfect gift is from above and cometh down from the Father of Lights." One of the gifts we continually pray for is that of good health. Another gift given from above is medical knowledge for the treatment of sickness. And yet, we seldom remember that there is a causal effect between sin and sickness in our lives. St. Paul wrote: "Wherefore, as by one man [Adam] sin entered into the world, death by sin; and so death passed upon all men, for that all have sinned" (Rom. 5:12). And: "For the wages of sin is death; but the gift of God is eternal lite through Jesus Christ our God" (Rom. 6:23). Therefore, there is a general relationship between sin and sickness--not to say, however, that a specific sin brings about a specific illness.

    Because illness is the result of our fallen, sinful human nature, St. James instructs us:

Is any sick among you? Let him call for the elders of the church; and let them pray over him, anointing him with oil in the Name of the Lord; and the prayer of faith shall save the sick and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him. Confess your faults one to another, and pray for one another, that ye may be healed. The effectual fervent prayer of a righteous man availeth much. (James 5:13-16)

      When St. Basil the Great was asked if going to a doctor and taking medicine was in keeping with piety, he replied: "Every art is God's gift to us, making up for what is lacking in nature... After we were told to return to the earth from which we had come [at the time of the Fall] and we were joined to a pain ridden flesh that is destined to die, and made subject to disease because of sin, the science of medicine was given to us by God in order to relieve sickness, if only to a small degree" (The Long Rules).

    Therefore we may certainly have recourse to physicians and medicine; when and how often we go to a doctor thus becomes a matter of common sense so long as we don't forget that "no one can be cured without God." He who gives himself up to the art of healing must also surrender himself to God, and God will send help. The art of healing is not an obstacle to piety, but you must practice it with fear of God" (Sts. Barsanuphius and John).

    As a priest I have visited many people in hospitals and nursing homes; I have seen (as every priest has) both a proper and pious use of medicine, and its abuse.

    For example, one young mother of four children was hooked up to machines to purify her blood, remove waste products, empty the stomach, help her breathe, and administer six different medications. She had been through exploratory surgery and also had a bone marrow transplant. All of this was done in order to stabilize her body functions and help her to recover. Indeed, after ten days or so, the problem had been successfully diagnosed and treated, and she was released.

    These complex procedures had been followed in order to restore her health, not to prolong her life with no hope of improvement. It was truly a pious use of medicine.

    At the same time, I was visiting a 96-year old parishioner in a nursing home. For several months he had been bedridden with bedsores, slipping in and out of consciousness. When he began to die, the doctors revived him and put him on artificial nutrition and hydration with NG tubes. This enabled him to "live" (or, rather, continue dying) for a few months. Then, with the onset of pneumonia and because of poor circulation, his feet developed gangrene. The doctors decided that his feet and lower legs should be amputated.

    Even though he had signed forms much earlier requesting that no such "extraordinary" attempts be used, the staff felt that artificial feeding and amputation were to his "benefit." His free will had been removed and the decision-making process was now in the hands of strangers. By God's mercy, he died just hours before the amputation was to take place.

    This was a case, it seems to me, where there was no obvious hope of restoring this man's health. What was done was only to unduly and cruelly prolong the act of dying. Only a generation ago he would certainly have died in peace some time before.

    We must never forget, in this "brave new world" created for us by medical science, that our bodies are temples of the Holy Spirit. It is only in this context that we can decide, with the help of our spiritual and medical advisors, what is best for our bodies and souls. If we decide to prepare the soul for the death of the body, then so be it. If we should care for the body for the sake of the soul, then so be it. But whatever is done must be what is spiritually best--and that will take some time, prayer, and consultation.

     We ought not to fear death, yet we must pray for "a Christian ending to our lives, painless, blameless, with a good defense before the dread judgment seat of Christ." 

Priestmonk Leonty Durkit


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