21 June 2005, 09:52
XI. Personal and national health
XI. 1. At all times the Church has been concerned for the human health, both spiritual and physical. From the Orthodox perspective, however, the physical health divorced from spiritual is not an absolute value. Preaching by word and deed, the Lord Jesus Christ healed people, taking care not only of their bodies, but above all of their souls, and as a result of the integrity of the personality. According to the Saviour Himself, he healed 'a man every whit whole' (Jn. 7:23). The preaching of the gospel was accompanied with healing as a sign of the power of the Lord to forgive sins. Healing was an integral part of the apostolic preaching as well. The Church of Christ, endowed by her Divine Founder with every gift of the Holy Spirit, was from the beginning a community of healing, and today too, in her rite of confession she reminds her children that they have come into an infirmary to come out healed.
The biblical attitude to medicine is expressed most fully in the Book of Jesus the Son of Sirach: 'Honour a physician with the honour due unto him for the uses which ye may have of him: for the Lord hath created him... For of the most High cometh healing The Lord hath created medicines out of the earth; and he that is wise will not abhor them. And he hath given men skill, that he might be honoured in his marvellous works. With such doth he heal [men,] and taketh away their pains. Of such doth the apothecary make a confection; and of his works there is no end; and from him is peace over all the earth, My son, in thy sickness be not negligent: but pray unto the Lord, and he will make thee whole. Leave off from sin, and order thine hands aright, and cleanse thy heart from all wickedness...Then give place to the physician, for the Lord hath created him: let him not go from thee, for thou hast need of him. There is a time when in their hands there is good success. For they shall also pray unto the Lord, that he would prosper that, which they give for ease and remedy to prolong life.' (Sir. 38:1-2, 4, 6-10, 12-14). The best representatives of the ancient medicine, included in the community of saints, gave a special example of holiness - the holiness of disinterested and miracle-working people. They were glorified not only because they often suffered martyrdom, but also because they accepted the medical calling as Christian duty of mercy.
The Orthodox Church has always treated the medical work with high respect as it is based on the service of love aimed to prevent and relieve people's suffering. The recovery of the human nature distorted by illness appears as the fulfilment of God's design for man. 'May the very God of peace sanctify you wholly and may your whole spirit and soul and body be preserved blameless unto the coming of our Lord Jesus Christ' (1 Thes. 5:23). The body, free from slavery to sinful passions and illnesses as their consequences, should serve the soul, while the spiritual powers and abilities, transformed by the grace of the Holy Spirit, should aspire for the ultimate goal and calling of man which is deification. Every authentic healing is called to be part of this miracle of healing accomplished in the Church of Christ. At the same time, it is necessary to distinguish the healing power of the grace of the Holy Spirit, given in the faith in One Lord Jesus Christ through participation in the church Sacraments, from conjuration, incantation and other magic manipulations and prejudices.
Many illnesses are still incurable and cause suffering and death. In the face of such illnesses, the Orthodox Christian is called to rely on the all-good will of God, remembering that the meaning of life is not limited to earthly life which is essentially the preparation for eternity. Suffering is a consequence of not only personal sins, but also the general distortion and limitation of the human nature and as such should be endured with patience and hope. The Lord voluntarily accepts suffering so that the human race may be saved: 'with his stripes we are healed' (Is. 53:5). This means that God was pleased to make suffering a means of salvation and purification, possible for every one who endures it with humbleness and trust in the all-good will of God. According to St. John Chrysostom, 'whoever has learnt to thank God for his illnesses is not far from being holy'. This does not mean that a doctor or a patient should not struggle with illness. However, when human resources are exhausted, the Christian should remember that God's strength is made perfect in weakness and that in the depths of suffering he can meet Christ Who took upon Himself our infirmities and afflictions (Is. 53:4).
XI. 2. The Church calls upon both pastors and her faithful to bear Christian witness to health workers. It is very important that medical teachers and students should be introduced to the bases of the Orthodox teaching and Orthodox-oriented biomedical ethics. (see, XII). The Church's spiritual care in the sphere of healthcare lies essentially in the proclamation of the word of God and the offer of the grace of the Holy Spirit to those who suffer and those who take care of them. Central to it are the participation of patients in the salvific Sacraments, creation of an atmosphere of prayer in clinics and the comprehensive charitable support of their patients. The church mission in the medical sphere is a duty not only for the clergy, but also for the Orthodox medical workers called to create all the conditions for religious consolation to be given to the patients who ask for it either directly or indirectly. A believing medical worker should understand that a person who needs his help expects from him not only appropriate treatment, but also spiritual support, especially if he upholds a worldview revealing the mystery of suffering and death. The duty of every Orthodox medical worker is to be for the patient the merciful Samaritan from the Gospel parable.
The Church gives her blessing upon the Orthodox brotherhoods and sisterhoods working in clinics and other healthcare institutions and helping to found hospital churches, as well as church and monastery hospitals, so that medical aid in all stages of treatment may be combined with pastoral care. The Church urges the laity to give all possible support to the sick to relieve human suffering with gentle love and care.
XI. 3. For the Church, the problem of personal and national health is not an external and purely social, because it has a direct bearing on her mission in the world damaged by sin and infirmities. The Church is called to participate, in collaboration with state structures and concerned public circles, in the development of such a conception of national healthcare whereby every person would exercise his right to spiritual, physical and mental health and social welfare under maximum life expectancy.
The doctor-patient relationships should be built on respect for the integrity, free choice and dignity of the personality. It is inadmissible to manipulate him even for the best purposes. The Church cannot but welcomes the development of doctor-patient dialogue taking place in medicine today. This approach is definitely rooted in the Christian tradition, though there is a temptation to reduce it to a purely contractual level. At the same time, it should be admitted that the traditional 'paternalistic' model of doctor-patient relations, rightly criticised for frequent attempts to justify the doctor's arbitrariness, can also offer a truly paternal approach to the patient, determined by the morality of the doctor.
Without giving preference to any organisational model of medical aid, the Church believes that this aid should be maximum effective and accessible to all members of society, regardless of their financial means and social status, also in the situation of limited medical resources. To make the distribution of these resources truly equitable, the criterion of 'vital needs' should prevail over that of 'market relations'. The doctor should not link the measure of his responsibility for giving medical aid exclusively with the financial reward and its amount, turning his profession into a source of enrichment. At the same time, worthy payment for the work of medical workers appears to be an important task for society and state.
While acknowledging the benefit of medicine becoming more oriented to prognosis and prevention and welcoming the integral conception of health and illness, the Church warns against attempts to make a particular medical theory absolute, reminding of the importance of keeping the spiritual priorities in the human life. On the basis of her age-old experience, the Church also warns of the danger that may be brought by attempt to introduce the occult-magic practice under the guise of 'alternative medicine', as this practice subjects the will and consciousness of people to the power of demonic forces. Every person should have the right and a real opportunity to reject those methods of influencing his organism which contradict his religious convictions.
The Church reminds the faithful that physical health is not self-sufficient, since it is only one of the aspects in the integral human being. It should be admitted, however, that in order to maintain the personal and national health it is important to take preventive measures and to create real conditions for people to engage themselves in physical culture and sports. Competition is natural for sports. Its extreme commercialisation, however, and the ensuing cult of pride, ruinous drug-taking and, all the more so, the contests in which severe injuries are purposefully inflicted cannot be approved.
XI. 4. The Russian Orthodox Church has to state with deep concern that the peoples she has traditionally nourished are in the state of demographical crisis today. The birth rate and the average life expectancy have sharply decreased, with the population continually decreasing in number. Life is threatened by epidemics, growing cardiovascular, mental, venereal and other diseases, as well as drug-addiction and alcoholism. Children's illnesses, including imbecility, have also grown. The demographical problems lead to deformation in the social structure and decrease in the creative potential of the people and become one of the causes of the weakening family. The primary causes of the depopulation and health crisis of these peoples in the 20th century are wars, revolution, hunger and massive repression the consequences of which have aggravated the social crisis at the end of the century.
The Church has been continually occupied with demographic problems. She is called to follow closely the legislative and administrative processes in order to prevent decisions aggravating the situation. It is necessary to conduct continuous dialogue with the government and the mass media to interpret the Church's stand on the demographic and healthcare policy. The fight with depopulation should be included in the effective support of medical research and social programs intended to protect motherhood and childhood, the embryo and the newborn. The state is called to support the birth and proper upbringing of children.
XI. 5. The Church regards mental diseases as manifestations of the general sinful distortion of the human nature. Singling out the spiritual, mental and bodily levels in the structure of the personality, the holy fathers drew a distinction between the diseases which developed 'from nature' and the infirmities caused by the diabolic impact or enslaving human passions. In accordance with this distinction, it is equally unjustifiable to reduce all mental diseases to manifestations of obsession - the conception ensuing in the unjustifiable exorcism of evil spirits, and to treat any mental disorder exclusively by medical means. More fruitful in psychotherapy is the combination of the pastoral and the medical aid with due delimitation made between the jurisdictions of the doctor and the priest.
No mental disease diminishes the dignity of a person. The Church testifies that a mentally ill person, too, is a bearer of the image of God, remaining our brother who needs compassion and support. Morally inadmissible are the psychotherapeutic approaches based on the suppression of a patient's personality and the humiliation of his dignity. Occult methods of influencing the psyche, sometimes disguised as scientific psychotherapy, are categorically unacceptable for Orthodoxy. In special cases, the treatment of the mentally ill requires both isolation and other forms of coercion. However, in choosing the form of medical intervention, the principle of the least restriction of a patient's freedom should be observed.
XI. 6. The Bible says that 'wine maketh glad the heart of man' (Ps. 104:15) and 'it is good... if it be drunk moderately' (Sir. 31:27). But we repeatedly find both in Holy Scriptures and the writings of the holy fathers the strong denunciation of the vice of drinking, which, beginning unnoticeably, leads to many other ruinous sins. Very often drinking causes the disintegration of family, bringing enormous suffering to both the victim of this sinful infirmity and his relatives, especially children.
'Drinking is animosity against God: Drinking is a voluntarily courted devil: Drinking drives the Holy Spirit away', St. Basil the Great writes. 'Drinking is the root of all evils: The drunkard is a living corpse: Drinking in itself can serve as punishment, filling as it is the soul with confusion, filling the mind with darkness, making a drunk prisoner, subjecting one to innumerable diseases, internal and external: Drinking is a many-sided and many-headed beast: Here it gives rise to fornication, there to anger, here to the dullness of the mind and the heart, there to impure love: Nobody obeys the ill will of the devil as faithfully as a drunkard does', St. John Chrysostom exhorted. 'A drunk man is capable of every evil and prone to every temptation: Drinking renders its adherent incapable of any task', St. Tikhon Zadonsky testifies.
Even more destructive is ever increasing drug-addiction - the passion that makes a person enslaved by it extremely vulnerable to the impact of dark forces. With every year this terrible infirmity engulfs more and more people, taking away great many a life. The fact that the most liable to it are young people makes it a special threat to society. The selfish interests of the drug business help to promote, especially among youth, the development of a special 'drug' pseudo-culture. It imposes on immature people the stereotypes of behaviour in which the use of drugs is seen as a 'normal' and even indispensable attribute of relations.
The principal reason for the desire of many of our contemporaries to escape into a realm of alcoholic or narcotic illusions is spiritual emptiness, loss of the meaning of life and blurred moral guiding lines. Drug-addiction and alcoholism point to the spiritual disease that has affected not only the individual, but also society as a whole. This is a retribution for the ideology of consumerism, for the cult of material prosperity, for the lack of spirituality and the loss of authentic ideals. In her pastoral compassion for the victims of alcoholism and drug-addiction, the Church offers them spiritual support in overcoming the vice. Without denying the need of medical aid to be given at the critical stages of drug-addiction, the Church pays special attention to the prevention and rehabilitation which are the most effective when those suffering participate consciously in the eucharistic and communal life.