by Peter Bushunow, M.D.

“God’s grace is as evident in the healing power of medicine and its practitioners as it is in miraculous cures.” — St. Basil the Great Regulae fustus tractatus, interogatio 55.

Illness and bodily suffering have important spiritual implications. When afflicted with illness, the Christian must turn to prayer and the healing sacraments of the Church. I will discuss a few practical aspects that an Orthodox Christian needs to bear in mind during interactions with modem medical care and its practitioners. In this essay, I use the word physician in its original definition -“person skilled in the art of healing”– to include all the doctors, nurses, therapists, and others who are now so quaintly referred to as “health care providers.”

      Christians can accept the practice of medicine and the good that it has to offer in healing illnesses, temporing suffering, and comforting the sick. However, as any human endeavor, if the medical art is applied without true spiritual discernment it can lead to excess and evil. Our earthly physicians, for the most part, are trained in a materialistic approach to care for the body and consider it improper to discuss religious beliefs, prayer, or spiritual issues with patients. Potentially even more dangerous are those who reflect philosophies or beliefs antithetical to Christian practices. It is very important not to overestimate the knowledge, authority and “powers” of an earthly physician. The patient must take an active role in preserving his health (stewardship of the Holy Temple of the Lord), in praying to God for maintenance or restoration of health, and in struggling with the spiritual illnesses which often exhibit themselves in physical illness, or are exacerbated by them. The patient thus has the responsibility to understand and to use discernment regarding the evaluations and treatments his physicians recommend.

      Medical recommendations are often presented to patients with great authority. Many patients feel ignorant about medical subjects and are uneasy questioning someone who wears a white coat and covers the walls with diplomas. Keep in mind that the true physician of our souls and bodies is Christ. To help keep the prescriptions of the earthly physician compatible with those of our Heavenly Father, I offer the following suggestions:

      Let your physician know your beliefs. You need not give detailed explanations or religious discussions but be straightforward and unembarrassed. Many physicians very much appreciate knowing that you have thought in advance about serious illness and death. Tell your physician that you want your family and priest to he involved with praying for you. It is important for your physician to know that you fast. (Fasting is very healthy for the body, but as the foods we eat do affect the body, fasting may necessitate changes in some medications.) Discuss medication dosage schedules with your physician (and priest) so that you can participate in fasting and the Sacraments as properly as possible.

      Do not be afraid to ask your physician questions. Do not be afraid of angering the physician or being viewed as “non-compliant” by asking for more information or deciding not to have specific tests or treatments. Try to reach a clear understanding of what a physician hopes to achieve with a particular test or treatment, and decline this intervention if you do not agree with the goal. (Excellent examples of these distinctions occur with prenatal testing. Some testing may help by identifying problems early and improving treatment before and during delivery, thus helping the baby and family. Testing done for the purposes of identifying an abnormal child with the expectation of performing an abortion should not be accepted, since abortion is unacceptable.)

      Be honest with your physician about accepting or rejecting his advice regarding treatment. Be honest if you are using any other type of remedy. Herbal and “altemative” remedies may interact with medications and treatments. You cannot expect the physician to take responsibility for the outcome of treatments he did not prescribe, but a good physician will not abandon a patient fi, after consideration, the patient declines to undergo a suggested therapy.

      Carefully consider the implications of advice regarding therapies, especially ones with a spiritual dimension. The physician has earthly authority and may not have considered (or agree with) Christian understanding of what he advises. There are strong elements of paganism and other non-Orthodox forms of spiritual treatment in many forms of popular psychology, “self-help,” meditation and yoga techniques. Be careful accepting advice on “relaxation” therapy, bio-feedback and many forms of psychotherapy, especially hypnosis and “regression therapy.” Some relaxation techniques teach patients how to become aware of, and to decrease, the racing heart, rapid breathing and other “fight-or-flight” nervous system responses that can worsen anxiety, pain, and overall health. These can be very helpful. Unfortunately, many therapists suggest images that include pagan beliefs, or reliance on the “inner” strength of a person’s own body. If learning to use a relaxation technique, make sure it does not ask you to “empty your mind” or “visualize” scenes with carnal pleasures, but instead, fill your mind with prayer and hope in the strength of the Lord to help you. Repeating a “mantra” is not appropriate; instead repeat the Jesus prayer, read an Akathist, pray. Turn to prayer, Holy Scripture, read the Fathers, and discuss any suggested treatments you are unsure of with your priest.

      When faced with hospitalization, remember that we can accept the technological expertise available in hospital, but always keep in mind that prayer is the most needed medicine.

      Your parish priest should know as soon as possible about admission to the hospital, planned operations and tests. One should not complain of every cough or sniffle, but the Christian does not wait to be on the death-bed before turning to prayer. Those who are ill can benefit much from commemoration at the Proskomedia, at Liturgy and from the other healing Sacraments of the Church.

      Never be embarrassed to express your faith and worship: make the sign of the Cross, wear a Cross, have icons in your room, have moleben services in the hospital room, and so on. In preparation for surgery you may be asked to remove all jewelry including your Cross. Because of the electrical equipment used during surgery, you may not wear metal chains or Crosses in the operating room, but should request to be allowed to wear a wooden Cross on a string.

      Politely but firmly refuse sacraments offered by non Orthodox. The modern view of religion is very humanistic and ecumenist. Many hospitals offer “interfaith worship services” and visitation by non-Orthodox chaplains with offer of participation in their sacraments. Ask that your medical records state that you are Orthodox and that you will be served by your priest.

      Reject euthanasia, assisted suicide, or any procedures which involve the occult or which are contrary to the teachings of the Orthodox Church.

      Consider and prepare the following documents: a Health Care Proxy with Advance Directives, Funeral Instructions and a Last Will and Testament. In our litigious society unless something is written down and signed, in the eyes of the law it doesn’t count. Preparing such papers and giving them to your physician is a good way to start a conversation about your spiritual needs and concerns. Hospitals are required by law to ask you to fill out a Health Care Proxy with Advance Directives. It is usually much better to do so prior to a severe illness, when you have time for thought and reflection.

        Naming a “Health Care Proxy” means identifying and empowering a person to make decisions about health care if you, the patient, are not able to. Traditionally, this would be the next of kin (spouse, child, parent, and so on) but does not need to be. Especially if there is no obvious person, or there may be disagreements between family members, it is good to formally name a proxy. This document is also called a “Durable Power of Attorney for health care,” and should not include financial, child custody or other directives. The Health Care Proxy document often includes “Advance Directives,” documenting your wishes regarding health care in specific situations. In such a document you may specifically address particular interventions (such as euthanasia) which you would refuse under any circumstances. A common type of advance directive is a “Living Will” which (usually) instructs the physician not to use heroic measures (which can be specified) in a situation of prolonged coma or when death is likely despite treatment.

      A “Do Not Resuscitate Order” (DNR) is an advance directive which instructs the physician not to attempt resuscitation if the patient is found to be not breathing or heart not beating. Resuscitation is a series of emergency treatments (artificial respiration, chest compression (CPR), electric shocks to the heart, etc.) used to try to restart the heart or breathing. If it is not performed, a person without a heartbeat will die in a matter of minutes. After successful resuscitation a person will usually require life support machinery (such as a ventilator) for some time afterward. Resuscitation efforts are effective and make sense for many people with reversible conditions such as heart attacks, accident or poisoning victims, but in certain cases such as patients with advanced cancer or general feebleness may only serve to prolong the dying process.

     After death, the body becomes the properly of the next of kin, and they are looked to for instructions on what to do. A document with “Funeral Instructions” should include specific information declaring your beliefs as an Orthodox Christian, your membership in a particular parish, and your request to be prayed for and buried in an Orthodox manner. While awaiting burial, your body should rest in the church, not in a funeral home. Funeral instructions should specifically reject cremation. Funeral instructions should not be included in the Will. While it may not be legally binding after your death, an explicit statement of your last wishes may help prevent any family arguments or misunderstandings about such final arrangements.

      You should have a Last Will and Testament, but this should be separate from your health care documents and funeral instructions, and should not be given to the physician. This document lists a person’s wishes as to what should be done with his property after his death. It takes effect only after death (often after prolonged examination by attorneys, and possibly probate) and should not contain funeral instructions or advance directives regarding health care. The church teaches us not to be attached to our worldly possessions. Part of good stewardship of what treasures God has given us is to arrange for the proper disposition of them. After your death your kin should be praying for you, and there is no worse distraction at such a time than for them to worry about your property.

      Some may argue that making such preparations is unnecessary, or evidences excess concern for our mortal remains or possessions. On the contrary, having a file of such documents with copies kept by a relative or close friend can prevent many difficulties. Preparing them is an act of kindness for your relatives, relieving them of the need to concern themselves with mundane matters at a time of grief and prayer. If nothing else, this type of preparation reminds us of our mortality, and, God willing, brings us to prayer. 

    Trust in God. Pray that His will be done. A specific healing or miracle may not be beneficial, so it is above all important not to despair from illness, but be strengthened thereby. 

It is good for me that I have been afflicted; that I might learn thy statutes. (Ps. 118)