21 June 2005, 09:52
XII. Problems of bioethics
XII. 1. The rapid development of biomedical technologies, which have invaded the life of modern man from birth to death, and the impossibility of responding to the ensuing ethical challenges within the traditional medical ethics have caused serious concern in society. The attempts of human beings to put themselves in the place of God by changing and 'improving' His creation at their will may bring to humanity new burdens and suffering. The development of biomedical technologies has outstripped by far the awareness of possible spiritual-moral and social consequences of their uncontrolled application. This cannot but cause a profound pastoral concern in the Church. In formulating her attitude to the problems of bioethics so widely debated in the world today, especially those involved in the direct impact on the human being, the Church proceeds from the ideas of life based on the Divine Revelation. It asserts life as a precious gift of God. It also asserts the inalienable freedom and God-like dignity of man called to be 'the prize of the high calling of God in Jesus Christ' (Phil. 3:14), to be as perfect as the Heavenly Father (Mt. 5:48) and to be deified, that is, to become partaker in the Divine nature (2 Pet. 1:4).
XII. 2. Since the ancient time the Church has viewed deliberate abortion as a grave sin. The canons equate abortion with murder. This assessment is based on the conviction that the conception of a human being is a gift of God. Therefore, from the moment of conception any encroachment on the life of a future human being is criminal.
The Psalmist describes the development of the foetus in a mother's womb as God's creative action: 'thou hast possessed my reins: thou hast covered me in my mother's womb: My substance was not hid from thee, them I was made in secret, and curiously wrought in the lowest part of the earth. Thine eyes did see my substance' (Ps. 139:13, 15-16). Job testifies to the same in the words addressed to God: 'thine hands have made me and fashioned me together round about: Hast thou not poured me out as milk, and curdled me like cheese? Thou hast clothed me with skin and flesh, and hast fenced me with bones and sinews. Thou hast granted me life and favour, and thy visitation hath preserved by spirit: Thou brought me forth out of the womb' (Job 10:8-12, 18). 'I formed thee in the belly: and before thou comest out of the womb I sanctified thee', says the Lord to the Prophet Jeremiah. 'Thou shalt not procure abortion, nor commit infanticide' - this order is placed among the most important commandments of God in the Teaching of the Twelve Apostles, one of the oldest Christian manuscripts. 'A woman who brought on abortion is a murderer and will give an account to God', wrote Athenagoras, an apologist of the 2nd century. 'One who will be man is already man', argued Tertullian at the turn of the 3d century. 'She who purposely destroys the foetus, shall suffer the punishment of murder: Those who give drugs for procuring abortion, and those who receive poisons to kill the foetus, are subjected to the same penalty as murder', read the 2nd and 8th rules of St. Basil the Great, included in the Book of Statutes of the Orthodox Church and confirmed by Canon 91 of the Sixth Ecumenical Council. At the same time, St. Basil clarifies: 'And we pay no attention to the subtle distinction as to whether the foetus was formed or unformed'. St. John Chrysostom described those who perform abortion as 'being worse than murderers'.
The Church sees the widely spread and justified abortion in contemporary society as a threat to the future of humanity and a clear sign of its moral degradation. It is incompatible to be faithful to the biblical and patristic teaching that human life is sacred and precious from its origin and to recognise woman's 'free choice' in disposing of the fate of the foetus. In addition, abortion present a serious threat to the physical and spiritual health of a mother. The Church has always considered it her duty to protect the most vulnerable and dependent human beings, namely, unborn children. Under no circumstances the Orthodox Church can bless abortion. Without rejecting the women who had an abortion, the Church calls upon them to repent and to overcome the destructive consequences of the sin through prayer and penance followed by participation in the salvific Sacraments. In case of a direct threat to the life of a mother if her pregnancy continues, especially if she has other children, it is recommended to be lenient in the pastoral practice. The woman who interrupted pregnancy in this situation shall not be excluded from the Eucharistic communion with the Church provided that she has fulfilled the canon of Penance assigned by the priest who takes her confession. The struggle with abortion, to which women sometimes have to resort because of abject poverty and helplessness, demands that the Church and society work out effective measures to protect motherhood and to create conditions for the adoption of the children whose mothers cannot raise them on their own for some reason.
Responsibility for the sin of the murder of the unborn child should be borne, along with the mother, by the father if he gave his consent to the abortion. If a wife had an abortion without the consent of her husband, it may be grounds for divorce (see X. 3). Sin also lies with the doctor who performed the abortion. The Church calls upon the state to recognise the right of medics to refuse to procure abortion for the reasons of conscience. The situation cannot be considered normal where the legal responsibility of a doctor for the death of a mother is made incomparably higher than the responsibility for the destruction of the foetus - the situation that provokes medics and through them patients, too, to do abortions. The doctor should be utterly responsible in establishing a diagnosis that can prompt a woman to interrupt her pregnancy. In doing so, a believing medic should carefully correlate the clinic indications with the dictates of his Christian conscience.
XII. 3. Among the problems which need a religious and moral assessment is that of contraception. Some contraceptives have an abortive effect, interrupting artificially the life of the embryo on the very first stages of his life. Therefore, the same judgements are applicable to the use of them as to abortion. But other means, which do not involve interrupting an already conceived life, cannot be equated with abortion in the least. In defining their attitude to the non-abortive contraceptives, Christian spouses should remember that human reproduction is one of the principal purposes of the divinely established marital union (see, X. 4). The deliberate refusal of childbirth on egoistic grounds devalues marriage and is a definite sin.
At the same time, spouses are responsible before God for the comprehensive upbringing of their children. One of the ways to be responsible for their birth is to restrain themselves from sexual relations for a time. However, Christian spouses should remember the words of St. Paul addressed to them: 'Defraud ye not one the other, except it be with consent for a time, that ye may give yourselves to fasting and prayer; and come together again, that Satan tempt you not for your incontinency' (1 Cor. 7:5). Clearly, spouses should make such decisions mutually on the counsel of their spiritual father. The latter should take into account, with pastoral prudence, the concrete living conditions of the couple, their age, health, degree of spiritual maturity and many other circumstances. In doing so, he should distinguish those who can hold the high demands of continence from those to whom it is not given (Mt. 19:11), taking care above all of the preservation and consolidation of the family.
The Holy Synod of the Russian Orthodox Church in its Decision of December 28, 1998, instructed the clergy serving as spiritual guides that 'it is inadmissible to coerce or induce the flock to: refuse conjugal relations in marriage'. It also reminded the pastors of the need 'to show special chastity and special pastoral prudence in discussing with the flock the questions involved in particular aspects of their family life'.
XII. 4. New biomedical methods make it possible in many cases to overcome the infirmity of infertility. At the same time, the growing technological interference in the conception of human life presents a threat to the spiritual integrity and physical health of a person. A threat comes also for interpersonal relations on which the community has been built from of old. The development of the above-mentioned technologies has brought about the ideology of the so-called reproductive rights, widely propagated today on both national and international levels. This ideological system assumes that the sexual and social self-fulfilment of a person has a priority over concern for the future of a child, the spiritual and physical health of society and its moral sustainability. There is a growing attitude to the human life as a product which can be chosen according to one's own inclinations and which can be disposed of along with material goods.
In the prayers of the marriage celebration, the Orthodox Church expresses the hope that childbirth, while being a desired fruit of lawful marriage, is not its only purpose. Along with 'a fruit of the womb to profit', the Church asks for the gift of enduring love, chastity and 'the harmony of the souls and bodies'. Therefore, the Church cannot regard as morally justified the ways to childbirth disagreeable with the design of the Creator of life. If a husband or a wife is sterile and the therapeutic and surgical methods of infertility treatment do not help the spouses, they should humbly accept childlessness as a special calling in life. In these cases, pastoral counsel should consider the adoption of a child by the spouses' mutual consent. Among the admissible means of medical aid may be an artificial insemination by the husband's germ cells, since it does not violate the integrity of the marital union and does not differ basically from the natural conception and takes place in the context of marital relations.
However, manipulations involved in the donation of germ cells do violate the integrity of a person and the unique nature of marital relations by allowing of a third party to interfere. In addition, this practice encourages the irresponsible fatherhood or motherhood, admittedly free from any commitment to those who are 'flesh of the flesh' of anonymous donors. The use of donor material undermines the foundations of family relationships, since it presupposes that a child has, in addition to the 'social' parents, the so-called biological ones. 'Surrogate motherhood', that is, the bearing of a fertilised ovule by a woman who after the delivery returns the child to the 'customers', is unnatural and morally inadmissible even in those cases where it is realised on a non-commercial basis. This method involves the violation of the profound emotional and spiritual intimacy that is established between mother and child already during the pregnancy. 'Surrogate motherhood' traumatises both the bearing woman, whose mother's feelings are trampled upon, and the child who may subsequently experience an identity crisis. Morally inadmissible from the Orthodox point of view are also all kinds of extracorporal fertilisation involving the production, conservation and purposeful destruction of 'spare' embryos. It is on the recognition of the human dignity even in an embryo that the moral assessment of abortion by the Church is based (see, XII. 2).
The insemination of single women with the use of donor germ cells or the realisation of the 'reproductive rights' of single men and persons with the so-called non-standard sexual orientation deprive the future child of the right to have mother and father. The use of reproductive methods outside the context of the God-blessed family has become a form of theomachism carried out under the pretext of the protection of the individual's autonomy and wrongly-understood individual freedom.
XII. 5. Hereditary diseases comprise a considerable part of the totality of human infirmities. The development of the medical genetic methods of diagnostics and treatment can contribute the prevention of these diseases and the alleviation of the suffering of many people. It is important to remember, however, that genetic disorders often stem from the disregard of moral principles and the vicious way of life, which result in the suffering of the posterity. The sinful erosion of the human nature is overcome by spiritual effort; but if vice dominates in life from generation to generation with growing power, the words of Holy Scripture come true: 'Horrible is the end of the unrighteous generation' (Wis. 3:19). And the reverse: 'Blessed is the man that feareth the Lord, that delighteth greatly in his commandments. His seed shall be mighty upon earth: the generation of the upright shall be blessed' (Ps. 112:1-2). Thus, genetic research only confirms the spiritual laws revealed to humanity in the word of God many centuries ago.
While drawing people's attention to the moral causes of infirmities, the Church welcomes the efforts of medics aimed to heal hereditary diseases. The aim of genetic interference, however, should not be to 'improve' artificially the human race or to interfere in God's design for humanity. Therefore, genetic engineering may be realised only with the consent of a patient or his legitimate representatives and only on the grounds of medical indications. The genetic therapy of germ cells is extremely dangerous, for it involves a change of the genome (the set of hereditary characteristics) in the line of generations, which can lead to unpredictable consequences in the form of new mutations and destabilise the balance between the human community and the environment.
The progress made in the deciphering of the genetic code have created real pre-conditions for comprehensive genetic testing with the aim to discover information on the natural uniqueness of every human being and his susceptibility to particular illnesses. Genetic screening, provided the information obtained is used reasonably, could help to rectify timely the development of illnesses to which a particular person is prone. However, there is a real danger that genetic information will be abused for various forms of discrimination. In addition, the possession of information on one's genetic susceptibility to severe illnesses may become for one a spiritual burden beyond one's strength. Therefore, genetic information and genetic testing may be possible only with respect for the freedom of the individual.
Ambiguous are also the methods of prenatal diagnostics making it possible to identify a genetic illness on the early stages of the intrauterine development. Some of these methods may present a threat to the life and integrity of the embryo or foetus under test. The detection of an incurable or severe genetic illness sometimes compels parents to interrupt the life conceived; there have been cases of pressure brought to bear upon them to this end. Prenatal diagnostics may be viewed as morally justifiable if its aim is to treat an illness detected on an earliest possible stage and to prepare parents for taking special care of a sick child. Every person has the right to life, love, and care, whatever illnesses he may have. According to Holy Scriptures, God Himself is 'a God of the afflicted' (Judith 9:11). St. Paul teaches 'to support the weak' (Acts 20:35; 1 Thes. 5:14). Likening the Church to the human body, he points out that 'much more those members of the body, which seem to be more feeble, are necessary', while those less perfect need 'more abundant honour' (1 Cor. 12:22, 24). It is absolutely inadmissible to use methods of prenatal diagnostics with the aim to choose a more desirable gender of a future child.
XII. 6. The cloning (production of genetic copies) of animals, realised by scientists, raises the question of the admissibility and possible consequences of the cloning of the human being. The realisation of this idea, protested against be many people, can become destructive for society. Cloning opens up an even greater opportunity than some reproductive technologies do for manipulations with the genetic component of the personality and contributes to its further devaluation. Man has no right to claim the role of the creator of his likes or to choose their genetic prototypes, thus determining their personal characteristics at his discretion. The conception of cloning is a definite challenge to the very nature of the human being and to the image of God inherent in him, the integral part of which are the freedom and uniqueness of the personality. The 'printing' of people with specified parameters can appear welcome only to adherents of totalitarian ideologies.
The cloning of human beings can corrupt the natural foundations of childbirth, consanguinity, motherhood and fatherhood. A child can become a sister to her mother, a brother to his father or a daughter to his or her grandfather. The psychological consequences of cloning are also extremely dangerous. A human being, who came to being as a result of this procedure, can feel not like an independent person but only 'a copy' of someone who live or lived before. It should be also considered that experiments with human cloning will inevitably produce as 'by-products' numerous unfulfilled lives and, most probably, the emergence of a numerous unsustainable posterity. At the same time, the cloning of isolated organic cells and tissues is not an encroachment on the dignity of the personality and in a number of cases has proved helpful in the biological and medical practice.
XII. 7. The modern transplantology (the theory and practice of the transplantation of organs and tissues) makes it possible to give effective aid to many patients who were earlier doomed to death or severe disability. At the same time, the development of this sphere of medicine, increasing the need for necessary organs, generates certain ethical problems and can present a threat to society. Thus, the unscrupulous propaganda of donoring and the commercialisation of transplanting create prerequisites for trade in parts of the human body, thus threatening the life and health of people. The Church believes that human organs cannot be viewed as objects of purchase and sale. The transplantation of organs from a living donor can be based only on the voluntary self-sacrifice for the sake of another's life. In this case, the consent to explantation (removal of an organ) becomes a manifestation of love and compassion. However, a potential donor should be fully informed about possible consequences of the explantation of his organ for his health. The explantation that presents an immediate threat to the life of a donor is morally inadmissible. The most common of all is the practice of taking organs from people who have just died. In these cases, any uncertainty as to the moment of death should be excluded. It is unacceptable to shorten the life of one, also by refusing him the life-supporting treatment, in order to prolong the life of another.
The Church confesses, on the basis of Divine Revelation, the faith in the bodily resurrection of the dead (Is. 26:19; Rom. 8:11; 1 Cor. 15:42-44, 52-54; Phil. 3:21). In the Christian burial, the Church expressed the reverence that befits the body of a dead. However, the posthumous giving of organs and tissues can be a manifestation of love spreading also to the other side of death. Such donation or will cannot be considered a duty. Therefore, the voluntary consent of a donor in his lifetime is the condition on which explantation can be legitimate and ethically acceptable. If doctors do not know the will of a potential donor, they should, if necessary, find it out the will of a dying or dead person from his relatives. The so-called presumptive consent of a potential donor to the removal of his organs and tissues, sealed in the legislation of some countries, is considered by the Church to be an inadmissible violation of human freedom.
A recipient assimilates donor organs and tissues entering his personal spiritual and physical integrity. Therefore, in no circumstances moral justification can be given to the transplantation that threatens the identity of a recipient, affecting his uniqueness as personality and representative of a species. It is especially important to remember this condition in solving problems involved in the transplantation of animal organs and tissues.
The Church believes it to be definitely inadmissible to use the methods of so-called foetal therapy, in which the human foetus on various stages of its development is aborted and used in attempts to treat various diseases and to 'rejuvenate' an organism. Denouncing abortion as a cardinal sin, the Church cannot find any justification for it either even if someone may possibly benefit from the destruction of a conceived human life. Contributing inevitably to ever wider spread and commercialisation of abortion, this practice (even if its still hypothetical effectiveness could be proved scientifically) presents an example of glaring immorality and is criminal.
XII. 8. The practice of the removal of human organs suitable for transplantation and the development of intensive care therapy has posed the problem of the verification of the moment of death. Earlier the criterion for it was the irreversible stop of breathing and blood circulation. Thanks to the improvement of intensive care technologies, however, these vital functions can be artificially supported for a long time. Death is thus turned into dying dependent on the doctor's decision, which places a qualitatively new responsibility on contemporary medicine.
Holy Scriptures treats death as the separation of the soul from the body (Ps. 146:4; Lk. 12:20). Thus it is possible to speak about a continuing life as long as an organism functions as a whole. The prolongation of life by artificial means, in which in fact only some organs continue to function, cannot be viewed as obligatory and in any case desirable task of medicine. Attempts to delay death will sometimes prolong a patient's agony, thus depriving him of the right to 'honourable and peaceful' death, for which the Orthodox Christian solicit the Lord during the liturgy. When intensive care becomes impossible, its place should be taken by palliative aid (anaesthetisation, nursing and social and psychological support) and pastoral care. All this is aimed to ensure the true humane end of life couched in by mercy and love.
The Orthodox understanding of an honourable death includes preparation for the mortal end, which is considered to be a spiritually significant stage in the life of a person. A patient surrounded with Christian care can experience in the last days of his life on earth a grace-giving change brought about by a new reflection on his journey and penitent anticipation of eternity. For the relatives of a dying man and for medical workers, an opportunity to nurse him becomes an opportunity to serve the Lord Himself. For according to the Saviour's word, 'inasmuch as ye have done it unto one of the least of these my brethren, ye have done it to me' (Mt. 25:40). The attempt to conceal from a patient the information about the gravity of his condition under the pretext of preserving his spiritual comfort often deprives a dying person of an opportunity to be consciously prepared for death and to find spiritual consolation in participation in the Sacraments of the Church. It also darkens his relations with relatives and doctors with distrust.
Death throes cannot be always effectively alleviated with anaesthetics. Aware of this, the Church in these cases turns to God with the prayer: 'Give Thy servant dispensation from this unendurable suffering and its bitter infirmities and give him consolation, O Soul of the righteous' (Service Book. Prayer for the Long Suffering). The Lord alone is the Master of life and death (1 Sam. 2:6). 'In his hand is the soul of every living thing, and the breath of all mankind' (Job 12:10). Therefore, the Church, while remaining faithful to God's commandment 'thou shalt not kill' (Ex. 20:13), cannot recognise as morally acceptable the widely-spread attempt to legalise the so-called euthanasia, that is, the purposeful destruction of hopelessly ill patients (also by their own will). The request of a patient to speed up his death is sometimes conditioned by depression preventing him from assessing his condition correctly. Legalised euthanasia would lead to the devaluation of the dignity and the corruption of the professional duty of the doctor called to preserve rather than end life. 'The right to death' can easily become a threat to the life of patients whose treatment is hampered by lack of funds.
Therefore, euthanasia is a form of homicide or suicide, depending on whether a patient participates in it or not. If he does, euthanasia comes under the canons whereby both the purposeful suicide and assistance in it are viewed as a grave sin. A perpetrator of calculated suicide, who 'did it out of human resentment or other incident of faintheartedness' shall not be granted Christian burial or liturgical commemoration (Timothy of Alexandria, Canon 14). If a suicide is committed 'out of mind', that is, in a fit of a mental disease, the church prayer for the perpetrator is allowed after the case is investigated by the ruling bishop. At the same time, it should be remembered that more often than not the blame for a suicide lies also with the people around the perpetrator who proved incapable of effective compassion and mercy. Together with St. Paul the Church calls us: 'Bear one another's burdens, and so fulfil the law of Christ' (Gal. 6:2).
XII. 9. Holy Scriptures and the teaching of the Church unequivocally deplore homosexual relations, seeing in them a vicious distortion of the God-created human nature.
'If a man lies with mankind, as he lieth with a woman, both of them have committed an abomination' (Lev. 20:13). The Bibles relates a story about a heavy punishment to which God subjected the people of Sodom (Gen. 19:1-19) precisely for the sin of sodomy. St. Paul, describing the moral condition of the Gentiles, names homosexual relations among the most 'vile affections' and 'fornications' defiling the human body: 'Their women did change the natural use into that which is against nature: and likewise the men, leaving the natural use of women, burned in their lust one towards another; men with men working that which is unseemly, and receiving in themselves that recompence of their error which was meet' (Rom. 1:26-27). 'Be not deceived: neither effeminate, nor abusers of themselves with mankind: shall inherit the kingdom of God', wrote the apostle to the people of corrupted Corinth (1 Cor. 6:9-10). The patristic tradition equally clearly and definitely denounces any manifestation of homosexuality. The Teaching of the Twelve Apostles, the works of Sts Basil the Great, John Chrysostom, Gregory of Nyssa and Blessed Augustine and the canon of St. John the Faster - all express the unchangeable teaching of the Church that homosexual relations are sinful and should be condemned. People involved in them have not right to be members of the clergy (Gregory the Great, Canon 7; Gregory of Nyssa, Canon 4; John the Faster, Canon 30). Addressing those who stained themselves with the sin of sodomy, the St. Maxim the Greek made this appeal: 'See at yourselves, damned ones, what a foul pleasure you indulge in! Try to give up as soon as possible this most nasty and stinking pleasure of yours, to hate it and to fulminate eternally those who argue that it is innocent as enemies of the Gospel of Jesus Christ and corrupters of His teaching. Cleanse yourselves of this blight by repentance, ardent tears, alms-giving as much as you can and pure prayer: Hate this unrighteousness with all your heart, so that you may not be sons of damnation and eternal death'.
The debate on the status of the so-called sexual minorities in contemporary society tends to recognise homosexuality not as a sexual perversion but only one of the 'sexual orientations' which have the equal right to public manifestation and respect. It is also argued that the homosexual drive is caused by the individual inborn predisposition. The Orthodox Church proceeds from the invariable conviction that the divinely established marital union of man and woman cannot be compared to the perverted manifestations of sexuality. She believes homosexuality to be a sinful distortion of human nature, which is overcome by spiritual effort leading to the healing and personal growth of the individual. Homosexual desires, just as other passions torturing fallen man, are healed by the Sacraments, prayer, fasting, repentance, reading of Holy Scriptures and patristic writings, as well as Christian fellowship with believers who are ready to give spiritual support.
While treating people with homosexual inclinations with pastoral responsibility, the Church is resolutely against the attempts to present this sinful tendency as a 'norm' and even something to be proud of and emulate. This is why the Church denounces any propaganda of homosexuality. Without denying anybody the fundamental rights to life, respect for personal dignity and participation in public affairs, the Church, however, believes that those who propagate the homosexual way of life should not be admitted to educational and other work with children and youth, nor to occupy superior posts in the army and reformatories.
Sometimes perverted human sexuality is manifested in the form of the painful feeling of one's belonging to the opposite sex, resulting in an attempt to change one's sex (transsexuality). One's desire to refuse the sex that has been given him or her by the Creator can have pernicious consequences for one's further development. 'The change of sex' through hormonal impact and surgical operation has led in many cases not to the solution of psychological problems, but to their aggravation, causing a deep inner crisis. The Church cannot approve of such a 'rebellion against the Creator' and recognise as valid the artificially changed sexual affiliation. If 'a change of sex' happened in a person before his or her Baptism, he or she can be admitted to this Sacrament as any other sinner, but the Church will baptise him or her as belonging to his or her sex by birth. The ordination of such a person and his or her marriage in church are inadmissible.
Transsexuality should be distinguished from the wrong identification of the sex in one's infancy as a result of doctors' mistake caused by a pathological development of sexual characteristics. The surgical correction in this case is not a change of sex.