Stages on Life’s Way: Orthodox Thinking on Bioethics 0881412996, 9780881412994

Table of contents :
FOREWORD II
ACKNOWLEDGMENTS 17
INTRODUCTION
Bioethics and the Stages on Life's Way 19
Acquiring the Mind of the Church 2
1
Divine and Human Personhood 23
Culture of Death or Culture of Life? 28
The Path Ahead 3 o
CHAPTER ONE
Bioethical Challenges in the New Millennium 3 3
The Threat of New Diseases 3 6
Engineering Ourselves 3 8
The Quest for Holiness 4
1
Our Common Priestly Ministry 4 5
CHAPTER TWO
The Covenantal Aspect of Christian Marriage 49
Reconceptualizing Sex, Gender, and Marriage 5
1
The Reason for Marriage 60
Characteristics of Christian Marriage 63
Does Christian Marriage Have a Future? 72
CHAPTER THREE
The Use and Abuse ofHuman Embryos 75
When Does Human Life Begin? 8 2
Manipulated Embryos and Designer Genes 9 8
Ethical and Not-So-Ethical Alternatives 105
Conclusions 115
Glossary 117
CHAPTER FOUR
The Sacredness ofNewborn Life 121
The Newborn Child and the Newborn Christ 1 24
Welcoming the Newborn Child 131
Children with Disabilities 135
Cherishing the Newborn Child 140
CHAPTER FIVE
On Addictions and Family Systems 145
Defining the Problem 145
Ethical Aspects of Addictions 148
Defining and Identifying Addictions 151
Statistics 152
Family Systems 155
Examples of Addictions 1 64
Tramna and Addiction 176
Defining the Solution: Recovery 177
Addictions and Recovery within the Church 181
CHAPTER SIX
The Hope of Glory:
From a Physical to a Spiritual Body 189
Body and Soul 190
The Body of Glory 200
The Paschal Victory zo6
CHAPTER SEVEN
Care in the Final Stage of Life 209
Euthanasia: A Good Death? 218
Care for the Permanently Incapacitated 231
Accompaniment in the Final Stage of Life 238

Citation preview

Stages

on

Life's

Way

ORTHODOX THINKING ON BIOETHICS John and Lyn Brech US

o ?rie«;

STAGES ON life's WAY

8S

Foundations series

Testifying to the faith

and

creativity of the

Church, the Foundations tradition to address the

series

Orthodox Christian

draws upon the

riches of

modem world. These survey texts

suitable both for preliminary inquiry

and deeper

Series Editor

are

investigation,

in the classroom or for personal study.

Peter C. Bouteneff

its

Stages

on

Life's

Way

ORTHODOX THINKING ON BIOETHICS

Book

1

of the Foundations series

John

& Lyn Breck

seminary press CRESTWOOD, NEW YORK Z005

ST Vladimir's

Library of Congress Cataloging-iii-Publicatioii Data

Breck, John, 1939-

on life's way Orthodox thinking on

Stages

:

cm.

p.

—

(Foundations

bioethics

/

John Breck

& Lyn Breck.

^ ;

bk. i)

^

ISBN-13: 978-0-88 141-299-4

(alk.

ISBN-io: 0-88141-299-6

paper)

(alk.

paper)

—^ReUgious aspects—Orthodox Eastern Church. Orthodox — Medical —ReUgjous apects—Orthodox Eastern Church. —Orthodox Eastern Church. Breck, Lyn. I.

Bioethics

2.

Eastern Church

ethics

^Doctrines. 3.

4. Spiritual life

n.

St.

Vladimir's

I.

Orthodox Theological Seminary (Crestwood, Tuckahoe,

Westchester County, N.Y.) EI.

Title.

IV. Series:

Foundations

(St.

Vladimir's

Orthodox Theological Seminary (Crestwood, Tuckahoe, Westchester County, N.Y.))

;

bk. i.

[DNLM:

I.

Bioethical Issues. 2. Eastern Orthodoxy.

WB 60 B829S

2005]

R725.56.B73 2005

—dc22

i74'.957

2005027259

©

2005 BY JOHN AND LYN BRECK

ST VLADIMIR'S

575

SEMINARY PRESS

Scarsdale Rd, Crestwood,

NY 10707

1-800-204-2665 www.svspress.com

All rights reserved.

No part of this book may be reproduced or

transmitted in .any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage

and

retrieval system, except as

1976 Copyright Act, or

may

be expressly permitted by the

in writing

from the

publisher:

ISSN 1556-9837

ISBN 0-88141-299-6 ISBN 978-O-8814I-299-4

PRINTED IN THE UNITED STATES OF AMERICA

For Margaret

Pitts Kleiber

and Helen Forgham Neville, with gratitude and love

1

1

1

CONTENTS FOREWORD

II

ACKNOWLEDGMENTS

17

INTRODUCTION Bioethics

and

the Stages

Acquiring the Divine and

Mind

on

Life's

Way

of the Church

Human Personhood

2

23

Culture of Death or Culture of Life?

The Path Ahead

3

19

28

o

CHAPTER ONE Bioethical Challenges in the

New Millennium

The Threat of New Diseases Engineering Ourselves

The Quest

for Holiness

3

33

6

38

4

Our Common Priestly Ministry

45

CHAPTER TWO The Covenantal Aspect of Christian Marriage

49

Reconceptualizing Sex, Gender, and Marriage

The Reason

for Marriage

60

Characteristics of Christian Marriage

Does Christian Marriage Have a Future?

I '

I

63

72

5

CHAPTER THREE The Use and Abuse of Human Embryos

When Does Human Life Begin?

75

82

Manipulated Embryos and Designer Genes Ethical

and Not-So-Ethical Alternatives

105

115

Conclusions Glossary

98

117

CHAPTER FOUR The Sacredness of Newborn The Newborn Child and

121

Life the

Newborn

Welcoming the Newborn Child Children with Disabilities Cherishing the

Newborn

24

135

Child

140

145

145

148

Ethical Aspects of Addictions

Defining and Identifying Addictions Statistics

1

131

CHAPTER FIVE On Addictions and Family Systems Defining the Problem

Christ

151

152

Family Systems

155

Examples of Addictions

Tramna and Addiction

1

64

176

Defining the Solution: Recovery

177

Addictions and Recovery within the Church

181

CHAPTER

SIX

The Hope of Glory:

From a

Physical to a Spiritual

Body and Soul

Body

189

190

The Body of Glory The Paschal Victory

200

zo6

CHAPTER SEVEN Care

in the Final Stage

Euthanasia:

of Life

A Good Death?

209 218

Care for the Permanently Incapacitated

Accompaniment

in the Final Stage of Life

231

238

foreword Our being made

in

God's image

is

both a

gift

and a

calling.

human being bears the divine image as an inalienable gift, must work to

attain to that

Living into the image of

our Christian

faith.

image

God

For faith

ings;

it is

our

Harmonizing faith and life ination

is

it is

more than a reality,

series

and

it

in the

of teach-

must pene-

lives.

is

a perpetual task entailing self-exam-

and the reorientation of our

the context of the sacramental

need some very

we

truly a divine likeness.

more than a consolation

a conviction about absolute

trate the very fabric of

it is

but

involves living in accordance with

and

face of a death-bound world,

until

Every

specific help in

life

Ufe, thoughts,

and actions

of the Church. But

we

also

making the connections between

—gleaned from Holy Scripture as read of Church tradition—and the often complex

the Church's theology

the light

in

in

situations

puts before us.

that

life

The

field

of ethics, from a Christian perspective,

precisely with

is

concerned

making those connections. Ethics is about applying

the revealed truth about

God, the world, and the human person

to situations within the context of our daily lives, in

all

of their

complexity and ambiguity. For these connections are not always apparent or easy to draw.

It's

one thing to apply "thou shalt not

11

STAGES ON life's WAY But

Steal" to the workplace.

pology to the situation of a

and now requiring a

how do we

apply Christian anthro-

relative suffei;ing

from Alzheimer's

respirator to sustain her life?

How

do we

How, in a

enter into the charged debate about stem cell research?

world which concocts more and more elaborate means of dehumanization, do a

life

we

live

a

life

that reflects the image of

God

in us,

that reflects genuine personhood?

In articles

and books dating from the

Breck, a pastor and

late

New Testament

with ethical questions, taking

1980s onward, Fr John

scholar, has

his place

Orthodox ethicists who emerged in the

among

been wrestling the handful of

late twentieth century.^ In

his written output as well as in classrooms in the United States

and

in Europe, Fr

teachings of the

John has been working to engage the absolute

Church with human

consistently reminds us that in

person

is

situations. In so doing,

Orthodox

teaching, the

he

human

a continuity from conception to resurrection. That

means that

before, during,

and

after a person's earthly life in a

body that breathes oxygen, we are dealing with a being created in God's image and whose In this volume, Fr

John

life

sets

has ultimate value.

out a series of reflections that takes

us along the stages in that continuum. In these pages,

we

find a

wealth of information and practical advice for readers seeking to apply their faith to their case studies

way

lives.

But

we

also have here a series of

on how an Orthodox Christian can

in the world,

how Orthodox

^Other Orthodox authors published in

find his or her

Christians "do" bioethics.

this field include Stanley

Harakas,

Alexander Webstei; Christos Yannaras, Tristram Engelhardt, Vigen Guroian,

and Joseph Woodill.

12

— Foreword

Here are some of the

principles that emerge, both implicitly

exphcitly, in the pages of this book;

* "Orthodox

ethics"

is

primarily a goal-oriented voca-

than an application of rules. Even the

titles

of Orthodox ethical reflections are indicative of

this:

tion, rather

Towards Transfigured Life (Harakas), The Freedom of Morality (Yannaras),

dox

ethics

like

and

is

God with Us

shows us what redeemed humanity looks

Orthodox

orients us in that direction.

not so

Ortho-

(Breck).

much

ethics

proscriptive ("thou shalt not") as

indicative ("thou ought" or "behold the goal!").

* Orthodox

ethics

Church. This

is

draws on the teachings of the

not as obvious as

many of the ethical decisions ing, for

it

may

sound, for

before us today

example, cloning, stem

cells,

—

^involv-

or eugenics

were not envisioned during the formative periods of the Church's teaching

on the human person. This

means that we have to acquire a

we have

a "patristic mind"; the tradition of the

takes

its

to

"scriptural

mind" and

become so steeped

in

Church that our thinking naturally

contours. In this way, even situations that

were unforeseeable to the ancients can be informed by the foundations they laid.

*

In order properly to

do

ethics,

and

especially bioethics

as helpfully defined in the early pages of Fr John's

introduction,

To negotiate

we need to be conversant with science. our way through, for example, ques-

tions about abortion, birth control,

13

and reproductive

and

STAGES ON life's WAY technologies,

we need

to consider

can properly be said to begin.^This

when human

Ufe

in turn requires a

thoughtful engagement with the empirical sciences, an

engagement that runs consistently through the history of the Church's theological reflection, ancient and

modern.

Having said this,

ethical

dilemmas posed to us today are complex

and delicate. There are no canons about cloning,

in vitro fertiliza-

tion, or, for that matter, the possibility of extraterrestrial

means that ples to

life.

This

ethics consists in the art of applying timeless princi-

time-bound

situations.

Orthodox

ethics constantly strives

to strike the right relationship between the absolute

and the

situ-

between universal, unchanging, timeless truths and

ational,

guidelines,

and the

particular, variable,

messy situations before us All of this

means

at a given

that any

and sometimes

terribly

moment.

good Christian

needs to be

ethicist

courageous, because this struggle for balance, a struggle which

—reproduc-

involves situations that are very close to our hearts tion, sexual orientation

—

dying

is

and expression,

illness,

death and

often going to result in an unpopular stance.

ethicist is likely to get attacked

from

all sides:

A good

for not being

absolute enough, for not being understanding or permissive

enough.

What he

or she needs

is

not our attacks but our prayers

and the sharing of our experience and understanding, is

also

As

an

ecclesial undertaking.

ecclesial or

communal

as ethics

may

be,

we

with the courage, the theological sense, and the to

make

for ethics

the necessary connections for us,

14

still

need people

scientific

acumen

and even to show us

Foreword

how we might make some of the comiections ourselves, so that our own decisions, our own Uves, may truly reflect our faith. May this

book be such a

A word

is

in order

Breck (chap.

5).

contribution.

about the contribution to

this

book by Lyn

Lyn's background as an instructor in spirituality

in a seminary context directly influenced her interest in applied,

from

as distinguished

concepts. She

our

lives?

is

theoretical, spirituality, in behavior versus

drawn toward questions such as. How do we live

What

are our ethical choices?

choices foster our witness to God's

us? For

many

years a counselor

Orthodox Church, she

is

and

How

do these

kingdom and its reality among and

retreat leader within the

especially poised to

make an Orthodox

contribution to thinking about addictions and family systems.

Such reflection ing a right

life

is

indispensable, for

if

bioethics has to

do with liv-

and with reflecting in ourselves and in our relation-

ships the image of

God, then due attention needs to be paid to

those behaviors and patterns which distort the image in particular

and damaging ways.

We

need to

alert ourselves to the

phe-

—

nomenon of addiction an awareness of which has increased in many circles but remains dormant in others and to learn about

—

helping ourselves and others in the

As

in the rest of the book,

we

way

are again

of recovery.

shown the importance of

drawing, though not uncritically, on secular medical and behavioral sciences in order to benefit

evidence.

Some may complain

from

their empirical, practical

that the Fathers didn't talk about

15

STAGES ON life's WAY addictions and dysfunctions and that therefore to concern ourselves

with them

is

an enslavement to

mo4em

secular thinking.

Well, the Fathers talked a great deal about the passions, and that is

precisely the sphere within

tions,

compulsions, and dysfunctional patterns of behavior and

relationships. sively

which we ought to consider addic-

Much

Orthodox;

of what Lyn Breck writes here

it is

not exclu-

practical information available to all

a wide variety of sources.

from

(Many of these sources, especially those

from Twelve Step programs, bear a strong But given what

is

we now know about

spiritual

component.)

brain chemistry, as well as

about addictions. Orthodox thinking on bioethics can no longer

go without addressing

this

dimension of hirnian experience.

—Peter C. Bouteneff

16

.

acknowledgments The authors

are grateful for the thoughtful

and

gentle editing of

Michael Breck, Al Rossi, Brian Phipps, and Peter Bouteneff

17

introduction

BIOETHICS AND THE STAGES ON life's WAY ver the past three decades, bioethics has seized the popular imagination like almost nothing else, especially

throughout the developed world. Newspapers and talk

shows dwell on a multitude of bioethical lar

and

religious journals attempt to

this

is

affect us,

phenomenon known

while both secu-

keep up with and to evalu-

ate the implications of those issues for

What

issues,

our

lives

as bioethics,

our families, and the society in which

Developed from the mid-1960s, bioethics

is

and our

future.

and how does

we

it

live?

usually described as

a discipline that evaluates the moral implications of recent devel-

opments

in medical research

and the applications of those

devel-

opments, particularly as they concern the beginning and end of

human

Ufe. It deals

with matters such as

nologies, the status of the

human embryo,

contraception, and abortion. ters

new

Then

it

procreative tech-

genetic engineering,

moves on to consider mat-

such as the definition of death, organ donation, and care for

the terminally

ill,

including the headline-grabbing topics of

euthanasia and physician-assisted suicide.

Considered in

this

narrow

perspective, the field of bioethics calls

up within us a sense of ambivalence.

19

On the

one hand,

it

seems

STAGES ON life's WAY to be an esoteric discipline, with positions,

which

is

and that

focus, after lives, as

Who

a

all, is

it

not

member

own

vocabulary and presup-

best left to the experts.

the disquieting feeling that personally,

its

somehow

On the

life

we have

concerns us directly and

it

represents both a promise

human

other,

and a

in the abstract but

threat. Its

my

of social, ecclesial, and famiHal communities.

makes judgments concerning medical intervention

beginning and end of life, and what criteria do they use? the decisions of speciaUsts determine the

at the

How v^

way I and my family are

treated in the maternity ward, in the emergency geriatrics clinic?

our

life,

room, or

in the

How can we defend ourselves and those we love

from the invasiveness of medical decisions and technologies their effect

to our

is

to create or terminate Hves in

ways

if

that run counter

most deeply held beUefs?

Bioethicists are

supposed to help us understand and evaluate

newly developed medical technologies and procedures that can be

appUed

at either

end of life's spectrum. For Christians,

this

means

they are to provide us with information and guidelines that will enable us to discern the will of

God

regarding the

logical existence should

come

appropriately to end.

an awesome

It is

into being

such,

we

we

are

and how

is

because, in St Paul's

"members of one another" (Rom

are responsible before

God

it is

bio-

most

task, one that involves not

only the speciaUsts but also each of us. This language,

way our

12.5).

As

for each other's welfare,

from conception to the grave and beyond. Yet bioethics can also be seen as a broader framework that encompasses not only the beginning and end of

Danish philosopher Seren Kierkegaard,

20

human life

but also what

in a very different vein.

Introduction

spoke of as "stages on

life's

courses in bioethics to seminarians to enter the ities

many years, I have taught men and women preparing

way." For

—

Orthodox priesthood or to assume other

within the Church.

I

have encouraged

the notion of bioethics well

and

effects of

human

our actions, and

construct moral judgments.

and bad,

right

my students to expand

beyond the scope one expects to

in a standard bioethics textbook. Ethics discipline that evaluates

responsibil-

It

it

is

behavior.

find

basically a descriptive It

considers the causes

lays the foundation

raises questions

on which we

about what

is

good

and wrong, appropriate and inappropriate. And

helps us to understand our moral duties

should shape our attitudes and

and obUgations

how we should act.

it

—how we

Bioethics

is

an

extension of this concern, one that concentrates particularly on the the physical, emotional,

fcios,

existence. This

means

and psychological aspects of human

that bioethical issues properly include not

only the inception and close of our that

lives

but also the various stages

mark our journeys throughout our

lifetimes.

Acquiring the Mind of the Church

How indeed is the Church to respond to the awesome challenges posed by recent developments in the burgeoning ical

technology?

field

of biomed-

How do we as pastors and other members of the

body of Christ provide adequate and

faithful

tions that, until the middle of the last century,

answers to ques-

had never even been

posed? Most of us, of course, have no formal medical training. Consequently,

we have very limited means for assessing the moral

implications of today's

"new medicine." Embryologists

arguing over the point at which

what

this

means

human

life

for the manipulation of the

21

are

still

actually begins and

human embryo.

STAGES ON life's WAY Molecular biologists are discovering new ways to control genes,

and some would offer us the ability to select the sex or other characteristics of

our offspring to create "designer babies." Neurolo-

gists are devising ever

more

sophisticated techniques for blocking

And

nerve paths to provide reUef to patients in chronic pain. gerontologists are scrutinizing other

phenomena

chromosomal telomeres^ and

that affect the aging process, in an effort to

extend Hfe spans by a third or more.

Such people are highly trained count ourselves laypersons,

we

specialists,

and most of us don't

among their number. Yet as priests and concerned are frequently called

—

on to

offer guidance

^to

medical professionals, to patients and their families, and to the

public—regarding the moral consequences of such research.

It's

a

daunting challenge, one that requires us to become conversant

with medical technology and

its

potential for

we ground our reflection ever more in

Holy

Tradition. Scripture

good and

ill,

while

deeply in Holy Scripture and

and Tradition

answers to questions concerning the use of

will

not give us pat

specific,

newly devel-

oped medical technologies. But they will provide us with the perspective

—

^the

whole of

"mind of the Church," shaped by Scripture and the

ecclesial tradition

—^needed to make moral judgments

and to offer pastoral direction to those who are involved firsthand with

critical issues.

To form our

that ecclesial mind,

faith.

tional

For our purposes,

we need this

to return to the sources of

means returning to the founda-

themes of Orthodox anthropology, to

set forth

once again

^Telomeres are the ends or tips of chromosomes, whose progressive shortening affects, and perhaps effects, the aging process.

22

Introduction

the Church's teaching

on the human person, created

in the

image

of God and called to grow toward the divine likeness, the likeness

of the

Holy

Trinity.

Divine and

Human Personhood

The Christian understanding of God ecclesial experience.

We

obtain knowledge of

throughout the history of Israel, in the

of

based on personal and

Old Testament witness

revelation: in the

the person

is

and work of

Christ,

Holy Tradition within the

and

life

to his

is

God

preserves

in the

in the

what Jesus

refers to in the

1 6. 1 3-1 5).

That

mighty acts

ongoing development

of the Christian community. their authority

himself in the person of the Holy

and discloses,

of

New Testament witness to

Behind each of these witnesses, guaranteeing truth,

God by means

Spirit.

The

and

Spirit

Church and in personal experience,

Gospel of John as

"all the truth" (Jn

fullness of truth provides us

with a paradoxical

image of God, one the mind can fathom and explain only to a limited extent

On

and with the

the one hand,

God makes

Lord of the natural

God

is

greatest difficulty.

order,

himself

known

as the creator

and

both macrocosmos and microcosmos.

thus the creative and sustaining

power behind

all

things,

from galaxies to elementary particles. Remarkable scientific tools, such as the Hubble space telescope and the electron microscope, reveal ever further the vastness Scientists

hensible

and complexity of his handiwork.

have good reason to believe that there exist incompre-

phenomena such

that constitute

all

as "dark matter"

and "dark energy"

but about 4 percent of material reality. They are

also investigating the possible existence of parallel universes.

23

STAGES ON life's WAY extra dimensions beyond space and time. Others are probing into the nanosphere, the realm of the imimagifiably small, while others are exploring the mysteries of the

still

human cell, a universe in

God indeed is Lord, and through the vastness and splendor of the created order, he makes himself known in all his power and itself.

majesty.

On the other hand, God reveals himself in weakness, poverty, and He makes

humility.

known and

himself

and witness of Jesus of Nazareth, and proclaims to be the one

divine,

accessible in the person

whom

the

one of the Holy

Church recognizes

Trinity. Jesus reveals

whom he calls Father to be the true father, the source and human

person.

He makes God known

redeemer as well as creator,

who by

virtue of his self-sacrificing

sustainer, of every

love offers to each person participation in God's

dent

life.

Father

The God who

creates

and

own

sustains all things

as

transcenis

also the

who loves all things and strives to draw every human per-

son into an eternal communion with himself. The ascetic tion of the

Church

tradi-

on grounds of personal

will even claim,

God in his infinite love and compassion is closer our own hearts.

experience, that to us than

This

God

who knows

of the macro and the micro,

mately than

we know

personal commimion.

ourselves,

is

by

us

his very nature a

The Church's teaching on

innermost being and reality

—

divine persons

Father, Son,

tradition insists,

life

to embrace

and

is

so great that

fill

God

of

within

—^who dwell together

Spirit

relationship of mutual, inexhaustible love. tic

God

not a monolith but a triunity of

is

and

inti-

Holy Trinity

the

attempts to spell out the nature of this communion. his

more

it

love, the patris-

overflows the limits of divine

the entire creation,

24

That

in a

and

first

of

all

human

Introduction

persons, 1.26).

who

God,

are

made

therefore,

"in the image

and

likeness of

God" (Gen

the archetype, as well as the source

is

fulfilhnent, of every personal

and

human existence.

Contemporary Orthodox theologians describe personhood as "Being in communion." This describes the inner relationships of

God

the

Holy

We

are persons, truly personal beings, insofar as

Trinity as well,

in his innermost being (ad intra).

we

reflect the

personal qualities of Father, Son, and Spirit that unite them in an eternal

communion

of being and action. These include

of

first

all

the quality of agape, or disinterested, self-sacrificing love. There-

—what makes us "beings in communion" rather than mere individuals— a quality bestowed on us by fore,

personhood

is

God. God, and not

social convention or

mines our personhood.

and

individual qualities

It is

our genetic legacy, deter-

God who

confers

capacities that reflect his

on each human own, beginning

with the quality of "person" and the capacity for self-giving love.

We are who we are as persons to the degree that we reflect in our being and actions the personal,

communal

that exists between the Father, the Son,

Yet this implies that

relationship of love

and the Holy

human personhood

is

Spirit.

more than

natural, a

mere function of our physical being bounded by time and space.

The very

fact that

God

means that our lives

are

bestows on us the quality of "person"

endowed with transcendent meaning and

a destiny that Ues beyond the limits of earthly existence.

and

fulfillment of

from earthly

life,

kingdom of God. tence

and to

human

—

life

^life's

basic purpose

—

is

through physical death, into eternal It is

to pass

beyond the

participate in the eternal

achieve this end, however,

it is

to

life

grow in the

limits of biological exis-

life

of the Holy Trinity.

necessary to

25

The end

grow

as well

To

"from

STAGES ON life's WAY image to likeness," from our natural state, as created in the divine image, to a personal state of sanctification,or holiness. St John of

Damascus

Orthodox

(f ca. 749), the great synthesizer of

patris-

theology, offers the classical definition of these terms:

tic

''According to the image refers to the intellect (reason) and freewill,

whereas according to the likeness

resemble

God

through the acquisition of virtue."^ Movement

from one to the other tic

necessarily involves us in

struggle against the passions

as lust, greed, anger,

human

soul.

indwelling

and

The aim of

this struggle is to acquire, Spirit,

by the

what the Fathers of the

that enables us to share in God's eternal us;

asce-

which invade and corrupt the

theosis or "deification": salvation

Only God can save

an ongoing

—against negative impulses such

jealousy,

power of the Holy

Church term

our capacity to

refers to

life

by grace

and

(alone!)

being.

we cannot save ourselves. This is the basic we have to respond to God's

truth of the gospel. Nevertheless,

saving initiative with an ongoing attitude of repentance, together

with gestures of compassion, mercy, and love. These are "the

good works which God prepared beforehand, that we should walk

in

them" (Eph

2.10). This response in the

tance and good works, by which ultimately divine virtues,

is

what

we

^John of Damascus distinction

Gen

gradually acquire

constitutes the

become moral, we grow toward the

form of repen-

likeness of

what

moral

life.

are

We

God, by behaving

On the Orthodox Faith 2.12 (Migne, PG 94.920B). This

between image and likeness was not in the mind of the writer of

1.26. There, the terms are

most likely intended to be synonyms, accord-

Hebrew parallelism ("in om: image" / "according to our likeness"). Numerous patristic witnesses make this distinction, however, and ing to the laws of

it

carries over into

contemporary Orthodox moral theology.

26

Introduction

in a

moral way. Yet paradoxically, we can behave morally only

insofar as the capacity to

behave in a moral way, a

ity to

only

do so

God can

words,

God

way truly pleasing to God,

a divine

only through Jesus Christ, and of

granted to us by God. The abil-

The Christian moral

confer on us.

like faith itself, is

is

one

in other

We can know God as Father

gift.

we

life,

is

are able to pursue the likeness

only through the sanctifying

work

of the

Holy

Spirit

within us.

Every

human creature, without exception, is created in the image

of God. Patristic tradition understands this image to be indelible.

While

it

can be tarnished and obscured by

most corrupt

obliterated, not even in the

and immutably human. The

other hand, refers to the vocation of the

assume the

soul.

can never be

The image,

there-

an aspect of human nature, what estabUshes us as

fore, refers to

inherently

sin, it

spiritual struggle, the

likeness of

God, on the

human person,

called to

"unseen warfare," that leads to

acquisition of divine virtues (justice, truth, beauty, mercy, love)

and ultimately to the image of

theosis, or

God, we are

communion in divine life. Created in

called to

assume the likeness of God.

This interplay between image and likeness

and purpose to our origin

existence.

The

stress a

on the question of how

what

fact, then, that

and ultimate end of human

anthropology will

is

life

means

gives

meaning

God is both the that

Orthodox

fundamental truth that bears directly

that

life

should be treated, including the

may be acceptably manipulated. This is the simple but profoundly important truth that every human person is of limits to

infinite

which

value

it

and

is

therefore

worthy of infinite compassion.

17

STAGES ON life's WAY Culture of Death or Culture of Life? Given

this basic conviction, the

ally qualifies as a

human

restricted to adults

who

autonomously? Or does

que^ion remains

person.

Is

it

actu-

that hallowed designation

and

include the mentally and physically

and even those who have not

emerged from the

womb?

human

and whether that

begins,

who

are capable of acting rationally

disabled, dependent children,

life

as to

This leads to the question of life

at

its

yet

when

earUest stages can

be properly qualified as personal. Yet of

it

also takes us

life,

beyond that question to consider every aspect

every stage in

human growth and

development. Ethical

reflection in recent times has focused almost exclusively

beginning and end of

life,

and

on the

for very specific reasons. Govern-

ment and the media have understandably obsessed over embryonic stem

cell

research and euthanasia. Already England and the

Netherlands have passed laws sanctioning each of these, and pressures to lessly.

do the same

in the

United States are grovmig relent-

As Pope John Paul n so often

insisted, ours

is

a "culture of

death," a designation equally appUcable to nations of every continent

on earth. Consider ethnic cleansing in Bosnia, Kosovo, and

the Darfur region of Sudan, or the beheading of criminals and captives of terrorists in the

of those ica,

Middle

East, or the "disappearances"

who oppose governments or drug cartels in South Amer-

or the compUcity of England and other countries in the "pre-

emptive" war in Iraq. Then consider the fact that the United States its

is

not the only country that puts to death the criminals in

midst, or encourages a

murder of children

in the

runaway gun

womb.

culture, or legalizes the

All of this, in addition to the

deadly abuse heaped on animals by the cosmetics industry, on

28

— Introduction

human embryos by

the pharmaceuticals industry,

Ours

infirm elderly by those they inconvenience. ture of death,

and we

vulnerable of

its

Nonetheless,

it is

fixate

is

and on the

indeed a cul-

with reason on the smallest and most

members. also a culture of

life,

in

which countless people

offer gestures of self-sacrificing love to those they barely in hospitals, in schools,

by tsunamis, or

when the

lights

in the

on the

battlefield, in coastlands

Twin Towers.

went out

in the

I

was

in

know ravaged

LaGuardia Airport

2003 breakdown of electric

grids

throughout the northeast and central parts of the country. The demonstrations of care and

matched those made by tember in

I ith.

civility

shown

in that critical time

New Yorkers during the disaster of Sep-

Other such signs abound. Abused children are taken

by concerned

workers. People

relatives or are cared for

who

by compassionate

social

could be earning small fortunes in industry

spend their time, with

little

financial reward, counseling those

addicted to alcohol and other drugs, while nurturing their code-

pendent family members. Nurses and other medical professionals

much

for a pay-

check as to render a real and precious service to those

less fortu-

tend to the needs of the sick and lonely, not so

nate than themselves. Charities flourish. Hospices abound.

And

Christian missionaries are rebuilding the spiritual infrastructure

of places like Albania, are creating seminaries and medical clinics

throughout Africa, and are otherwise Uving, as well as proclaiming, the gospel of peace.

Gestures such as these go a long way toward countering the culture

who performs such gestures, they serve as an irrefutable witness to the reality of the image of God in the inner

of death. Li each person

depths both of themselves and of those to

29

whom they minister:

STAGES ON life's WAY The Path Ahead In the following chapters,

the

most important

we

beginrwith ^n overview of some of

bioethical problems

we

face today in the

United States and throughout the world. This will be followed by reflections

on the mystery, or sacrament, of Christian marriage,

together with the sensitive matters of sexuality and sexual expression.

Then we turn to the critical and

divisive issue of the use

and

abuse of human embryos, looking especially at their potential for providing therapies that can cure some of the most devastating

ill-

we now face, including HTV infection and neurological diseases such as Parkinson's and Alzheimer's. From there, we move on to further stages in the growth and development of the human nesses

person. These include proper care offered to newborns, including the physically

and mentally

disabled.

They

also include the dys-

functional dynamic that governs family systems, together with

and often burdensome task of recognizing, acknowl-

the delicate

edging,

and

treating addictive behaviors. Because

many

my

wife,

Breck, has

worked

professionally for

addictions

and has

specialized in family-systems therapy,

invited her to write this particular chapter.

stage along ularly as I

life's

it is

will offer

journey,

Lyn

years in the field of

Moving

I

have

to the last

we take up the mystery of death, partic-

presented in the thought of the apostle Paul. Finally,

some thoughts regarding our

for the terminally

ill,

responsibilities in caring

including the comatose and those diagnosed

as being in a persistent vegetative state.

In each instance, our concern

we

will raise less

the light of

from a

is

to examine the various questions

strictly ethical

point of view and more in

what Orthodox theology has

human person, and

the world

we Uve

30

in.

to say about

God, the

The chapter on

the use

Introduction

and abuse of human embryos reason,

I

have included with

used in the

more

field

it

is

this

a brief glossary of some key terms

The other chapters should prove

of embryology.

accessible to readers

unavoidably technical. For

who have no special training in science

or medicine.

Our concern, then,

is

to look at a spectrum of stages

beginning with the creation of

human

life,

on life's way,

passing from infancy

through adulthood, and closing with the silence of death. Each of these stages can

mark

a paschal

that unites us intimately

death,

and

resurrection.

the Christian

our whole

into the Ught it

and

life

our

"offer ourselves, is

a

lives,

moment

Christ's passion,

Each stage challenges us

to Christ our God."^ This

itual calling: to bring

in

and personally with

community to

life

moment

as

members of

and each

other,

our fundamental

one another, from the

womb

and

spir-

to the tomb,

of the resurrected Lord. At the same time,

—^through

describes our basic moral obUgation to acknowledge

attitudes,

words, and gestures

divine image in every that person with the

our

human

—

^the

beauty and majesty of the

person, and to devote ourselves to

same love that God has so richly poured into

own hearts by the presence and power

common petition in Orthodox litanies.

31

of his

Holy

Spirit.

"

chapter one

BIOETHICAL CHALLENGES IN THE NEW MILLENNIUM There's a battle outside,

and

it's

raging,

—Bob Dylan, "The Times They Are A-Changin' The

soul's

war with

—

With

the

enemy

lasts until death,

Staretz Silouan, in St Silouan the Athonite

the recent sequencing of the

human genome,

development of radically new reproductive techniques, including cloning,

modify human

ity to

nature

^we as Christian people

terrify. It is

and

^

—to

alter

ethical challenges that

both fascinate

we

find ourselves

no exaggeration to say

today at a radical juncture in

more

resulting possibil-

human and members of the human race

at its basic level

—

are faced with moral

and

life

and the

that

human existence, one that will have

far-reaching consequences than any that has preceded

it.^

A slightly modified version of this chapter appeared in St Vladimir's TheoJohn Breck, "Bioethical Challenges in the New Millen-

logical Quarterly:

nium:

An Orthodox Response,"

St Vladimir's Theological Quarterly 46, no.

4 (2002): 315-29; and 5^ Vladimir's Theological Quarterly 48, no. 4 (2004): 339-53-

33

STAGES ON life's WAY Speaking from an evolutionary point of view, dicting that in the developmental

ens

—whom Scripture

identifies as

created in the image of

—

scheme of

God and

Adam,

Homo

things,

the

is

destined to give

way

to

Homo

called to attain the divine like-

scientificus.

man," the new creature of the new

This

whose

age,

only maintained by technology but also (for cybernetic

existence

defined by

is

it.

applications,

makers for the heart to microchips implanted

functioning

is

is

is

not

When the

organism) came into use around

would actually exist. Yet recent scientific

that:

and

"scientific

is

i960, no one expected that within four decades a bionic

produced precisely

sapi-

human person

currently drawing near to extinction

ness, or holiness

term cyborg

scientists are pre-

human

beings

human

from pace-

in the brain,

whose normal

have

biological

enhanced by technological wizardry. Recent exper-

iments with rats and monkeys have proved that brains and electronics can interact in such a precisely directed

way that an

animal's activity can be

by electrodes implanted

in the pleasure centers

of the brain. Neural implants have already allowed mute patients to

communicate

via

computer and deaf persons to

advances in the interlink between the

hear. Similar

human brain and electronic

devices will enable the paralyzed to regain use of their limbs.

some,

this represents the fulfilhnent of the gospel

dumb

will speak, the blind will see,

others,

it

promise that the

and the lame

will walk.

To

human and artificial life is While neuroimplants may allow some patients to

means

perilously thin.

To

recover physical

that the line between

movement and others to communicate or to acti-

vate thought-controlled limbs, this

new technology

also poses a

potential threat to personal autonomy. If electronics allow us to control, they could also allow us to be controlled,

tion

is.

By whom and

to

what end?

34

and the ques-

Bioethical Challenges in the

Still

more radical and potentially more troubling are the new pos-

sibilities

into a

for modifying genes in vitro during the zygote's

human embryo. On

extraordinary and welcome ties

New Millennium

growth

the one hand, this could lead to

new

caused by defective genes.

cures for illnesses

and

disabili-

On the other hand, these develop-

ments open the way to production of "designer babies," children

whose

traits are selected

by the parents and whose very nature

substantially modified in the interests of a

However might be

is

new eugenics.

accurate the Darwinian or other evolutionary models (for

example. Harvard paleontologist Stephen Jay

Gould's "punctuated equilibrium"), the natural forces behind those models are being superseded by

remaking ourselves in an image that

human

reflects

ingenuity.

We

are

both arrogance and

we belong to ourGod, and that therefore we have the right to

desperation. Arrogance, in the assumption that selves rather

than to

reshape ourselves according to our most appealing fantasies. Desperation, to the degree that the quest for perfect health, longer life,

greater physical strength,

and a superior IQ stems from a gut-

wrenching dread of death and annihilation. This transformation from of

man

created in the image and likeness

God to man fabricated according to his passions and desires is

revolutionary rather than evolutionary.

human

cloning, the

first

years of this

marked by the most rapid and

From gene sequencing to

new millennium have been

potentially dangerous change in

human history. The ethical questions and challenges raised by this transformation are daunting. Will

human?

Or, as

some have

of Res scientificus, the

Homo

suggested,

human

scientificus in fact

do we

be

need to speak rather

being transmogrified into a techno-

logically sophisticated thing or object?

35

STAGES ON life's WAY The Threat of The major

New

Diseases

bioethical challenges

made. They don't

all result

w$

face today are not

all

man-

from a human inventiveness that

Some of the most fearsome challenges new outbreaks of disease over which we have little or no control. The ethical issue concerns the way we react to those diseases and how we use available resources in an could too easily go awry.

concern our response to

effort to heal those afflicted

by them and to eradicate the diseases

wherever possible.

The most obvious

is

the

human immunodeficiency

that has caused millions to suffer as the rate of infection

is

and to

declining in our

to forget that the African continent

its

occurrence. For

from AIDS. As long

own

country,

it is

facing a horrendous

is

epidemic, and that Southeast Asia increases in

die

virus (HIV)

is

easy

AIDS

registering frightening

some Orthodox

Christians,

been easy to ignore the tragedy under the pretext that

it is

it

has

caused

primarily by homosexual activity, which could have been avoided.

AIDS

Some Orthodox, and many

as God's

other Christians,

still

see

punishment for what they judge to be sexual per-

version. In reality,

most cases of HIV

infection

around the world

occur through heterosexual activity and other means, such as

blood transfusions or transmission from an infected mother to her unborn child.

God

And it needs to be stressed again and again that

does not infUct as punishment epidemics that strike indis-

Nor is there any indication that in his eyes homosexconduct is any more reprehensible than many commonly

criminately.

ual

accepted heterosexual practices ful acts

such as slander,

theft,

or,

for that matter, than other sin-

or child abuse.

AIDS is a tragic con-

sequence of viral infection, whatever the means of transmission.

36

Bioethical Challenges in the

It

needs to be recognized for what

New Millennium

it is

and combated with every

appropriate resource at our disposal. Each of us must be con-

cerned by

it, if

for

no other reason than the fact that to one degree

or another, each of us

is

threatened by

it,

and that threat will only

increase in the foreseeable future.

Central Africa sorts,

an incubator for incurable diseases of many

is

and with the ease of modem travel, the spread of those is

inevitable.

Many diseases,

culosis,

and other

bacterial infections,

eases

are thriving,

and

such as staphylococcus, tuber-

and

viruses,

such as HTV,

others, once thought eradicated, are

making an

ominous comeback. Perhaps the most threatening virus it is

virulent, widespread,

dis-

—

and incurable

is

the Ebola virus. This

deadly infectious agent causes a hemorrhagic

and internal bleeding, and

—because

fever,

with severe

it

has already decimated

entire villages in parts of Africa. It too

knows nothing of geo-

external

graphic boundaries.

One of the most curious and potentially deadly sources of disease, in

both humans and animals,

protein that contains it

acts like a virus,

no

it is

is

the prion. This

nucleic acid

not one, yet

it

(DNA brings

or

is

an infectious

RNA). Although

on

viral-like

symp-

toms, including loss of motor control, paralysis, dementia, and eventually brain death. Autopsies reveal large vacuoles in the cor-

tex

and cerebellum

away at the disease,

resulting

brain. In animals,

from the it

prion's tactic of eating

produces the notorious

whose human equivalent

is

mad cow

Creutzfeldt-Jakob disease,

together with other potentially fatal syndromes, including FFI (fatal

famiUal insomnia). Whether infectious or hereditary, or

both, prion-related diseases are increasingly

common and

threaten vital links in the food chain, as well as

human

37

beings

STAGES ON life's WAY directly. (In

French, the plural term prions also signifies the imper-

ative "Let us pray." Prayer

may

in fact be

our best and perhaps

only hope of defending against them.)

Finally,

we need

known

as Alzheimer's, a widespread degenerative disease of the

to mention the increasing spread of the

central nervous system. This well-known,

ness results

tion,

ble

understood,

first,

Its

symptoms

afflict chiefly

the elderly and

memory, then gradual loss of speech, of cogni-

loss of

and consequently of relationship with the world.

and

terrifying illness,

raises grave

It is

a

terri-

which makes inexorable progress and

moral questions regarding appropriate care for victims

who find themselves

in

its

Once a person has

irre-

and with himself or

her-

terminal phase.

trievably lost contact with other persons self, is it

ill-

from the modification of a natural protein that becomes

toxic to the brain. include,

if litde

malady

our moral duty to maintain them in a

limbo, especially

when

state of cognitive

they are no longer able to feed and other-

wise care for themselves?

Or

does compassion oblige us to end

through euthansia their tragic condition? While most of us may feel

we know

the answer to that question,

cases,

not always evident to the medical team or to family mem-

bers

it is

when

it

comes to

specific

who suffer the overwhelming grief of gradually losing a loved

one to what

is litde

more than a

lingering, living death.

Engineering Ourselves In the introduction,

I

pointed out that the

field

mally covers issues related to the beginning of

of bioethics nor-

life

and to

its

end.

Accordingly, textbooks and collections of articles in the field tend to focus initially

on questions such

38

as the status of the

human

Bioethical Challenges in the

New Millennium

embryo, abortion, and medically assisted forms of reproduction.

Then they move to the other end of the spectrum, to take up issues such as the definition of death (whether

by cardiorespiratory

failure or

by the

it

should be determined

irreversible cessation of

brain functioning in the cortex, the cerebral hemispheres, or the brain stem); euthanasia (the relation between active and passive

forms, together with physician-assisted suicide); the debate over

medical heroics and palliative care (including the question of

withdrawing or withholding food and hydration from dying patients); together

with related matters such as burial practices

and cremation.

Today, however, other issues have captured the headlines and vastly extended the range of questions that fall under the rubric

of bioethics. Foremost

human beings. crucial issue

among

these

is

the genetic engineering of

Beginning with 2001 (prior to September 11), the

was manipulation of the human embryo, particularly

with a view to harvesting embryonic stem cells.

stem

cell

research) then set the stage for the following year's

obsession with

human

cloning. Cloning involves asexual repro-

duction by inserting the nucleus of a somatic to be cloned into the enucleated

ovum

successful, this procedure produces

complement of from the

ESCR (embryonic

forty-six

from the person

of a donor.

Where

it is

an embryo with the usual

chromosomes,

original somatic cell.

cell

all

of which are derived

The technique, which initially pro-

duced the celebrated (and prematurely deceased) ewe named Dolly,

was subsequently

refined

human embryo that grew to the and the United

and used to produce six-cell stage.

States to Argentina

and

Italy,

at least

one

From South Korea

researchers are rac-

ing to perfect the technique, in order to produce embryos in vitro

39

STAGES ON life's WAY for therapeutic purposes. Recent legislation sanctions

ESCR

Korea, England, and the Netherlands, and the United States

is

in

on

the verge of following suit.^

However, an important point needs to be made. Something of a false distinction

has been

made between

ductive cloning. All cloning by

whatever the length of of

human embryos

destroyed.

life

the

very nature

its

new

being

may

is

and repro-

reproductive,

enjoy.

Thousands

are at present being created in order to be

The moral impUcations

government or

therapeutic

in the

Church have

are mind-boggling, yet few in raised their voices in opposi-

We all, it seems, have been seduced by false promises of med-

tion. ical

panaceas that will result from embryonic stem

and

cloning.

The

fact that adult

stem

cells

cell

research

have proven in

many

cases to be as effective as their embryonic counterparts has received relatively

little

press.

For in

this utilitarian society of

we dare not admit that the objects of this manipulation are fact human lives. Otherwise, we would have to raise serious

ours, in

questions about everything from the profit margins of pharmaceutical

companies to the legitimacy of abortion on demand.

These are simply the most visible and passionately debated moral issues of

our day.

Any survey

of bioethical challenges has to con-

sider as well other concerns that tions.

and

have been with us for genera-

These would include the breakdown of the nuclear family

its

impact on our youth; the increasing

particularly

handgun

violence, in our

levels of violence,

homes and

^At the beginning of 2005, the U.S. Congress was

still

schools; an

debating legislation

that would provide government fundiag for ESCR. In the very near

embryonic stem sition

cell

future,

research will likely be government policy, despite oppo-

by the Bush administration.

40

Bioethical Challenges in the

New Millennium

economic system that favors the rich and the strong over the poor

and the weak;

lingering racism that

nomic advancement of identification of

hampers the

and eco-

large segments of our population; the

democracy with capitalism

and

leads Americans to value competition tice

social

and the public good; and

last,

in this country that

profitability over jus-

but certainly not

the

least,

problem of addictive behavior, whose symptoms of alcohoUsm, obesity, bankruptcy, religious fanaticism,

bioethical issues of the

behavior, they impact

persons, and they

first

and sexual abuse are

importance. They concern

on the growth and well being of

demand

that hard choices be

made

attempt to ameUorate their effects on personal and social

human human in

any

life.

The Quest for Holiness Listing

some of

the world's

are cloaked in the

make

as

ills

euphemism

us feel overwhelmed.

we

killing

and being

even

when

they

"ethical challenges," can easily

We

read in the newspapers of

embryos created to be destroyed, of our children

just have,

killed

partial-birth abortions, of

by other kids on the play-

ground, of widespread corporate crime, of terrorist attacks in our

own

backyard, which our government responded to with a mur-

derous, preemptive war.

We feel helpless to reverse a flood tide of

moral deterioration that threatens to wash away our most cherished social and cultural values, including the institution of marriage

and the freedom to pray

in public.

Perhaps the major moral and spiritual challenge to Orthodox Christians

comes

less

from the realm of medical technology than

from the temptation to what could be

41

called "benign apostasy."

STAGES ON life's WAY This

—

the pernicious temptation to renounce

is

Christianity—

^values

in the

name

and convictions that give ultimate meaning

to our Uves, values such as justice, truth,

and beauty, and convic-

tions such as those enshrined in the Church's creeds.

a temp-

It is

which many Christian churches have already

tation to

succumbed. But benign apostasy threatens the Orthodox as It is

subtle

vance."

of

and

insidious, easily excused

Do we

really

under the cover of

well.

"rele-

need Holy Tradition, an elaborate Uturgy,

or even Scripture in this postmodern age?

(I

my

remember

first

evening in a Protestant seminary back in i960. The young

who

instructor

spoke to us insisted repeatedly,

the gospel relevant to our people!" then, as

do now,

I

couldn't help wondering

I

the point isn't rather to

if

"We must make

make our people rel-

evant to the gospel.)

The

real ethical challenge for us, as

every age,

become

is

to

commit ourselves

it

has been for Christians of

to a quest for holiness, to

holy, as our heavenly Father

Christian faith

is its

conviction that the

is

holy.

Fundamental to

human person is called by

God to change, to grow in the power of the Holy Spirit from spiritual infancy to spiritual maturity.

This involves above

what the Holy Fathers term the

gle against

all

a strug-

passions. These

include our basest inclinations as well as thoughts and feelings that drive a

wedge between ourselves and God, between ourselves

and other persons. The passions are not selves.

They

are,

when wrongly

Food was intended

fruit.

Sexuality

was intended

ing through intimate

for nourishment.

directed, transforms the natural act of

eating into gluttony, represented by

den

and of them-

however, the product of corrupte*d nature, and

as such they incite to sin.

Passion,

sinful in

Adam's eating of the

for procreation, for participat-

and joyful conjugal union

42

forbid-

in God's

work

of

Bioethical Challenges in the

creating

human

New Millennium

persons in his image and Ukeness. Misdirected

passion transforms sexuaUty into a self-centered drive to satisfy lust.

An innate longing for God characterizes human nature

was intended to an insatiable

and manipulate gods of our

Passion turns righteous indignation into anger and

condemnation.

It

turns desire for participation in the glory of

God into vainglory, praise. It distorts a

sions of anger

By obeying

it

be. Passion transforms that longing into idolatry,

desire to worship, serve,

own making.

as

the need to please others and to receive their

commitment

and a

the

thirst for

to truth

and

justice into expres-

vengeance.

commandments

of Christ, by immersing them-

selves in the cycle of liturgical worship,

by devoting themselves to

prayer and the constant reading of Scripture, and by joining confession of sins to onciliation.

an ardent quest for mutual forgiveness and

Orthodox Christians acknowledge

their

rec-

need for

thoroughgoing change and take significant steps to

effect

change. The goal of that inner movement, once again,

is

such

holiness.

Movement toward that goal is impossible without the transforming

power and grace of the Holy

our sanctification. Insofar as Spirit to

ourselves

work

we

Spirit,

who

is

achieve this goal and allow the

that transformation within us,

and the world around

the sole source of

us.

we

sanctify both

Thereby we lay the indispen-

sable foundation for

any appropriate response we may

the critical bioethical

and other moral

issues that

we

offer to

face in our

day-to-day experience.

How do we embark on the pathway to holiness? The first step is to desire

it,

to allow

God to awaken within

in his perfection, his glory, his loving

of the Holy Fathers, this

compassion. In the language

means opening

43

us a longing to share

ourselves to the divine

STAGES ON life's WAY energies or attributes that penetrate to the depths of the

soul

and effect a radical change in our being, which we are wholly

incapable of effecting for ourselves, l^uther ian

is

in total bondage, yet the Christian

is

was

mind and

heart that create the illusion that

of the universe.

We

are in

right: the Christ-

wholly

bondage to ourselves and our passions, to the of

human

free.

We are in

fallen inclinations

we

are the center

bondage to our perceived needs and

unconscious habits, to our prejudices and self-righteousness. Left

on our own, we Christian

is

are in total

bondage and without hope. Yet the

also wholly free.

We have been Uberated from the cor-

rupting powers of sin and death, transferred from the dominion

of Satan to the dominion of Christ, and therefore longer in the flesh but in the

God

alone can save us;

we

live

no

the Spirit of God.

spirit,

we cannot

save ourselves. Salvation,

including the gift of holiness, comes to us as a free

gift.

"Holy

things for the holy," the priest intones as he elevates the eucharistic

bread before the fraction.

holy,

one

Father!"

is

And

the choir responds,

the Lord, Jesus Christ, to the glory of

We partake of God's holiness,

works out

for us

life

it is

God

is

the

his holiness that

and within us the transformation of soul and

body known in patristic tradition ipation in the

and

"One

of

as deification, or eternal partic-

God himself.

is gift.

Yet there is an essential synergy or cooperation between

ourselves

and God in the work of salvation. To the extent that we

All

assume our part in that synergy and remain faithful to its ultimate purpose,

we

are blessed with the

renews our innermost being. the holiness of God, tures

and

we

And

power of God's grace

as

we

ourselves

that

grow toward

influence other people, even social struc-

institutions. Holiness is a

44

dynamis, or power.

It is

a

Bioethical Challenges in the

New Millennium

divine energy that brings about change in the world around us, just as

works change

it

Our Common

in ourselves.

Priestly Ministry

Practically speaking,

is

there really

any possibility for us as Ortho-

dox Christians to effect real and positive change in a world fraught with such massive ethical challenges? for holiness impact in

How can our personal quest

any significant way the decisions and actions

of those in positions of power, whether in government, in the cor-

porate world, or in the laboratory? foolish, to think that

Isn't it

Utopian, or just plain

we can somehow influence persons who

motivated by the lure of

scientific discovery,

by the promise of

effective therapy for heretofore incurable diseases,

by the promise of virtually limidess

Whenever we

and above

irresolvable,

all,

profits?

are faced with challenges or dilemmas that

overwhelming and

are

it is

seem

important to remember the

words of the morning prayer attributed to monks of the Optino monastery: "Teach

me

to treat

the day with peace of soul,

governs

all

affirmed,

things."

on the

that

comes to me throughout

and with firm conviction that Thy will

Over the

centuries, countless witnesses

have

basis of their personal experience, that God's will

does indeed govern simple,

all

all things. It is this

humble people

to

conviction that has enabled

become courageous martyrs, many of

whom have suffered and died in recent years. This conviction too has sustained people of faith whose friends, parents, and children

have been murdered in suicide bombings or schoolground massacres.

Out of the most

expression of

evil,

pointless tragedy

God can

and the most

bring meaning and

45

relentless

work out

his

STAGES ON life's WAY purpose. This sonal

is

crisis that

as true with bioethical issues as

may overtake

with any per-

it is

us. ^

How are we to respond in the face of the many ethical challenges The answer

that beset us today?

respond as clergy;

is

very simply that

are to

not reserved to the ordained

The

First Letter of Peter,

which

is

all

hood," called "to offer

spiritual sacrifices to

Christ" (2.5).

of us as

very likely a bap-

members of a "holy

tismal homily, refers to

God's

we

a fundamental aspect of our vocation as baptized

it is

Christians.

Priesthood

priests.

is

God

priest-

through Jesus

As "a chosen race, a royal priesthood, a holy nation,

own people," we have been called from darkness into Ught,

in order to declare

God's marvelous deeds of salvation

(2.9).

A major aspect of that proclamation is to speak God's judgment on every form of cent human

life.

sin,

wanton

destruction of inno-

Equally important, and equally an element of our

common ministry, hold up to God's

who

including the

is

intercessory prayer.

light

By our

and God's compassion the

intercession, lives

we

of all those

are victims of the destructive acts of other people, together

we

with the perpetrators themselves. Thus priestly offering of every destroyed

are called to

make

embryo, every aborted

a

infant,

who is subjected to violence and other forms of abuse. Our priestly service also includes offering up to God ^with com-

every child

—

passion and ongoing care

—

^the

disabled

members of our

society,

whom we too easily label "handicapped" and proceed to marginalize.

That

strength, sick,

service includes fervent prayer that begs God's mercy,

and peace upon

all

those

who care for the

disabled, the

and the dying, whether family members or medical profes-

sionals. It also entails praying for those

violence, asking

God

who perpetrate crimes of

to quicken their conscience, to transform

46

Bioethical Challenges in the

their hearts,

and to heal

New Millennium

We

their destructive impulses.

pray for

the aggressors as well as for the victims of aggression.

makes no

difference

dlers of child

if

pornography over the

This kind of priestly service

is

Christian, without exception.

God

it

they are terrorists on the city streets, pedInternet, or practitioners of

abortion and euthanasia in our hospitals and

can offer to

And

both those

clinics.

the responsibility of every baptized It is

who

a service by which each of us create ethical

dilemmas and

who suffer the consequences of those dilemmas. Whether it concerns persons we judge guilty or persons we deem innocent, we hold all of them up before God, asking for his forgiveness and healing grace. In similar fashion, whether the diseases we are facing are caused by sexual misconduct, human indifference, or some uncontrollable plague, we intercede before God on behalf those

of

all

those afflicted, seeking his guidance for a just and proper

distribution of medical resources.

able conviction that

work out It

God will use our prayers and our concern to

his will for

might sound

everyone concerned.

simplistic or naive to suggest that

priate response to the bioethical

today

is

our most appro-

and other moral challenges we face

we were capable of swaying votes in banning human cloning, or providing alternatives to

to pray. Yet even

Congress, or

And we do so with the unshak-

if

abortion and self-inflicted euthanasia, there would be no ultimate

purpose to our

and

efforts if they

were not undertaken for God's glory

for the fulfillment of his purpose for the world's salvation.

"There's a battle outside,"

That raging

conflict,

Bob Dylan

insisted,

"and

according to the apostle Paul,

a struggle against principalities

it's

is

raging."

essentially

and powers, against world

47

rulers

STAGES ON life's WAY of this present darkness, against the spiritual hosts of wickedness in the heavenly places struggle,

which the Church and

against a culture

of death.

all

It is

its

a profoundly spiritual

people are called to wage

too appropriately characterized as a culture

Where we can speak and act in such a way as to impede

further destruction of

those in need, then

and

(Eph 6.12).

human life, and bring healing and peace to

we must do

spiritual resource at

so with every political, economic,

our disposal.

Although in many areas the slope has become too slippery for us to reverse a moral decline,

the

more

fervently

we

are not without hope.

We rely all

on the power and authority of the God who

has created the world and sacrificed his

own life for its

salvation.

We put on the whole armor of God, as the apostle insists, and we "pray at

all

times in the Spirit, with

(Eph 6.18), assured that

them according to If

we

God

his desires

all

prayer and supplication"

hears our prayers and will act on

and

his intentions.

are to respond to these moral challenges in a

way

that

accords with God's will and purpose for ourselves and the world in

which we

live,

we need

priestly gesture that submits

need to hold them in the

to assume these challenges with a

them

God's hands.

entirely into

light of Christ's resurrection

victory over sin, violence, death,

—

and corruption

—

We

Christ's

^with the serene

and certain conviction that God's will truly does govern all things.

48

chapter two

THE COVENANTAL ASPECT OF CHRISTIAN MARRIAGE He who

woman, and

loves a

realization in his,

into a

is

beam of the

brings her

able to look in the

to present

life

Thou of her

eyes

eternal Thou,

—^Martin Buber, I and Thou Throughout the Western world, secularizing influences are impacting as never before the nuclear family, which historically, in virtually all cultures,

has been recognized and

protected as the basic unit of social organization. tution of marriage

is

The very

threatened in the United States, Canada, and

Western Europe, and a similar trend countries of Eastern Europe.

As the

is

increasingly apparent in

relentless

march toward the

dissolution of the family continues, there inevitably occurs

we

are

now

insti-

witnessing: a radical reconceptualizing

and

what

restruc-

turing of conjugal relationships, together with a calling into question of the very

meaning of marriage.

In this chapter,

would like

I

to offer

dox understanding of marriage,

some reflections on the Ortho-

particularly as

it

relates to the

covenantal relationship between Christ and the Church.

49

As

the

STAGES ON life's WAY term covenant implies, this is a relationship of mutual commitment,

God and human

sealed between

persons.

A covenant is

based on

shared trust and responsibiUty. In Christian terms, marriage

grounded

same kind of mutual

in the

relationship

is

God established

with great figures of the Old Testament, such as Abraham, Moses,

and King David.

Its fullest

and perfect expression

is

the

new

covenant (or new testament) promised in the prophecy of Jeremiah (31.31-34) and

fulfilled in

love between Christ

These

and

the relationship of mutual service

his body, the

reflections offer neither a

and

Church (Eph 5.21-33).

formal analysis of marriage nor

an exhaustive review of possible remedies for the malaise that afflicts it

today.

I

make

these remarks simply as a

way to

refocus

our attention and concern on the spiritual and sacramental aspects of conjugal ture

and

As with

in

all

Church

life

as they are revealed to us in

things Orthodox,

essential that

it is

hand, acknowledgment of certain sexuality,

Scrip-

tradition.

ance. In this case, the needed balance

and

Holy

is

we

strive for bal-

between, on the one

realities

concerning gender

both heterosexual and homosexual, and on the

other hand, affirmation of the Church's traditional stance regarding sexual activity in general and conjugal relations in particular.

As Orthodox

Christians,

we

are called today to preserve

traditional values, especially in the realm of sexuality,

and to do

so in the face of tremendous secularizing pressures. This

or should not be, because ical

grounds or

revulsion.

It is

recoil

is

not,

we reject sexual expression on puritan-

from same-sex unions out of homophobic

because the Church recognizes that intimate sex-

ual relations are

endowed by God with unitive, sacramental, and

procreative potential that can be realized only in a healthy and

50

— The Covenantal Aspect of Christian Marriage

holy

way

within the context of a monogamous, heterosexual,

blessed, conjugal union. In

what

follows,

I

would

like to discuss

each of these terms and to explain the reason for the Church's traditional view regarding the nature

and meaning of the

covenantal marriage bond.

Reconceptualizing Sex, Gender, and Marriage

To

me

set the stage for these reflections, let

begin with some

vignettes that illustrate the complexity of the issue. like to suggest possible

responses to

some of

Then I would

the challenges sug-

gested by these vignettes, responses that have taken shape in

my

own pastoral experience.

A weekly news

magazine recently ran an

famiUar theme. Teenagers were asked tion between unmarried boys

and

girls

the past decade or so. For some, love," yet being equally ers, it

why

with an

too

all

the rate of cohabita-

has increased so greatly in

was a matter of "being

wary of long-term commitment. For

was because "everybody

among kids

it

article

else is

doing

in

oth-

Like smoking

it."

a generation ago, cohabitation without the benefit of

marriage has today become something of a status symbol. often harmful effect, however,

is

Its

a certain depersonalization in the

sexual and emotional relationship of the couple, precisely because

genuine commitment chastity is

and

—which implies appropriate conjugal

ascetic struggle to

so often missing.

was

first

the needs of the spouse

The depersonalization of

hardly limited to couples

conmiitment. The

put

who

article also

live

sex, however,

together with

no long-term

mentions the remarks of a

entering her last year in high school.

51

When

is

she

girl

who

was asked

STAGES ON life's WAY about the lack of emotional nurturing that accompanies casual sex, she replied, "I

have

my friends

for

my emotional needs,

don't need that from the guy I'm haVing sex with."

"Young people

chologist points out,

"How

I

As one psy-

are learning to view each

other as interchangeable sex objects." rhetorically,

so

And

she adds, almost

can they ever be developmentally ready for

real-life relationships?"

A short time ago, my wife spoke to me about a situation that's far more prevalent than ica's children,

I

had

realized. Increasing

numbers of Amer-

beginning in middle school, are engaging in oral sex,

often in groups.

When asked about it, they tend to deny that they

are "having sex" at

all.

They have, it seems, been persuaded by the

arguments of a former occupant of the White House that anything

—or other than—completed coitus does not qualify as

short of

sex.

One young girl commented about the intimacy she shared with her boyfriend, "Well,

To which

it's

just like kissing

any other part of the body."

my wife repUed, "No it's not, honey!"

A fellow whom I didn't know phoned last fall and asked whether I

as

an Orthodox

would

priest

would marry him and

be, he added, his fourth marriage.

didn't wait for

an explanation.

his girlfriend. This

When

I

refused, he

He just hung up.

A while back, I picked up a video at our local Pick-a-Flick. It was to be a lazy diversion

were too tured,

tired to

on a Friday evening when

do anything more

and was produced

had appeared

my

constructive.

by, a popular, highly

in a couple of innocent

wife and

The

I

film fea-

paid actress

who

comedies the year before.

Halfway into it, there was a scene that depicted her and her costar engaged in the most graphic intercourse imaginable. The scene

52

The Covenantal Aspect of Christian Marriage

was

gratuitous;

ever. I

it

had no relevance to the

found the minuscule

rest of the film

hadn't bothered to look for in the video store.

much

the point that

have carried a large

whatso-

R on the cover's rating chart, which I

of what today

is

It

brought

rated merely

home

PG-13 would

X when I was in school. But then, that was a

long time ago.

On May

18, 2004, the state of Massachusetts joined the Nether-

lands, Belgium, the city of

San Francisco, and several Canadian

provinces in offering marriage licenses to couples of the same gender.

Then, in the early summer of 2005, the Canadian parliament

passed legislation that permits throughout the provinces marriage

between two

men

two women. Spain and other

or

countries,

including our own, are not far behind. Same-sex marriage

longer an oxymoron.

Such call

is

It

is

no

has become enshrined in the rule of law.

today's reality: couples living together in

what we used to

concubinage; young teenagers engaged in sexual activity

their parents hardly

have the vocabulary to describe;

serial

divorce as an increasingly normal aspect of our social order; blatant, in-your-face

pornography

in everything

from mail-order

catalogs to video entertainment, cable television, and the Internet;

and marriage redefined so

as to include same-sex coupling.

As Fr Thomas Hopko^ began pointing out many years ago, "sex and gender"

is

toral issue of

our day.

Before

I

go any

without question the chief theological and pas-

further, let

me say a word about what I feel needs

to be our response to at least

some of these situations I've just noted.

^Former Dean and Professor of Dogmatic Theology Emeritus Vladimir's Seminary.

53

at St

— STAGES ON life's WAY It

would be easy

for us as

Orthodox Christians

condemn

to

out-

right this kind of behavior

on the part of young and not-so-young

members of our

We

society.

could* react with a polemic that

invokes bibUcal passages against everything from divorce to fornication to homosexuaUty.

Or we could

quietly resign ourselves

hope that our

to the realities of this fallen world, hoping against

own

somehow be

children will

approach

is

helpful; neither

insulated from

it all.

approach speaks to the

Neither

real needs of

our adolescents.

However we may judge today,

it is

various expressions of sexual behavior

imperative that we, as

members of the body of Christ,

hear our young people, attempt to understand their reasoning,

and speak to lovingly, as

it

we

and to them can.

as directly, yet compassionately

and

At the same time, we need to provide them

with serious, balanced, and healthy education on the subject of

—from

sexuaUty

life-giving procreation to death-dealing

and to do so within our homes

AIDS

as well as in our parish churches.

With regard to unmarried couples living together, we need to hear the reluctance of many people to enter into a legal marriage today,

when

the divorce rate hovers near 50 percent and prenuptial

agreements can't eliminate either the heartache or the red tape involved in a divorce settlement.

what we consider it's

often because

able

they seem willfully to ignore

to be Christian values related to married

Then

again,

if

fulfilling

sex and to strip

we have it

conjugal rela-

our children's attitude toward sexuality

distressingly casual, devoid of real depth

largely because

life,

we ourselves have failed to offer them an accept-

model of appropriate and ultimately

tionships. is

If

and commitment,

it's

allowed our cultural milieu to cheapen

of genuine mystery.

54

If

they act out sexually in

The Covenantal Aspect of Christian Marriage

ways

that older generations

chi,efl.y

due to

on our part

a failure

truth that each

might find shockingly salacious,

human person

to

convey certain

of infimte value

is

truths: the

and therefore

deserves unconditional respect, including respect for bodily

macy; or the truth that the

joy, the beauty,

pose of authentic marriage are given by in the

kingdom

in general, reflects as

and the ultimate pur-

God

as foretastes of life

and the dissolution of sexual morality

much on

us as

it

does on them. Rather than

blame, condemn, and reject them and their behavior,

teacL to guide, to

understand

inti-

of heaven.

O'li children's behavior,

LLsteru to

it is

bless,

and

to forgive.

—even when we cannot approve—

we need to

We

need to

motiva-

their

we need to rediscover the essence of Christian marriage, for ourselves as much as for them, and allow it to transform our own conjugal rela-

tions, their fears,

and

their longings.

Above

all,

tionships into a Hving image or icon of the love and mutual offering that unite Christ

Eph 5.31

and the Church

m

a "great

self-

mystery"

.

Nluch of the same approach

is

needed with regard

to

same-sex

unions, whether or not they are granted the legal status of marriage.

Again,

it

would be easy

for us as

Orthodox Christians

to

condemn homosexuality and same-sex coupling without attempt-

mg

to understand the motivations of the persons

factors that

underUe

their behavior. Scripture

condemns homosexual

who commit

acts,

mvolved or the

unambiguously

and the apostie Paul adds that those

such acts "will not inherit the kingdom of God." To

those thus condemned, however, he adds as well those

prone to verbal abuse

'loidoroi),

the greedy \pleonektai)

1

1

who

are

drunkards methusoi), and even ^

Cor 6.9-10 j. The point is not that these

STAGES ON life's WAY are acceptable behaviors

point

is

that

and that Paul was simply wrong. The

we now know

that behind

many

behaviors recog-

nized in antiquity as inherently sinful/there are often unconscious

motivations and impulses that condition those behaviors. They

assumed them to

are not necessarily, as everyone until recently

be,

expressions of the will acting in unrestrained freedom. Drunken-

we now rightly identify as alcoholism, an addiction properly characterized as a disease. And all of us, from time to time, succumb to verbal abuse and greed. ness

This

is

not to minimize these

inclusion in St Paul's historical,

list

sins. It is to

say rather that their

needs to be understood in

and even medical contexts. The same

its

is

cultural,

true with

homosexuality. Until recently, that too was thought to be an expression of free will. Today,

we know

that there

is

"homo-

a

sexual orientation" distinct from particular acts. Whether that orientation

ment,

is

is still

should

still

due to nature or nurture, to genes or to the environ-

an open question. However

it

may

be resolved,

we

attempt to understand the feelings and behaviors that

gays and lesbians experience. This does not

approve homosexual

acts.

To

mean

that

we must

the contrary, despite self-justifying

protestations from the gay community, pastoral experience, cou-

pled with the genetic and environmental factors involved in homosexuality, lead

many

of us to the conviction that there

is

something unhealthy, dysfunctional, or disordered in the homosexual condition

itself,

and that therefore it is potentially destruc-

when it issues in sexual activity. Nevertheless, it is imperative that we condemn the sin and not the sinner, particularly where the

tive

person desires either to change their sexual orientation, insofar as that might be possible, or to accept the rigors of chastity.

56

The Covenantal Aspect of Christian Marriage

Can the Orthodox Church, then, ever bless gay marriage or samesex unions? The answer must surely be no. Once again, this is not, or should not be, a puritanical or

what many people consider ior.

Rather,

itual

it is

to be aberrant

because there

and physical well being.

that persons with

homophobic

reaction against

and repulsive behav-

way in terms of both spirThat better way might well require

is

a better

marked homosexual tendencies accept a

life-

long struggle to remain chaste, together with sincere repentance

when and

if

they

fall.

In this regard, however, they are

ent from unmarried heterosexual

no

men and women, who

differ-

likewise

have to struggle against sexual desires and temptations in order to remain chaste. Certainly this is

is

an unpopular

considered thoroughly outmoded even by

stance,

one that

many of our faithful.

Nonetheless, the Church's monastic tradition long ago confirmed the spiritual and physiological value of chastity, the virtue of refraining

from sexual

activity.

Not

all

of us are called to monas-

many

people will reply, and they are right. This does not

alter the fact,

however, that the body's sexual energy can be redi-

ticism,

rected

and

from a

lustful quest for sexual gratification

toward a deep

sanctifying expression of charity. This redirection

for creating

is

essential

an appropriate chastity within marriage, one based

not on sexual abstinence but on mutual love and respect, together

with ongoing concern for the other's needs and desires. Particularly for those

flesh

who

life

of celibacy, the eros of the

can and should be progressively transformed into a "divine

erds," expressed as

the

are called to a

God

an

insatiable longing for ultimate

union with

of love.

This said,

it is

here to stay.

clear that same-sex unions are with us,

and they are

Our local Greek church recently pubUshed its annual

57

STAGES ON life's WAY bulletin, replete

with photos of parish couples, husbands and

wives smiling broadly at the camera. There in the midst of them is

a photo of

two smiling young meA, who obviously form

their

own couple. I asked the priest how he dealt with the situation pastorally. Like so many of our priests today, he finds himself in a quandary. For better or for worse (more likely the

adopted a "don't ask, don't ties

tell" policy.

Many

he has

latter),

of our

are wrestling with similar situations. Sometimes

communi-

homosexual

couples attend services but refrain from communion. Others

come

we

to

commimion but

refrain

from confession. In both

cases,

are confronted with a serious pastoral issue.

we have to ask the following question: Is homosexespecially as expressed by a stable couple who have com-

Nevertheless, uality,

mitted themselves to each other, a serious enough sin destructive

enough influence

municating them?

We

in parish

life

—

^to

—or a

warrant excom-

don't excommunicate those

who

fall

into

when the parish budget depends on their sizeable contributions. Nor do most of us excommunicate drunkards, that is, alcoholics, even when they give in repeatedly to the bottle. We recognize that communion in St Paul's category of the greedy, particularly

the

Body and Blood of

soul

Christ

is

offered to us "for the healing of

and body." What indeed is an appropriate pastoral approach

to same-sex couples

who participate

Without attempting to resolve the the following.

It

actively in parish life?

issue here,

we can

say at least

seems appropriate to make a distinction between

same-sex unions and same-sex marriage. Regarding the former,

same-sex unions are

now

a given in

including our own. In their defense against legal

is

many Western

societies,

the fact that they protect

and social injustices. They also provide an alternative

58

The Covenantal Aspect of Christian Marriage

rampant promiscuity that has

to the

death in this age of

adopt

offer

some

much

suffering

AIDS. Also, since such couples may

children, granting social

would

led to so

stability

and

legally

and legal recognition to their union

and protection to those children who

might otherwise go without. it

seems equally clear that the

bless

such unions. Insofar as they

Despite these points, however,

Church should not formally

involve active homosexual relations, they are based

on a relation-

we can view only as sinful and unhealthy. That relationship, by the way, may be particularly unhealthy when such couples ship

adopt children or bring them into the world via nation.

A

picture of the

life

and

All the

sures

of a young

girl

paints a favorable

who is the child of a lesbian coubut there

is

better off, all other things being equal,

mommy and a itself,

Has Two Mommies^

may have two mommies,

Heather

would be

insemi-

popular book written some years ago for grammar

school children. Heather

ple.

artificial

it

daddy. This

is

a truth inscribed in

no doubt she if

she had a

human

nature

needs to be recognized and defended accordingly.

more

firmly,

we must

categorically reject

growing pres-

toward universal acceptance of same-sex marriages. The

term marriage itself needs to be retained, preserved, and protected to signify exclusively the union of one

joined in a formal

bond characterized by

nence. This definition, as

we

shall see,

is

man and one woman, faithfulness

and perma-

inadequate with regard

to Christian marriage. But even in secular usage, the term marriage needs to retain

its

conventional definition. This

to preserve the social, psychological, ditional nuclear family, ity

which

between husband and wife.

is

is

necessary

and spiritual roles of the tra-

based on gender complementar-

It is

59

also necessary to preserve the

STAGES ON life's WAY

possibility for Christians, Jews,

and other beUevers to

conditions of marriage according to

Same-sex marriage

is,

and always

define the

own convictions.

tjieir

will be,

an oxymoron. Despite

pressures for political correctness in this environment of moral relativism, the

term marriage must be preserved to designate the

unique union between a

man and a woman that God himself has

established, in order to serve his purposes for the propagation of life

and the salvation of us

tate a constitutional

all.

Whether or not

amendment,

it

this will necessi-

requires that

we as

Christian

new life to our traditional concept

people rediscover and give

of

More important than any piece of legislation is the witness we can offer to the world around us. For that witness to be effective, however, we need to embody in oui* families the marriage.

commitment and

God

responsibility, the faithfulness

calls for in the

and

love, that

covenantal and sacramental bond of conju-

gal union.

The Reason for Marriage In his still-valuable ethical treatise titled

Nicholas Berdyaev declares that "love

The Destiny of Man,

is

the ontological basis of

the marriage union." And, he continues,

"The meaning and pur-

pose of the union between

man and woman is to be found not in

the continuation of the species or in sonality [personhood] in

ness of Ufe

and

its

its

its

social

import but in per-

striving for the completeness

and full-

longing for eternity."^

^Nicholas Berdyaev, The Destiny of Man i960), 239-40.

60

(New York: Harper and

Brothers,

The Covenantal Aspect of Christian Marriage

With these words, Berdyaev provides a profoundly Orthodox answer to a question long debated in Roman Catholic and Protestant circles. There the question as to the basic

meaning and end

of marriage has led to a certain polarization. Catholic theology

has tended to argue that marriage

ation. Directly or indirectly, this

on contraception and,

it

not

emphasis led to a magisterial ban

could be argued, to the mandatory

celibacy of priests. Protestants,

on the other hand, have tended to

of marriage,

stress the unitive value

in

justified primarily, if

by creating the appropriate framework for procre-

exclusively,

and wife

is

its

capacity to unite husband

an affectionate bond that serves to strengthen mutual

commitment between the spouses and thereby strengthen family integrity. In this perspective,

primary.

many

As

procreation

sterility),

yet their marriage can be blessed

As Berdyaev's remarks unitive

truth.

it is

not

evidence, Protestant ethicists point to the fact that

Church, and their conjugal union

it

important, but

couples are incapable of procreating (because of age, for

example, or

Yet

is

is

in

by the

no way diminished.

Orthodoxy considers both the

indicate.

and the procreative aspects of marriage to be important.

finds the ultimate reason for conjugal

Husband and wife

union in a higher

are joined in marriage to participate in

a self-giving love of transcendent origin. That love, which creates

mutual desire as its

it

most sublime expression

eternal

life

in

new reality of "one flesh,"

brings forth a

finds

in the longing the couple shares for

communion with

the

Holy

Trinity. In addition to

procreation and committed union. Orthodoxy understands the ultimate purpose and meaning of marriage to be soteriological:

through their

it,

husband and wife are

called

and enabled to work out

mutual salvation. To grasp the mystery of one-flesh union as

61

STAGES ON life's WAY God intended

it,

therefore,

we need

to approach

it

from the per-

spective of the Church's theology, rather than, for example,

modem

that of the medieval conception of romantic love or the

psychotherapeutic notion of love as a means for

from

self-fulfillment.

A more appropriate model for expressing the mysterion, or sacramental quality, of conjugal love

profound

insights into the

is

provided by Martin Buber's

human person

expressed as the rela-

and Thou. In marriage, he

tionship between

I

man and woman,

enter into the transcendent world of

perceive in each other unique value

two

affirms,

I's,

Thou, to

and meaning. Each becomes

for the other a veritable symbol, a reality that brings together the

temporal and the eternal. Yet because they dwell in the sphere of time and space, each spouse tends to lapse into an objectivity characterized as the sphere or world of

It.

Conjugal love in

all its

complexity, which encompasses every aspect of the couple's being, has as

its

basic function to lead the objective

He and

She

back to a relationship of I-Thou.^ Anglican theologian Derrick Bailey expresses sage of his

this

theme

book The Mystery of Love and Marriage

in a pas-

that under-

scores the difference in perspective between an onlooker

couple

who

are united as lover

and the

and the beloved. "To the

onlooker," he says, "the beloved belongs to the world of she

is

and

accordingly assessed by conventional standards at her 'face

value.'

But to the lover she

of falling in love, with as she

It,

is,

its

is

Thou: through the

relational event

vision of perfection, he has seen her, not

but as she may become by the grace of God

—and he can-

not forget what he has seen. She has been revealed as

God made

^Martin Buber, / and Thou, 2nd ed. (New York: Scribner's, 1958).

62

The Covenantal Aspect of Christian Marriage

her to be and wills her to become, and she

and

as grace

may remake

is

loved both as she

is

her.'"*

Perhaps the most important ness

is

way

to maintain conjugal faithful-

to love the other precisely as he or she truly

is,

yet also as

may remake them. To encounter the other on their own terms, as God has created them and has willed them to become, grace

is

to engage in a unique meeting with the other.

marriage relationship in struggle. Yet at the reality, to

same

all

It is

to root the

the harsh reality of daily

time,

it is

life

and

to constantly transcend that

discover in the other the beauty and perfection of the

person, who bears the divine image and likeness. While they enjoy all

the fruits

and

joys of erotic love, the couple thereby

together in a deeper eros, experienced as a

grows

hunger for eternal

union with God. Sexual relations, then, are not to be set aside and are certainly not to be despised as a concession to the fleshly passions.

God-given means by which the couple can the greatest possible intimacy

and

other with God,

who

is

are a

know each other with

fullness.

nal knowledge, they can enter into

They

By means of that

car-

communion through each

the object of their deepest

and most sub-

lime longing.

Characteristics of Christian Marriage Earlier,

I

qualified Christian marriage with four adjectives:

monogamous,

"^Derrick

heterosexual, blessed,

Sherwin

Bailey,

and conjugal. Each of these

The Mystery of Love and Marriage (New York:

Harper and Row, 1952), 16.

63

STAGES ON life's WAY for establishing the unique covenantal

is critical

husband and wife that

reflects the relationship

between Christ and the Church,

bond between

of sacrificial love

^

f

These adjectives describe the content and

union

limits of the

assumed by a Christian couple through the sacrament of marriage,

understood in

its

broadest sense. Like the liturgical offices

of baptism and chrismation, the marriage service tion. It introduces the couple into a

being, as

it

new

reaUty, a

makes of them a new creation of one

mental aspect of that

new creation

service but should continue

is

one of

is

initia-

new mode

flesh.

The

of

sacra-

not limited to the Uturgical

and grow throughout the

lifetime of

the persons concerned. Just as one's entire Ufe consists of an ongoing renewal of baptismal grace through the Spirit,

power of the Holy

so in marriage there should be a continual deepening and

perfecting of the grace conferred through the Church's blessing at

wedding

the time of the

The term marriage, ful

service.

therefore, refers to a lifelong venture of faith-

and responsible commitment to the welfare and salvation of

the other, the spouse. Yet

it is

people. Christian marriage

between Christ and its

power and

relationship.

its

his entire body, the universal

Marriage

it is

responds to the

an icon of the loving relationship Church.

It

finds

ultimate purpose through participation in that

Intensely personal

intimacy,

is

more than a imion between two

is

on the

thus essentially an ecclesial

level of sexual

reality.

and other expressions of

profoundly communal insofar as the couple call to

make

of their relationship an authentic

covenant: a bond between persons, yet a bond that unites them

with

God and

with the entire

ecclesia, the universal

of saints, both living and departed.

64

communion

The Covenantal Aspect of Christian Marriage

Elsewhere

I

have attempted to

Christian marriage, here.^

It's

enough to

and

ple Israel, sealed with

out the covenantal nature of

want

to repeat that reflection

God's covenantal bond with his peo-

Adam, Abraham, Moses, David, and

prophets. "In each case," tal

don't

I

recall

spell

I

note, "the

the

two parties of the covenan-

bond commit themselves to unconditional faithfulness toward

The

the fulfillment of a pledge or promise that will last forever."

key terms here are "unconditional faithfulness" and "forever." This does not

mean

that the

bond cannot be ruptured and

covenantal relationship ended. Israel repeatedly betrays

mitment to the Lord. That commitment

is

only by means of repentance, to which

God

giveness.

most

restored

through divorce. Yet

and renewed

also be broken,

like Israel's relationship

Yahweh, the covenant of marriage can

com-

responds with for-

The covenantal bond of marriage can

visibly

its

the

with

also be effectively voided

by adultery, rebellion, or mere indifference. Where

infidelity,

abuse, or neglect characterize relations between spouses, the

sacramental aspect of their union

is

vitiated

covenantal dimension of their relationship

and the

is lost,

specifically

broken. Yet

it

too can be restored by genuine repentance coupled with willing forgiveness.

Monogamous. it is

If

Christian marriage

is

necessarily

precisely because of the couple's relationship with

the prophets of Israel repeatedly affirm, the

His love for his people to

monogamous,

all

is

of humanity and to

Lord is a jealous God.

complete and without all

God. As

limit. It

extends

of creation. Yet that love also focuses

uniquely on every individual. Each one of us becomes in God's

^John Breck, The Sacred Gift of Life: Orthodox Christianity and Bioethics (Crestwood, NY: St Vladimir's Seminary Press, 2000), 60-69.

65

STAGES ON life's WAY eyes his unique beloved, his "only begotten" child.

As God com-

two

mits himself to us, so Christian marriage requires that sons, a

man and

woman, comfnit

a

per-

themselves, totally and

without compromise, both to each other and to God. Their loving

commitment too

such can

it

is

exclusive, unique,

and complete. Only

as

bear witness to the boundless and unique love of

Christ for his Church.

To be loved someone

is

a basic

human

in particular. Equally basic

to direct both affective

son—

^the

need, and especially to be loved by

It is

the need to love another,

and sexual energy toward a

beloved—^who

vided devotion.

is

calls forth

our absolute trust and undi-

precisely the uniqueness of the relationship

that enables that person,

and that person alone, to become

a Thou, so that we might share together and

most

specific per-

significant times

and spaces of our

fill

for

me

for each other the

daily existence.

The monogamous character of Christian marriage

therefore

excludes not only polygamy but also adultery, and that in

all its

forms, including fantasies directed toward someone other than the spouse.

mount

To look

at another

with

lust,

Jesus declared,

to committing adultery with that person. This

saying, especially for our sex-saturated society. But

one, in that

it

calls

it is

is

is

tanta-

a hard

a crucial

us repeatedly to repentance and a refocusing

of our care and our affection on the person

who

shares the

covenantal bond with us.

Monogamy allows for mutual care, nurture, and growth, while it opens before the couple a pathway that leads beyond the flesh and into the realm of spirit. This

is

simply not possible with casual

partners taken in serial or simultaneous relationships, in which

66

The Covenantal Aspect of Christian Marriage

the primary motivation

person

is

is

sexual gratification. There the other

inevitably objectified. In Ruber's language, they are ren-

He or a She in a world of It. The chief virtue of monogamy that it allows the time to know the beloved in all the complex

dered a is

and beautiful mystery of his or her being. To acquire knowledge

requires a lifetime, since

every day.

And

it

can

kind of

persons change and grow

beyond a

last

this

lifetime,

when

the living

spouse maintains with the deceased loved one a relation of ongoing

communion, a

blesses

relation of

second marriages,

it

ple so desires

it,

is

—quaUty.

to say eternal

strive to attain

it,

the coufaithful

sacramen-

their covenantal,

union can endure and grow beyond death and into

Heterosexual In the second place. Christian marriage ily

If

and if through their mutual devotion and

commitment they tal

and Thou. Although the Church

also affirms that conjugal union pos-

—^which

sesses a sacramental

I

eternity.

is

necessar-

heterosexual. Until very recently, the notion that any marriage

can be only heterosexual was accepted as axiomatic in virtually every major world culture. In an extraordinarily brief period of time, the popular attitude

toward homosexuality has

shifted

universal rejection to near universal acceptance. This

is

from

due in

part to recognition that a homosexual orientation does in fact exist.

According to frequently cited

that can be changed in fewer than

such change

^Statistics

is

how

an orientation

40 percent of the cases in which

desired.^

regarding successful attempts to change a homosexual orientation

vary widely. This to

statistics, it is

is

treatment

due is

in part to the

taboo surrounding the subject, but also

applied and healing

is

measured. Depending on the

read that anywhere from 25 percent to 65 percent of those who seek medical or psychological therapy achieve their goal. See John F. Harvey, source,

we

The Truth about Homosexuality (San Francisco:

67

Ignatius, 1996), for a

STAGES ON life's WAY More significant, though, is the prevailing atmosphere in Western societies that sets personal rights

and individual freedom above

notions of social responsibility. Sexflal acts committed between

consenting adults, the argument goes, should remain private,

Any suggestion that private

whatever their nature. public consequences

is

brushed aside as

acts

may have

politically incorrect

and

fundamentally intrusive.

Then

again, the "gay agenda" has been

championed by much of

the media, including such influential foriuns as prime-time televi-

sion this

and Newsweek magazine. In our schools and has reached the point where First

ously jeopardized.

It's

Amendment rights are seri-

increasingly difficult,

gerous, to say anything at

all in

universities,

if

not downright dan-

public that questions the morality

we may expect to see laws passed that will penalize not only negative of sexual activity between same-sex partners. Before long,

comments but mere

references to biblical passages that

homosexuality. Then

it

condemn

will be impossible to take a public stand

against same-sex unions or marriages, because such argimients will be classed as "hate speech."

As a result.

Christians, Jews,

Muslims who preach against such unions, even within

and

their reli-

gious communities, will be liable to prosecution.

On the other hand, it is important for us as Orthodox to place the may well be condemned by moral tradition. It may be unhealthy

matter in perspective. Homosexuality Scripture

and the Church's

detailed discussion

by a

Roman

Catholic priest and therapist

significant success in helping persons

who

sexual orientation; and Jeffrey Satinover, M.D., Homosexuality itics

has had

change from a homosexual to a hetero-

of Truth (Grand Rapids, MI: Baker, ^99^), esp. 168-209.

68

and the Pol-

The Covenantal Aspect of Christian Marriage

and even

life-threatening

when

there

is

Homosexual

other sexually transmitted infection/ distasteful,

even repulsive, to those

a possibility of

who do

genitalia

even

when

acted out,

is

be

hardly the worst of

and

homo-

represent a travesty of God-intended sexual relations. But sexuality,

or

not share those pro-

They may well involve a misuse of our

clivities.

acts

HIV may

More

sins.

reprehensible, certainly, are other offenses that directly threaten

both the social welfare and the Church's

integrity, offenses

such as

corporate corruption, child abuse, or bishops willy-nilly excom-

municating each other. These sins impact

directly,

and

in the

most

serious way,

on the

whose

has been betrayed. Consequently, they deserve our

trust

Ufe

and welfare of

large

numbers of persons

much as, if not more than, homosexual acting particularly when the latter involves two people who engage

attention at least as out,

in those acts freely within a

Yet

it is

committed

relationship.

of the essential nature of marriage that

heterosexual, a union of one

plementarity tional sense

is

it

be and remain

man and one woman. Gender com-

necessary for procreation, at least in the conven-

and for the foreseeable

future.^

significant the unitive value of conjugal Ufe

And however

may be, the basic rea-

son for sexuality and marriage remains the God-given invitation to "multiply

^t

is

and

fill

the earth."

important to note that

activity,

which

is

the

HIV

is

It is

precisely the heterosexual

also transmitted through heterosexual

most common mode, for example, throughout

Africa.

^Embryologists are talking today about the feasibility of parthenogenic reproduction, a sort of "virgin birth," by which an

ovum

is

stimulated in

and embryonic development without being fertilized by a male gamete. This raises ethical issues of huge proportions, which we

vitro to begin mitosis

will discuss in the next chapter.

69

STAGES ON life's WAY quality of marriage that enables the couple to procreate, to participate in

God's ongoing work of creating persons

who

bear his

^

divine image.

'

The third adjective that qualifies

Blessed,

one that makes blessed by tutes the

specifically Christian.

it

God through the pubUc,

wedding ceremony. That

authentic marriage

is

the

A conjugal union is^to be

sacramental ritual that consti-

on the couple

blessing bestows

the grace that creates of their union a genuine vocation, a divine calling, 1.2,8).

whose

basic task

is

to "be fruitful

and multiply" (Gen

As a blessed reaUty, marriage unites the couple in a new and

way to

unique people.

It

the covenant that

inserts

them

God establishes with his

faithful

into the flow of salvation history,

which

begins with the patriarchs and culminates in the Ufe of the Church.

Therefore, the great prayer of the Orthodox crowning service repeatedly asks

God

to bless them, as he blessed

Abraham and

Sarah, Isaac and Rebecca, Joachim and Anna, Zechariah and Elisabeth:

"Bless," "preserve,"

and "remember them,

O

Lord, as

You remembered Enoch, Shem and Elijah. Remember them, O Lord our God, as You remembered Your forty holy martyrs, sending down upon them crowns from heaven."

This blessing

which

is

effectively

symbolized by the wedding crowns,

in the Russian tradition are

both ornate and heavy. They

represent both the glory of the newly formed couple and the ascetic

struggle that lies

through the

ritual

ahead of them. God's

blessing, expressed

crowning, involves the spouses in a pilgrimage

that joins them, in both struggle

and

70

victory,

with patriarchs and

The Covenantal Aspect of Christian Marriage

prophets of the Old Covenant, and with apostles and martyrs of

New. This double emphasis

the

The mother's

also reflected in childbearing.

is

participation in God's creative

both suffering and

joy.

"When

a

woman

declares, "she has sorrow, because her

she

is

delivered of the child, she

for joy that a child

is

hour has come; but when

born into the world"

(Jn 16.21).

Assuming

husband and wife together Specifically, the

becomes a symbol of the hour of

delivery

Christ's passion. Yet

the

in travail," Jesus

and labor once "the hour has come."

woman's hour of

life is

is

no longer remembers the anguish,

the weighty crowns of conjugal union, struggle

handiwork involves

through

both—her

anguish and his—new

brought forth. As Christ's death issued in resurrection, so

woman's travail issues

in

new birth. Accordingly, the wedding

crowns witness to God's promise that for those who remain faithful to his

covenant, sealed by his blessing bestowed through the

marriage ceremony, crowns of martyrdom will one day be trans-

formed into crowns of victory and

joy.

Conjugal, Finally, Christian marriage

is

truly conjugal. This

should be a tautology. But in today's atmosphere of serial divorce

and minimal commitment, perspective, marriage

a

is

it

needs to be affirmed. In a Christian

truly conjugal only insofar as

it

represents

new creation of one flesh, which images the union in perfect love

and devotion between Christ and Christian marriage, then,

is

his

Church.

utterly different

from secular unions,

including those nominally sealed by a church service.

and

essential

The primary

component of a genuinely Christian marriage

commitment on

the

the part of each spouse to love, forgive, embrace,

and nurture the other as Christ loves, tures all those

is

who

forgives, embraces,

are baptized into his body.

71

and nur-

The Holy Fathers

a

STAGES ON life's WAY repeatedly invoke nuptial imagery to describe the relationship

between Christ and the

They

soul.

frequently use the language of

the biblical Song of Songs to spealc of the passionate, truly erotic quality of love that unites the soul to Christ, as a bride

her beloved. is

If this

imagery

because Holy Tradition

united to

acceptable to our spiritual elders,

is

itself

and meaning of marriage: to

is

it

so highly values the true purpose

serve as a living icon of divine eros,

divine love.

Does Christian The

IVIarriage

Have a Future?

institution of marriage, in conventional terms,

ened today that

its

future

is

clearly in jeopardy.

is

so threat-

But

this fact

merely underscores the need within God's world for authentic marriages that both witness to God's covenantal love and provide the matrix in which that love can

work out salvation, both for the

spouses and for their children.

In the face of

all

of the challenges thrown up today against the

institution of marriage, It is

to rediscover

and

our vocation as Christian people

relive

is clear.

within our conjugal unions a depth

of devotion, commitment, faithfulness, and love that heals and

transforms the profound loneliness that threatens the of us in a hostile and meaningless world. truth that marriage

is

It is

lives

of each

to rediscover the

most firmly grounded in friendship

—

delight in the other person, a joy in their presence, a respect for their feelings

that

we

what

integrity,

and a devotion so pure and boundless

are willing to die for that person. If the divorce rate

it is, if

society,

and

it is

domestic violence and neglect are so largely because the spouses

72

is

common in this

have never discovered in

The Covenantal Aspect of Christian Marriage

—a unique confidant, a source of

each other a real friend tual stimulation

intellec-

and spiritual enlightenment, a person with whom

they can share laughter, tears, and mutual delights. Christian marriage certainly has a future, well, to the degree that believing couples

union as a

spiritual vocation that

God. And

it

will be a

is

and a promising one assume

given, blessed,

as

their conjugal

and fulfilled by

union not only of obligation and

sacrifice

but also of devotion and joy insofar as they take to heart a simple bit of popular

wisdom each

ator door: happiness

is

of us should tape to our refriger-

being married to your best friend.

73

1

chapter three

THE USE AND ABUSE OF HUMAN EMBRYOS It is

a curious thing to observe the excitement

geneticists express over the

many

mere prospect of increasing

man's intelligence (they express no desire whatsoever for increasing man's humility). Insufficient intelligence, ever,

has never been a serious

many of our problems that

is

human

Before I formed you in the I

its

saving graces of

and wisdom,

—Donald DeMarco, you were born

fact,

are associated with intelligence

separated and isolated from

humility, understanding,

problem. In

how-

in

The Concentration Can

womb I knew you, and before

consecrated you; I appointed you a

prophet to the nations,

—Jeremiah 1.5 Behold, you will conceive in your

and you

shall call his

womb and bear a son,

name Jesus,

—Luke 75

1.3

STAGES ON life's WAY

From on human

the perspective of

Orthodox

Christianity, all research

—including embryonic stem search (ESCR) and cloning—should be guided and subjects

cell re-

limited

by the Christian understanding of the human person as created the image of God.^

We

in

can understand the Church's attitude

regarding the beginning of human life, and consequently the impUcations of

ESCR and cloning,

only on the basis of theology.

God

alone estabUshes meaning and purpose in human existence. Therefore,

it is

only

we can make

God who provides

the moral

framework by which

judgments regarding medical technology and the

manipulation and treatment of human persons.^ In today's secular, postmodern,

and highly pluraUstic world,

kind of affirmation sounds sectarian and retrograde,

if

this

not absurd.

How can we as Christians impose our standards of moral conduct on a

society that has

abandoned those standards

in favor of a

philosophical relativism that rejects the very existence of absolute values and truths? Indeed,

how can we

perspective regarding moral judgments

even speak of a Christian

when Christians of various

confessional backgrounds hold very different opinions as to

we

are to interpret Scripture

how we

^I

and

early

Church

tradition,

how

and

to

should apply our interpretations in specific cases?

wish to express my very sincere thanks to Dr Gayle Woloschak of the Fein-

berg School of Medicine, Northwestern University, and to

Weaver of the Massachusetts Institute of Technology, for criticisms they

have offered on

this subject

and

Dr Terry Orrcomments and

for scientific materials they

have provided for me. All interpretations and conclusions drawn here of course, tions

on the questions

^Note:

all

are,

my own and should not be taken to reflect their opinions or posiraised.

terms in boldface appear in the glossary at the end of this chapter.

76

The Use and Abuse of Human Embryos

Given this diversity of perspectives,

we as Orthodox Christians can

only bear witness to what we know and hold to be true. This means that

we

Holy

turn to

revealed his will,

God

has

and through those

tra-

Tradition, with the conviction that

and continues to do

so, in

ground of our

ditional sources that serve as the

faith: the

Old and

New Testaments, early patristic teachings, the Church's liturgy, and others. In other

words, in

this

postmodern world, we need to hold,

with unwavering conviction and determination, to "the faith once

and

for

all [te

hapax] delivered to the saints" (Jude

Such a commitment ern, after

all,

may sound

self-evident.

originally signified the

3).

The term postmod-

abandoning of modernist

trends

—

more

traditional values. In recent years, however, the term's

in art, literature,

meaning has ernism

and culture

shifted, so that

signifies

now,

in

in general

—to return to

popular usage, postmod-

something more akin to relativism.

basically, a rejection of absolute

and

objective values

in the beUef that all subjective interpretations of what

One

true are of equal standing.

person's notion of

or appropriate in any given situation

whatever that notion

may

be.

really begins at birth, then

please,

in

am

and is

truths,

good and

what

as valid as

implies,

any

right to

other's,

my opinion, human life

free to dispose of fetuses as

I

life is

be important for you, but you have

ill.

for our treatment of those

If I feel

who

are disabled or

they would be better off dead, then

no moral qualms about euthanizing them.

If I

public and the courts to agree with me, then spective

only

impose that conviction on me.

The same holds terminally

may

right

is

with no moral consequences. Your conviction that

sacred from conception

no

I

If,

is

It

becomes enshrined

in law.

77

The

I

have

can persuade the

my relativistic per-

result

is

legislation such

STAGES ON life's WAY as

Roe u Wade, which

sanctions unrestricted abortion, and Ore-

Measure i6, which authorizes physician-assisted

gon's

Both of

these,

popular as they are

in the face of traditional perspectives

Our

responsibility before

world faith

God and

nevertheless, to preserve

is,

once and for

all

on the

sanctity of Ufe.

neighbor in

is

just

this

and to proclaim

delivered to the saints."

question that arises for us

postmodern

precisely "the

The

chief ethical

how we apply the givens

faith in specific situations that involve the beginning

human

"God

alone all

is

good," Jesus affirms. This means that

goodness and that

by which goodness anything

is

What

is

which

view, the its

and end of

good

is

he

who

it

Without God,

good is determined by its

the

offers us the criteria

ethics are merely utiUtar-

From

good or

interests. In the field

^that is,

its

by the degree

a utihtarian point of

and particularly by

amount of pleasure and hap-

number of people.

itarian determination of the

—

usefulness,

capacity to provide the greatest

by economic

is

measured by expediency rather than by

reflects divine perfection.

piness to the greatest

God

judged. Without God, Dostoevsky declared,

permissible.

is

it is

conformity to absolute, immutable truths to

of that

life.

source of

ian.

suicide.

m today's culture of death, fly

On a practical level, util-

useful

is

strongly influenced

of medical technology, biotech

companies and the pharmaceuticals industry wield extraordinary

power in the damental

setting of policies that

level,

concern

human life

at its fun-

poUcies such as the use of embryonic stem

78

cells

— The Use and Abuse of Human Embryos

and

fetal tissue in the

often, the

development of new therapies. All too

moral impUcations of

not only in the interests of

this research are

brushed aside

knowledge but also because

scientific

those therapies are potentially so lucrative. In such a world, is

ethically permissible tends to be

what

whatever promises the most

success in providing those therapies

and the

profits associated

with them.

When the laws of the marketplace govern medical care and medical research, as

they do in the United States, the potential for

innovative therapies

is

matched by the potential

for abuse.

ing the past few years, secular voices in the medical ceuticals fields, together

convince us that the

with

human

its

individual.

and pharma-

of the media, have tried to

human embryo,

preimplantation stages of

than a

much

Dur-

especially in the earliest

growth, constitutes something

The embryo, they

claim,

is

less

to be

regarded as mere tissue, with no claim to individual identity

a

This

fortiori^ to legal protection.

is

merely an extension of the

reasoning behind the proabortion movement. fetus it

or,

If

a third-trimester

can be aborted with no ethical or legal consequences, then

seems only reasonable to conclude that embryos can be created

and destroyed with impunity.

A growing consensus

sees such a

conclusion as self-evident because of the potential usefulness of

embryonic stem

variety of neurological

and other

be considered to be incipient

—and

sonable

medical therapies for a wide

cells for creating

ethical

—to use

diseases.

human life, their

stem

Even

if

embryos can

people ask, cells in

isn't it rea-

order to relieve

the suffering of countless patients of Parkinson's or Alzheimer's disease, even

the

if

harvesting those cells inevitably destroys

embryo?

79

—

skills

STAGES ON life's WAY The answer to that question should be clear, although it goes very

much against the reigning mentality in today's culture. In Romans 3.8, the apostle Paul lays down thfe basic ethical principle that governs the Church's approach to the matter: we may not do evil so that good may come. A good result does not justify an immoral action. If

Orthodox ethicists have consistently condemned the use

of embryonic stem earliest stages,

it is

cells

and

will

Once

its

human

life

begins at conception,

the nuclei of sperm and

grow in a continuum from Orthodox

created in the image of existence, before death

that confers

from the

From onic

its

ovum

unite, a geneti-

unique being exists. Under normal circumstances, that being

to physical death. is

at

traditionally has been understood to be coterminous with

fertilization.

cally

life

because they hold to the theory of immediate

animation, the theory that

which

similar manipulations of

through birth and on

tradition also holds that

God and

human

life

bears that image throughout

and beyond the grave.

on the human

earliest stages of

fertilization

It is

that image

individual the quality of "person"

human

development.

the viewpoint of the Church, therefore, to destroy embryto destroy a

life is

potential

good

human

to be derived

person. Even

if

we

from embryonic stem

as the harvesting of those cells destroys the embryo, killing of a

inherently

consider the cells,

involves the

it

newly created personal being. Since that act

evil,

there

is

has any validity, because before God,

good

itself is

no ultimate good to be derived from it.

moral calculus that weighs the good against the bid

to obtain a

insofar

No

in this case

we may not do evil in order

result.

This kind of thinking, once again, appears retrograde and repug-

nant to most people. They have been persuaded that

80

ESCR holds

The Use and Abuse of Human Embryos

an immense therapeutic potential, and they wonder at the Church's intransigent refusal to bless and support

Orthodox

on the other hand, the

Christians,

as clearly as

any other the

different worlds,

fact that

one governed by

other by the gospel of Christ.

because

we

To many

it.

conflict here reflects

are actually living in

utilitarian

two

expediency and the

We speak different moral languages

we fail to share the same moral perspectives and commit-

ments. With radically different moral presuppositions, traditional Christianity

and postmodern secular

ethics

with regard to any resolution of moral

may be able to common basis, no one

makes

it

remain worlds apart

conflicts.

Although each

understand the other's position,

we

share

no

"canonical content-full moral vision" that

possible for us to resolve in the public square bioethical

or other moral disagreements.^

To paraphrase Dostoevsky once lar, it

again, without

plurahstic environment, anything

can serve

utilitarian

extending the

life

dience to God,

span.

With God, on

human

the other hand,

if

health and

and

in obe-

we accept the moral requirement to refuse even the is

purchased at the cost of

human Ufe. From the perspective of the gospel, we may

not save or ameliorate the conditions of one another, except

^The expression

where that

(i.e.,

sacrificing

entails self-sacrifice (Jn 15.13). This

problem of

that separate traditional

by

life

in quotes belongs to Tristram Engelhardt.

ceptive analysis of the

tives

in this secu-

permissible, particularly

ends such as improving

good when that purported good destroying

is

God

differing

is

For a highly per-

moral languages and intuitions

Orthodox) Christianity from

ethical perspec-

with a different values content, see his work: Tristram Engelhardt, The

Foundations of Christian Bioethics (Lisse, Netherlands: Swets and Zeitlinger, 2000), esp. chap. i. As he points out, "Moral acquaintances can be moral strangers** (37).

81

STAGES ON life's WAY the

work

of Christ, accomplished once and for

the cross.

As

human

that

for ourselves, life

finds

its

ultimate Value

and worthy

goals.

by

his death

on

we hold to the truth

and purpose beyond the

Good health and a long life are desir-

limits of biological existence.

able

essential that

it is

all

They

are so, however, only to the extent

growth toward what Orthodox

that they exist to further our

tra-

—eternal participation of the

dition calls theosis, or deification

human person in Our

divine

life,

the true purpose of

In

life

as

an end

suffering

its

life

of the Holy Trinity.

rejection of certain medical procedures that lead to the

destruction of embryonic

our

the

and

life,

human

then,

is

grounded

existence: not to

improve or extend

in itself but to surrender that

its

limitations, into the

what follows, I would

like to spell

our vision of

in

together with

life,

open arms of God.

out the basic reasons for the

Orthodox consensus regarding the manipulation of human embryos and efforts to clone human persons. This will entail, of all, taking up the question of the beginning of human Ufe.

we

will

first

Then

draw some conclusions regarding morally acceptable

forms of stem apies that

cell

research and the development of various ther-

make up what

When Does Human

is

called today "the

Life

new medicine."

Begin?

Roman CathoHc counterparts. Orthodox theologians are reluctant to speak of a specific point at which God endows the

Unlike their

newly created embryo with a a certain

soul.

Western thought

duaUsm in this regard, holding that the

with the body, or that the soul point after fertilization.

is

infused into the

To the Orthodox,

82

soul

is is

marked by co-created

body

at

some

this reifies or objectifies

The Use and Abuse of Human Embryos

the soul, distinguishing

it

from the body as a separate

the holistic perspective of the

Greek Fathers,

entity.

From

would be more

it

appropriate to speak of the body not as having or possessing a soul

but as being ensouled. life

It is

animated by the God-given psyche^ or

principle, at every stage of its existence. Neither

ultimately exists without the other, even

if

a certain separation of the soul from the

embraces

flesh, soul,

and

spirit,

body nor soul

physical death involves flesh.

The body (soma)

and although the

flesh "returns to

dust," the bodily or somatic character of our existence abides into eternity."^

This

is

why, adopting

biblical imagery,

Christ's victory over death results

we

affirm that

not in the immortality of the

soul but in the resurrection of the body.^

Therefore, rather than affirm that the

human person receives and

possesses a soul, as an entity distinct

from the body,

more accurate

is

to say that the person

it

would be

an ensouled being, and

such from fertilization onward. The soul, in other words,

understood as the animating principle in

development of the person from into the

human

fertilization

life

is

is

to be

that guides

through death and

kingdom of heaven.

way of thinking leads to the important conclusion that human life is sacred from its very beginning, since from its

This

conception,

'^See

it is

an ensouled existence. As such,

chap. 6 for a fuller discussion of the body.

relation

between body,

found in

J.-Cl. Larchet,

1992), esp. chap.

Toward

and

spirit in

a personal

A valuable discussion of the

Greek

patristic

thought can be

Therapeutique des maladies mentales

(Paris: Cerf,

i.

^See, in this regard, the

to Ashes:

soul,

it is

thought-provoking

article

by John Garvey, "Ashes

a Christian Understanding of Death,**

no. 2 (January 30, 2004): 16-19.

83

Commonweal 141,

STAGES ON life's WAY existence, created in the tity

that destines

embryonic stem question,

for eternal Ufe.

it

The most pressing

issue

cells

When

image of God and endowed with a sanc-

and to cloning

does

attempted to address eries in the field of

we have to face with regard to the use of

human

life

this question

is

the familiar, long-debated

begin? Several years ago,

by referring to recent discov-

embryology.^ The conclusion

—^meaning

human gamy

^with the fusion of the nuclei of

duce a

single-cell zygote. It

life

begins at conception

—

I

seemed to

I

drew was

fertilization,

that

or syn-

sperm and ovum to pro-

me

continuum

that the

between fertilization and birth is such that no other point can reasonably be argued as marking

hold that view, I

it

life's

actual beginning. While

I still

would be worthwhile to nuance the conclusions

drew, and to raise again the question as to whether those con-

clusions are based

on sound

with a brief overview of the

Throughout question of

history, a

scientific evidence.

Let

me

proceed

issue.

number of answers have been given

when human

life

begins.

The

basic choice

is

to the

between

"immediate" and "delayed" animation, or hominization; that

whether the zygote

itself

is,

human indihuman tissue), or

can be considered to be a

vidual (and not merely an

amorphous

whether individuality actually begins after the gestation period.

bit

of

at a later point, during or

Those who defend the

delayed animation suggest a variety of

latter

possibilities.

view of

Some hold

human life, properly speaking, begins only with implantation of the fertilized ovum in the uterine wall; others hold that it begins

that

only slightly later with the appearance of the neural streak, or

^John Breck, The Sacred Gift of Life, chap.

84

3.

The Use and Abuse of Human Embryos

primitive

body

spinal cord

axis, that signals the earUest

development of the

and central nervous system. Others

—

often,

it

pointed out, with an agenda to preserve abortion rights

must be

—locate

human life at quickening, when the mother first feels the child move in her womb, or at birth, when the child the

stage of truly

first

takes

its first

gulp of air and begins to breathe on

would withhold from a newborn

others

child

own.

its

any claim to

Still

legal

recognition and protection until the child proves to be free of

serious genetic anomalies, impaired intelligence, defects. In this view,

human

life

begins only

when

and other

society says

it

does and confers the status of human being or person on the new-

born

infant.

There

is

no question

tilization,

the newly created

uniqueness, or genetic

but

out

it

in anyone's

more

embryo

that from the point of fer-

is

characterized by genetic

precisely, genetic individuaUty.

That unique

makeup does not of itself constitute the embryo,

will characterize

its

mind

lifetime.

each

cell

of course,

of the developing being through-

The twenty-three chromosomes

received

from

each parent align themselves in a unique combination that produces

new chains

the blueprint

of

DNA (deoxyribonucleic acid), which

and the fundamental building material of

early 1953, Francis Crick

is

both

life.

In

and James Watson of Cambridge Uni-

versity,

with the collaboration of Rosalind Franklin and other

entists,

produced a model of the

sci-

DNA molecule that has enabled

subsequent researchers to confirm

its

key role in

human

develop-

ment, specifically in storing and transmitting hereditary information.^

The molecule

is

structured as a double helix, rather like

DNA science and the history of James D. Watson, The Double Helix (New York:

^For fairly nontechnical introductions to

DNA

research, see

two

85

STAGES ON life's WAY nested corkscrews.

It

consists of a

"backbone" of two

thymine and guanine-cytosine. These hydrogen bonds, code of

life.

by

pairs, held together

A-T and G-C, the

"spell out," in the letters

basic

In each living being, the inherited genetic code

unique. Although

it

is

can be repUcated through monozygotal, or

"identical," twinning prior to implantation of the

uterine

spiraling

and pyrimidine base pairs: adenine-

chains, linked by purine

embryo

in the

membrane, with fertilization a unique being has come into

whose genome

existence

of either parent. There

(genetic blueprint)

then,

is,

ogists as to the point at

is

different

from that

no disagreement among embryol-

which genetic individuality

begins.

It

begins "at the beginning," with the creation of the zygote.

What

is less clear,

viduality latter

is

and the point

at issue,

is

whether genetic

indi-

accompanied by developmental individuaHty. By

expression

we mean

this

the stage at which embryonic cells

begin to differentiate such that they become increasingly specified,

That

leading to the development of particular tissues and organs. differentiation

caused in large measure by gene expres-

is

sion: individual genes,

working

switching themselves on and stages of

effect of

beginning during the very early

The question

tiation begin in a definitive it

formation ity for

off,

have the

embryo development and continuing throughout

lifetime of the organism.

Or does

in combination,

is.

Does

the

cellular differen-

way during the preimplantation stage

begin only after implantation, with the radical trans-

known as gastrulation,

twinning

is

lost

or singularity,

when the capac-

and organogenesis, the production of

specific organs, begins.^

Penguin, 1968); and especially his recent and more detailed work,

The Secret of Life (New York: Knopf, 2003).

86

DNA:

The Use and Abuse of Human Embryos

The question may not seem momentous. But for determining the Church's stance vitro fertilization (IVF),

in fact

it is

crucial

on procedures such

as in

ESCR, and cloning. This is for a very sim-

ple reason. If fertilization estabUshes both genetic

mental individuality, then

we must

with the creation of the zygote.

If,

affirm that

and develop-

human

human life

this latter case, the so-called

begins

however, cellular differentia-

we need

tion actually begins only with implantation, then affirm that an individual

life

to

begins only at that point. In

"preembryo"

(prior to implantation)

could properly be considered to be what has been called the "substratum of human Ufe," the necessary biological prerequisite that

human life. But it would not be an such, and much less a person.

holds the potential to become individual

To

human

the minds of

being as

many

for delayed animation

specialists in this area, a decisive is

the

phenomenon known

the capacity to generate a complete organism cell.

as totipotency,

from an individual

Totipotent is a term used to describe the blastomeres, the indi-

vidual, loosely associated

embryonic

cells

blastomeres can spUt off from the main contains the

full

produced

cell cluster.

Since each cell

genome, and since individuation or

through gene expression either has not begun or stage,

in the early

During this preimplantation period, one or more

stages of mitosis.

is

specification

at a very early

each blastomere or group of blastomeres can develop into a

complete

human

Each individual the

argument

being. This

is

what produces

cell at this stage is

identical twins.

totipotent in that

it

possesses

same potential as the zygote to produce a new human life. This

quality of the preimplantation

the idea that the zygote being,

itself

many people to reject considered an actual human

embryo

can be

leads

and to hold to the theory of delayed animation.

87

— STAGES ON life's WAY Those who support this view of delayed animation do so not only because of totipotency and the fact that there

is

the true onset of developmental irfdividuality.

powerful, intuitive argument in the

a question as to

They

phenomenon

also find a

that carries the

unfortunate label "wastage." This refers to the vast number

—of

estimates vary from 3 5 to 75 percent that are spontaneously expelled

implantation and before she

is

fertilized

ova (embryos)

from the mother's body before

even aware that she

is

pregnant.^

These "mini-miscarriages" are part of the natural, God-given process of procreation. In themselves, the demise of these

embryos poses no particular moral problem. The mother responsible for their loss, and since she rence, she need feel neither guilt nor

In trying to explain the

is

unaware of

its

it

in

not

occur-

any sense of regret.

phenomenon of wastage

to parishioners

and other laypeople who have been concerned about usually placed

is

the framework of theodicy—

^the

it, I

have

seemingly

God who is omniscient and omnipotent, and the reality of evil. To many people's minds, it is incomprehensible, even impossible, that God could allow such wastage, if indeed it involves actual human life if the preimplantation embryo is in reality a human individirresolvable conflict

between the image of a good

—

ual, bearer of the divine

being. This in itself is

image and consequently an ensouled

enough to convince many people, including

^Proponents of the theory of delayed animation often argue that prior to implantation of one or more embryos, the they hold,

is

woman is not pregnant; the term, who hold to immediate ani-

inappropriate at this stage. Those

mation consider the mother to be pregnant from the point zygote to

is

formed and begins to grow.

It is

interesting that

at

which the

many women claim

know they were pregnant dmring the first week of the embryo's existence,

well before implantation.

88

The Use and Abuse of Human Embryos

a great

many

Catholic and Orthodox Christians, that

human Ufe

begins not with fertiUzation but with singularity, or gastrulation,

when, following implantation, the embryonic

cells

reorganize

themselves to produce the primary germ layers of ectoderm,

mesoderm and endoderm, followed by

the development of the

primitive streak. Prior to this radical reorganization of cellular material, they hold, sider the

wrong

to con-

embryo to be developmentally individuated human

to hold that

Those

inappropriate or simply

it is

who

it

constitutes a living

human

life,

being.

defend a view of delayed animation also point to the

relationship between

mother and child that is

personhood (defined as "Being relationship,

in

essential for

human

communion''). Without that

which requires implantation and development in the

womb, they would argue that the embryo created in vitro is in fact a "preembryo."

As a

potentiaUty, but

its

there

is

it is

not a

it

deserves respect because of

human

person. This implies that

—

a fundamental

—

cal

fertilized egg,

difference

in philosophical language,

between an embryo created

in utero

an ontologi-

and one

ated in the laboratory, at least insofar as the latter transferred to a gests that

womb

for purposes of procreation.

It

is

cre-

not

also sug-

embryos expelled as wastage, prior to implantation and

establishment of the mother-child relationship, are not actual

human

beings but simply hold the potential to

question

is.

Does the embryo

constitute a

apart from any personal relationship

mother? Or

is

that relationship the basic

in transforming a

If

serious

human

such.

being in

itself

may have with

and indispensable

The the

factor

group of cells into an incipient human child?

the theory of delayed animation

no

it

become

is

correct, then

we

could have

moral objections to manipulating or even destroying

89

STAGES ON life's WAY If this

methylation theory is accurate,

so-called

what we misleacRngly term an embryo, then a

we would have to affirm that fertilization. And if so, the preimplanta-

then a child. Consequently,

hiunan tion

confirms the view that the

"preembryo" grows in an unbroken continuum, becom-

ing progressively fetus,

it

begins with

life

embryo should be

legally

and

the fullest sense a himian being

socially

acknowledged to be

in

and deserves to be cherished and

protected accordingly.

This

is

a critical issue that

date, the

very

much

Christians, have vigorously, even passion-

opposed the harvesting of stem

cells

precisely because of the conviction that

human

Roman

to resolve. For to

Roman Catholic and Orthodox churches, together with

numerous Protestant ately,

we need

life,

that

a

it kills

human

from human embryos it

destroys incipient

being. For similar reasons, the

magisterium (the Congregation for the Doctrine of the

Faith) strongly opposes

because again

embryos

—

it

new procreative technologies such as IVF,

involves the creation and destruction of

for purposes of experimentation,

embryos produced

and because not

all

can be transferred to the mother's

in vitro

uterus without the risk of multiple implantations

and consequent

pressure for "fetal reduction," the selective abortion of one or

more of the

children growing within the mother.

With regard

to

and Orthodox

express themselves

ESCR and ethicists

cloning specifically, most Catholic

have concluded that they are morally

somewhat differendy in each cell or cell

cluster,

and each

newly implanted embryo receives new epigenetic information from the uterus.

While such twins share an

identical

genome, the obvious differences

between adult twins indicate that those differences have period prior to implantation.

92

their origins in the

The Use and Abuse of Human Embryos

unacceptable. Their opposition

is

based on the theory of immedi-

ate animation, the conviction that the soul tion.^^ If it

embryo the

is

is

created at fertiliza-

can be shown conclusively that the preimplantation

in fact

merely a substratum of

human

existence, that

phenomena of totipotency and wastage mean

be considered to be a

human

obliged to drop our opposition to least for therapeutic

Because there

that

it

cannot

we would be ESCR and human cloning, at

individual, then

purposes.

a great deal of confusion over these matters,

is

we

should spell out briefly the difference between normal embryonic

procreation and cloning. Cloning

is

achieved asexually by

somatic-cell nuclear transfer. In this procedure, a fully differenti-

ated somatic-cell^^ nucleus from the animal to be cloned is inserted

Roman CathoHc ethicists hold to the theory of immediate animation. Although recent Vatican documents (Donum Vitae, 1987; Evangelium Vitae, ^^Not

all

1995) imply that ensoulment occurs with

fertilization, the

language

what ambiguous ("personal presence," "unity as a body and cally,

the Catholic

God two ethicists

of

human

life

influential Catholic

Cefalo, et

at implantation, largely

al.)

argue for

on grounds of

and wastage. The notion of the soul's infusion at a specific moment,

at conception or latei;

overtones. This

that the

many

(Norman Ford, Thomas Shannon, Robert

locating the beginning of

istic

some-

Church has defended the notion that the soul is "infused" by

or more weeks after conception. Today,

totipotency

is

spirit"). Histori-

embryo

is,

is

is

foreign to

Orthodox anthropology because of its dual-

why it seems preferable to use biblical language and state

rather than has or receives, a soul

(cf.

Gen

2.7,

by the

Spirit

God man became a living being). The question is whether that becoming, in form of a new and ensouled creation, occurs immediately with fertilization

the

or as the result of a process that ^^All cells in the

is

only completed with implantation.

body are somatic

cells,

with the exception of the germ, or

sex, cells, also called gametes. Modifications introduced into

become part of the organism's erations. This

is

genetic legacy

not the case with somatic

93

germ

cells

and carry down to future gen-

cells.

STAGES ON life's WAY If this

methylation theory is accurate,

so-called

what we

misleadiilgly term

an embryo, then a

we would have to affirm that with fertilization. And if so, the preimplanta-

then a child. Consequently,

human tion

confirms the view that the

"preembryo" grows in an unbroken continuum, becom-

ing progressively fetus,

it

life

begins

embryo should be

the fullest sense a

legally

human

and

socially

acknowledged to be

in

being and deserves to be cherished and

protected accordingly.

This

is

a critical issue that

date, the

very

much

Christians, have vigorously, even passion-

opposed the harvesting of stem

cells

precisely because of the conviction that

human

Roman

to resolve. For to

Roman Catholic and Orthodox churches, together with

numerous Protestant ately,

we need

life,

that

a

it kills

human

from human embryos it

destroys incipient

being. For similar reasons, the

magisterium (the Congregation for the Doctrine of the

Faith) strongly opposes

because again

embryos

it

new procreative technologies such as FVF,

involves the creation and destruction of

—for purposes of experimentation, and because not

embryos produced

all

can be transferred to the mother's

in vitro

uterus without the risk of multiple implantations

and consequent

pressure for "fetal reduction," the selective abortion of one or

more of the

children growing within the mother.

With regard

to

and Orthodox

ESCR and ethicists

cloning specifically, most Catholic

have concluded that they are morally

express themselves somewhat differently in each cell or cell clustei; and each newly implanted embryo receives new epigenetic information from the uterus.

While such twins share an

identical

genome, the obvious differences

between adult twins indicate that those differences have period prior to implantation.

92

their origins in the

The Use and Abuse of Human Embryos

unacceptable. Their opposition

is

based on the theory of immedi-

ate animation, the conviction that the soul tion.^^ If

is

created at fertiliza-

can be shown conclusively that the preimplantation

it

human existence, that the phenomena of totipotency and wastage mean that it cannot be considered to be a human individual, then we would be obliged to drop our opposition to ESCR and human cloning, at embryo

is

in fact

merely a substratum of

least for therapeutic purposes.

Because there should

spell

a great deal of confusion over these matters,

is

we

out briefly the difference between normal embryonic

procreation and cloning. Cloning

is

achieved asexually by

somatic-cell nuclear transfer. In this procedure, a fully differenti-

ated somatic-cell^^ nucleus from the animal to be cloned

i^Not

is

inserted

Roman Catholic ethicists hold to the theory of immediate animation. (Donum Vitae, 1987; Evangelium Vitae,

all

Although recent Vatican documents

1995) imply that ensouhnent occurs with

fertilization, the

what ambiguous ("personal presence," "unity cally,

the Catholic

God two ethicists

locating

is

some-

spirit"). Histori-

Church has defended the notion that the soul is "infused" by

more weeks after conception. Today, many influential Catholic (Norman Ford, Thomas Shannon, Robert Cefalo, et al.) argue for the beginning of human life at implantation, largely on grounds of and wastage. The notion of the soul's infusion at a specific moment,

at conception or latei;

overtones. This

that the

language

body and

or

totipotency

istic

as a

embryo

is,

is

is

foreign to

Orthodox anthropology because of its dual-

why it seems preferable to use biblical language and state

rather than has or receives, a soul

(cf.

Gen

2.7,

by the

Spirit

God man became a living being). The question is whether that becoming, in the form of a new and ensouled creation, occurs immediately with fertilization of

or as the result of a process that ^3 All cells in

the

is

only completed with implantation.

body are somatic

cells,

with the exception of the germ, or

sex, cells, also called gametes. Modifications introduced into

become part of the organism's erations. This

is

genetic legacy

not the case with somatic

93

germ

cells

and carry down to future gen-

cells.

STAGES ON life's WAY into

an enucleated oviim (an ovum from which the nucleus has

been removed). The somatic nucleus

is

fused to the host

ovum by

a small electric charge or in culture/ and this initiates cleavage, or cell division.

cells

After four to six days, a blastocyst of

would not be harvested; instead, the

newly created embryo would be transferred to the rogate mother and,

if

possible, brought to term. Cloning, there-

summary, somatic-cell nuclear transfer

the genetic material

is

is

as that of the original animal.

embryo

asexual. Nearly

of

all

derived from the original somatic nucleus

and hence the newly formed embryo has

genome

womb of a sur-

no new or unique genome.

fore, creates

the

sixty-four

forms, from which it is possible to harvest stem cells. In repro-

ductive cloning, the stem cells

In

some

same

essentially the

And the cells that produce

are already differentiated. Natural embryonic repro-

duction (traditional procreation), on the other hand,

is

sexual,

involving the union of a male gamete with a female gamete. This

produces a zygote whose genome

is

indeed unique, although

can be repUcated through twinning and cloning. That zygote undifferentiated

cell;

is

it

an

differentiation will begin only after early

embryonic development. These differences between cloning and natural reproduction are significant. It

has not yet proved possible to clone a

human

being

and produce a viable human embryo by somatic-cell nuclear transfer,

although attempts to do so are continuing in several

countries, particularly in South Korea, Italy, States.^"*

and the United

These attempts, although they hold out the promise of

I'^The Raelian

announcements of successful human reproduction through

cloning were a hoax. Advanced Cell Technology, a Boston-based research

company under the direction of its founder, Michael West, succeeded several

94

The Use and Abuse of Human Embryos

extraordinary

new therapies, have made

clear certain limitations

inherent in the process of nuclear transfer.

mal

The presence of abnor-

DNA methylation patterns in cloned embryos, for example,

seems to be responsible for the low percentage of success in attempts to create clones of mice and bovines. Similar abnormal

human cells. If so, the conhuman cloning may in fact be moot.^^

patterns

seem to be present

tentious

argument over

The ever,

in cloned

fear that hirnian cloning will indeed

has led to interesting,

if

become a

reality,

troubling, questions. Will a

how-

human

More to the point for our purposes is the conclusion dawn by many people that a nonimplanted human or nonhuman embryo produced by somatic-cell nuclear clone be an ensouled being?

transfer

though

is

not, for the reasons just given, a true

embryo, even

can potentially develop into a complete being (mouse,

it

sheep, goat, cat,

etc.).

Since that

years ago in growing a cloned

embryo is the product of asexual

embryo to the

six-cell stage. Recently,

a

research team in South Korea announced successful nuclear transfer in a

procedure that could open the hand, the cloning of individual

way to cloned himian beings. On the other human cells for research purposes has long

been routine.

^^Fairbum

et al., "Epigenetic

Reprogramming,** concludes with the follow-

"The discovery of aberrant DNA methylation patterns in cloned bovine embryos may be an important first step towards increasing the ing warning:

efficiency of [cloning].

But the differences in early methylation patterns

between mice and cows provide strong evidence that what holds true for one

mammal

is

not necessarily the case for

attempting to clone a ^^I

have argued that

human

is

all,

human clones,

if

ever they

be ensouled, personal beings. See John Breck, in Christian Life

2.003),

and

and

is

a further reason

why

simply out of the question."

Faith (Crestwood,

47-55-

95

NY:

become

reaUty, will certainly

God with

Us: Critical Issues

St Vladimir's

Seminary Press,

STAGES ON life's WAY reproductive techniques and possesses no unique genome, the question arises as to

its

moral

status.

Even

if

harvesting stem cells from embryos created

we

consider

cloned

it

we reject the idea of by fertilization, may

morally acceptable to extract those

cells

from

human embryos?

Cloning of human

cells

and tissues has been practiced for years.^-^

Most people can accept it without moral ambivalence, convinced that the scientific teams are working with

with individuated

human

material,

bone, blood,

etc.),

the status of a

or

a conclusion that seems

cell lines in

on the order of somatic

is

human

then the harvesting of

the embryonic clone

individual? If its

stem

cells

the interests of creating

pose no ethical problems.

who

life,

self-evi-

Ambiguity remains, however, regarding the cloned embryo;

dent. is it

human

human material but not

(It is

it is

cells (hair, skin,

itself

merely

to be accorded

human

material,

and the production of stem

new medical therapies would

important to note that to those

defend a theory of delayed animation, there

ference between such a procedure

is

no moral

dif-

and the harvesting of stem cells

from blastocysts created by sexual reproduction. Both are acceptable because neither involves an actual

human

individual.)

i^uman stem cells have been cloned to facilitate skin grafts, bone marrow transplants, etc., as well as for pharmaceutical research.

Shall

We Clone a Man^

Kenneth Alonso,

Genetic Engineering and the Issues of Life (Atlanta:

makes an important point in this regard: "These [cloned] more differentiated somatic cells from a diseased organ removed, for example, or the cells of skin and intestine replaced

Allegro, 1999), cells (as

well as those

surgically daily),

though possessing potentially the information necessary to

replicate

a whole human, are determinate and have identity. But they are not a the

same sense

as

is

the

whole human.

Clearly, then, there

than biology in the determination of the

96

human person"

is

life

in

more involved

(68f).

The Use and Abuse of Human Embryos

As

by defending the position of

have pointed out elsewhere,

I

immediate animation,

we

up a major obstacle

set

to research

which could lead to the development of medicines and other therapies that can potentially cure a broad array of neurological

other diseases. Even though adult stem

cells,

as

and

we shall see, hold

extraordinary therapeutic potential, embryonic stem

cells (in-

cluding those produced by cloning) are easier and cheaper to harvest.

Does God

call

us to oppose this potentially lifesaving and

life-enhancing research?

Or

is

our opposition simply a replay of

the Church's response to the Copernican revolution

and

its

con-

demnation of Galileo, a well-meaning but misinformed and misguided reaction against what science has discovered about the

way God governs

the universe?

Some people might argue

that

we cannot allow science to

dictate

the convictions of the Church. This well-intentioned objection

is

based on a misunderstanding of the relation between science and

our

faith.

God

is

the ultimate source of

all

genuine knowledge,

including knowledge gained through scientific inquiry.

We should

not lapse into a fundamentaUst rejection of scientific findings simply because they call into question view. After

all,

we no

longer find

it

some

aspects of our world-

necessary to argue for a

flat

earth or for "water above the firmament," since our cosmology

now

corresponds more closely to reality than did that of the

author of Genesis.

With regard to the beginning of human

Ufe, then,

we

are faced

today with momentous questions whose answers will determine ^^"The Larger Question," a column in the Life in Christ

dox Church

in

series of tlie

America web page, www.oca.org, August 2003.

97

Ortho-

STAGES ON life's WAY how we future.

respect, protect,

and preserve human existence

in the

One of the most important of those questions concerns the

nature and status of the preimplaBtatioil embryo. This can be finally first

answered only by determining exactly what occurs in the

two weeks of human

life.

Until scientists can provide us with satisfactory answers to this

fundamental question,

we

will be lacking critical information

needed to make certain moral judgments about the nature and status of the gether.

embryo and, we might add, about human

For ultimately there

—

the moral right ourselves? Are

is it

we

in

is

another basic question.

the will of

some

God

—

^to

Ufe alto-

Do we have

use ourselves to heal

bizarre sense cannibalizing ourselves

in the selfish interests of better health

and longer

Hfe?

Or

is it

—

we exploit fully, yet respectfully and with great caution ^the new knowledge and the new technologies at our disposal? Are we being called to beware of the increasingly slippery slope that has ahready produced a culture of death? Or does our capacity to use our own cells for therapeutic ends in fact enable God's will that

—

us, for the first time

command,

and

in nearly miraculous ways, to

obey the

"Physician, heal thyself"?

Manipulated Embryos and Designer Genes The therapeutic usefulness of embryonic stem cells (ESCs) was first discovered in 1998 by James versity of Wisconsin.

ESCs

Thompson and

his

team

at the Uni-

are undifferentiated cells with

two

important characteristics: they can be multiplied to create a permanent reservoir, and they can be induced to become differentiated cells

that perform a specific function. Accordingly, the potential

98

The Use and Abuse of Human Embryos

exists for

stem cells to produce replacement tissue for the body

(e.g.,

blood, nerve, muscle, brain) and even to create entire organs. Their therapeutic potential, therefore,

huge and awesome.

is

The extraordinary plasticity characteristic of ESCs has already led to the production of nerve, heart, muscle,

and other

treat laboratory animals. Until recently,

was thought

could produce only somatic

cells.

In

it

May

cells

used to

ESCs

that

of 2003, however, the

journal Science reported that a team of French and American researchers

had transformed ESCs taken from mice

cells, specifically

into ova. These then

into

germ

line

produced an embryo by

parthenogenesis (vsdthout the benefit of fertilization by sperm).

The embryo remained

viable for only a

pable of becoming implanted.

few days and was

inca-

The team leader, Guy Fuhrmann of

the French Centre National de Recherche Scientifique, noted that

they are presently testing to see as well. If they can,

it

if

ESCs can produce male gametes

means that stem cells retrieved from embryos

have the potential to reproduce not only specific tissues and organs but also entire organisms, each v^th

The media has touted

less

and aging

their occasional

(spring

more

around the corner.

growth into

It

cell

by the autoinmiune system lethal tumors.

At

this point

2005 ), it is still too early to know whether ESCs will prove

useful in the development of various therapies than, for

example,

fetal tissue

has been. In the early 1990s, scientists

focused enthusiastically on fetal diseases such as Parkinson's, ders.

lies just

coverage to the dangers inherent in stem

therapies, including their rejection

and

unique genome.

these successes so as to give the impression

that a panacea for illness

has given far

its

To

date, results

cells in their

search for cures for

ALS, and other neurological

disor-

have been rather disappointing, although

99

STAGES ON life's WAY may prove

recent tests indicate that fetal cells

ment of Huntington's chorea to

useful in the treat-

symptoms of

relieve

spasticity

^

and dementia.

'

The dangers and

limitations of

ESCs and

fetal tissue

need to be

acknowledged. In themselves, though, they do not warrant a

moratorium on research and experimentation. indeed called

for, it is

If

a moratorium

on other grounds, namely, the moral

is

status

of the embryos and fetuses used and destroyed for these purposes. It is this

concern that recently led the Russian Orthodox Church,

under the leadership of Patriarch Alexis municate not only

scientists

who

cells.

grounds for

who

Although to some people this

to threaten to

excom-

clone embryos in order to har-

vest their stem cells but even patients

those

11,

warning are found

seek to benefit from

this

sounds extreme,

in the basic Christian princi-

ple that

we may

another.

To quote Richard Barnes, director of the New York State

not

Catholic Conference,

sacrifice

"We

one

life

in the interest of saving

sympathize with those

who

suffer

ill-

ness or disabilities that can potentially be aided by stem cell research. But nothing can justify the creation

human

and

killing of

beings for the purpose of possibly curing other

human

beings." This statement, of course, reflects the current official

position of the Catholic Church,

which holds to the theory of

immediate animation. With most Orthodox Christians, the

Roman

Congregation for the Doctrine of the Faith beUeves that

science

and theology concur

embryo

as

an

actual,

cloning.

viewing the preimplantation

and not merely a

This perspective has also led distinction usually

in

potential,

human

being.

many in both traditions to reject the

made between

therapeutic and reproductive

To those who defend the theory of immediate animation,

100

The Use and Abuse of Human Embryos

any such distinction

embryo Ufe,

a

human

nonexistent.

being,

and not

then creation of that embryo

stem is

is

is

ceils are

harvested, then the

indeed the preimplantation

If

just the

is

substratum of

human

ipso facto reproductive. If

embryo

dies

its

and a human being

killed in the process.

A theory of delayed animation, however; leaves room for a legitimate distinction to be

The

tive cloning.

early

embryo

latter

made between

therapeutic and reproduc-

would occur only with

to the mother's

womb.

If

the transfer of the

such a transfer

rejected

is

on principle, then researchers would be free to create embryos the purpose of acquiring

and manipulating

out moral consequences. This the

Human

is

their

stem

the conviction that

cells, lies

for

with-

behind

Cloning Ban and Stem Cell Research Protection Act

0/2003, cosponsored by Senator Arlen Specter (R-PA), one of the

most ardent supporters

would allow

in

for the cloning

act

and manipulation of embryos

for

therapeutic purposes during the tence, after which,

ESC

The

Congress of

first

research.

fourteen days of their exis-

by law, those embryos would have to be

destroyed. While this latter provision

is

to prevent reproductive

cloning, including the creation of designer babies, to those

consider those embryos to be

human

beings,

it

who

marks another

human life.^^ Everything, then, turns on the question. When does human

government-sponsored step toward the desecration of

life

begin?

The matter of embryonic stem

cell

separated from another issue that

^^The Specter

bill

101

I

causing a tremendous

stir

prompted Senator Rick Santorum to propose a ban on Human Cloning Prohibition Act of 2003.

cloning by introducing the

I

is

research cannot really be

STAGES ON life's WAY because of

its

potential long-term consequences. This

of "designer genes," the modification of one's

ducing into

it

is

the issue

genome by

intro-

genetic material that4ias been altered for a specific

purpose, either to replace defective genes in hopes of curing disease, or to

enhance certain traits deemed desirable, such as height,

strength, intelligence,

and

amiability.^^

One

of the most vocal

opponents of the "new eugenics" program that presently

embarked on

Enough: Staying

is Bill

Human

in

McKibben.

In his recent book.

an Engineered

declares that "lured by the prospect of

scientists are

Age,^'^

making

McKibben

better babies,

stand on the threshold of changing forever what

it

we

means to be

human." As an example, he quotes Michael West,

CEO

of

who declared that "the dream of biologists is to have the sequence of DNA, the programming code of life, and to be able to edit it the way you can [edit] a docAdvanced

Cell Technology (ACT),

ument on a word

processor."

Michael West has been

by everyone from the president to

vilified

the pope because his

company produced

clone (although, as

we

stage).

noted,

it

the

first

known human

survived only to the six-cell

To many minds, the ACT team proceeded with inadequate

precautions and with blatant disregard for the legislative debate that might well have

made its research illegal.

It

plunged ahead with no consideration for the

human

seemed that they

intrinsic value of

life.

^^Gene therapy in somatic

cells

many human embryos.

has been practiced successfully for

years.

The question

^^Bill

McKibben, Enough: Staying

at issue concerns inserting genes into

Human

York: Times Books, 2003).

102

in

an Engineered Age (New

The Use and Abuse of Human Embryos

summer

In the

of 2003,

1

spoke at length with Michael West and

came away from the conversation moderately argued, in fact, that

my

position

and

his

if

light years.

sation persuaded that he, like

the

holds

I

did not point out the fact

But

I

did leave the conver-

most other scientists working in the

human life in the highest regard. These people are not

wanton

desecrators they are so often depicted to be.

This said, however, the kind of caveat formulated by

and others needs to be heard. The slippery slope sures

is

McKibben

real,

and pres-

toward a new eugenics movement are powerful, perhaps

irresistible.

The human genome now has been sequenced, and the

capacity does exist to "program the code of

some

living

life

my position of immediate animation is correct, then those

few days are equivalent to

field,

human

being

the appearance of the primitive streak. that

He

—a —comes into existence only with implantation and

apart," since he believes that individuated

human

relieved.

were "only a few days

radical exceptions,

world opinion

is

life."

Although, with

solidly against

human

much less opposition has been voiced regarding the modification of the human germ line for purposes of "ameliorating" the human gene pool or "improving" inherited characteristics.^^ But as McKibben points out, those who engage in eugenics are captive to the "myth of the perfect cloning for reproductive purposes,

child."

Such perfection, or even the desire to accord our children

^^See the following articles in Hastings Center Report-.

Nanqr M.

P.

King,

"Accident and Desire," Hastings Center Report (March-April 2003), 23-30; Mark Frankel, "Inheritable Genetic Modification and a Brave New

2003 ), 3 1-3 6. These articles germ line effects produced by gene transfer. Not all modintroduced into the genome by these new techuologies are inten-

World,** Hastings Center Report (March-April discuss inadvertent ifications

tional,

nor do

all

of them represent improvements.

103

STAGES ON life's WAY certain genetic advantages, will always remain unattainable. This is

because of the laws of competition. Wealthy parents will seek

to give their children an edge relative to die children's peers

so will program certain capabilities into the embryo. ling

comes along a few years

latere

and

When a sib-

however, technology will have

advanced. This second child, then, will be further programmed

with the outstrip

latest genetic

older sibling in as

its

ming will

improvements. That child will inevitably

allow. This

means

many ways

as the

new program-

that there will be constant social

and

economic pressure to "upgrade" our children, much like the pressure to will

buy the

latest version

The

of computer software.

result

be to turn our children into products rather than autonomous

persons.

And

utilitarianism will

have achieved

its final

triumph.

Add to all of this the effects of natural curiosity ("Can it be done? If so, then do it!") and we have a formula for unbridled abuse. Perhaps the most appalling example to date

on July

New

2003, concerning

3,

York-Chicago

duction.^^

fertility

Norman

is

the one

announced

Gleicher and his private

group. Centers for

Human

Repro-

The group's research team created a human "shemale"

by transplanting

cells

from a developing male embryo into a

three-day-old female embryo.

The

resulting hybrid

nous, a hermaphrodite combining thoroughly

and female

characteristics.

was androgy-

programmed male

Supposedly undertaken to faciUtate

research toward various therapies, the experiment

condemned by European

scientists,

was roundly

one of whom declared, "This

research happened in America, but

I

can't imagine

it

being

accepted anywhere in Europe, I'm happy to say!" The obvious rejoinder

is,

"Just

you wait ..."

^^www.ananova.coin/news/story/sm_79 629 5 .html ?menu.

104

The Use and Abuse of Human Embryos

ominous, but a source of equal concern,

Slightly less

ing production of chimeras,

life

ACT

scientists

human

somatic

human and

had created a transgenic cow, a

Cibelli

and

cell into

the

human-bovine hybrid. Jose nucleus of a

forms that are part

the grow-

May of 1998, the journal Science

part something else. Already in

reported that

is

his

team inserted the

ovum

of a cow, also in

the interests of research. At the turn of the millennium, a San

Francisco

company announced whose brain

quarter of

entists at the

cells

their

had created a

strain of mice, a

And

just recently, sci-

were human.

Second Medical University

reported that they had fused [ova] to

it

"human

in Shanghai, China,

skin cells with rabbit eggs

produce early stage embryos, which

stem

claiming

cells.

it

"^"^

The research team

was a means

human embryos.

Pro-life

in turn are killed for

justified the

for providing

experiment by

ESCs without

groups have raised their voices against

the procedure, however, because of the mixing of

animal

cells.

sacrificing

human with

The chimeras of ancient Greek mythology,

it

seems,

are prescient images of today's unsettling reality.

Ethical

and Not-So-Ethical Alternatives

Where does at the

all

of this leave us? Are

bottom of the slippery

nize ourselves as truly

endowed with

slope, unable

human

the image of

we destined

to land in a heap

any longer to recog-

or to appreciate ourselves as

God?

Fortunately, with regard to stem cells

and

peutic value, there are alternatives to

ESCs

their potential thera-

that

may

well prove

equally useful and effective. Perfecting those alternatives will not

^'Svww.iifenews.com/bio5 3 .html.

105

STAGES ON life's WAY Stop morally challenged researchers from creating chimeras and carelessly destroying embryos.

use and abuse embryos as successful

and

But

it

might eliminate the need to

we do no\v, for purposes

lucrative therapies to treat

of developing

and possibly cure dev-

astating diseases.

Of

the alternatives

now

available or being developed that have

been proposed as ways to eliminate the need to create embryos for their stem cells,

we can mention and comment briefly on five:

(i)

"extra embryos" from FVF procedures, (2) parthenogenesis,

(3)

"master genes,"

(4) tissue engineering,

(i)

Extra Embryos,

A growing number of voices, including those

and

(5) adult

stem cells.

of pro-life activists, are urging governments to sanction the use of the hundreds of thousands of "extra embryos" that are

left

over

from IVF procedures throughout the world.^^ These have been cryopreserved (frozen) either to be implanted in the mother's

womb

if

the

first series

does not "take," or

else to

be used for

experimentation, in order to perfect FVF techniques or to extract their

stem

cells.

and offered to

In rare cases, they have been put sterile

couples or to single

up

for adoption

women who

wish to

bear them and bring them to term. Normally, such frozen

embryos are destroyed better

after

and more reasonable,

about it is

five years. Certainly it is far

argued, that they be used to fur-

ther reproductive technologies than that they be destroyed,

allowed to

die,

or otherwise go to waste.

Orthodox and Roman Catholic on the grounds

^^It is

that those extra

estimated that there are

ethicists

tend to reject that logic

embryos should never have been

some 400,000 such embryos

States alone.

106

in the United

The Use and Abuse of Human Embryos

created in the

demns rVF

first

The Catholic magisterium

place.

altogether, as

it

procreation, because of

manipulation of them.^^

in fact con-

does other forms of medically assisted

what

perceives to be the

it

human gametes and

The Orthodox have been

immoral

the embryos formed from

less

outspoken about assisted

reproduction in general. They have reached the clear consensus,

however^ that extra embryos should never be created and, a fortiori^

that they should never be subjected to experimentation.

basis for this rejection

once again

is

The

the principle enunciated in

Romans 3.8, that we may not do evil so that good may come. However promising embryo research may be, however great the potential for therapies derived

from embryonic stem

cells,

the

ends simply do not justify the means. (2)

Parthenogenesis.

Some people concerned with

these issues

have argued that a morally acceptable alternative to the harvesting of ESCs can be provided by the technique genesis.

The term means

generation." tion, in sion. In

It

known as partheno-

literally "virgin birth"

or "virginal

consists in asexual reproduction without fertiliza-

which an ovum February 2002,

is

chemically induced to begin

ACT

scientists

cell divi-

reported in the journal

Science that they had created a line of stem cells by parthenogenesis;

the

ovum

of a

macaque monkey was chemically induced

to

begin segmentation.

The pressing

ethical question

is

whether embryos created by

parthenogenesis have the same moral status as those created by natural fertilization.

The journal Stem

Cells reported in early

^^See especially the Congregation for the Doctrine of the Faith, "Instruction

on Respect for Human Life

(Donum

Vitae),

in Its Origins

February 22, 1987.

107

and on the Dignity of Procreation"

STAGES ON life's WAY 2003 that both mouse and human embryos had been produced by parthenogenesis. Since these could not

gestate,

some

scientists

concluded that they are unique and do not qualify as true embryos.

The reason such embryos cannot gestate, however, is because they lack a trophoblast (the outer layer of the blastocyst), which essential for the

formation of the placenta. They cannot grow

because they cannot implant. Yet in identical to ordinary cally

is

from human

embryos.

cells are

If

all

other respeas, they are

embryos derived parthenogeni-

to be considered

nonhuman simply

because they cannot gestate, then any miscarried child would also

have to be

classified as

nonhuman.

Others have argued that parthenogenically produced embryos are in a class apart because they are

not the product of syngamy, the

union of a male and a female gamete. Since they possess no unique genome, they are not endowed with genetic individuality

and therefore are not human embryos

in

any conventional

sense.

Yet the same could hardly be said of an identical twin, whose

genome

From

is

not unique

either.

the viewpoint of Christian anthropology, parthenogenic

embryos possess the same moral

status as

any other human

embryo. This does not mean, however, that the Church can sanction or bless the manipulation that produces them. If we speak of

procreation rather than reproduction,

it is

because

we understand

"God made them male and female," with the aim that they participate in God's ongoing work of creation (hence procrethat

ation).

The

divinely willed

ing this creative activity

is

and

divinely given

means

for continu-

through the sexual union of a

108

man and

The Use and Abuse of Human Embryos

a,

woman. They become one flesh in relation to one another, a new

creation that brings forth a further

the offspring

who

embryos that reduces them to nothing more than reproit

them of human

providing stem

cells for

Master Genes, In

thwarts their God-given purpose and

dignity.

As an

alternative

method

for

therapeutic purposes, the parthenogenic

creation of embryos, then,

(3)

form of

and exploitation of gametes and the

ductive material. Thereby

deprives

creation in the

are born of their union. Parthenogenesis

involves a manipulation resulting

new

morally unacceptable.

is

May

of 2003, the scientific journal Cell

reported the discovery of so-called master genes. These are the

genes that are responsible for the pluripotency of embryonic stem cells. Scientists

named them "nanog

Celtic land of Tir

Nan Og, whose

young. By inserting copies of

embryonic mouse those

cells

from

cells,

inhabitants remain forever

human nanog

or master genes into

researchers found they could prevent

They

differentiating.

expression so that the

genes," from the mythical

cells

successfully inhibited gene

functioned as pluripotent stem

cells.

This seemed to be an acceptable alternative to the harvesting of

human embryos were

ESCs, because no

created.

Nevertheless, in perfecting the technique, a great

embryos have to be destroyed. Moreover, the involves creating chimeras using is

to reprogram

genes,

human

and thus to

entire process

human cells. Although the hope

adult cells by activating their master

restore

can function as stem

many human

cells,

them

to a state of pluripotency so they

those

who defend a theory of immedi-

ate animation find that the procedure raises irresolvable

that lead inevitably to the abuse of

109

human embryos.

problems

STAGES ON life's WAY (4) Tissue Engineering,

A

far

more

positive

development

one

is

that promises to eliminate both the need for organ transplants

and the use of ESCs. This which aims to create

is

the

new

field

of tissue engineering,

body

in the laboratory cells,

even vital organs. For many years,

scientists

and

tissues,

have been able to

cul-

The problem has

ture cells to produce two-dimensional tissues.

been to create three-dimensional structures that will allow for the

making of entire organs. In early 2003,

scientists at

Clemson Uni-

and the Medical University of South CaroUna announced

versity

through the local media that they had developed a process for

tis-

They did

sue printing that could produce just such 3-D models.

so by creating a scaffold using alternating layers of cellular

clumps and a supergel. The device adapted for simple desktop printer, modified so that living

this

cells

purpose

is

and the gel

a

fill

the printer cartridges, and the nozzle prints alternating layers

onto a glass sUde. As the

cells

grow and form

clusters, the gel is

washed away. This gradually produces cellular structures that can develop into whole organs. The potential of this procedure that

it

such

has been backed by the National Institutes of Health. The

research team estimates, however, that they are years

is

away from

five to ten

true organ construction.

The promise of this new technology, even extraordinary. If it can be perfected, vesting

still

it

in

its

infancy,

is

indeed

would eliminate organ har-

and transplants, just as it would put an end to the creation

and destruction of human embryos

in order to acquire their

stem

how-

cells.

Tissue engineering also requires stem cells. Those

ever,

need not come from embryos. They can be harvested from

an inexhaustible reservoir of adult somatic that

we need to

direct

our attention.

110

cells,

and

cells,

it is

there

The Use and Abuse of Human Embryos

(5)

Adult Stem

Cells,

Whether we opt

or delayed animation, there

is

for a theory of immediate

only one real solution to the prob-

lem of the use and abuse of human embryos. This quest for stem

cells to

to limit our

those found in sources such as placentas,

umbilical cords, and adult somatic Verfaillie of the University of

ery of

is

MAPCs—^multipotent

cells.

In late 2001, Catherine

Minnesota announced her discovadult progenitor

Commonly

cells.

referred to as adult stem cells, these have roughly the

apeutic potential as ESCs.^^

The

in such diverse sources as blood, sue,

and even baby

ther-

have been found

fact that they

bone marrow,

same

skin, fat, brain tis-

teeth suggests that practically

any

cell in

the

human body might have its DNA rendered pluripotent so that the cytoplasm can be reprogrammed to

needed for the production of cell,

in other

initiate the

specific tissues.

gene expression

Any

adult somatic

words, might contain the potential to serve in the

place of embryonic stem cells.^^

^^Through 2002, adult stem

cells

were considered by most

multipotent rather than pluripotent, as are ESCs.

were programmed only for

It

was

specific tissues (hematopoietic

example, thought to be able to produce only blood-cell

scientists to

be

believed that they

stem

lines),

cells,

for

and that they

cells. More may not exist, as suggested by

could not be multipUed indefinitely to produce undifferentiated recent research indicates that such limitations

our continuing discussion and the following footnote. 28 Ted Peters of the

Center for Theology and the Natural Sciences suggests

this possibihty in his article

Cell Debates,"

"Embryonic Persons

Theology and Science i,no.

the Ust of scientific questions the

is

this one:

in the

Cloning and Stem

(2003): 51-77.

i

how

He writes, "On

does the cytoplasm

program

DNA nucleus so as to express the genes that make specific tissue? Once

this is learned

and technical control of gene expression

haps the cytoplasm in virtually any somatic specific

gene expression" (66).

Ill

cell

is

attained, then per-

could be reprogrammed for

STAGES ON life's WAY To

date,

no

safe

and

developed for use with

effective treatment using

human beings.

ESCs has been

Reports have recently been

published, nevertheless, indicating that

human embryonic

can repair myelin, the insulating layer that surrounds nerve

cells

fibers.

Rats, paralyzed because of spinal cord injuries, have been successfully treated,

and the hope

is

that the technique might prove

adaptable to impaired patients. For the time being, however,

it

remains merely a hope.

Adult stem

cells

(ASCs), on the other hand, have already proven

to be highly effective in clinical trials using both animal

and

human

subjects.

Areas in which successes have been recorded

include

immune

deficiency disorders, stroke, sickle-cell anemia,

leukemia

(as well as

lymphoma, pancreatic cancer, and other can-

cers), heart disease,

Parkinson's disease.

type

i diabetes, spinal

The following

sources, including scientific journals

#

list

was

culled

and Internet

injuries,

and

from various

sites.

April 2002: California Parkinson's patient Dennis

Turner was treated with his

own neural stem cells. His

symptoms were reduced by over 80

*

cord

percent.

February 2003: Sixteen-year-old Dimitri Bonneville's heart

was pierced by a

three-inch nail.

ASCs from

his

own blood were injected into his coronary artery, providing significant improvement.

^^For useful information, check the following: http://stemcells.nih.gov; http://excr.nih.gov; wwrsv.prolifeinfo.org; www.americancatholic.org;

www.ananova.com/news/science&discovery; New England Journal of Medicine; Journal

of the American Medical Association; Hastings Center Report;

National Catholic Bioethics Quarterly

(esp. vol. i, no. 2,

112

Summer

2001).

The Use and Abuse of Human Embryos

# March

2003: The journal of Clinical Investigation

reported successful treatment of diabetes using ASCs.

Bone-marrow stem producing beta

*

April 2003:

cells

cells to

The

were converted into

replace

insulin-

damaged pancreas cells.

British journal

Nature reported that

symptoms

brain stem cells injected into mice relieved

of muscular sclerosis. They stimulated myelin-producing cells to repair lesions

on the nerve

sheaths.

Throughout 2003 and 2004, research continued, proving the usefulness of adult stem cells for various therapies ability in a

broad variety of body

tissues.^^

and their avail-

Most

recently, in

December 2004, German researchers reported that extracted from the fat of a seven-year-old

damaged bone

in

skull; fat cells, in other

human

beings.

girl

cells

helped repair her

words, can apparently generate

At the same time,

scientists at the

Johns

Hopkins School of Medicine and elsewhere announced the covery of a reservoir of stem

with stem repairing

cells

cells in

the heart. These, together

derived from bone marrow, offer

damaged

dis-

new hope

for

heart tissue.

These successes with adult stem

cells

have been matched,

if

not

surpassed, by stem cells taken from placentas and umbilical cords.

Cord blood cells,

for example, recently provided a cure for

^^See, for example, the following articles

K. Hirschi and

M.

from the journal Gene Therapy. K.

A. Godell, "Hematopoietic, Vascular and Cardiac Fates

of Bone-Marrow-Derived Stem Cells,"

Gene Therapy 9, no. 10 (May 2002):

648-52; and A. Peister et al., "Stable Transfection of MSCs by Electroporation," Gene Therapy 11, no. 2 (January 2004): 224-28. ("Human marrow stromal

ogous

cells

cell

[hMSCs] are an

and gene

attractive source of adult

therapy** [from the abstract].)

113

stem

cells for autol-

STAGES ON life's WAY who was

three-year-old Spencer Barsh,

afflicted

with

adrenoleukodystrophy (ALD), an inherited metaboUc disorder in

which the myeUn sheath of nerve sively lost.

fibers in the brain is progres-

Leukemia and diabetes

afflicting fifty-four-year-old

Steven Sprague were cured by a cord blood transplant. In

fact,

successes with cord blood have been hardly less than spectacular, offering further evidence that stem cells

from sources other than

embryos are readily available and possess a remarkable therapeutic potential.^^

It

should be noted, nevertheless, that adult stem

embryonic counterparts, pose certain itations.

They

we have

seen, they exist in a

and are

are relatively rare in the

by the

factors lead

recipient's

And

(although, as

tissues

and organs)

stem

suffers

cells

from a genetic

might transfer that

there remains the possibility of

autoimmune system. These and other

many scientists, whose moral integrity is unquestion-

able, to conclude that successful

medicine requires and

stem

clear lim-

pure form that makes them ther-

disorder^ transplanting his or her

rejection

human body

donor of such cells

disorder to the recipient.

and exhibit

wide variety of

difficult to isolate in the

apeutically useful. If the

risks

cells, like their

justifies

development of regenerative

continued research on embryonic

cells.^^

^^The National Cord Blood Program of the lected over twenty

New York Blood Center has col-

thousand donations of cord blood, which can be banked

for future use. See the report of the

NCBP, dated June

12, 2003,

www.nybloodcenter.org.

3^0n

this issue, see the

study produced by the National Research Council,

and the Future of Regenerative Medicine (Washington, D.C.: National Academy Press, 2002), esp. 19-39 on adult and embryonic stem cells and their promise and limitations. Stem

Cells

114

The Use and Abuse of Human Embryos

Conclusions

Orthodox

Christians, including priests

hold that Scripture and

and theologians, often

liturgical tradition

support the notion of

immediate rather than delayed animation. They point to Old Tes-

tament passages such as Psalm 13 8/13 9.1 3, where the psalmist

God

declares that

Jeremiah 1.5, where

you

God

in his mother's

womb,

assures the prophet, "Before

I

or

formed

womb I knew you, and before you were bom I conseyou." One of the most frequently cited New Testament

in the

crated

passages

is

kinswoman

Luke 1.39-42, which recounts Mary's

was

visit

to her

When Elizabeth heard Mary's greeting, her womb" in acknowledgment that Mary

Elizabeth.

"the babe leaped in

herself pregnant with the Messiah.

None the

him together

"knit"

of these passages, however,

Church celebrates

is

decisive.

Nor

is

the fact that

feasts of the conceptions of Christ, the Vir-

gin Mary, and John the Baptist. Each of these scriptural and liturgical texts affirms the idea that individual, exists "in the belly,

body

the ancient tubes. ily

The

womb." Yet by "womb"

(beten, koilia: stomach,

cavity) the bibUcal passages signify the uterus, since

Hebrews knew nothing of ovulation and

biblical

and

liturgical witness, in other

fallopian

words, can eas-

be understood to support a notion of delayed animation that

situates the beginning of

If

even personal, Ufe

human life

at implantation.

many of us feel uncomfortable with this conclusion, it is largely

because of the famous slippery slope. titudes of

We are well aware that mul-

embryos have been created and destroyed

for utilitar-

we are to slow the sUde toward unrestricted manipulation of human life at its elemental stage, then we feel we ian purposes.

If

115

STAGES ON life's WAY wind and

must

insist against

That

insistence, however, as

tide that life begins at fertilization.

we have

show,

tried to

grounded, based on evidence provfded by

specialists in the field

of embryology as well as on the Church's ages-old intuition. are correct, there

is

no such thing

as a preembryo,

between gametes and embryonic

ate stage

well

is

life.

If

we

an intermediAccordingly,

despite the objections to the theory of immediate animation raised

by the totipotency of the blastomeres and the phenomenon

of wastage,

we

continue to defend the notion that conception

occurs at a protracted

ovum unite To remain then,

last as

the nuclei of sperm and

to create the genetically unique, single-cell zygote.

faithful to the perspective of

we must

tion that

moment when

any reformulation of the notion of concep-

resist

would

Orthodox anthropology,

define

it

as

an ongoing process, one that might

long as ten or twelve days, beginning with formation of the

zygote and coming to completion only following implantation

and the appearance of the neural

streak.

As much

as the scientific

community, pharmaceuticals industry, and other vested

interests

might want to convince us of some theory of delayed animation,

we must

continue to

insist,

dence, that individuated

on the

human

basis of

life

sound

scientific evi-

begins during the very

first

stages of mitosis.

Manipulation of the ethical issues

the

human embryo

we have

most important,

is

one of the most

to grapple with today. Yet

since the

it is

difficult

also one of

approach we take depends on our

116

The Use and Abuse of Human Embryos

understanding of the meaning and value of

human

hfe

postmodern world, there are enormous pressures to

this

commodity

as a

to be exploited for utilitarian ends.

members of the body of Christ,

responsibility, as

proclaim a different truth: that

human

destined to return to the transcendent

life

life

itself.

In

treat life It is

our

to perceive

and

from and

derives

is

of the Holy Trinity.

—

Human life from fertilization until biological death—is a sacred gift,

destined for a greater and

more

glorious existence than our

minds and hearts can imagine. Our moral

God and

before each other,

preserving and protecting existence.

its

It is

the developing ister to

embryo

responsibility, before

to acknowledge that sacredness by

human

life

at each

to behold the presence

and every stage of

and purpose of God

as well as in the dying patient,

in

and to min-

both with unfailing love and compassion. Thereby we can

honor the divine image death, as

of

is

in all

human persons, from conception to

we surrender them into the merciful hands of the author

life.

Glossary

A cell of the early embryo, produced as the fertilized ovum divides before it implants in the wall of the uterus. A blas-

blastomere.

tomere

is

a totipotent

cell

produced by mitosis, the segmentation

or division of the original one-cell zygote. (The totipotency of the early ine

embryonic

cells is lost

once the embryo implants in the uter-

membrane.) Each blastomere contains the

full

genome and

thus contains the potential to develop into a unique organism. blastula, blastocyst. five

days after

A

spherical cluster of cells,

fertilization.

From about

117

formed four or

the sixty-four-cell stage.

STAGES ON life's WAY the morula (an aggregation of blastomeres) becomes a blastocyst,

a hollow, fluid-filled sphere, concave and bounded by a single layer of cells.

The

forms the inner portion

cavity, or blastocftele,

of the blastocyst and contains embryonic stem cells. layer

becomes the trophoblast

(or chorion),

which produces the

becomes the embryoblast. This

placenta; the inner cell mass

form the embryonic

During the fourth

organizes

itself

week,

develops into a tube-shaped gastrula.

this

to

DNA (deoxyribonucleic acid). The

disc.

"genetic blueprint" of

molecule, found mainly in the nuclei of inherited characteristics.

The outer cell

The molecular

cells,

life;

a

which determines

basis of heredity,

DNA

is

constructed of a double helix held together by hydrogen bonds, plus oxygen

and carbon. The

purine and pyrimidine bases

helical chains are linked

ATGC:

by the

adenine, thymine, guanine,

These bases code hereditary information in the polynu-

cytosine.

cleotide chain of

DNA.

(Uracil replaces

thymine as one of the

bases that codes genetic information in the polynucleotide chain

of RNA.)

The human genome is composed of some 3 5,000 genes,

segments of

epigenesis.

DNA that code for proteins.

The development of a

plant or animal from an egg or

spore through a series of processes in which unorganized

cell

masses differentiate into organs and organ systems. Epigenesis the process that leads

from the genotype

(the genetic

is

composition

of an organism) to the phenotype (the physical -properties or

makeup

of the organism that results from the interaction of the

genotype and the environment). fertilization.

The process by which a male gamete

(sex cell)

and a

female gamete unite to form a genetically unique single-cell

118

The Use and Abuse of Human Embryos

zygote and thereby initiate the growth of a ization initiates this development full

new individual.

by restoring

Fertil-

in the zygote the

somatic number of forty-six chromosomes, arranged in

twenty-three pairs, half received from the

ovum and half from the

sperm.

I

gastrulation.

The process, occurring with implantation, by which

the cells of the tissues

embryo become

specialized to

and organs. Gastrulation marks the

development that leads to singularity

(loss

form various body

stage of embryonic

of the capacity for

twinning) and the onset of organogenesis (development of organs). Gastrulation establishes the three primary

germ layers of

the embryo: the ectoderm (forms brain, nerve, skin, hair, nail,

eye tissues), the

mesoderm (forms

and

heart, bones, muscles, glands,

and reproductive organs), and the endoderm

circulatory system,

(forms the epitheUum of the digestive tract and respiratory sys-

tem, and produces certain internal organs).

methyl, methylation.

A chemical marker that indicates the begin-

ning of gene expression, as different genes are activated in the early embryo.

Methyl is a chemical substance (CH3 derived from )

methane by the removal of one hydrogen atom. (Methane [CH4], a gaseous hydrocarbon,

is

produced by the decomposition of

organic matter.) Methylation refers to the introduction of a

methyl group, as into the cytosine base of note

DNA.

(See chap. 3,

9.)

morula.

A globular mass

sixteen-cell stage of

of blastomeres, beginning at about the

embryonic development. The morula

is

pro-

duced by the cleavage or segmentation of the zygote through mitosis. {Morula:

from the Latin and Greek

119

for "mulberry.")

STAGES ON life's WAY totipotenqr.

The capacity of an

individual blastomere to develop

into a genetically unique organism, or to differentiate (become

transformed into any of that organism's

cells

or tissues). Pluripo-

tent or multipotent cells (such as stem cells) can develop into specific cells is

or tissues but not into complete organisms. Totipotency

lost at gastrulation.

zygote.

The

gamete (sex

single-cell cell)

organism created by the union of a male

and a female gamete, containing a

full

ment of forty-six chromosomes. The zygote marks the in

comple-

first

stage

an individual's growth and is both genetically and developmen-

tally

unique.

120

"

11

chapter four r

I

I

THE SACREDNESS OF NEWBORN LIFE Jesus took a child

and put him

in the

midst of them.

And

taking him in his arms, he said to them, ''Whoever

my name receives me; and whoreceives not me hut him who sent me,

receives such a child in

ever receives me,

—^Mark 9.36-37

Recent discussions in bioethics have focused the public's attention abnost exclusively

stem

cell

on the

issues of

research and the cloning of

embryonic

human embryos.

These are crucial issues that threaten to undermine the conviction, basic to

Orthodox

Christianity, that

human life is inherently

sacred and deserves to be nurtured and protected from conception until death. ^ Ethicists

who

are caught

up

share this belief in the sacredness of in cultural warfare

human

life

with opposing forces whose

chief motivations are the potential profits to be

made from stem

^This chapter appeared in a slightly modified form in John Breck, "The

Sacredness of

Newborn

Life," St Vladimir's Theological Quarterly 47, no.

2 (2003): 221-27.

121

STAGES ON life's WAY based therapies, together with preservation of the right to

cell

abortion on

demand

at

any stage of a pregnancy. For

ernment were to acknowledge thatliumah

—^meaning

tion

—

fertilization

^then

it

life

if

the gov-

begins at concep-

would jeopardize

the future

of embryo experimentation and undermine the principle of unrestricted abortion enshrined in judicial interpretations of

Roe

v.

Wade,

The dust cloud kicked up by matter that

rights over responsibilities

value of persons. This social, famihal,

In

what

is

that child

newborn

child

and our

and ecclesial responsibilities in that child's regard.

follows,

calls

and convenience over the

the issue of the

I

would Uke

the child in vitro or in utero

God

has obscured a related

equally significant in today's utilitarian atmosphere,

is

which places

this struggle

to

move away from the

question of

and turn our attention to the way

us to welcome the newborn infant, particularly is

marked by some form of genetic anomaly or

when physi-

cal disability.

As we advance

into this

dren are facing a

crisis

new millennium,

it is

clear that our chil-

worse than they have ever known. Chil-

dren have always been threatened by poverty, forced labor, prostitution,

and abandonment. Today, we have to add to that list

such threats as partial-birth abortion, which

emerges from the

who

womb;

believe a child

infanticide,

kills

a child as

recommended by

must demonstrate a

ethicists

viability free of genetic

defects in order to have the right to Hve; together with

palling increase in violence, both in school

estimates suggest that one

and that one

American child

in six suffers

it

and

at

an ap-

home. Recent

in five lives in poverty

from hunger. Although drug use

is

dovm relative to its levels of ten years ago, it is concentrated today

122

The Sacredness of Newborn

I

Life

—and not only the poorest—and,

in certain sectors of society

as

I

the French writer Francois Chateaubriand said about love,

I

"devastates the souls in which

it

it

reigns."

I

I

In 1999, the whole world

came

to

know

the

name

of Littleton,

Colorado. This obscure western town became a symbol of the violence

and wanton

killing

committed increasingly by young-

I

sters against their

ited

own

kind. Hospital emergency

by a growing number of children

and sexually abused.

who

rooms

are vis-

have been physically

Much of that abuse has been perpetrated by

Christian parents and clergy. In Europe as well as in the United States, certain

forms of violence directed against the very young

have become virtually institutionalized. ple, gross neglect

We may note, for exam-

and abuse in the foster care system; or the incar-

ceration of teenagers with adults in our state prisons, where the

frequency of rape makes their punishment, by any civilized standard, "cruel and unusual."

And

it is

clear that the responsibility

for these kinds of violence lies in large part with social

and eco-

nomic systems that favor the wealthy and the powerful over the poor and the

defenseless.

In the face of

all

of

this,

we can well understand why so many of

our young people no longer find any meaning to their future. In

become

many

life

or hope for

parts of the world, children are born to

either victims or aggressors, or both. (Think, for

ple, of the generations

exam-

of Lebanese and Palestinian youths

who

—and the

have spent their entire childhoods in a world at war children of Iraq

who

To be

is

sure, this

tion that gives too

are swiftly joining their ranks.)

a one-sided and pessimistic view of the situalittle

consideration to the

123

many

children

who

STAGES ON life's WAY are nourished by loving families

and supported by intelligent and

effective social structures. Nevertheless, there

no denying

is

that

many children today find th&iselves in a crisis not of their

a great

own making. body of

It is

incumbent on

Christ, to seek out

us, therefore, as

ways to ameUorate

members of the

this critical situa-

tion faced by our children even before the time of their birth. This

the

is all

more necessary when

marked with

disabilities,

it is

a matter of those children

who by that very fact are

systematically

marginalized and often threatened with extinction.

The Newborn Child and the Newborn

Who

in fact

is

this

Christ

we know and welcome

one

as the

newborn

child?

To answer the question. Christian anthropology Christology.

To understand who we

the image of the eternal

humanity,

are,

Son of God, who

who became

flesh

we need is

refers us to

to begin with

the archetype of our

by assuming the

fullness of

our

human condition and our human destiny, including death. A mystery envelops every child, a mystery

of the Christ child. This

is

whose key

loving affection or aborted as an

This ceive

is

image

is

is

welcomed with

unwanted nuisance.

the fullness of time came," St Paul

forth his Son, born of a

in the

true whether the child in question

born thriving or born dead, whether that child

"When

lies

woman, bom under

tells us,

"God

sent

the law" (Gal 4.4).

the child prophesied by Isaiah: "Behold, a virgin will con-

and bear a child, and shall call his name Emmanuel," which

means "God

is

with us"

virgin, is described

(Is

7.14). This child,

bom

of a humble

by the author of the Episde to the Hebrews

124

in

— The Sacredness of Newborn

remarkably exalted language: "In these

ken to us by a Son, through

whom

glory of

God and

days [God] has spo-

he appointed the heir of

Son

also he created the world. This

the universe by his

adds to

whom

last

Life

all

reflects the

bears the very stamp of his nature, upholding

word of power" (Heb

i .2-3

this extraordinary affirmation, "In

of deity dwells bodily, and you have

).

The apostle Paul

him the whole fullness

come

to fullness of

who is the head of all rule and authority" Every human existence finds its fulfillment in the him,

tle child,

the eternal God."

The

meaning of

liturgy

and

in the

Christ's incarnation

is

person of the

(Phil 2.7)

—

^this

transfigure

it

divine

lit-

It is

there that

we

him who contains

himself the fullness, the pleroma, of divinity. that kenotic or self-abasing

"this

revealed to us in the

iconography of the Church.

find graphically portrayed the "descent" of

in

life

(Col 2.9-10).

one whom the kontakion of the Nativity proclaims to be

true

things,

By

in

that descent

movement toward our

fallen state

Son was able to assume our humanity and

into the glory that he possessed with the Father

before the foundation of the world

(cf.

Jn 17.5).

Within the Orthodox tradition, two principal icons depict the incarnation of the Son of

The most well known ity.

This

is

is

God

in the person of the Christ child.

the icon of Christmas, the Lord's nativ-

an image of the ideal family, comprising Mary, Joseph,

and the infant

Jesus.

It is all

the

more

ideal because

it

so elo-

quently represents both the poverty and the abandonment that

weigh on them. These painful conditions presage the journey that the child himself will undertake, a journey

him

to the Cross

wrapped not

in

and to death. Even

which

will lead

at his birth, the child

swaddling clothes but in a shroud, and he

125

is

is

laid

STAGES ON life's WAY not in a manger but on an altar of sacrifice. His ostensible Joseph,

is

shown under

paternity of this

father,

attack by demonic doubt concerning the

newborn

infant.^

And Mary

herself gazes into

the infinite distance, contemplating the mystery of a birth that

both for the child and for his

will lead ineluctably to suffering,

mother. Nevertheless, as in the icons called Hodigitria, or "Guide," or

more

in those that

evoke the Eleousa, Umileniye, or "Tender-

ness," the principal theme of the icon of the Nativity

What Mary has received

as a gift

is

that oigift.

from the Father she presents to

the world in a supreme gesture of love. also

still

Through her

prayer, but

by her physical being, welcoming the Christ child into her

womb,

the

Mother of God

offers herself

and her

child, so that in

him and by him the world might be transformed from the corruption of death to the glory

and beauty of eternal

This motif appears as well in those icons

Ufe.

known

as "the Sign."

This the second sacred image which represents—^which renders present and the experience of the worshiper— is

accessible in

^the

mystery of God incarnate. Here, Virgin

Mother who makes

Mary appears as the

ceaseless suppHcation

all.

Bearing the Christ child in her

life

of the world.

is

on behalf of us

she offers

him

for the

Her womb, as the Uturgical texts declare, is more

spacious than the heavens, since

^This

womb,

Orante, the

one interpretation of the

it

contains the Incomprehensible

figure standing before

Joseph in the comer

of the icon. Other interpreters have seen here the representation of a shepherd,

who comes

to announce the glad tidings to the child's "ostensible

father." Still others identify this figure

with the prophet Isaiah,

who declares

to Joseph that the prophecy of Is 7.13 has been fulfilled: a virgin has given birth to a child,

Emmanuel.

126

The

Sacredness of Newborn Life

and Uncontainable One. This antinomy by the Uturgy of the Nativity

One

feast.

repeatedly expressed

is

of the major themes of

that celebration holds that the incarnation of Christ occurred atreptos, "without change." This

means

that the

became the son of Mary without surrendering

Son of God

his divinity, with-

out changing his essential identity.

who

Beholding him [Adam,

represents

all

of humanity]

who was created in his image and likeness, fallen because bowed

of his transgression, Jesus

down. He dwelt within the

the heavens and

womb

came

of a Virgin without

undergoing change, so that within her he would reform the deformed

Adam, who

your appearance,

cried out to him, "Glory to

my Redeemer and my God!"

—Compline, Nativity The aposticha assumed

flesh

verses of this

same

"The Word

but did not separate himself from the Father."

was God, and he remains God The

service declare,

Vigil

He

for all eternity.

liturgy of the Nativity feast gives eloquent expression to this

ineffable gesture of total humility,

"humbled

himself,

upon a cross"

by which the author of creation

becoming obedient unto death, even death

(Phil 2.8).

According to the Nicene Symbol of

Faith, this kenosis or self-abasement occurred "for us

men and for

our salvation."

Beholding man, the work of his perdition, the Creator

bowed

own

hands, destined for

the heavens

and came

down. From the pure and holy Virgin he clothed himself

127

STAGES ON life's WAY in the fullness of

human

existence

and

truly

took

flesh,

for he has covered himself with glory.

—^MatinSrof The

Ode

i

salvation accomplished by the incarnate Son, however,

is

limited to delivering us

child in the

little

If

God became

the eternal

womb of the Virgin, it was in order to lead us known

along the pathway

way

not

from perdition, to Uberating mankind

from bondage to death and corruption. a

Nativity,

in

Orthodox

ascetic tradition as the

of "purification, illumination, and deification."

O our defender Christ, you have covered with shame the enemy of mortal man, now that you have

ineffably taken

flesh as a shield and, in this

form, you have given us the

of deification. For

the desire for that gift that

gift

caused us to

fall

it is

from above into the

pit of darkness.

—^Matins of These sacred images and

throw

light

Nativity,

Ode 7

themes that

liturgical texts recall several

on the mystery of the Incarnation. At the same

they clarify another mystery: that of the newborn child. eternal

Word is the

archetype of the

—

human person

if

he

time, If

is

the

both

Adam—he is also, by virtue of his nativity in the flesh, the archetype of every child who is born into this world.

the

first

and the

As author of

last

life,

as creator

and redeemer, he submits himself to

the conditions to which every child

Today

is

is

subjected.

born of the Virgin the One

who

holds

all

creation in his hands.

As a mortal, in

he, the incomprehensible

swaddling clothes.

128

One,

is

wrapped

The

As God, he

is

Sacredness of Newborn Life

laid in a

manger, he

who in the

beginning

estabhshed the heavens.

He

takes as food his mother's milk, he

manna

who poured

out

to his people in the wilderness.

He, the Bridegroom of the Church, He, the son of the Virgin, accepts

We worship your Nativity, O

invites the

Magi.

their gifts.

Christ.

Grant us to behold your holy Theophany!

—

^Nativity,

The

Troparion of the Ninth Hour

divine child, born of a virgin, accepts to be

manger

wrapped in swad-

dling clothes

and

like Lazarus,

from the shroud of the dead and to

laid in a

the depths of death

in order to liberate

mankind,

raise us

and corruption. He who fed the

up from

Israelites in

the desert feeds himself from his mother's milk, in order that he

might become Eucharist, the heavenly bread that feeds the multi-

He who invites the magi accepts their gifts, in order to foreshadow the offering of his own life as the supreme gift, the

tudes.

supreme

sacrifice that

works out the world's

salvation.

God accepts to humble himself through the incarnation for a single reason: because

to seek

and

he loves the world he has created and longs

find, to save

and

divine image. His purpose

purity and innocence.

is

To do

glorify the children

to restore so, the

Adam

who

bear his

to his original

Son of God assumes the

humility and innocence proper only to

little

children. For chil-

dren are the very image of the Innocent One, the spotless

Lamb

who represents the perfect offering to God the Father. According to St Gregory Palamas, "Before the

mind becomes embroiled

with them, the passions which are naturally implanted in

129

chil-

STAGES ON life's WAY dren conduce not to sin but to the sustaining of nature. For reason they are not at that stage evil."^ The child of Christ, as Christ child.

the icon, th^ prototypical image, of the

is

like little children in

heaven (Mt 18.3-5; i9-i4;

and

many themes that illustrate the incarnate Christ and the

receives fice is

all

those

who

order to enter the kingdom of

Jn 1.12).

cf.

In the Church's iconography

family, united

thus the icon

is

This includes not only the newborn but also

become

this

liturgy,

we

thus find a great

intimate relationship between the

newborn child. There

is

the theme of the

by prayer and by love; the theme of the mother who

from God the

back to him as a

child she will offer

sacri-

of praise; and the theme of the Innocent One, whose vocation

to offer himself to others wholly

knows no

and

freely,

with a love that

limit.

Who, in fact, is this newborn child we are called to welcome, protect,

He

nurture,

or she

is

and love?

the image of Christ, the

Son of God, who, "without

Mary for the salvation of the world and the deification of all those who receive him with thanksgiving and devotion, "To all who received him," the evangeUst John tells us, "to all those who beUeved in his name, he gave power to become children of God" (1.12). To become a child of God is to

change," became the son of

^St

Gregory Palamas, "To the Most Reverend

Philokalia, vol. 4, eds. G. E.

H. Palmer,

(London: Faber and Faber, 1995), 310.

130

Nun

Xenia," 42, in The

Philip Sherrard,

and

Kallistos

Ware

The Sacredness of Newborn

Life

return to our original state of innocence, purity, and beauty, but also of vulnerability,

which characterized the

fashioned in the image of his creator. This

first

human person, Adamic

the

is

state,

proper to every newborn child. Yet it is a state soon lost in a world of sin and violence, where the innocent, inside or outside the

womb,

are massacred like the

The newborn

little

children of Bethlehem.

child bears within himself the divine image, the

image of Christ, and with that image comes the deification.

But

of corruption. the

two

this tiny infant also bears

possibility for

within himself the seeds

The continuous and arduous

struggle

—between deification and corruption—

will lead

inevitably along the

born child

between

is

pathway of

suffering

an image of the Christ

him

and death. The new-

child, but

he

is

also

an image

of Christ crucified.

Welcoming the Newborn Child If

the child born into this world

Christ, he will also

is

indeed an image or icon of

become the image of his

parents.

We live in an

age in which the traditional role of the parents has largely been rejected as a relic of a distant past. faith, altruism,

For virtues such as religious

obedience, honor, rectitude, and

civility

we have

substituted egotistical attitudes of autoidolatry, self-gratification, in-your-face aggressiveness,

and cutthroat competition, tempered

only by a concern to think and act in a poUtically correct.

way regarded by others

as

And parents are expected to inculcate such dis-

torted attitudes in their children. Pressures behind such expectations

come from our social and cultural miUeu, conditioned as it is

by television, films, and other media. Quite naturally, our children,

131

— STAGES ON life's WAY obsessed with the Internet, an

like their parents, are increasingly

extraordinary instrument of communication but one that transmits anything and everything in the

Rather than lose ourselves in a

name

fruitless

quest for

pretechnological age of the past, though, tion. Is

it

sis

way

idealized

to ask a ques-

and the

that stresses spiritual values

then we are facing a greater cri-

self-centered attitudes? If not,

than most of us imagine. For the first responsibiUty of parents

—

in fact, their basic vocation

is

image of God, an image of truth,

The

parents, however,

to reflect to their children the faithfulness, integrity,

do not bring up

Their role in raising their offspring ity

we need

some

possible for us today to reconsider the role

responsibilities of parents in a

over

of information.

is

and

love.

their children in isolation.

complemented by the

activ-

of other members of the Church. At least four basic actions are

indispensable for raising our

young

appropriately, actions that

need to be undertaken and sustained both at home and in the parish community. Children need to be welcomed, nourished^

educated,

and

loved.

The welcoming of a

child

is

a complicated matter that requires a

great deal of preparation. First of

all,

the parents need to prepare

themselves to assume both the pregnancy

and moral obligations that become

itself

and the material

theirs following the birth.

Preparation of this kind requires an ongoing attitude of prayer, by

which the parents make a child

ceaseless offering to

and of themselves. Yet

of the Christian

The eighth day

community

their prayer

is

God

both of their

necessarily the prayer

as well.

after the birth, the child receives a

name, often of

a saint commemorated on the day of the birth. Tliis creates a vital

132

The Sacredness of Newborn

link

between the newborn infant and a member of the eternal

communion ing

Life

of saints.

The prayer

offered by the priest at the lay-

on of hands asks God "that the

light of

your countenance

might shine upon your servant (Name), and that the Cross of

your only Son be impressed on his/her heart and thoughts." This is first

of

all

a request for a blessing.

Then

it

goes on to ask for

protection against "the vanity of the world and every evil counsel

of the enemy."

As soon

as the

associates the

name

is

given, the Church,

newborn

by

its liturgical

prayer,

child with Christ. This unites the child

with Christ's crucifixion and also with his victory over demonic

power and over

death. This intimate link between the child

Christ will be reaffirmed

when

the child

is

and

baptized, chrismated,

and then "churched," introduced into the communion of the faithful

on the fortieth day after the

for the

mother on that day captures

birth.

The final prayer offered

just this emphasis.

O God the Father Almighty, who by your mighty-voiced Prophet Isaiah foretold to us the incarnation through a Virgin of your Only-begotten Son and our God; these latter days, by your

ation of the

Holy Spirit,

who

in

good pleasure and the cooper-

for our salvation,

and because of

thy boundless compassion, graciously willed to become a

babe by her.

...

Do now, O Lord, who preserves children,

bless this infant, together

with his/her parents and his/her

sponsors; and grant that, in due season, he/she united, through water

and the Spirit of the

new

your holy flock of reason-endowed sheep, which

by the name of your

Christ.

133

may

be

birth, to is

called

STAGES ON life's WAY The Church's welcome of the newborn only baptism, recognized as the

rite

child thus comprises not

of initiation, but also the

prior giving of a name, which signifies for the child that he or she is

inscribed in the

Book of Life

This ecclesial welcome mality.

To ensure

that

child into the family of

turing ents

—

and

it

Rev

of course, to be

more than a mere

for-

represents a genuine integration of the

God, which will provide appropriate nur-

community appoints godpar-

who assume

primary responsibiUty for the

and

spiritual

development of the

child, all the while

embracing that child with abundant love and parents are called to

work

affection.

in close relationship

and the parish community, to provide the itual

3.5; 21.27).

spiritual formation, the

spiritual elders

religious

is,

(Phil 4.3;

nourishment and training.

It is

The god-

with the parents

child with needed spir-

they as well who, during

childhood trials or adolescent crises, offer loving support not only to the child but also to the child's parents.

It's

deeply regrettable that

we have

importance of godparents in the dren.

lives

lost

any

real sense of the

and formation of our

chil-

The Church in its wisdom grants to these sponsors roles and

responsibilities that the parents are incapable of

assuming

because of their lack of objectivity. The newborn child needs to be welcomed, nourished, educated, and loved not only by

its

parents but also by the Church family, represented above the

godmother and godfather. (This

both, must be a faithful and active parish.) It

is

own

all

by

why at least one, if not member of an Orthodox

is

incumbent on us to recover the true meaning of

sponsorship within the Church and to support by every means possible the service rendered

communities.

Our

by godparents within our parish

children today are in very great need of their

134

The Sacredness of Newborn

ministry, ately

and

Life

and it is our obligation before God to respond appropridecisively to that need.

Children with Disabilities Everything

we have

who comes

into the

personal value. derives

said to this point

from the

The

the

he bears a

similarity

fact that

between

his

image and

from conception, that

Christ's

child bears the

and by the very fact of his exis-

birth,

Savior. Child of

endowed with the sacred

him

clear that the child

visible witness to the beauty, the innocence,

humihty of our

enable

it

world possesses an absolute and inviolable

image of his creator. From his tence,

makes

gift

of

God and child of Adam,

life,

whose ultimate purpose

and intimately

to share fully

in the very Ufe of

and he

is

is

to

God.

But can we affirm the same thing with regard to handicapped children, those born with deformities or disabilities? child

is

marked by genetic

of beauty or her brain

is

same honor and have a mal" child

who

seems offensive,

is

in

defects,

if

the

newborn

any semblance

his face lacks

damaged, does that child possess the

right to the

same protection

good physical condition?

we need

If

nonetheless to raise

If

it

as a "nor-

the question

today. This

is

because more and more self-proclaimed guardians of public morality argue that each viability

newborn

infant should give proof of her

and her "human value" before

society grants her the

right to Uve.

That sort of attitude represents an extreme form of utilitarianism, one based on sheer expediency. UtiHtarianism

is

today in Western Europe as well as in the United structionist

approach to

gaining ground

States. Its

decon-

ethical analysis rejects every absolute

135

STAGES ON life's WAY

—every standard,

norm

ria for all itself.

down

principle, or truth

—and

locates the crite-

moral decision-making within the immediate situation

The

result

moral

is

in respect for

relativisrh,

God and

with a consequent break-

other persons.

Where moral

absolutes are systematically rejected, the inevitable effects of sin are to substitute expediency for principle

and

self-interest for sac-

rificial love.

From

this utihtarian perspective, the

strictly functional criteria:

rational

and motor

human person

is

defined by

consciousness, for example, with the

capacities necessary to

make

decisions

and

take action. These are criteria of social utiUty, derived from a philosophical position that places function above being. ple fact that one exists

is

no longer

sufficient for that indi\'idual

worthy of respea and

to qualify as a person,

The sim-

legal protection.

That individual must be able to think and act rationally and be

endowed with

the capacity to contribute actively

and

positively

to social hfe. Otherwise, the argument goes, society has

no obU-

gation whatsoever to assume the financial and psychological bur-

dens that a profoundly handicapped person imposes on

Those

who

preach

disabilities that

this

it.

kind of utilitarianism propose a gamut of

render the child marginalized, a prime candidate

for abortion or infanticide. Others

who tend to

be more conserva-

tive or traditional will often accept a first trimester abortion yet reject unconditionally the killing of a

newborn child

On the other

hand, they recognize the appropriateness of refusing sustained treatment to children ities

bom with terminal illnesses or severe disabil-

such as anencephaly, Tay-Sachs disease, or the Lesch-Nyhan

syndrome. Each of these

results

from genetic anomalies that bring

on premature death, often within hours of

136

birth. In

such cases, as

The Sacredness of Newborn

we may

all

agree, medical treatment should be strictly palliative,

and allowing the parents

caring for the child's comfort their

dying infant.

No

way,

artificially,

a rule of

patient,

thumb

that should apply to any terminally

one whose prognosis indicates

clearly that

has lost

all

he or she

is

ill

suf-

an accident or disease and

fering the irreversible consequences of

capacity for self-sustained existence.

much more radical. "nonviable" (those who have

of today's utiHtarians, however; are

They include no claim

in the category of the

(those affliaed vdth trisomy 21,

chromosome.) In Joseph

Down's

Down's syn-

to being persons in the true sense) even

drome children first

since in cases like

such efforts merely prolong the dying process. (This, by the

is

Many

to hold

heroic efforts should be undertaken which

merely extend biological existence these,

Life

child

is

an extra twenty-

Fletcher's view, for example, a

not a person because of the profound intellectual

deficiency that usually accompanies the anomaly.

Such children,

pejoratively referred to as mongoloid, are accordingly to be elim-

inated by abortion or by infanticide.^

There are two comments sacred character of child at ical

its

would

I

human

life,

like to

'^We return to this Fletchei;

theme

"The

is it

is

the phys-

a function of the

dignity of "person"

God, not by human convention. This

invests in the

way depend on

or mental health of the individual, nor

DNA. The

First of all, the

which God himself

conception, does not in any

quaUty of one's

^J.

make.

is

bestowed by

why an embryo,

in the final chapter.

'Right' to Live

and the

'Right' to Die,"

Humanist 34

(July-August 1974): 12-15; see also Richard C. Sparks, To Treat or Treat: Bioethics

and

the

like a

Handicapped Newborn (New York:

chap. 4, esp. 2 5 off.

137

Not

to

Paulist, 1988),

STAGES ON life's WAY patient in deep coma,

of the term.

And

is

this is

and remains a person

why

in the fullest sense

can never be sanctioned

infanticide

or blessed by the Church. Whereas paUiative care and gestures of love offered to a profoundly handicapped infant are always

morally obligatory, the expediency of infanticide, including partial-birth abortion,

must be

The second comment

who

has

known

an act of murder.

rejected as

I'd like to

make

is

more

personal.

Anyone

or Hved with Down's syndrome persons

knows

the difficulties and challenges of raising and educating them.

Their physical and emotional needs can be extreme and exhaust-

But those

ing.

who

care for

them

—and they always remain a

child

family and I

child

the

I

know how much

such a

—gives joy and love to the

those around them.^

all

often think back to the late 1960s

and

also

and

early '70s,

had frequent contact with Marie (Masha,

when my wife

to her friends),

Down's syndrome child of a former professor at the

St Sergius

Theological Institute in Paris. Every Holy Friday, Masha, dressed all

in black, lived the

agony of the

crucified Christ,

and every

Pascha morning, she rejoiced at his resurrection. Her face was radiant and her joy palpable.

The entire parish community, which

had embraced her unconditionally, was profoundly enriched by her presence and her prayer.

One day we were invited by Masha 's mother to her family. As

%

is

my wife and I entered the child's room—at that time

not only Down's children

love. See Flannery

Mary

share a meal with

Ann,' " in

who so bless a family that receives them with

O'Connor's remarkable "Introduction to *A Memoir of

S.

and R.

Fitzgerald,

Noonday, 1962, 1969), 213-28.

138

Mystery and Manners (New York:

Sacredness of Newborn Life

The

—^we found her busy

she must have been about forty years old

was

playing. All the while she

talking to a photograph of her god-

who had

a beloved and long-deceased priest

father,

Masha spoke with him,

dear friend of ours.

just as little children

speak casually with angels. There was nothing nothing at

contrived. She

all

her godfather, that's

all.

also been a

artificial

about

it,

was carrying on a conversation with

And

he was most definitely present, in

some indefinable but unmistakable way, a way that was absolutely real.

Masha spoke

him now

to

in French,

now in

Russian.

—

she noticed our presence, she greeted us with a smile

^in

When

EngUsh.

We later learned from a family acquaintance that her mother had long before taught her to recite several prayers in German.

An exceptional child, the love

yes.

But Masha was exceptional because of

and the tender compassion she received from her parents

and others who cared for her, persons whose Uves were profoundly touched and blessed by her presence, her

Do we

really

Masha,

just

are legal?

I

want

faith,

and her

love.

to live in a world devoid of persons like

because in utero genetic testing exists and abortions

desperately hope

has gripped this country solution" in which

is

we

don't. Yet the

rapidly

new

eugenics that

moving us toward a

no genetic anomaly

"final

will be tolerated,

no

"defective" child will be born or allowed to live.

How,

then, should

would want

own

to be

we welcome

welcomed

a disabled child? Just as

ourselves, as

healthy children to be welcomed.

we

we would want our

Where

genetic or other

deformations are so deleterious that the child is destined to a brief existence

face

marked by acute pain, where death stares the child in the

day by day and moment by moment, there we can certainly

139

STAGES ON life's WAY opt for

There, once again, medical heroics

Strictly palliative care.

have no place, no

justification. Biological existence is

not an end

in itself, to be preserved at all costs'despitb intractable

and dehu-

manizing suffering that no pain management can adequately

demands

relieve. Rather, charity

team do

all in its

power

and to prepare the Yet

it is

to provide whatever comfort

child for a gentle

is

possible

and peaceful death.

our responsibility, as members of the body of Christ, to

accompany the difficult

that in such cases the medical

child, together

pathway that

with the

child's parents,

stretches before them,

along the

and by our ceaseless

prayer on their behalf, to surrender them into the open hands of the

God

of love and of

Cherishing the

life.

Newborn

Child

With regard to every newborn child, and disabled children in particular,

we need to keep

child born into the

certain points in mind. First of

world

is

gifted

all,

every

by our creator with absolute

value and personal worth. Consequently, to recall an oft repeated affirmation of Olivier Clement: every child without exception "is

worthy of infinite compassion."''

From conception divine image,

until death, the child

is

a person, a bearer of the

whose primary vocation

is

to

conform increasingly

to the likeness of God. This vocation consists in a long

and

diffi-

cult quest to acquire virtues or divine energies, such as justice, wis-

dom,

beauty, compassion,

and

love.

Human Ufe is sacred from its

^or a brief and highly sensitive treatment of this theme that reveals just such compassion, see John Chryssavgis, The Body of Christ:

A Place of Welcome

for People with Disabilities (Minneapolis: Light and Life, 2,002).

140

The Sacredness of Newborn

origin because

assume the is

created in the image of

it is

ascetic struggle that leads

life.

This

is

sacred

life,

of the Father's creative love, and share eternally in the personal,

Second, tially

God and

toward divine

called to

perfection.

It

vocation that transforms every individual existence

this exalted

into personal

Life

its

since

it

originates

ultimate end

communal

life

is

from an

act

and

to glorify

of the Holy Trinity.

we need to remember that every newborn infant is essen-

a child of the Church. Each one

become an

ecclesial being,

Christ. Therefore,

it is

an

integral

is

created and called to

member

of the body of

our responsibiUty as adult members of that

body, to assure that the children of our famiHes and our parish

communities are welcomed, nurtured, educated, and loved with a devotion ness

and

Finally,

and

faithfulness that reflect the unshakable faithful-

crucified love that Christ offers to us.

with regard to disabled children,

selves constantly of

excellence

made

is

one basic

truth.

we need to remind

our-

The innocent victim par

Jesus Christ himself. He, the eternal Son of God,

himself utterly vulnerable in order to accomplish the great-

est gesture

of love

we can imagine. As the

was despised and

rejected by

Suffering Servant,

"He

men; a man of sorrows, and

acquainted with grief; and as one from whom men hide their faces

he was despised, and

we esteemed him

not.

.

.

.

But he was

wounded for our transgressions, he was bruised for our iniquities; upon him was stripes

It is

we

the chastisement that

are healed"

precisely this

(Is

53.3,

made us whole, and with his

5).

image of the Suffering Servant,

person of Jesus, that affirms and confirms the

fulfilled in

infinite

the

value of dis-

abled children, and obliges us to welcome them with gratitude

141

STAGES ON life's WAY and with

who

love.

The handicapped person

—together with those

care for that person with patience, courage, and selfless

—

devotion

is

the very image of the Suffering Son of God. In that

we have

person,

a continual confirmation of St Paul's paradoxi-

cal observation: the

Cor

12.9).

The

so-called

power of God

is

made perfect in weakness

normal child born into

this

world can

benefit

(2

from

a broad spectrum of practically inexhaustible possibiUties. This

is

who will suffer all of his life the

not true of the disabled newborn,

consequences of some severe malfunctioning of his body or mind. In order that his infirmity not reach to the depths of his soul,

we

need to assume the responsibility to welcome him with compassion, understanding, courage,

That

is,

to

welcome him

as Christ

spiritual defects, weaknesses,

Who,

then,

is

Whatever the ties,

ily

he

and

^It is

is

this

and an abundance of

newborn

and

child

state of his health,

an icon of Christ and a

welcomes

us,

affection.

with our

own

suffering.^

who comes whatever gift

into the world?

his defects or disabiU-

from God, both

for the Church. Consequently,

we

for his fam-

are invited to

welcome

perhaps necessary to add that in a family into which a disabled child

is

bom, the parents need to be especially sensitive to that child's siblings. The disabled child will require more attention and more resources than the other children, less

tain

and it is of the utmost importance that those

favored.

Here again, godparents can play a

siblings

not feel neglected or

crucial role in helping to

main-

an atmosphere of harmony and mutual support within the household.

142

The

Sacredness of Newborn Life

him with open arms and to

do

for

to

do

for

him what we

one another: to offer him as a

are always called

sacrifice

of praise and

God who is the author of his life, just as he is own. "Thine own of thine own, we offer unto thee." We

thanksgiving to the of our

should

make

this liturgical, priestly gesture

whenever a child

is

bom. Receiving him from God as a unique and infinitely precious

we offer him back to God by our prayer, by our love, and by compassionate and attentive care we give him.

gift,

the

At the same time, we assume

fully

and without

hesitation the Ufe

of this infant, whatever his mental or physical condition. Both in the family as the

and

magi and shepherds

commit

ourselves to

like Jesus himself,

grace of

we welcome this child welcomed the child Jesus. And we

in the ecclesial

do

all

in

community,

our power in order that

this child,

might grow in wisdom and stature, and that the

God might repose on him.

143

chapter five

ON ADDICTIONS AND FAMILY SYSTEMS Lyn Breck God's wish that each day

It is

start

we should be renewed and

up again with a virtuous change of will, and with a

renewal of mind.

—

St Isaac the Syrian,

The Wisdom of St Isaac the Syrian

All things are lawful for me, but not all things are helpful.

All things are lawful for me, but I will not be enslaved

by anything.

—

I

Corinthians 6.12

Defining the Problem

was two a.m. Rita stumbled down

It

kitchen. Shaking

and anxious, she held onto the banister to

steady herself, then as she

made

her

the stairs toward the

floor beneath her feet

felt

the cold

tile

way down

the hall.

Not wanting

145

to

wake her

STAGES ON life's WAY husband, Stan, she cautiously opened the freezer door and searched for the turkey. Her tension eased tle

she

felt

the bot-

of vodka inside the frozen bird. TBracing herself, she began to

pull

it

out.

It

wouldn't budge. Removing the entire turkey from

the freezer, she placed it

when

it

on the

table, then

onto the

floor,

used her foot to steady

The bird slipped, careened

as she pulled at the bottle once more.

and glided across the kitchen, the

bottle

still

firmly

Tense and sweating, Rita heaved the slippery mess back

inside.

onto the table, then decided the sink would work hoisted the carcass into the sink and once

better.

She

more began pulling, this

time with more success. Suddenly Stan appeared at the kitchen door. "Rita," he blurted, tle

"what are you doing?" He saw the bot-

now clenched in her hand, with the

my God,

Rita, you're

bird

still

in the sink.

"Oh

an alcoholic!"

Rita had been hiding her alcoholism for twenty years, or so she

thought.

Some people around her knew. Those

however, didn't want to believe

it.

closest to her,

They were unable, or

ing, to piece together her history of absenteeism, the

the

fall

store.

unwill-

DUI charge,

down the stairs, her moodiness, her late night trips to the

She was actually in

late stage

alcoholism and struggling

with the invasive "detox" symptoms of shakes and sweats. Only another drink would stop the symptoms, and then only temporarily.

After the turkey episode, her husband

was

in shock,

and so

were her children. This story and others you'll find in this chapter are true, though

names and some

details

have been changed to preserve

anonymity. They are the stories of

many

families.

are misinformed about the disease of addiction

recognize

it

when it

Most,

in fact,

and are unable to

occurs in their midst. Addictions of different

146

On Addictions and Family Systems

kinds are rampant throughout our country: in homes, schools,

workplaces, churches, and organizations such as the miUtary and the government.

Without treatment, an

change. This

because addiction provokes a modification in

is

brain chemistry that requires therapy

—

tual

^if

a genuine healing process

apy, addicts manifest the

give

is

addict's behavior doesn't

—both medical and

to begin.

Without such

spiri-

ther-

symptoms of addiction even when they

up the addicting substances or behaviors.

In this chapter,

we

will consider the

and other forms of dysfunction take ginia Satir, a

immense

toll

that addictions

in all areas of

our Uves. Vir-

well-known family therapist, used to say that 96 per-

American famiUes are dysfunctional, and the other 4 percent are lying. This is a humorous way of making the point that cent of

all

in our society, addictions

and other forms of dysfunctional behav-

whether mild or acute, are nearly universal.

ior,

will

My purpose here

be to look specifically at the most common addictions, includ-

ing codependency, alcohol

workahoUsm, and

and drug dependency, sex addiction,

reUgiosity.

We

want

to consider the roles that

trauma and loss often play in the development of addictions. Then too ily

we will explore the effects of addictive behavior on other fammembers. This will require that we introduce the concept of

"family systems theory" to provide a framework for understanding the interconnectedness of

members of an

addictive family.

By God's grace and with appropriate therapy, recovery from addictions

is

possible,

and a portion of

this

chapter will be devoted to

questions of intervention and treatment.

Then we

will consider a

series

of delicate topics: the way our parishes function as family sys-

tems,

how the Church tends to respond to addictive behaviors, and

what a recovery-oriented church might look like, particularly in an

147

STAGES ON life's WAY Orthodox setting. A significant number of Orthodox parishes were founded by people

who came from countries where

cultural alco-

holism abounds and dysfunctional 6i unhealthy behavioral symp-

toms of the disease are considered normal.

We

need to challenge

and the codependent responses they eUcit. We

these age-old notions

need as well to create educational programs, both for our parishes

and

for our seminaries, to help

Orthodox

deal appropriately with addiction in the following information will direction.

At the

all its

make

faithful

forms.

understand and

It is

our hope that

a small contribution in that

outset, attention will be devoted to addictive

how addictive behaviors lead how spiritual growth can occur

behaviors as a bioethical problem, to to spiritual bankruptcy,

and

to

through the healing process.

Ethical Aspects of Addictions

Why

does a book on Orthodox bioethics feature a chapter

this?

Because addictions affect body, mind, and soul. Our calling

as Christians

is

to reflect the divine image in

ated. Addictions, however, erode that less

image and make

it

less

cre-

and

compatible with the holy. Serious health problems, accompa-

nied by significant physical symptoms, ble to

obey

our bodies"

God-given erly.

which we were

like

St Paul's (i

Cor

command

6),

Human

gift that requires

Brain chemistry

is

lives,

it

virtually impossi-

God

in

and through

neurophysiological capacity

is

a

appropriate care to function prop-

affected

and the behaviors we choose.

make

to "glorify

by what we put into our bodies

We need to be wise stewards of our

our bodies, our emotions, and our choices. All of these

choices, in the final analysis, are related to the state of our soul.

These

are, in fact, ethical choices. In the addictive state, cognitive

148

On Addictions and family Systems

abilities are

clouded as the addict becomes increasingly preoccu-

pied with the addicting substance and

marked by impaired judg-

ment. Rather than seeking the mind of Christ, addicts tend to

compromise their moral values and embrace a tion.

As the person

secret life of decep-

sinks ever deeper into addiction, their spirit

becomes enslaved to a form of idolatry. Simply put, the addicting substances or behaviors ily,

work, and

become more important than God, fam-

life itself.

The very essence of our Christian being

is

communal, but under

circumstances of addiction, true community impossible.

becomes

all

but

An undivided focus on the object of the addiction pre-

vents the addict from becoming an integral

of Christ.

life

member

of the body

The addict instead devotes time and attention to acquir-

ing the addicting substance or engaging in the addicting activity

(such as gambling, sex, computer games, high-risk sports) or to

ensuring an adequate supply of the stimulus and recovering from the effects of

its

use.

The

call to holiness is

abandoned

in a des-

perate search for a high.

On some

level,

addictions are a veiled

tion of our natural longing for

and misguided manifesta-

God, an attempt to

ultimately can be filled only by

life

physician of our bodies and souls.

in Christ,

Long

fill

who

a void that is

the true

ago, before the

coming

of Christ, Old Testament prophets witnessed to and proclaimed

God

"divine ethics," a morality in keeping with the will of God.

proclaimed through Ezekiel, "I will give you a a

new spirit within you;

give

you a heart of

I

will

new heart and put

remove your heart of stone

.

flesh" (Ezek 36.26). This passage goes

.

.

and

on to

affirm that by the indwelling of God's Spirit, each person will live in conformity

with God's ways.

149

STAGES ON life's WAY During Holy Week, we servant, for

soul

and

I

am

Once

afflicted;

"Turn not away Thy face from Thy

hear

me

At some point

deliver it!"

God

turning back to

sing,

speedily, fti

draw near unto my

the addictive process, that

(metanoia.^ repentance)

possible.

person becomes a coworker with

this occurs, the addicted

God, advancing toward

becomes

his or her healing.

Then

the person can

reclaim the ethical values lost with the addiction, making amends

and embracing a

life

of spiritual growth through the process of

recovery.

In

Orthodox Christian

practice, the prayers in preparation for

Holy Communion help to strengthen the longing for holiness: "O Savior, sanctify

grant me, ion]."^

my

mind,

my

When

heart and

my

is

addressed by the

God (Name),

priest:

receives the holy

Body and Blood of our Lord and God and

Christ, for the remission of sins gifts

body, and

the faithful approach the chalice to receive the

vant (or handmaid) of

holy

my

O Master, to approach the fearful Mysteries [commun-

bread and wine, each person

cious

soul,

and unto

life

"The

ser-

and pre-

Savior, Jesus

everlasting." These

they receive "for the healing of soul and body."

Addictions

fall

squarely within the realm of bioethical considera-

tions because their threatening.

consequences are

They jeopardize the

life

spiritual

damaging, even

life

and physical well being

of individuals, families, and communities. Yet despite the fact that addictions have devastating consequences, they can also

a

become

means of grace.

^Prayer Book, 4th ed.

rev.

Qordanville,

NY: Holy Trinity Monastery, 1986),

345-

150

On Addictions and Family Systems Defining and Identifying Addictions

The term addiction refers to an unhealthy relationship with mindaltering substances or behaviors,

which has life-damaging conse-

quences. This definition, proposed by John Bradshaw^ in many of his

workshops,

More

is

generally,

applicable to

we can

all

addictions, not just alcoholism.

speak of addiction in terms of the model

proposed by Alcoholics Anonymous (AA). Step

i

AA

of

other Twelve Step programs acknowledges that a person

is

"pow-

erless" over the particular addictive substance or behavior

that the person's Ufe "has

and and

become unmanageable."

Addictions occur most often in those

who become predisposed to

the illness through a combination of their genetic their lifestyle choices. Just as those

who

makeup and

have a family history of

heart attacks need to lower their risk by exercising and eating a

healthy diet, so those with a family history of addictions are also at risk

and need to make

lifestyle

choices that will promote

good

we need to stress that those without any such family history are not immune to developing addictions.

health. This said, however^

Over the past several decades, addictions have been recognized as diseases that are chronic, progressive,

and

if

untreated, deadly.

Typically they unfold in three stages: early, middle,

of the basic characteristics of addiction ally refuse to

admit they are

ill.

and others who

is

When the

level of denial reaches

the addict. Denial

counselor and theologian, John Bradshaw for Creative field

Growth and

is

One

denial; addicts gener-

aware that they

also characteristic of family

live close to

late.

is

that of self-deception, they are usually not even

have a problem. Denial

and

is

is

members

not lying.

It is

associated with the Center

author of half a dozen bestselling books in the

of family and related therapy.

151

STAGES ON life's WAY the ability to close out or transform the facts in order to minimize the pain of reality.

How do we know when behavior is addictive? Specific symptoms outlined in the section "Examples of Addictions" later in this

chapter will suggest answers to this question. to

The main thing

is

know what to look for, to trust our observations, and to notice

the progressive severity of

symptoms

in

both the addict and the

family involved.

Finding an appropriate path toward recovery depends on correctly identifying the

problem, and diagnosis

straightforward. People tive fit

who

is

not always

struggle with compulsive or addic-

behavior yet whose problems are minor will not necessarily

the profile of an addict.

On the other hand, not all persons who

manifest serious dysfunctional behavior are addicts; for example, those afflicted with schizophrenia, ders.

One must

ask

if

ADD,

or sociopathic disor-

the problem in question

is

really addiction.

Often a single meeting between a concerned friend or family

member and an will

addictions speciaUst (consult the Yellow Pages)

answer the question.

Statistics

Millions of people in this country are directly affected by addictions

and addictive behavior.

All those

who

live,

work, or attend

school or church with addicted people are themselves affected. In the United States, alcohol-related auto accidents claim

20,000

lives

some

each year.^ Thirty-six percent of convicted offenders

^Bureau of Justice

statistics,

www.safetycops.com/cirunk_driving.htm.

152

On Addictions and Family Systems

were drinking

in correctional institutions offense. In

at the time of the

2001, nearly 1.5 miUion drivers were arrested for driv-

ing under the influence (alcohol or narcotics). This

one arrest for every 137 licensed

drivers.

Six out of ten adult children of alcoholics themselves.

When

become

alcoholics

both parents are alcoholics, the probability

that their offspring will

no

amounts to

secret that drugs

become addicted

rises to

80 percent.

It is

and alcohol are rampant on our college cam-

puses. Intoxication leads to a

breakdown

in values

because inhibitions are weakened. At one college,

mined that 60 percent of students who engaged were under the influence

at the time.

The

and morality it

was

deter-

in sexual activity

result

is

a dramatic

increase over the last decades in sexually transmitted diseases,

sexual assaults, and abortions.

90 percent of sexual assaults occur when the perpetrator is high on drugs or alcohol. One out of every six boys

It is

estimated that

will be sexually

of every four

widespread children.

abused before the age of eighteen, as will one out

girls.

Pedophilia, one facet of sexual addiction,

affliction that

The

damages the

latest national

lives

survey holds that there are 374,270

and Africa who are victims of sex traf-

Recent reports note the high incidence of sexual abuse in

the refugee the

The global

such addiction can be seen in the miUions of women and

children in Southeast Asia ficking.

a

of vast numbers of

registered sex offenders in the United States alone."^ effect of

is

camps

set

up throughout South Asia

2004 earthquake and tsunami.

"Svww.nationalalertregistry.com.

153

in the

wake

of

^

STAGES ON life's WAY Eight out of every ten people in America gamble, although of

course not everyone

who gambles

Gambling behavior

played out

is

iif

is

addicted to the activity.

a wicfe variety of forms and

environments, from the simple purchasing of a lottery ticket in a grocery store to high stakes casinos, sporting events, and hitemet poker.

Any

of these can become compulsive and unmanageable.

Most compulsive gamblers

are male; only 3 percent of those in

treatment are female. In one

state,

revealed that the average

they

first

a study of compulsive gamblers

amount of money a person owed when

sought treatment was in the neighborhood of $45,000.

About 75 percent of those included in this study admitted that at one point they had thought of suicide as a solution. Seventeen percent had actually attempted suicide. The rate of suicide

among gamblers is six times the highest among all those with mental

attempts

national average and

the

illnesses.

Compulsive

gamblers create other societal problems as well. Seventy-eight percent have committed a gambling-related felony, 22 percent

have cashed bad checks, and

There are no available

18

percent have embezzled funds.

statistics

regarding

work

referred to popularly as "workaholism." Suffice

workaholism

is

rampant throughout

this society

it

addiction, to say that

and has

signifi-

cant and harmful social ramifications.

Religious addiction

and abuse

in religious settings

spread. In every confession, including Orthodoxy, for

some people, both

means

clergy

and

laity,

is

also wide-

God becomes

the drug of choice and the

for controlling other people.

^Mary Heineman, Losing Your

Shirt (Center City,

xvi, xvii.

154

MN:

Hazeiden, 1992),

On Addictions and Family Systems

Situations like these indicate the

how

society, as well as

tions

and

their effects

responsible for untold ing

from unprotected

broad range of addictions

in

our

pervasive and damaging they are. Addic-

span

the stages

all

on

life's

way. They are

numbers of unwanted pregnancies

result-

sex, as well as for the spread of sexually

transmitted diseases. During gestation, the fetus

is

especially vul-

nerable to the mother's use of drugs and alcohol, leading to devel-

opmental

difficulties

such as

fetal

alcohol syndrome. Crack

j

I

babies

come into the world with life-threatening detox symptoms

(diarrhea, intestinal cramping, chronic

runny nose and

families thus involved attempt to put

on a good

eyes).

The

,

j

Ij

fall

apart under the influence of the addict in their midst.

riages break

Mar-

on the rocks of addiction, and children are among

the chief victims.

Throughout

a seemingly limitless

Ufe's

various stages,

we

encounter

number of crises which may be provoked by

addiction: disabilities resulting I

face while they

from addiction-related

accidents,

the deterioration of physical health, mental illness, incarceration,

and

finally

premature, addiction-related death.

Family Systems Family Systems Theory

An

exploration of addictions generally necessitates looking into

the

ways

in

bear on the

which addictive and other dysfunctional behaviors

lives

of the household.

The effects of addictive behav-

ior are never restricted to the person alone;

we

are

all

intercon-

nected, and the ties that bind families and other close

communities are particularly strong.

God

is

holy, then

we need to

If

our goal

explore the ways

155

is

to be holy as

that our behavior

STAGES ON life's WAY as persons as well as in family groups, including our parishes,

from

either fosters or detracts

can

this goal.

Family systems theory

'

facilitate this task.

Family systems theory developed out of the the 19 50s through the initial

known clinicians,

field

of psychiatry in

work of Murray Bowen. Other well-

such as Virginia

Satir,

Menuchin, have shed a great deal of

Jay Haley, and Salvador

light

on family dynamics,

while offering effective strategies for healing, particularly in

situ-

ations of addiction.

In the family systems approach, the development of trust within families

is

paramount, as

is

the facilitation of patterns of conmiu-

nication that enhance this trust.

An intergenerational perspective

on the family sheds light on the way issues and emotional legacies are transmitted

from parent to

child.

Some

of the most

common

intergenerational patterns that descend the family tree are rigid,

black-and-white thinking

(all

or nothing, zero or ten); a height-

ened need for approval; a tendency to blame others and transfer

shame and chronic

and the burden of

anxiety;

sively responsible for the happiness of others.

very antithesis of the kind of

life

feeling

compul-

These represent the

the gospel calls us to lead.

At first glance, family systems theory may seem to be a purely secular science.

To

the contrary, however,

it

can serve as a highly

effective tool for diagnosing tendencies within -families that

impede growth toward a Christlike

and wholeness to Christian systems approach

is

life,

and

for bringing health

families as well as to parishes. This

particularly effective insofar as

it

shifts the

focus from individuals and particular issues to concentrate

more

broadly on the overall functioning of family and parish groups.

156

On Addictions and Family Systems among some Orthodox Christians to embrace Orthodox sources of wisdom. Much of modern science,

There only

is

a tendenq^

however, derives from non-Orthodox sources. While

it is

vital to

explore the compatibility of modern research and experience with

Orthodox

and thought,

life

With

ern discoveries out of hand.

not to reject mod-

just as crucial

it is

that in mind,

we

should note

that one of the best resources for family systems theory

apy as apphed to parish hfe Generation to Generation,^ ices to clergy

of

parish families

many

is

and

ther-

Rabbi Edwin Friedman's book

A therapist who has offered his serv-

faiths,

Friedman describes

do and do not work

effectively,

in detail

how

and how they can

be led toward healing.

Family systems therapy

is

equally applicable to individual

parishes, since they typically function as family systems.

understand

how

this is true,

To

and to explore particular parishes

in terms of their generational family tree,

we can

ask questions

such as the following:

When was the parish founded, and under

what circumstances?

Who

their ethnic

and linguistic backgrounds?

grate into their tion,

were the founders, and what were

How well did they inte-

new environment from the perspective

work, language, customs, social

family,

and

roles within the

are the current

parish?

toward work, money, authority, the

munity?

An

attachments to

community? Of which generation

members of the

wives, the parish council,

class,

of educa-

and

their

What

are their attitudes

role of the clergy

own

and clergy

roles within the

com-

exploration of intergenerational dynamics that

begins with questions like these can be especially helpful for

^E. Friedman, Generation to Generation

157

(New York:

Guilford, 1985).

STAGES ON life's WAY Orthodox parishes that are deaUng with their historical and cultural legacies as they attempt to integrate appropriately into

contemporary American

'

life.

*

Components of the Family System Examining a few basic aspects of family systems understand their dynamics.

Specifically,

and very

will help us

briefly,

we

will

consider (i) emotional distance, (2) triangulation, (3) family

symptom

roles, (4) family rules, (5) the "identified patient" or

bearer,

and

(6)

homeostasis.

Emotional distance

refers to the degree of

or closeness within families.

opment

is

emotional separation

The continuum of growth and devel-

intimately connected to

and dependent on emotional

distance. Infants require emotional closeness in the

turing

and loving physical

contact.

form of nur-

As children grow, autonomy

and independence become increasingly important. At a stage, children require a healthy

and balanced, yet

later

flexible, inter-

dependence. Partners in marriage go through various stages in their relationship, often

in

maturing from an

initial

period of fusion,

which boundaries between spouses are blurred, to one of

greater personal independence. Often spouses will attempt to use

geographical distance to solve emotional problems. regulate emotional distance with others often

The

ability to

comes down to the

capacity to define oneself in a relationship. Flexibility

is

the key:

maintaining different distances at different times, according to the needs of each partner or each

member of the family unit. Easy

and effective modes of conmiunication, together with free expression of feelings, are essential for discovering and preserving

appropriate emotional distance.

158

On Addictions and Family Systems

Triangulation refers to a dysfunctional strategy of communication. In

"When any two

Friedman's words,

parts of a system

become uncomfortable with one another, they focus

own

upon a

approaches the time of their parents and children

The

bride

may

aisle so as

way

of stabilizing their

When

a divorced couple

third person, or issue, as a

relationship with one another."'^

all

child's

will triangle in or

wedding, for example, the

experience a certain level of discomfort.

prefer that her older brother

walk her down the

not to hurt her mother's feelings by asking her

estranged father to play that role.

To

deal with the conflicting

emotions provoked by the situation, the triangulating bride avoids speaking to her father directly. Rather, she approaches the pastor with a request that he transmit her message to the parties

concerned. By bringing the pastor in as a third party, she avoids confrontation with her father, and the triangulation

Family roles are famiUar to ple, of the

all

of us.

is

complete.

We have all heard, for exam-

"black sheep of the family." This

is

usually a

member

who has not followed the estabUshed family rules. Or it could be someone who has brought shame to the family and has consequently been rejected by the other hand,

is

its

other members.

The

"rich uncle,"

on

member who provides financial supsystem, offering such things as money for

the family

port to others in the

education or medical care. Each plays a central family role: the black sheep through being rejected, the rich uncle through being accepted.

In addition to roles, families have rules, whether spoken or

unspoken.

A typical rule for most famiUes is,

^id., 35.

159

"Don't

air the dirty

STAGES ON life's WAY laundry! " This if

made

public

is

a way of saying that

would

all

families

tarnish their image.

rules are unconsciously passed

have secrets that

Many

do>^ from one

of these family

generation to the

next.

The symptom bearer or family

who manifests

identified patient

is

the

member

of the

signs of stress or pathology that character-

ize the entire system. In

most famiUes,

this is

a child

who

acts out

family conflict by wetting the bed, failing in school, becoming

involved with drugs or alcohol, becoming pregnant, or being hyperactive and disruptive. Other ignore their their It is

own

members of

the family can

own responsibility for collective stress, that is, ignore

dysfunction, by laying blame

on the

identified patient.

he or she who bears the symptoms and manifests the dysfunc-

tion of the entire family. Resolution of the problem, therefore,

requires intervening in the

whole family dynamic rather than

focusing solely on the behavior of one of

its

The entire spectrum of family dynamics

marked by a healthy or

is

members.

unhealthy quest for homeostasis. In a healthy family, the

mem-

bers have a secure sense of belonging to the group, while they receive appropriate support in forging their personal identities.

Here there

is

encouragement of open expression and shared

ings. Trust

is

an

integral part of a healthy family system,

possible change without

hand,

is

crisis.

cause of everyone

By

else's

homeostasis, although

making

An unhealthy system, on the other

characterized by a focus

resistance to change.

feel-

on an

identifying

identified patient

and by

one family lAember as the

problems, the family remains in a state of

it is

unhealthy and potentially destructive.

160

On Addictions and Family Systems The Addictive Family System same family dynam-

Families affected by addiction live out these ics in particularly

dysfunctional ways. They achieve their

imhealthy homeostasis or equilibrium by adopting a number of

and

classic roles

rules.

common

There are three basic rules

to

all

addictive family sys-

tems: "Don't talk!" "Don't trust!" "Don't feel!" Secrets are an

symptomatic of

integral part of such a system because secrets are

the addict's condition and of the disease secret

is

want

a family

among members. However much nonaddicted members may

divulged and the truth comes out, trust

the family

Once

itself.

to hve in an environment built

on

trust,

is

eroded

they cannot. They

have too often been hurt by betrayal. In an addictive family system, children learn early

not allowed to express themselves addict in the family

who

freely.

on that they are

Generally

claims that right.

it is

only the

The children

are

brought up never to discuss with anyone, including other family

members, what happens

in the

home. As a

increasingly isolated both within

result,

and outside the

they become family.

cannot bring other children home, for example, because

They

it's

too

dangerous. They might be shamed by a parent's dysfunctional behavior, such as drvmkenness, outbursts of anger, inappropriate joking, or physical violence.

The parents

in

an addictive family usually

children's feelings.

The atmosphere of the home

to validate their is

one of perpet-

and chaos. The addict usurps the

right to express feel-

and does so with anger or withdrawal

(passive aggression).

ual crisis ings

fail

That anger

is

usually directed toward other family

161

members and

STAGES ON life's WAY is

accompanied by messages that convey both blame ("You are

guilty;

you made the mistake!") and shame ("You

you are the mistake

!

")

r

.

are worthless;

^

In such a situation, family roles are remarkably predictable.

The

spouse and children of the addict tend to become enablers; they facilitate

or accommodate the addiction and the addict's behav-

ior in order to retain a

role of the enabler

is

modicum

of peace within the home.

The

to allow (enable) the addict to continue in

their addictive behavior

by tolerating what

is

in fact intolerable

conduct. Enablers tend also to wrap themselves up in denial. They just don't

want

to believe

it's

"that bad."

Within family systems, the children of the household tend to adopt

specific

and

clearly defined roles. Typically, the first child

adopts the role of "hero."

He

or she

is

the responsible one

who

overfunctions and overachieves in order to maintain the required

homeostasis, the balance the family needs to go on functioning

without changing in any radical way. While

this child

may receive

praise for various achievements, he rarely receives affirmation,

the sense that he

is

truly appreciated.

Pushed toward ever more

heroic accomplishments (assuming the functions abdicated by the parents, for example, or excelling in school), this child experi-

ences a deep-seated sense of inadequacy. This in turn presses

toward

still

greater achievements.

of a perfectionist.

The

Here we have

all

him

the makings

successes of this "heroic child" serve to

cover the family's shame. Outwardly, the child becomes the source of family satisfaction and pride.

On

the inside, however,

He takes the

dys-

upon himself and thereby

car-

he tends to be lonely, confused, and depressed. function of his parents or sibUngs ries the family's guilt.

162

On Addictions and Family Systems

A second child arrives in such a family and finds that the place of approval

already taken by the older sibling.

is

To

find her

own

place in the system, this child tends to seek attention through negative i

means, by acting out. Thus the child becomes the family the one

who

"scapegoat." This

is

patient. She hides,

more or less

a sense of abandonment,

The core

feeling of

end up

cases, they

When

effectively, feelings

in trouble

is

of anger, grief,

and aUenation from the family group.

such children

the third child

usually becomes the identified

bom

is

profoimd hurt.

And

in

many

with the law. into this dysfunctional system, the

addiction has progressed. Acutely aware of the chaos that reigns in the household, this child attempts to hide

This

file.

terized

is

by

by taking a low pro-

the role of the so-called "lost child," which

silence

and

grief.

is

charac-

His main feelings are loneliness and

depression, sometimes to the point that he becomes suicidal.

A fourth child who arrives in the midst of such a family discovers that

most of the

atmosphere relief

roles

have been taken by her older

from the

intensity of the family

clown." This

humor

The

so heavy and depressing, this child tends to seek

is

role the child assumes, therefore, ily

siblings.

is

the comic,

is

drama. The most frequent

that of the "mascot" or "fam-

who

relieves tension

to diffuse potentially hazardous emotional

by using

and physical

stresses

among

and

of fun, she also becomes dysfunctional, bearing inside a

full

other family members. Apparently lighthearted

heavy burden of fear and pain. These roles are not necessarily permanent, nor are they exclusive.

The hero can scapegoat.

also be a mascot, just as a lost child can

become a

As older siblings leave the home to estabHsh themselves

163

STAGES ON life's WAY elsewhere, the children

left

behind tend to

shift roles in

an attempt

to maintain the desperately needed family homeostasis.

The

result of these pressures

family in codependency, which live close to

to ensnare each

is

is itself

member

of the

an addiction. Those

who

an addict adopt behaviors that are similar to or com-

plementary to

his.

Codependents may become addicts themchemicals some

selves, seeking in the use of

way

to medicate the

pain they experience living in an addictive family. Others will develop psychiatric disorders. All of them, in any case, will be affected

As grim

by depression, and many develop somatic disorders. as these scenarios

actually be, ble.

Before

would be

and codependency may sound and

we need always to remember that recovery is possiwe turn to various means for recovery, however, it

useful to look

more

closely at specific addictions,

including their characteristics and consequences.

Examples of Addictions Alcoholism and Drug Addiction

Alcoholism and drug addiction often begin surreptitiously. social drinker

out realizing

may cross

it.

A

the line into full-blown addiction with-

A person taking prescribed tranquilizers begins to

adjust dosages, then to visit other doctors

and pharmacies to

avoid detection. Adolescents are particularly vulnerable to pressures that lead to addiction. ecstasy, for

Illicit

drugs (cocaine, marijuana, or

example) are innocuously labeled "recreational," and

people both young and old are lulled into beUeving such drugs are

not addictive.

164

On Addictions and Family Systems

Jean and

Jimmy were

when they used to Going from glasses.

By

little

children, eight

and nine

respectively,

"clean up" after their parents' cocktail parties.

table to table, they finished off the alcohol left in the

the time they were thirteen

and fourteen, they were

became addicted to marijuana and heroin as

addicted. After she

Jimmy became some forty-seven

well, Jean died in her thirties, a victim of suicide.

a career alcoholic, bearing his affliction for years.

learn

Now

skills,

in his

fifties,

he

is

sober and in recovery, trying to

both social and occupational, that he normally would

have learned in his adolescence.

What we

usually see in the

stages of alcoholism seems

first

innocuous enough: the urgency of that first drink of the day, occasional drinking to medicate feelings,

and a gnawing sense of guilt.

Very quickly tolerance develops, and the addict needs more of his drug of choice to achieve the same

effect, to

reach the same high.

Jimmy, for example,

at nine years old could achieve a high

half a glass of beer.

By

beers to feel tipsy

the time he

was

thirteen, he

on just

needed two

and four to get drunk. He began having black-

outs, chemically induced states of amnesia. (Although a person

does not actually lose consciousness with blackouts, he or she

is

unable to remember what occurred while under the influence.

Jean would find unfamiliar things in her coat pocket: a train ticket to Washington, D.C., or a used syringe. She

had gotten

there.)

As people move

to the second stage of alcohoHsm, they tend to

adopt grandiose and aggressive behavior. over, they are

and

family,

had no idea how they

moody and

irritable.

They begin

becoming more and more

others to control their drinking

fail,

165

When

isolated.

they are himg-

to avoid friends

Any

attempts by

since they refuse to admit or

STAGES ON life's WAY even to discuss the problem. They regularly break promises and

many

experience regret over cates

of their actions,

all

of which indi-

an increasing pattern of mord deterioration.

In the late stage of alcoholism, people just can't stop drinking.

They develop

detoxification

become

lems, poor

sweats,

and

food and basic physical care. Their

seizures, while they neglect lives

symptoms of shakes,

increasingly unmanageable,

marked by

legal prob-

work performance, money

troubles,

and family

disintegration.

It is

often said that alcohol

riages,

and

work

is

a solvent, capable of dissolving mar-

contracts, car keys,

The end

spiritual values.

dictable: car crashes

bank accounts, physical

station for

and other

many

health,

alcohoUcs

is

pre-

accidents, physical collapse or

other serious health issues, psychiatric disorders, homicide, suicide,

jail.

This tragic picture can take shape over a period of fifteen to

twenty years from the onset of drinking. For drug addicts, the final stage

comes more quickly. A cocaine addict, for instance, can

bottom out

in six

months, taking their entire savings as well as

and

their mental, physical,

was twenty-six years from it

on

spiritual health

old, Phil received a

his aunt. In the space of

his cocaine habit.

his condition finally

with them.

When

he

$70,000 inheritance

one summer, he spent every

bit

By September, he was so emaciated

of

that

broke through his parents' denial. They

brought him to the emergency room, where the doctor told them Phil

would not have

ization,

lasted another week. After a short hospital-

he was transferred to a drug rehabiUtation center^ where

he spent a month getting clean. His greatest regret, he relates, was

166

On Addictions and Family Systems

having to give up his white sports

car, his favorite place to

do Unes

of cocaine.

To support their habit, many drug addicts become involved in the sale of drugs, in prostitution,

and

in other illegal behavior. If they

and often

are parents, they seriously endanger their children

them to the

foster care system.

As

addicts

become

lose

increasingly

enslaved to their addictions, their families develop the disease of

codependency

in

an

the addicts' erratic

effort to

and

maintain homeostasis and control

destructive

ways of acting

out.

Codependency There are many definitions of codependency. Family therapist

and author Robert Subby writes that codependency tional, psychological,

is

"an emo-

and behavioral condition that develops

as

a result of an individual's prolonged exposure to and practice of a set of oppressive rules which prevent the open expression of feeling as well as the direct discussion of personal

sonal problems."^

Many

and

interper-

people describe themselves, relative to

the addict, as "caretakers" or "fixers."

Ann Smith,

a specialist in

the field of addictions, describes codependency as "a pattern of

painful dependence

on compulsive behaviors and on approval

"^ seeking in an attempt to gain safety, identity and self worth.

This painful dependence on compulsive behaviors

^R. Subby, in Sharon Wegscheider-Cruse, ed., Codependency: Issue

^A.

is itself

an

An Emerging

(Pompano Beach, FL: Health Communications, 1984).

W. Smith, workshops. See her Grandchildren of Alcoholics: Another

Generation of Co-dependency (Pompano Beach, FL: Health Communications, 1988).

167

STAGES ON life's WAY addiction,

which explains why we need to consider codependency

in this chapter. People

who

live

with and work around addicts

have a tendency to develop codepehdency, unless they attempt to counteract the negative influences of the addict's behavior by

going into a program of recovery such as a Twelve Step support group.

Like

all

addictions, codependency erodes a person's spiritual Ufe.

God calls us to find our identity, safety, and self-worth in him, and on him

to be dependent

in a healthy

and holy manner. Codepen-

dents, however, seek security in people, things,

are unfulfilling

and situations that

and often harmful. Symptoms of the codependent

family system include chaos and an ongoing state of crisis. Codependents, like alcoholics, will create a

does not already ily

exist.

crisis

atmosphere

if

one

This serves to focus everyone in the fam-

system away from their true feelings, producing a state of

numbness. In sufficiently

this

way, homeostasis

is

preserved, since

no one

is

motivated to introduce change into the system.

Codependency almost always involves some form of enabling behavior. This

means

that the codependent person puts a great

deal of energy into maintaining an environment that removes or

minimizes the consequences and pain of another person's addictive behavior.

This makes

it

easier for addicts to continue their

dysfunctional patterns of thinking and acting.

Enablers tend to minimize the effects of addiction by apologizing for the addict: "It isn't that bad." rationalize:

"She behaved that

"He didn't mean it." They also

way

only because she cares about

you." In other words, enablers are master excuse-makers and cover-up

artists.

A wife, for example, might phone her husband's 168

On Addictions and Family Systems

boss and spin a

to explain her spouse's absenteeism, tardiness,

lie

or inability to complete a task in the time allotted for

it.

How can we distinguish enabling from healthy compassion? True compassion

is

grounded

in love, based

on

Christ's teaching to

feed the hungry, clothe the naked, visit those in prison, heal the sick, give to the

those of the

may

needy (Mt 25.3 5 ff).

Holy

originate in

Spirit (Gal

are compatible with

5.22-23). While enabling behavior

compassion and

addicted person in their addiction. ior are those associated

Its fruits

love,

The

it

actually facilitates the

fruits

of enabling behav-

with the progressive nature of addictions.

Examples of enabling are loaning money to a compulsive gambler,

buying alcohol for an alcoholic, or ordaining a

known

reli-

gious or sexual addia to the priesthood.

When we choose true compassion over enabling, we open our Uves and the lives of those we are trying to help to an experience of grace. we can offer a gift that becomes the catalyst for the addict's healing. Yet we need to be aware that it By "speaking

the truth in love,"

can also provoke, at

least for a time,

a situation of conflict.

In the long run, the moral fiber of the enabler becomes

mised, because he

tells lies, lives lies,

and makes others

fortable believing Hes. In his misguided attempt to better, the

comprofeel

make

com-

things

enabler merely perpetuates the addict's unhealthy

behavior.

Workaholism

Work

addiction

addiction.

aged

It is

is

particularly insidious because

not only socially acceptable;

—

in schools, in the workplace,

169

and

it is

in the

it is

a "clean"

highly encour-

Church. In the

STAGES ON life's WAY CEOs

corporate world,

tend to push employees into worka-

holism, requiring average

workweeks of

fifty

to eighty hours.

Schools bless workaholic students >Vith scholarships, and universities

reward them with everything from early acceptance to Phi

Beta

Kappa

keys. Priests

and pastors often burn out because

unspoken expectations both from hierarchs and parish councils pressure

them

sense of guilt front,

into addictive patterns of activity, playing

when

workaholism

they don't measure up. Even on the is

is

3. 1 7-19).

How,

their

home

rampant. Housewives compulsively keep

busy to the point that their Uves are ruled by

Yet work

on

a necessary then, are

stress

and

component of everyone's

we

to

know when work

fatigue.

life

(Gen

has become

addictive?

Certain symptoms or characteristics offer significant clues.

Workaholics rarely ask for help and spend large amounts of time preoccupied with their current

activity.

They

are caught

dual sense of urgency and frustration. "There time," because the addict lines.

Multitasking

talking

on a

writing a

cell

is

is

is

up

in a

never enough

constantly setting unreaUstic dead-

a hallmark of workaholism. Simultaneously

phone, purchasing something in a

store,

and

memo seems perfectly normal to the workaholic.

Work addicts are plagued by perfectionism. From childhood they have learned that the only passing grade

is

an A, and therefore

every result, every achievement, must be perfect and flawless.

Otherwise, they have

failed.

Each project they undertake requires

an inordinate amount of time and energy.

It

becomes

their sole

focus, thereby eliminating family gatherings, socializing with friends,

and

just relaxing.

On

a workaholic's

170

list

of priorities.

On Addictions and Family Systems

personal needs

come

As a

last.

result,

to health crises, sleep disorders,

WorkahoUsm

work

addiction often leads

and depression.

afflicts individuals, institutions,

even churches. In a workaholic environment, the person attempts to

live in

a balanced and healthy

for not doing enough. guilty. In

one

They

will be

way will

made

and

organizations,

to feel

religious institution, the faculty

and

to review the job description of each person, based

who

be criticized

ashamed and staff

gathered

on their actual

performance. The intention was to reduce the level of stress within the institution by decreasing each one's workload to manageable proportions. But because everyone

was mired

in

worka-

holism, the meeting actually served to identify the unassigned tasks that

still

many

needed to be done. This extra load was

then parceled out to the already overburdened individuals

had gathered looking

for

some

respite.

Many

of them

who

left

the

meeting bemused, angry, or desperate.

The workaholic

will stay late

weekends, accept double

shifts

on

the job, go in early,

and duty on hoUdays, and take on

special projects with unreaUstic deadlines. Because the is

work on

workaholic

not able to meet needs in an intimate relationship, the spouse

tends to lose himself or herself in a similar pattern of behavior. wife, for example, will

become overly involved

A

in social events or

attempt to micromanage the Uves of her children. For their part, the children in such a family experience an

immense

void, since

they have no one they can rely on to meet their normal emotional needs.

The work

addict can always justify the addiction by point-

ing to the need for extra income.

The

potential results of this

behavior are no different from the outcome of other addictions: depression, divorce,

and

in

some

cases, suicide.

171

STAGES ON life's WAY Rigid expectations, coupled with obsessive-compulsive tendencies, fuel the

workaholic's addiction. They are rewarded

("stroked") by praise, pay raises, and promotions, each of which serves to reinforce the choice to

When

the workaholic

is

overwork to the point of burnout.

a priest or pastor, the parish

members

often feel the results of his addiction in his attempts to control that goes

on

in the

community.

He and

they together

fall

all

into a

kind of bondage. Once again, the gospel of Christ has another message. "It was for freedom that Christ set us free," St Paul declares. "Therefore,

keep standing firm and do not be subject

again to a yoke of slavery" (Gal 5.1).

Sexual Addiction

Ken, Tania, and their two children were

just sitting

down

for

supper when the doorbell rang. Tania got up to answer. The color drained from her face

when

she

saw

the

two policemen. They

asked for her husband. "Is anything wrong.^" she asked. The cers

went

into the dining

him, and read him his itation of puter.

shock.

underage

They

left.

room, told Ken to stand up, handcuffed

He had been accused of online soHcOne of the officers asked for his com-

rights.

girls.

Ken and computer

in tow, Tania

As the case unraveled, Tania learned

sex addict from his teen years, supplied

offi-

when an

that

and the kids

in

Ken had been

adult family friend

a

had

him with pornographic magazines.

With the advent of the

Internet

and on-demand cable TV, cyber-

sex has invaded the homes, hotel rooms, and workplaces of

America. The immediate availability of the Internet, coupled with the presumed anonymity of bers of those

its

use, has served to swell the

num-

who are sexually addicted. The Internet's interactive

172

On Addictions and Family Systems

capabilities, while

enhancing access to information, also serve

sexual predators in search of unsuspecting victims.

Sexual addiction

is

a disease of

levels.

Patrick

Games,

the Shadows, describes these levels of behavior

behef system.

At

level i, sexual addiction

bation, pornography, prostitution,

in

and the

Out of addict's

can include mastur-

and compulsive heterosexual

or homosexual relationships. Level 2 includes exhibitionism,

voyeurism, indecent phone

calls,

and indecent

Uberties (such as

using a hidden camera to film a toilet booth, filming up a woman's

or "feeling" in a crowd). At level 3, sexual misconduct

skirt,

includes child molestation, incest,

Core

beliefs, in

and rape.

Carnes's analysis, have to

tionships, personal needs,

and

do with self-image, rela-

sexuality. In dysfunctional cases,

am basically a bad, unworthy me as I am." Although addicts

they include the conviction that "I person, and

no one would love

experience sex as their most important need, they are convinced that they cannot in their

depend on others to meet and

satisfy

it.

Trapped

world of excessive need, they try to resolve the tension

in

unhealthy ways. Attempting to avoid painful feelings, their behavior in fact increases feelings of shame.

Many

persons addicted to sex are victims of childhood sexual

abuse.

They have been emotionally abandoned and perpetuate the

cycle

by abandoning themselves. They often engage in harmful

activity or

make harmful choices, such as missing work in order to

seek out prostitutes or other sources of sexual stimulation.

^^P.

The

Games, Out of the Shadows: Understanding Sexual Addiction (MinCompCare, 1983), 23-61. See also his A Gentle Path through the

neapolis:

Twelve Steps (Minneapolis: CompCare, 1993).

173

STAGES ON life's WAY result flict,

usually a

is

breakdown and

financial problems,

due to con-

in family relationships

alienation. r

A cautionary note needs to be sounded about self-help groups for those with sexual addictions.

forms of sexual

Many of these groups allow various

activity outside the

framework of a

traditional

marriage. This works against any real healing process. self-help

group that

Sexaholics

is

appropriate for Orthodox Christians

Anonymous, which allows

between spouses

in a

The one is

for sexual activity only

monogamous, heterosexual conjugal union.

Religiosity

ReUgious addictions,

like all other addictions, are progressive

and

chronic. In the early stages, the addict typically engages in fre-

quent Bible reading and church attendance in order to cakn ings

and

lessen anxiety.

One could

reply that

many

perfectly

normal people attend church often and read the Bible giously." Religious addicts, however, attend church

Scripture compulsively, ety

when

feel-

"reli-

and read

and they experience a great deal of anxi-

they are unable to maintain those behaviors.

In the middle stage, the reUgious addict

makes moral judgments

on others while they damage

himself. For example, he

that reflect will often

neglects

view any sexual

normal family and professional

religious duty or service. guilt

activity as dirty

and shame to

all

Then

those

ical tactic in transferring

is

activities in

f^vor of

some

again, the addict tends to transfer

who do not

beUeve as he does.

A typ-

shame is to invoke what is pleasing or not

pleasing to God: "Anything other than

need, or beUeve)

and unacceptable. He

X (whatever

I

want,

feel,

not worthy of God." ReUgion thus becomes a

174

On Addictions and Family Systems

tool for manipulation. This goes discuss

any

issue that

hand

in

hand with a

might lead the addict to change

refusal to

his

mind or

alter his convictions.

In the late stage of religious addiction, the obsession leads to psychiatric disorders, financial losses (due to

religious causes),

immoderate giving to

and to decisions that disrupt family Ufe and

jeopardize the family's well being. Such decisions include going off

on missionary

trips or religious pilgrimages,

family in the process. Father Leo Booth,

who

abandoning the

has long worked

with victims of religious addiction, holds that

this affliction

"keeps people chained in superstitions, in ignorance, and in hypocrisy.

"^^

In addition to the addictions

we have

outlined here, there are

many others that we often don't recognize. Among them are nicotine

and

caffeine addictions, compulsive shopping

ing, bulimia

and anorexia, "working out"

and

shoplift-

to extremes,

and

engaging in high-risk sports for the high they produce. Generally speaking, any substance or behavior can

become the source of

addiction. All addictions exhibit progression through stages, end-

ing in sickness

and heartbreak

for the victim

and

all

the codepen-

dents around him. Everyone within the addict's social network affected; therefore, to

^^L.

some

is

degree, everyone needs treatment.

Booth, Breaking the Chains: Understanding Religious Addiction and

Religious

Abuse (Longbeach, CA: Emmaus

175

Publications, 1989), 65.

STAGES ON life's WAY Trauma and Addiction

Many

people turn to potentially addictive behaviors as a means

of covering the pain of past traumas. Life events are often over-

whelming, and they can render people helpless in the face of uncontrollable circumstances. in the

body and the

affected,

brain.

and they can

The effects of trauma

Memory and

are inscribed

emotions are deeply

recycle traumatic feelings into the present

whenever an experience similar to or a sensory memory of the original sations).

trauma occurs

(smells, sights, tastes, sounds, tactile sen-

Even the calendar can

trauma, as

it

recalls the date

trigger a full-blown response to a

on which

that event occurred.

The

ACOA (Adult Children of Alcoholics) movement, which began in the 1970S5 highlighted the role of trauma in addicted families.

Many

of the adult children of those families suffer from

symptoms not

(post-traumatic stress disorder), manifesting unlike those of soldiers

who

return from a

war

first

memory was

plate glass his father's

zone.^^

war

In effect, families affected by addiction are

zones. Jeffrey's

of looking up to see his father smash through a

door to grab

dnmken,

his mother.

violent rage.

She had become the object of

An

older sibling intervened to

break up the fight, and the younger children escaped to frey flict

was four years old raises for

PTSD

him

at the time.

To

this day,

safety. Jef-

any hint of con-

a code-red alert, including the

same

physiological responses provoked by the original trauma.

^^See Janet Woititz, Adult Children of Alcoholics

Health Communications, 1983). This

classic

major bookstores.

176

work

(Pompano Beach, FL:

is still

available at

most

On Addictions and Family Systems When trauma and loss are at the root of addictions, they must be treated as well. Otherwise, relapse

apeutic technique

known

as

is

almost inevitable. The ther-

psychodrama^^ can be an

tool for healing trauma, because

it

targets emotions

effective

and thoughts

simultaneously in the context of the recreated experience.

newly created psychodrama scene

A

offers a solution for healing

and

role training to prepare the person for future healthy behav-

ior.

Other trauma-reduction techniques, such as

EMDR

(eye-

movement desensitization and reprocessing), can effective. Then again, group therapy can be a critical

aid in heal-

mark

the lives of

ing the disordered relationships that so often

adult children of alcoholics

Defining

What

Is

tlie

also prove

and other trauma sun ivors.

Solution: Recovery

Recovery?

In Christian terms, recovery refers to the rediscovery bishing of the divine image in sists

which we were

all

created.

of a lengthy pilgrimage that leads us to identify

of God, and to

and

all

refur-

It

that

con-

is

not

make new, healthy, and holy choices in our Uves.

It

we need to begin anew in order to change our understanding of who we are and to assume healthier patterns of behav-

impUes that

ior.

This usually requires the help of other people, trained

professionals

who can guide the process toward healing with intel-

Ugence, sensitivity, and compassion. In

i3Psychodrama

is

cases, that

guidance

a therapeutic technique originated by the late psychiatrist

Moreno and further developed by his widow, Zerka Moreno. It is a useand highly effective method that is increasingly known and used in the

J. L.

ful

some

United States and throughout the world.

177

STAGES ON life's WAY may take help

is

the

form of a planned

someone who

offered to

highly successful

intervention, a process

by which

in the grip of addiction.

is

means of engaging the addicted person

It is

a

in recov-

Vernon Johnson's book 77/ Quit Tomorrow^^ details the inter-

ery.

vention process, which

who

Counselors

is

similar for all types of addictions.

specialize in addictions are available

Yellow Pages or the

referral

through the

network of Alcoholics Anonymous.

Treatment Treatment step

first

means through which recovery

the

is

toward treatment

addicted person stop using addictive behaviors.

random

A

urine samples

all

addictive substances

monitoring system, which

whether progress

being made.

many

The

and cease

may

all

include

and "breathalyzers," along vdth behav-

by competent

Treatment takes

possible.

abstinence. This requires that the

is

ioral observation is

is

staff

members, determines

forms: in-patient rehabiHtation programs

(from several weeks to months in duration, including detoxification

when

needed), halfway houses (intended to provide a sup-

portive, abstinent

an in-patient

community

after the patient

facility), intensive

for sixteen hours a week), less

intensive regular addictions counseling

ily

members

among

is

family

^'^V.

Johnson,

esp.

48-61.

I'll

on an

self-help support groups.

an

integral part of

members

is

discharged from

out-patient rehabilitation pro-

grams (usually an evening program

and Twelve Step

is

out-patient basis,

Treatment of the fam-

most programs. Reconciliation

an important part of the recovery

Quit Tomorrow (San Francisco: Harper and Row, 1980),

178

On Addictions and Family Systems

process, in that

it

shame, and grief of

addresses the accumulated hurt, anger, all

fear,

those involved. Effective treatment will be

individually tailored to the specific stage of recovery of each person.

A treatment plan outlines objectives along with an anticipated

timeline for their achievement.

Most treatment

plans include referral to Twelve Step programs.

These programs, which are invite

free of charge, exist

worldwide. They

people to share their experience, strength, and hope, to

accept the guidance of a sponsor (a peer with rience),

and to "work the

steps."

more recovery expe-

Programs of

this

kind include

Cocaine Anonymous, Narcotics Anonymous, Codependents

Anonymous, Overeaters Anonymous, Adult Children of Alcoholics,

Kleptomaniacs and Shoplifters Anonymous, Emotions

Anonymous, and many

others.

Al-Anon was founded

port group for spouses and other family as Alateen

alcoholics,

was for adolescents. Al-Anon, Alateen, Adult Children

of Alcoholics, and Codependents inevitable

members of

as a sup-

Anonymous

codependency that develops

all

target the

in the lives of persons

who

have close contact with addicts.

While hospitals

offer crisis

management

in cases of addictions

(dealing with overdose, detoxification, etc.)

and provide medical

treatment for physical symptoms, they usually do not address

long-term recovery needs in the areas of spirituality and psychoeducation. This can be confusing both for addicts and their families,

who

often believe that the addict has already received

necessary treatment during a hospitalization.

A

all

well-rounded

treatment program, however, will focus on three complementary aspects of the healing process: medical, psychoeducational, spiritual.

179 I

I

and

STAGES ON life's WAY Relapse

is

a

common

part of recovery, because addicts have so

much to learn and so many old habits to overcome. To help avoid relapse, addicted persons

ships, especially those

need to modify

their personal relation-

which involve codependency. People,

places, or things that merely fostered the addiction

need to be

eliminated from addicts' lives altogether. For example, a person in recovery

must have absolutely no contact with

mer

who suppUed

friends

drugs;

if

dealers or for-

a paycheck served as a trigger

money should

for buying alcohol or for gambling, the

be

deposited automatically into a bank account; and sex addicts

should get rid of

all

pornography and

install

a

filter

on any com-

puter to which they have access. Even persons with the best of intentions can relapse during the healing process.

those

who do

About

half of

relapse get back into recovery, while the other half

return to their former, dysfunctional patterns of behavior. Addicts in recovery

may also switch addictions, giving themselves over to

another compulsion.

Treatment resources can be found online and in the Yellow Pages.

You may call an addictions counselor or the help line in your area. You can

also find online

lists

of rehabilitation programs nation-

wide. Bookstores are also a good source of information.

An

essential part of treatment

is

the aftercare plan for both the

addicted person and his or her family members. People are likely to relapse

if

plans. If they

they do not follow through with their aftercare

do

relapse, the

new

situation

is

to deal with, since the person can

now claim

been to treatment and has learned

all

son

falls

there

is

even more

that he or she has to

know. The per-

again into denial, and the disease continues

ing progression.

180

difficult

its

devastat-

On Addictions and Family Systems

I

Addictions and Recovery within the Church Addiction within the Church Just as addictive nuclear families are plagued with denial, so too is

the church family. Denial

is

allows people to go through

a powerful defense life

in

how

their

call to holiness.

This

without considering

thoughts and actions are at odds with the leads to a

mechanism that

moral dilemma. As A. W. Schaef and Diane Fassel write

The Addictive Organization^ "Ethical deterioration

inevitable

outcome of immersion in the addictive system.

to understand

to yourself

how this

and

denial, grabbing

happens.

If

your Ufe

is

the

is

It is

easy

taken up by lying

others, attempting to control, perfectionism,

what you can

for yourself,

and refusing to

let in

information that would alter the addictive paradigm, then you are spiritually bankrupt.

"^^

Just as in family systems, addicts ple

assume roles within the parish. Peo-

do not want to admit that the

priest or choir leader

could be an

alcohoUc, drug addict, compulsive gambler, or sex addict, although they tend to applaud their workaholism and perfectionism. In one area with a high rate of alcoholism, priests attempted to

control the abuse in their communities by the pledge system.

As

people with a drinking problem came to confession, they were

asked to sign a statement, promising they would no longer drink.

No

accompanying treatment was

priests mistakenly

offered, however, because the

beUeved that sobriety

is

a matter of willpower.

They were not aware that addiction is a disease that can be healed i^A.

W. Schaef and Diane

cisco:

Fassel,

The Addictive Organization (San Fran-

Harpei; 1990), 67.

181 I

STAGES ON life's WAY only through a therapeutic recovery process involving mind, body, and

As a

spirit.

members went back shame and

guilt

pledge system

result, the

to drinking,

caused by

tlie

now

failed.

with the added burden of

Church's condemnation.

Examples of denial are found among the Orthodox, are in virtually

all

eral years ago, a

Church

just as they

reUgious organizations. Christian or not. Sev-

committee was formed to investigate sexual

abuse by clergy and to propose guidelines for dealing with the

problem. Once

it

was himself engaged cially

member

of the committee

in sexual misconduct, the

group was unoffi-

was learned

that a

disbanded. The other committee

members were never again

contacted by anyone with regard to their assignments. This

primary

rule:

is

work

or possible future

a perfect example of the addictive system's

"Don't talk!"

Enabling in churches takes the same form as enabling in famiUes.

One

parish responded to

the influence by getting

before a lenient judge.

was

ing that he

its priest's

him out

of

ply because

jail

under

and making sure he went

A seminary dean sent a student home, stat-

suffering

from extreme

avoided dealing with the student's holic bishop

arrest for driving while

was enabled

fatigue. In this

known use

of cocaine.

way, he

An alco-

to continue his addiction for years, sim-

no one dared to confront him. He went into treatment

only following a health

make arrangements

crisis

that led his doctor to intervene

and

for appropriate treatment* All of these

enabling behaviors prove to be destructive for everyone involved.

Monastic communities can also be caught up dysfunctional family systems.

grew up

in

Some who

in addictions

seek the monastic

and life

alcohoHc homes and never received treatment. They

182

On Addictions and Family Systems

might arrive at the monastery with a deep and genuine spiritual longing, yet also hoping to acquire a sense of belonging

meaning.

on an

If

the abbot or abbess rules autocratically or functions

affective level as father or mother, they

tilization in less stable

Then

nity.

survivors.

and

and

They do

their

the monastic rule. Yet

mature members of the commu-

less

again, a significant

number of monastics

utmost to lead a

if

can foster infan-

life

are

trauma

of prayer, faithful to

they are burdened by acute losses that

they were never able properly to grieve, their consequent dysfunctional behavior

and

attitudes affect each of their monastic broth-

ers or sisters, just as they

do among those

in the

world outside.

God's grace can penetrate the frozen depths of psychological and emotional woundedness that

many

people in the Church, includ-

ing many of those in monastic orders, bear within themselves. True

miracles of healing have occurred, either because of, or in spite of,

a dysfunctional atmosphere. Nevertheless, a great deal of suffering

is

perpetuated in parishes, in seminaries, and in monastic com-

munities by ignorance or denial. Because of these factors, persons

who

are caught

up

in that suffering often refuse to seek the help

they so desperately need. Their denial takes the form of reUgious platitudes

("We

for recovery tic

way" or

rely

are relying

on God") or

from addictions is

"is

"not Orthodox."

on God throughout

some forms of treatment

assertions that treatment

not compatible with the monasIt is,

of course, essential that

the recovery process.

And

it is

true that

are incompatible with the spiritual

This matter requires discernment.

What

we

life.

therapeutic process will

help addicted people rediscover and give expression to the image

God that Ues v^thin the depths of their being? In fact, there are many such processes, including those proposed here. of

183

STAGES ON life's WAY Fortunately, monastic communities, seminaries,

and parishes are

slowly opening their doors to the appropriate assistance that

is

increasingly available to them. Foi^that assistance to be effective,

however, the church community must begin by recognizing and dealing responsibly with the addictions in

admit that in purely these dysfunctional

the

human

terms,

it is

midst.

It

needs to

powerless to deal with

and destructive patterns of behavior. Seeking

power and grace of God through

spiritual fathers

its

the guidance

and prayer of

and mothers, together with effective medical and

psychological therapy, the parish

grow toward genuine and

community can then begin

to

lasting healing.

The Recovery-Oriented Church Throughout

this chapter, I

from addiction nity as

it is

is

have repeatedly insisted that recovery

possible. This

is

as true for the church

commu-

for the nuclear or extended family.

For those preparing to enter the priesthood, seminary

is

the

appropriate place to acquire basic information about addictions.

The screening of seminary candidates (background checks and psychological evaluations), already practiced at theological schools,

is

some Orthodox

a crucial element in helping to eliminate

those who are addicted or who have psychiatric disorders that are

incompatible with the priesthood.

A

comprehensive seminary program in the area of addictions

could provide both clergy and lay leaders with a means for creating recovery resource networks in their communities. Visiting

treatment faciUties and becoming acquainted with clinicians will

not only

facilitate

a team approach but will also allow for referrals

184

On Addictions and Family Systems

to be based

on appropriate knowledge and experience. In particu-

lar, it is vital

to

become

work. The most

familiar with the Twelve Step self-help net-

effective

way

to understand these programs

is

through firsthand experience. Some Orthodox churches have actually

founded

Increasingly,

own Twelve

Step recovery programs.

an Employee/Student Assistance Program

many

able in

their

jurisdictions for clergy, seminarians,

families. This service offers assessments fidential

and

and

referrals

avail-

is

and

and

is

their

con-

free of charge.

A healthy church will develop appropriate guidelines and policies regarding substance abuse and addictive behaviors, as has already

been done in several of our jurisdictions. Parishes will be designated as drug-free zones. gical function, as

is

When alcohol is served as part of a liturHoly Saturday

the case after

Hturgy, then

water or juice should also be available not only for children but also for recovering alcohoHcs. Bars should have

churches. Supervision at

all

is

When

in

our

parish events should be mandatory.

This includes supervision of children

wine

no place

who serve at the altar, where

available.

problems do occur within a parish community, they need

to be addressed immediately. This

is

particularly true of sexual

misconduct within churches, seminaries, and monasteries. Our various jurisdictions have published guidelines regarding sexual

misconduct, and these should be posted and brochures that people can take tims, in

and

made

home and study.

their famihes, together

available in

Perpetrators, vic-

with the entire community, are

need of healing when sexual misconduct does occur.

i^N. Hopkins and

MN:

M.

Laaser, Restoring the Soul of a

Liturgical Press, 1995).

185

Church

(Collegeville,

— STAGES ON life's WAY To

date, a significant

abused in church

when

number of people who were

settings

sexually

have been revictimized by the Church

ecclesiastical lawyers

have advised hierarchs to have no

contact with those bringing the allegations. In some cases, victims of sexual abuse and their families have resorted to lawsuits to seek restitution, although for the

most

part, they

would have

been content to receive from a bishop or priest an acknowledg-

ment of the abuse

(validation), together

assistance to cover the costs of therapy.

to require a gag order for victims

with sufficient monetary It is

standard procedure

who settle with the Church out

of court. This practice not only reinforces the "don't talk" rule; it

also perpetuates a sense of

and

As a

shame and abandonment in victims

their families.

result of these pressures

—

denial, enabling,

the local church, like the family, can

codependency

become an unsafe

place,

unwilling to break the silence, unwilling to take steps toward

developing educational tools and policies needed to minister adequately and faithfully to those with addictions in

A

recovery-oriented church

is

its

its

members.

children, whatever the cost,

is

proactive in the

It is

dia-

concerned to

A recovery-oriented

domain of education and prevention on

all

topics relating to addictions.

In

Orthodox Christian

tradition, the role of a healthy, well-

informed, compassionate spiritual father or mother

one person in the

open

by establishing and imple-

menting poUcies that ensure the safety of all. church

midst.

willing to establish an

logue on any subject that affects protect

its

addict's life has the

is vital. If this

wisdom and courage to con-

front their spiritual child with the truth, gently yet firmly, guiding

186

On Addictions and Family Systems

him or her through

and on to appropriate treatment,

their fear

extraordinary heaUng could result. Scripture declares "the truth will set

truth

often a painful process.

is

Many Twelve

Step programs use

you free, but first it will make you miserable." This

ticularly true of addictions

temporary misery

pay

free." Getting to the

but they add an important caveat: "The truth

this affirmation,

will set

you

in order to

ings of Christ,

For those

is

par-

and addictive behavior. Perhaps

this

the price that

become

we and our

healthy, to be truly

churches have to

founded on the teach-

and to be open to healing and growth.

who embrace recovery, there is the possibility of giving

up addictive behaviors, roles they

is

identifying the dysfunctional rules

and

may have adopted over the years, and making new life

choices compatible with health

and

holiness.

who have been in denial, the information provided in this chapter may cause a certain amount of hurt, anger, and pain. For people

It

can be extremely

and those we ing.

Yet

we

love,

difficult to

and to take the necessary steps to achieve heal-

each need to

uals, as families,

The pathway

make

and

fail if

heart.

this

courageous effort as individ-

and as members of the body of

to recovery

is

tive particular therapeutic

mately

confront the truth about ourselves

the person

From

is

essentially spiritual.

approaches

may

not healed at the

Christ.

However

be, they will ulti-

level of spirit,

the perspective and experience of

187

effec-

mind,

Orthodox

STAGES ON life's WAY Christianity,

we

recognize that prayer

is

an

integral part of the

communion,

healing process, as are the sacraments of confession,

and unction. In and through the ^tire recovery process, we can

draw the

strength, hope,

same

and heaHng grace from Jesus

yesterday, today,

and

forever. Jesus

who

Christ,

promised that at

is

his

second coming, he would wipe away every tear from our eyes

(Rev 21.4). As we await this eschatological blessing, to undertake intense preparation in our

we are called

own Hves and in the Uves

of our famihes, our neighbors, and our church communities. That

preparation includes healing from addictions, a healing worked

out ultimately by the Spirit of

We

God who

dwells within us.

need to embrace our true calling with boldness and with a

genuine desire for holiness. To the extent that

we do

every reason to expect that our lives will be

filled

thanksgiving, and joy. That joy Christ himself,

our

who

human nature

vation and eternal

is

incamational.

so,

we have

with peace,

true source

Its

is

entered into our world and took on himself

open before us the pathway to

in order to life.

invites us to be healed

Christ

is

the light of the world.

It is

sal-

he who

and who shows us the way out of the dark-

ness of addiction. This unfettering from compulsive behaviors leads to true freedom, a freedom each of us can selves

and

as

members of the

embrace for our-

Christian community.

Once we achieve that liberty, we can grow, in the power and grace of Christ, toward a

freedom, tion

that

is

truly

moral and truly

we can allow the Spirit to work within us

from a

we were

life

fallen

holy. In that

a transforma-

and broken image to the divine image

created.

Thereby we

will reflect ever

more

in

which

fully the

beauty and glory of that image, to ourselves and to those around us, as

God and

all

the angels in heaven rejoice.

188

chapter six

THE HOPE OF GLORY: FROM A PHYSICAL TO

BODY

A SPIRITUAL Christ in you, the

hope of glory

—Colossians 1.27

At

we turn to

this point,

a difficult yet crucial subject that

concerns each of us in the most direct and personal way: the "mystery of death." This

since the conflict

more

meaning of both our

life

closely than ever before at the ultimate

and our death. War, terrorism, poverty,

earthquakes, and epidemic

place

it

an especially timely topic,

and violence that so mark the world today force

us to look perhaps

nerabilities, take

is

illness,

together with our personal vul-

death out of the realm of the hypothetical and

squarely in the context of our daily experience.

morning headlines to

tragic accidents

and wasting

From the

diseases,

we

are constantly reminded of our mortality. These reminders oblige

us to ask whether that mortality leaves our lives with any real

transcendent meaning and value.

major element in any bioethical In the next

and

Orthodox

spiritual tradition,

final

The mystery of death,

reflection

chapter of this book,

on

then,

a

life.

we will turn to the way

informed by medical science,

189

is

calls

STAGES ON life's WAY US to accompany those persons

who

have entered the terminal

phase of their earthly existence. The aim of this present chapter to set the stage for those

more

practical' reflections

is

by providing

a theological grounding for our approach to death and the question of

what appropriate

Since the topic

is

care

so vast,

I

we can

would

offer dying patients.

like to focus here

yet misunderstood aspects—

on one of its

most

significant

what

the apostle Paul calls the physical (Uterally the "psychic")

^the

body to the resurrected to the

spiritual body,

soma pneumatikon

(i

as a theological perspective, this transition in

Cor it is

transition

from

from the soma psychikon

From a pastoral as well

1 5.44).

important for us to understand

order fully to hear the gospel proclamation. That

proclamation, in

brief,

existence to eternal

holds that the transition from our earthly

life

occurs in such a

way

as to preserve

somatic (bodily) identity from one state to the other. Death, in other words, does not

nor does

it

mean

annihilation of our bodily existence,

involve an entirely

new creation. For those who

die in

—a metamorphosis or

Christ, death involves a transformation

rebirth

—

^in

continuity with our physical being, which preserves

our distinctive personal identity and integrity while

it fulfills

within us and for us what the apostle terms "the hope of glory."

Body and Soul In

Orthodox pastoral

practice,

praying, in cases of terminal

we have

illness, for

acquired the habit of

the "peaceful separation

of soul and body." This well-meaning formula could be problematic, as it

might suggest that the human person

two fundamentally

different elements:

190

is

constituted of

an earthly body and a

The Hope of Glory

heavenly soul. This the Platonic

is

not a biblical perspective.

—or simply the phe-

and redemption

nomenon of physical death—

^to

consist in the liberation of the

from the body, with the subsequent return of the soul to

place of heavenly origin. Underlying this notion

is

ple

its

the belief that

souls are preexistent, that they existed before our bodies ated. This

of

and Hellenistic dualism that conceives the body to be

the prison house of the soul,

soul

It is reflective

were cre-

kind of dualistic anthropology, represented for exam-

by third-century Christian theologian Origen of Alexandria

(t254),

was rejected by the great majority of early church fathers,

long before Origen's final condemnation at the Fifth Ecumenical

Council in 5 5 3 heretics

is

(if

indeed his inclusion in the

list

of anathematized

not a later interpolation).

Already in the second Christian century, the apologists Justin

Martyr

(f ca.

question.

165) and Tatian (f ca. 160) posed the fundamental

Does Christian

faith affirm the "immortality of the

soul," or the "resurrection of the at

each side of the question. Put simply, the notion of the immor-

tality is

body" ? Let us look more closely

of the soul

is

subject to death.

based on the idea that only the physical body

The

soul does not die;

powers of death and corruption. The

exempt from the

soul, in this view,

a time becomes incarnate in a mortal

its

some-

origin in

dies, the soul is released to return to the place

origin.

is

God and for human body. When that

times pictured as a divine spark that has

body

it is

of

its

divine

Some of those who hold to the immortality of the soul also

see the soul as preexisting the body; others say

it is

created simul-

taneously with the body. But either way, the soul does not die.

Once

the

body has ceased

to live, the soul simply passes

dwell with other souls in the

kingdom of God.

191

on

to

STAGES ON life's WAY "Resurrection of the body," on the other hand, means that the

power of death (and in the Scriptures, death is indeed known to be

human existence, soul may be characterized

a power) touches and affects evdry aspect of including the Ufe of the soul. While the as eternal or even immortal,

it is

nevertheless subject to death inso-

psychosomatic unity with the

far as death tears apart the soul's

body. In this perspective, soul

animates and sustains

is

the

life

human existence

force or

life

in all

aspects, physical,

its

principle that

mental, and spiritual. Death brings about the dissolution of the

human

psychosomatic unity that constitutes the that will be reestablished only with the

of

God and

"rise

from

their

tombs

5.28-29; 11.24), will bring about a

mind, and

spirit in

a

new

So

Adam

it is

ishable,

body,

is

ing

all die,

is

(cf.

Jn

of soul,

the resurrected

be fully preserved, and God's

so also in Christ shall

raised

is

imperishable. ...

raised a spiritual

of these views

body"

(i

all

be

made

alive.

What is sown is perIt is

sown

a physical

Cor 15.22, 42-44).

—immortality of the soul or resurrection of

—did the early Christian apologists and other church

body

fathers defend ity

Day"

full reintegration

with the resurrection of the dead.

what

it is

Which the

at the Last

event,

of creation and redemption will be brought to completion.

"For as in ...

momentous

somatic reality that

spiritual body. Personal identity will

work

coming in glory of the Son

the universal resurrection. That

when the dead will

person, a unity

and preach?

Clearly,

it

was the

latter.

"Immortal-

of the soul" distorts the Christian understanding of the mean-

and value of the human body, while

it

undermines a

biblical

eschatology that sees resurrection of the body as the means by

which we are able to

participate in Christ's

glorification.

192

own resurrection and

The Hope of Glory

Tatian, for example, declared, .

.

.

but mortal. Yet

cos, 13

).

is

possible for

(

not in

itself

immortal

not to die" (Oratio ad Gre-

f ca. 200), subsequently affirmed that the soul

not intrinsically immortal but

life

it

is

The greatest biblical theologian of the pre-Nicene period,

St Irenaeus of Lyon I

it is

"The soul

is

God and

created by

is

granted

by God: "For just as the body animated by the soul is not itself

God

the soul, but participates in the soul as long as

wills, in the

I

same way the soul life

j

I

that

is

not

God grants to

To the present

itself life,

it"

day, the

but rather

it

participates in the

(Against Heresies 2.34.4).

Orthodox consensus holds

that the soul

we

created simultaneously with the body. In today's language,

would say

it is

created at fertilization,

when

the nuclei of

and ovum unite to form the human zygote. As noted

is

sperm

earlier,

the

we can affirm not that we have or possess a soul but that the human person is soul. The created human being is ensouled existence, animated by the nephesh or life breath of God (cf. Gen 2.7). Soul, then, is the principle of animation, originating with God, who is the source of life. The unity of soul

soul

is

and body

so total that

is

proper to the body;

composition.

Once

it is

a constituent element of the body's

created, however, the soul

immortality in the sense that for those

who

is

characterized by

live in Christ, it will

not die but will be reintegrated into the transformed, spiritual

body

at the general resurrection.

Thus

St Irenaeus

once again:

I-

i

;

j

We cannot is

speak of the "mortal soul," because the soul

the breath of life

of being that

is

breath, without

To

die, in effect, is to lose the

way

proper to living things, to be without life,

without movement, and to become

jj

dissolved into the elements from which

we

received the

I

II

principle of our existence. This, however, cannot

jl

193

happen

STAGES ON life's WAY to the soul, because

pen to the It is

spirit,

the breath of Ufe; nor can

because

it is

dissolves

taken.

little

Thus

it is

Once

into the earth

little

St Irenaeus

the flesh which

and the

distinguish between

Eternity

entire

two key concepts:

is

as

eternity

it is

an endless extension through

rather a quality of being, in ceaseless

that the soul, the principle of

from

creation at conception,

its

essential to

and immortaUty.

begins in the present age and endures beyond death

that

was

5 .7. i ; cf. 13.3

ion with God; thus the Johannine notion of eternal

To say

it

life;

mortal.

is

Orthodox tradition,

must not be thought of

time. Eternity

the soul has

from which

—Against Heresies To

hap-

without breath and without

is left

by

it

not complex but simple

the flesh that experiences death.

departed, the flesh it

it is

life, is it

life,

(cf.

eternal,

commun-

is

which

Jn 5.24). to affirm

possesses the capacity to

human creature from the beginning of his or her existence, and to dwell in permanent communion with God in the realm of his divine being, a communion that will endure beyond the limits of earthly existence. (This is why we can even now participate in the "eternal communion of saints," sharing with deceased holy people their glorification of God and asking them animate the

They

no longer

to intercede

on our

they are

characterized by ensouled existence.

still

behalf.

tence they share both with us

are

in the flesh, but

And

that exis-

and with God.) The doctrine of the

immortality of the soul, on the other hand, impHes that the soul is

exempt from death,

oblivion, or annihilation, because

it is

metaphysically distinct from the body and independent of

According to

this view,

mately does not affect

death has no power over the soul and it.

194

it.

ulti-

The Hope of Glory

The human soul is not mortal, as is the flesh; the soul does not simply disappear with the irreversible cessation of cardiorespiratory

functioning and subsequent "brain death." Yet the soul cannot be said to be tive

immortal in the sense that

exempt from the destruc-

power of death. At death, once again, the soul is tragically sep-

arated from

its

bodily or somatic reaUty. (Tragically because

The

created us for Ufe, not for death.) it

it is

God

soul thus "dies," insofar as

succumbs to the devastating consequences of death:

inevitably

The

disintegration of the body's various constituent elements. soul, nevertheless,

is

same dissolution

the

eternal, in the sense that

it

does not undergo

as the flesh but continues to exist after the

death of the flesh (which we habitually speak of in a confusing and rather misleading

way

In this perspective, cal language,

as the physical body).

we can easily understand

which declares that

"separated from" the body, even ing.

(More

the Church's Uturgi-

at death the soul "leaves" or if

is

that language can be mislead-

accurately, the soul leaves the flesh or mortal aspect of

our nature.) Our empirical experience in and with the communion of saints

—

live

tells

us that those

who die in Christ continue to exist

in him. Their state of existence

—

^to

can be properly termed

ensouled. Certainly they have been subjected to the destructive

power of death,

just as Jesus

was

at his death

on the

cross. In

Philippians 1.2 1-2 3, however, the apostle Paul alludes to an aspect of human existence

—a

critical stage

on life's way

—

^that

can

be termed an intermediate state between earthly and resurrected existence. After physical death

and before the general resurrection

at the last day, there

(or,

is

a time

perhaps

tence, since physical death takes us

space) that

is

better,

a

mode

of exis-

beyond the bounds of time and

"with Christ," a condition that Paul declares

195

is

STAGES ON life's WAY "much

better" than

life

in the flesh, or earthly existence. In that

away from

condition, the soul has indeed been torn flesh,

being subjected to the

body of

powef of death. Yet "with

Christ," in

power of Christ, the

soul awaits

the presence and infinitely greater the final resurrection,

the

when

the dead, in their full somatic reaUty

and integrity, will be raised to new and eternal life. Then "we be changed," transformed from a nature that

is

shall

perishable to one

imperishable ( i Cor 15.5 2-5 3 ).

that

is

It is

the continuing existence of the soul into God's eternity that

perhaps explains the well-known phenomenon of resuscitated patients

who

—^persons who have been pronounced

clinically

dead yet

preserve a degree of awareness of their surroundings until

we

they are resuscitated, until, as

again misleadingly say, their

soul "returns to their body." (In fact, the soul reunites with the flesh to reconstitute the psychic or

further explains

how

who

the saints,

entered into God's eternity, can be

though they are disembodied

is

as ensouled beings have

known

more

(or

persons. Because their existence

ensouled earthly body.) This

as living souls, even

accurately disenfleshed)

ensouled, even

can be in communion with them. With

all

if

not fleshly,

we

the deceased, they

await the transformation of their ensouled existence into a "spiritual

body"

at the general resurrection, a transformation that will

overcome the destructive and This, in essence,

thians 15.44,

is

what the

divisive

consequences of death.

apostle Paul describes in i Corin-

where he affirms that the psychic body (soma

psychikon) will be transformed into a spiritual body (soma pneumatikon).

The human being is created specific space, yet

he or she

at a specific is

moment in time and in a

destined for eternal Ufe.

196

The

soul

The Hope of Glory

(psyche), together with the flesh (sarx) all

created to constitute the

decays, since is

it is

The

mortal.

not subject to corruption.

and

spirit

(pneuma), are

body (soma).^ At death, the soul, however,

is

flesh

not destroyed.

It

To the contrary, the soul continues to

with the potential to enjoy communion with God. Yet the

exist,

soul awaits final reintegration into a newly constituted spiritual

body

at the universal resurrection.

Accordingly, early Christian theologians utterly rejected the

Greek understanding of the relation between soul and body expressed by the Platonic wordplay soma-sema (body-tomb). This implies that the immortal and preexistent soul

is

entombed

in the body, so that salvation consists in liberation of the soul its

return to the realm of divine existence, while the

annihilation. Christianity,

body

and

suffers

on the other hand, teaches resurrection

of the body not as a complement to immortality of the soul but as

its

corrective. Resurrection of the

body depends on Christ's vic-

tory over death, and hence the theological importance of the

paschal hymn: "By his death he has trampled soul were in fact immortal, there that victorious death.

It

would

dovm death! "

If

the

would have been no need

for

suffice

simply for us to die and

thereby allow the soul to continue existing, unencumbered by the body.

If

the soul, however,

is

the animating principle that deter-

mines bodily integrity and personal

identity,

leads not to the soul's liberation but to

ration

^Again

from the

we need

flesh,

then physical death

—again,

its

thereby destroying the person's somatic

to recall that St Paul never intended to present a systematic

description of the body's constituent parts. Consequentiy,

to is

tell

when

—sepa-

tragic

the term spirit refers to an aspect of

used synonymously with soul, or

when

197

it

human

it is

often difficult

existence,

refers to the Spirit of

when

God.

it

STAGES ON life's WAY identity.

That

can be restored only through the death on

identity

the cross of the one

who fully assumed our human nature, died in and ascended, bearing that redeemed and

that nature, then rose

and only

restored nature in himself. Thereby,

thereby,

we can

share in his death, resurrection, and glorification.

The two perspectives, immortaUty of the

soul

and resurrection of

the body, are therefore essentially irreconcilable. course, raises questions about our that the

two can

resolved

if,

Orthodox prayers

in fact be reconciled.

with St Irenaeus and

And

this,

of

that suggest

The problem would be

patristic tradition in general,

we

substituted the term flesh for body, or prayed for the peaceful sep-

aration of the soul from the sion,

we would

body of

flesh.

By

this latter expres-

be making the same distinction St Paul makes

when he distinguishes the physical from the spiritual body. "Body of flesh" would refer to the mode of earthly existence that ends with physical death. The soul that separates from that body continues to "be with Christ" (Phil 1.23). Yet

it

awaits the transfor-

mation of the disintegrated person from an earthly to a heavenly body, from a psychic to a spiritual body, that will occur at the general resurrection. spiritual body,

and

Then

which

the soul will be fully integrated into the

in turn will fully restore personal integrity

identity.

The important point

is

that continuity

from one

state to another,

from the physical to the spiritual body, is preserved by the somatic or bodily aspect of our being. a physical body."

A person's unique reality

Then that body dies and undergoes

because at death the soul departs, and this tion of the flesh. Christ's.

But

The

just as

person's death

is

is

sown

dissolution,

followed by corrup-

real

Christ rose from the dead

198

"is

and

total, as

was

in his resurrected

The Hope of Glory

and

glorified

—

body

^yet

earthly condition that

was his prior to his crucifixion

be raised up, not as a

changed from a physical to a

body of

to a

—so we our-

new and different person renewed and transformed body. Our body will be

selves shall finally

but as a

retained full personal identity with the

spiritual body,

from a body of death

But our personal identity will be preserved.

glory.

What

preserves that personal identity from earthly

death,

and

tinuity

between earthly and heavenly existence, between the phys-

ical

into resurrected existence

body and the

is

life,

through

precisely the somatic con-

spiritual body.

In I Thessalonians 5.2.3, St Paul employs a traditional tripartite

formula:

"may your

spirit

and soul and body be kept sound and

blameless at the coming of our Lord Jesus Christ." This

Normally he

in his writings.

nature and elements of the

is

unique

retains a Jewish perspective

on the

human

between sarx and pneuma. To characterizes

human

existence

his

is

not sinful as such;

lives,

it

(flesh), like

our being that noted,

it

is

in

human

is

communion with

speaking of the

dwelling and acting within us Nevertheless,

it is

condition,

on the other hand,

does so to the point that

whether Paul

and

the

spirit rather

Hebrew basar,

and death. The term

subject to temptations, sickness,

mortality. Spirit,

flesh

represents the superficial aspect of our

thus designates the fallen

and

mind, the real dualism that

between

than between body and soul. Sarx is

person, making a distinction

it is

marked by passions

designates the aspect of

divine

life,

and

as

we have

often difficult to determine

human

(cf. i

flesh

spirit

or the Spirit of

God

Cor 2. 10-16).

important to recognize a further distinction in

St Paul's thought.

The deeper

sense of flesh and spirit in his

anthropology refers not to two dimensions or elements of the

199

STAGES ON life's WAY human

being but rather to two opposing orientations. One's

entire being

is

oriented either toward the.flesh, with

its

passions,

mortal weakness, and tendency to rebel against the divine it is

oriented toward the

mits

itself

which means

spirit,

to the authority

or

voluntarily sub-

it

and dominion of the

will,

God

Spirit of

(cf.

Gal 5.16-25). It

would

body

what we term

in Paul's perspective refers essentially to

person as I

require a detailed exegesis to prove the point, but the

for example, the use of the term

(cf.,

Cor 6.1 5-20; 7.4; and Eph

son as a whole;

similarly,

Mk

5.28; here

body in passages such

soma indicates the per-

5.29 and parallels).

sense signifies the entire composition of the created

including flesh, soul, mind, and that of the Jewish tradition in

the

spirit. Paul's

Body

in this

human being,

anthropology, like

which he was

raised,

is

hoUstic

When he speaks of the body, he is normally whole person, created in the image of God and

rather than dualistic. referring to the

grow

called to

in Christ

"from glory to glory"

(2

Cor

3.18).

The Body of Glory The phrase "body of glory" (soma

New Testament.

such in the tes

The

tes

doxes) does not appear as

closest expression to

it is

doxes autou, the "body of his glory," referring to the

body of the risen Lord frequently

person.

(Phil 3 .21).

Yet the

and eloquently about the

We

soma

glorified

New Testament speaks

glorification of the

human

already mentioned Philippians 1.23, noting that

it

presupposes an intermediate stage of existence, between physical

death and the general resurrection, during which the deceased believer

is

in

immediate communion with Christ.

200

We have noted

The Hope of Glory

as well I Corinthians 15.44

and

briefly to that passage. Finally,

we need to consider 2

its

context and must return Corinthians

5.1-10, where the apostle speaks not of a transformation from

one body to another but of our longing to "put on our heavenly dwelling."

There seems to be a progression in Paul's thought from

i

Corinthians to 2 Corinthians, and on to the final stage repre-

On the one hand, he

sented by the later letter to the Philippians.

never abandons the conviction, expressed in

i

God

concerning the universal resurrection, that

Corinthians 15 will transform

our ensouled physical bodies (soma psychikon) into glorified spiritual bodies.

There

is

—

total somatic

^that is,

personal

—continuity

between the two. The physical body, bound by time and space, dies

and

is

buried in the earth;

it is

raised

up

to share in Christ's

own transcendent, glorified existence. The continuity between the two

states,

however, must be described precisely as somatic, and

not material. Body, once again, refers to personal existence, created in the image of

would

Paul's statements

referred to the

God and

bearing that image into eternity.^

raise fewer questions for us

if

he had

form of our earthly existence as a soma sarkikon,

a "body of flesh."

^The question as to

The

just

fact that

when

he speaks specifically of a psychic

that transformation

from the physical to the

will take place has troubled interpreters of every age.

We are

accustomed to envisioning the Parousia as occurring at the end of

history,

spiritual

body

presumably

in a far distant future. Since physical death leads to a

existence that

God there

is

is

beyond time and space, however, and

no duration but everything

is

(Is this

1.23?)

201

mind of

immediately present, some inter-

preters hold that this transformation, together with

immediately after our physical death.

since to the

form of

judgment

what Paul

is

itself,

occurs

thinking in Phil

STAGES ON life's WAY body apparendy

reflects his

concern to combat certain gnosticiz-

ing tendencies in Corinth that soul even in

The

ism.

its

would

body and

earthly state, reflecting once again a Platonic dual-

earthly body, for Paul,

mind, and

radically separate

is

the unified reaUty of flesh,

governed by the soul, or divinely bestov^ed

spirit,

principle. In the resurrection, the soul will be transformed

life

with

every other element of somatic existence to become a spiritual

body, a body charged with the grace, the power, and the

Holy

Spirit.

The

fallen

image of earthly humanity

life

of the

will itself be

transformed and restored to the original perfection in which and for

which

it

was created

(cf.

Gen

i.26f).

Thus Paul can

declare,

we have borne the image of the man of dust, we shall also bear the image of the man of heaven [Christ]" (i Cor 15.49). "Just as

The

fact that Paul

was repeatedly persecuted and imprisoned may

well have influenced the development in his thought between his first

and second canonical

letters to

the Corinthians.^

By

the time

he wrote the latter, he was aware that he would likely die before the Parousia, the second coming of Christ in glory. This led reflect

on the state

—

tence

of the human person—

in the period

^the

him

to

body or somatic exis-

between physical death and

final resurrection.

In 2 Corinthians 5, therefore, he attempts to deal with this question in a tic

way

that contradicts his opponents (probably Hellenis-

Jewish Christians)

who

held that death means the separation

of the soul from the body, such that any intermediate existence

would be

necessarily bodiless, characterized

ness." Accordingly, he uses

^We know from

i

Cor

mixed images to declare that

5.9 that the

the Christians in Corinth that

by somatic "naked-

aposde wrote

was not included

Scripture.

202

at least

one

in the Church's

at death

letter to

canon of

The Hope of Glory

we

a heavenly dwelling": "While we are

still

in this tent,

not that we would be unclothed, but that we would be fur-

iously;

ther clothed, so that (2

we "put on we sigh anx-

are not stripped of our somatic reality but rather

Cor

what is mortal may be swallowed up by life"

5.4).

The phrase "further clothed" renders the sense of the Greek verb ependuomai. The prefix epi could indeed signify putting one

—a dwelling or a garment—over another. Yet the verb could

thing

from the lowly earthly habita-

also express a quaHtative change,

tion to the glorious heavenly habitation,

skin"

(cf.

Gen

from a "garment of

3.21) characterized by weakness, passion, and

mortality to a transfigured

body

with the Lord" (2 Cor 5.8)

^

that allows us to be "at

home

A consistent theme appears in patristic commentaries on this passage in 2 Corinthians 5 identity exists

.

It is

the conviction that personal, somatic

between the earthly body and the heavenly body.

Origen declares, "In regard to our bodily nature

we must under-

we now

use in lowliness

stand that there

is

not one body which

and corruption and weakness and a use hereafter in incorruption and

different

one which we are to

power and

glory, but that this

same body, having cast off the weaknesses of its present existence,

"^For a

thoughtful discussion of the "garments of skin" and Orthodox

anthropology in general, see Panayiotis Nellas, Deification in Christ: The

Nature of the Human Person (Crestwood, NY: 1987). The

flexibility

St Vladimir's

and lack of systematic precision

Seminary Press,

in Paul's language

is

Cor 5.6-10. Here body from God" that awaits those who die in Christ. As the overall context of 2 Cor 5 indicates, however, that building, "eternal in the heavens," is the same as the "spiritual

well illustrated by the passage 2

signifies

existence as contrasted with the eternal "building

body" of

I

Cor

15.

203

our earthly

"

STAGES ON life's WAY will be transformed into a thing of glory

Theodoret of Cyrrhus

in Syria (f ca.

and made

spiritual."^

466) makes the same point:

"The heavenly body is not some different one but the one we have now, which will be transformed."^ Yet the continuity between the

two

states of the body, earthly

and heavenly,

is

so total that St

Paul can declare regarding the mystical experience described in 2 Corinthians 12:2 that he was unaware whether he was "in the

body" or "out of the body"

(referring to the

body of flesh or body

of death). Even in this present psychic body, the most intimate

communion with third heaven,"

Christ

possible, including experience of "the

is

where Paul received

ineffable "visions

and

revela-

tions of the Lord."

In a similar vein, he can exhort the Corinthians, tempted to sex-

ual inmiorality, to glorify

not

know

that your

God

body

is

you, which you have from

were bought with a (i

in their somatic reality:

"Do you

a temple of the Holy Spirit within

God? You

are not your

price. Therefore, glorify

own; you

God in your body!

Cor 6.19-20).

In St Paul's understanding, our true death does not occur with

the end of physical existence. Mortality has been defeated by the

redemptive work of Christ, opening before us the possibility for

new

life

even in the present age. Our true death,

^Origen of Alexandria

we need

to

On First Principles ^.6.6, in Ancient Christian Com-

mentary on Scripture [hereafter ACC5],

vol. 7 (Downers Grove, EL: Interof the body's destiny, unlike the Varsity, 1999), 239. This perception

Origenist notion of eternal, preexistent souls, conforms fully to

Orthodox

anthropology.

^Theodoret of Cyrrhus Commentary on the Second Epistle to the Corinthians 313, in

ACC5,

vol. 7,

240.

204

The Hope of Glory

remember, occurs at baptism^ with the transformation of the

man"

"old

into the new.

new

put on the after the

nature,

image of

Similarly, Paul

its

By baptism, Paul

which

Creator" (Col 3.10;

flesh.

Eph

2.15; 4.24).

"We were buried with was

from the

raised

we too might walk in newness of

a present reality that characterizes our

life

in the

In the perspective of the Gospel of John as well, the Ufe of

the age to

hears

is

cf.

into death, so that as Christ

dead by the glory of the Father,

"you have

being renewed in knowledge

can declare in Romans 6.4,

him by baptism hfe." This

is

declares,

come

is

"He who

already present and accessible to us:

my word and believes him who sent me has eternal Ufe; he

does not come into judgment, but has passed from death to

life"

(Jn 5.24).

The

"realized eschatology" of the

New

Testament obliges us to

make a thoroughgoing reassessment of the way we usually understand the relation between

life

and death,

body of death and the resurrected us and destined us for glory

as well as

between the

God has created Col 3.4). Yet because we

spiritual body.

(Rom 9.23;

have already died and been co-buried (synetaphemen) with Christ,

and have been raised with him to lead a new life

(kainoteti

we can here and now glorify God and share in his transcendent glory, even in our mortal bodies (Rom 6.4; i Cor 6.20).

zoes),

The

earthly

body (soma sarkikon or psychikon)

ticipate in the glory of spiritual

is

called to par-

God by means of its transformation into a

body (soma pneumatikon). This transformation, how-

ever, begins in the present age. It is initiated

by baptism into the

death and resurrection of Christ (2 Cor 4.10; Col 2.12); fected through ongoing faith in Christ

mandments

(Jn 5.24);

and

it is

and obedience to

brought to

205

its

it is

his

per-

com-

ultimate fulfillment

STAGES ON life's WAY after physical death,

with the second coming of Christ and the

universal resurrection.

We

are faced, therefore, with another Pauline paradox.

one hand, the transformation from a physical to a will occur "in a

moment,

(i

ment. Yet

this

an

in the twinkling of

Cor 15.51-53),

trumpet"

at the Parousia

transformation

is

On

spiritual

the

body

eye, at the last

and the

final judg-

already underway, by virtue of

baptismal grace and our present union with Christ. To resolve this tension between present and future, between our earthly somatic reality

and the transfigured

to come,

life

we can

speak most

appropriately not of future and realized eschatology but of

what

Fr Georges Florovsky called "inaugurated eschatology." Through sacramental grace and the indwelUng power of the Holy Spirit within our psychic bodies, the

life

we

participate already in the glory of

to come. Nevertheless, the fulfillment

still

Hes ahead. In

our present condition of sinfulness and mortality, "we await a Savior, the

be

Lord Jesus

like his glorious

Christ,

body"

who will change our lowly body to

(Phil 3.20-21).

The Paschal Victory Orthodox anthropology, together with foundly rooted in biblical tradition.

Its

its

eschatology,

vision of

depends on the witness of Holy Scripture, which

by the experience of the apostolic authors.

life

is

pro-

and death

itself is

shaped

St Paul suffered

imprisonment and knew he might well follow his Lord to martyr-

dom. Yet Paul tical vision

also

knew

the joy

so powerful that he

and

ineffable

was unable

wonder of a mys-

to determine whether

he was in or outside of the body. His experience in the face of

206

The Hope of Glory

death and his unshakable hope in the promise of coming glory, the transformation of his physical

body

into a glorified spiritual

body, can and should inform the approach every Christian takes to the mystery of death

and the promise of eternal

In our tragically fallen world, cal

promise of transfigured

it is

life

life.

tempting to dismiss the bibU-

as

mere wishful thinking. For

many

people, the fact that

leaves

them void of hope. Yet the Church prays unremittingly for

life

beyond death

is

void of proof

"a Christian ending to our lives," one in which the hope of resur-

and

rection

eternal

life

will be

aspect of the Church's mission in the world, therefore, the faithful to live

life

and to

A

abundantly realized.

face death with the

is

primary

to enable

hope of glory.

The most important conclusion we can draw from our overview of bibUcal themes can be stated in this way: For those

mit themselves to Christ, death

is

who

who com-

submit themselves to his lordship,

no longer an implacable enemy. Death

in fact has

been

transformed into a paschal entryway into the kingdom of God.

Our true death occurs at our baptism, when we die and are buried with Christ, in order to rise up with him in newness of life. From that

moment onward,

nature

is

death has lost

its sting.

Because our mortal

marked by anxiety and doubt, we continue

against our worst tendencies, against passions that threaten constantly to plunge us once

darkness and death. Yet even there, Christ

we

preserve the hope of glory.

And

more is

to struggle

and temptations into

present.

an abyss of

Even there

that hope, as the apostle

declares, "does not disappoint us, because God's love has

poured into our hearts through the Holy given to us"

(Rom

5.5).

207

Spirit

been

which has been

STAGES ON life's WAY That hope, unshakably established

in the

mind of the

apostle,

is

shared equally by later representatives of the Orthodox spiritual tradition. It

would be appropriate

to close this chapter with a

quotation attributed to one of those witnesses, St Macarius of Egypt, whose vision and language are thoroughly shaped by those of the apostle Paul:

own

Every soul that through

its

leged in this present

to put

life

is

initiated here

faith

is

[his]

and now, personally,

great day of the resurrection, the

body

form

like the

body of

co-inherit the eternal

Christ's glory,

.

.

into the in the

also will be glori-

with that same heavenly image of glory.

caught up by the Spirit to the heavens,

.

incorruptible

knowledge of all the heavenly mysteries. Moreover,

fied

privi-

on Christ completely,

and to unite with the heavenly Ught of image,

and

effort

it

It

will be

will be given a

and with him

it

will

kingdom.^

Symeon Metaphrastis, "Paraphrase of the Homilies of St Makarios of Egypt," in The Philokalia, vol. 3, eds. G. E. H. Palmer^ Philip Sherrard, and Kallistos Ware (London: Faber and Faber, 1984), 348f (trans, slighdy mod^St

ified).

208

chapter seven

CARE IN THE FINAL STAGE OF LIFE To care well for the dying, we must trust deeply that these people are loved as

much

as

we

are,

them

to let

go of

their fears

and we must make

We must encourage

that love visible by our presence

and

to

hope beyond the

boundaries of death,

—^Henri

Death

is

better than a

J.

M. Nouwen, Our

life

Greatest Gift

of misery, and eternal rest than

chronic sickness,

—Sirach 30.17 My desire is

to depart

and be with

Christ, for that

is

far

better,

—

^Philippians 1.23

years ago, an aunt of mine committed Nearly twenty her generation and was She was the youngest

sui-

in

cide.

always

my

favorite.

We

laughed and played together

when I was a child, and when I proposed at the tender age of five, she promised with a broad smile that she

209

would stop getting older

STAGES ON life's WAY and wait

for me.

I

was

delighted.

Some

four decades

later, after

her husband had died of cancer, she found herself caring for her oldest son,

who had been seriously brain damaged in a tragic acci-

dent. Pressures accumulated, pushing her into a

of depression. Although she

world crumbling away.

I

was

should have realized

was when she

depression really

me

told

planned a brief stopover at her home. didn't.) I

The

permanent

state

secure financially, she found her

("I

not to

how

deep her

visit after I

should have"

.

.

.

had

but

I

never saw her again.

was

funeral

many

like so

others. People cried, her children

put on brave smiles, the pastor fumbled for something

tried to

appropriate to say. As a young girl,

my aunt had been turned away

from the Church by a combination of verbal abuse and hypocrisy

on

the part of both clergy

have

known

better.

The

and

lay

members, people

pastor's eulogy

was

who

should

predictably banal,

void of any real consolation or expression of hope. At the graveside,

we gathered under a tent as he deUvered another brief, empty

prayer.

grave.

The casket was

A green rug,

over the prayer, to

mound

set

on

the usual supports over the open

supposed to imitate grass, had been thrown

of dirt set to one side. Immediately after the

my astonishment, everyone turned to leave.

"My God,"

I

blurted to

no one

in particular, "aren't

we going to

bury her?" "No," somebody repHed. "The grave diggers take care of that."

We

left

friends gathered in

the cemetery, then family and a few close

my

aunt's living

room

for a

spoke soothingly nice things to her children as

little

food.

We

we wandered

around, taking in the transformation that had come about during the last

months

in her

dishes all over the place,

once beautiful home: her unmade bed,

no pictures left on the walls, no curtains

210

Care in the Final Stage of Life

on the windows, empty wine left.

All in

all, it

bottles in the pantry. Finally,

was a depressing and

in

some ways

we

infuriating

experience.

I

couldn't help comparing that day with another

and

I

wife, Lyn,

had shared with our boys, Paul and Michael, when they

were about in

my

an old

and three

five

village

respectively.

We were living at the time

house in a magnificent Swiss valley

just

north of

Neuchatel. Years before, the house had been divided into small apartments. Across the hall there lived three elderly women. One,

Xante Jeanette, was suffering from Parkinson's disease. Each day

toward the end of her cards or just to

sit

life,

our boys went into her room to play

by her bedside and

tell

her stories. Sometimes

they took a spoon and carefully fed her, since she able to feed herself.

home, they cried a

They laughed with

her,

was no longer

and when they came

knowing they would soon

Uttle,

lose her.

One winter evening, her sister appeared at the door to tell us that Jeanette

had passed away.

went across the room. Cold

air

hall.

The

We

sister

washed over us

was wide open, and

hugged

her,

then the boys, and

opened the door to Jeanette 's bedas

we stepped inside. The window

several neighbors stood in corners of the

room. There on the bed, propped up against pillows and sur-

rounded by large clumps of lovely flowers, lay Jeanette, her eyes closed, looking

more peaceful than we had ever seen her. Paul and

Michael went over to

her,

The look on

their faces

They took

in

it

adults in the

back

at us

touched her cold hand, and

was one of sadness but

just stared.

also of wonder.

with an understanding and acceptance that the

room found hard to match. Finally, they both looked

and smiled.

211

STAGES ON life's WAY The next day, the

some clutching

entire village gathered at the front of the house,

flowers, others holding candles.

few men

down the narrow stairs and met the pastor at

brought the casket

the village street. Then, while

we

A

some sang

quietly

processed informally through the village,

and others wept,

first

to the church,

then to the cemetery. With simple prayers and a eulogy spoken

from the

heart, the pastor,

Another

story:

remained

at

with the

rest of us, laid Jeanette to rest.

When a dear older friend, Michael, was

home, where

his family cared for

dying, he

him with

extraor-

One morning, Lyn and I were called to the house by his devoted wife, who somehow had transferred Michael from the bed to an easy chair. When we entered dinary attention and affection.

the room, his eyes were closed. Several of us spoke to him, but there

was no

response. Finally,

down, and spoke loudly

Lyn stood

into his ear,

close to him, leaned

"Good morning, Michael!"

His eyes opened wide, then with a radiant,

beatific smile,

he

A moment

or

looked at his wife and at the others in the room.

two

later,

he closed his eyes again, and

we

left.

Later that day,

Michael died.

The

burial

was held

we

an old Russian cemetery some miles from

As the celebrating

the family home. prayers, then

in

priest, I offered the final

sang the funeral hymn, and

I

stepped back. In

Russian practice, family members and friends come forward at that

moment, scoop up a handful of earth from an outstretched

shovel,

and drop

it

into the grave. After everyone

turn, Michael's family took

had had

up shovels to complete the

their

burial

by

hand. Lyn took up a shovel too, and others joined in by turn. Shovelfuls of soil dropped with a hollow casket, then

it

was

soil

on

soil until there

212

thump on

the exposed

was a small mound over

Care

in the Final Stage

Each of us, working

the grave.

of Life

together, participated in that bur-

acknowledging the tragedy and sadness of death, yet sharing

ial,

through our tears the unshakeable conviction that Christ has destroyed the power of death and that Michael the fullness

now reposes in all

and joy of the communion of saints.

me a great deal about death, and perway we are to care for dying persons.

These vignettes have taught haps

As

still

my

more about

the

aunt was sinking ever farther into chronic depression,

complicated by alcohoUsm, she isolated herself from both family

and

Out

friends.

interfere,

we

of

some

in effect

distorted sense of discretion, afraid to

abandoned

her.

Unable to care for her son

as she felt she should, she

became panicked, confused, and hope-

numbed

herself with alcohol, got into her car,

less. Finally,

she

and started the engine in a closed garage. I could have cared more. I

should have cared more.

more. But

Nothing

I

really

wish

I

had cared

redeems an act of abandonment, especially when are dying. Nevertheless, in his

mercy God

shine out of the darkness, often in unexpected ways.

took our children, kindness, to teach tion,

I

didn't.

we abandon those who lets light

God knows how

Httle kids

me

with

all their

It

simple and heartfelt

about the need to offer tenderness,

affec-

and personal warmth to those whose lives are slipping away.

So too our joint participation in Michael's burial enabled us to share fully in the true significance of a dear friend's death: "Thine

own

of Thine own,

we

offer

unto Thee."

213

STAGES ON life's WAY How are we to care for dying people, and how are we to deal with the grief that follows their death? In this final chapter, I'd like to

a Uttle

reflect

on both of these

questions.

thing here might be of use to readers

I

would hope

who

find themselves con-

fronted with the mystery of death, with hopefulness,

some

sense,

its

challenges

and

obligations.

that some-

all

of

dread and

its

These remarks

are, in

my discussion of end-of-life care in

complementary to

an earUer book, The Sacred Gift of Life, ^ There I tried to deal with technical matters concerning appropriate measures to sustain in terminally

make

ill

patients, together

life

with ways to help those patients

their final paschal journey in peace

and with

dignity.

concern throughout was to provide a response to persons

My who

defend practices the Church has always rejected and must continue to reject, including euthanasia I

also dealt to

and physician-assisted suicide.

some degree with matters of terminal

Ufe-support,

together with questions raised by so-called hard cases, in which decisions have to be

made, on a case-by-case

to suffering persons in a

we know it from Here

I

would

way

Scripture

basis, to bring relief

that conforms to the will of

and the Church's

like to return to

God

as

tradition.

some of those

issues in a less for-

mal and more personal way. The thread that connects these reflections, at least in

my

mind,

language, the question

is

is

that of care. In

how we

more

biblical

can offer to dying patients a

depth and quality of love that will most effectively guide them along the

final stages

existence to

life

of the pathway that leads from this earthly

in the

kingdom of God.

The Sacred Gift of Life. See chap. ing the End of Life," and esp. 223-39. ^Breck,

214

5,

"A Blessed Pascha: Approach-

Care in the Final Stage of Life

First of all,

the

it is

essential that

we recognize the utter distortion that

"American way of death" imposes on believing Christians as

well as

on

others.

Lawn approach"

We

have become so accustomed to a "Forest

to death

or simply hidden—

^that

and burial

we have

—

lost

^in

which death is sanitized

any

real sensibility

the mystery that properly surrounds the end stage of transition to

life

life

toward

and the

beyond. In his widely read book The Denial of

Deaths Ernest Becker explains the nearly universal denial of the

phenomenon For

many

itself

Christians, this

fear that God's if

as due to the "terror" associated with death.^

indeed there

is

terror of the

unknown, coupled with

judgment will outweigh his mercy to the point that is

an afterlife, they may well spend it in hell, a place

God where they will be subjected to eternal punishment. Given what many Christian children are taught about heaven and hell at home and in Sunday school, it's no wonder that many of them grow up hoping that death means simply of separation from

annihilation, yet dreading the possibility that ful retribution for their sins.

And

it's

least in this country, cling to the

unbiblical

it

will lead to venge-

no wonder

that so many, at

fundamentalist and wholly

hope of "once saved, always saved,"

in

which the

"once" depends on nothing more demanding than standing up in church one day and "taking Jesus as

my personal Lord and Sav-

many

people attenuated, at least

ior."

This expediency has for

somewhat, the terror of death.

It

has done

enable them to face death reaUstically,

Orthodoxy

taUsts are,

is less

it is

^Ernest Becker,

however, to

much less to embrace

a passageway to a glory and joy beyond If

little,

all

it

as

comprehension.

certain about salvation than the

fundamen-

far more reahstic about the narrow path that leads

The Denial of Death (New York: Free

215

Press, 1973).

STAGES ON life's WAY to

If

it.

Orthodox Christians expect

arduous,

filled

that

pathway

to be long

and

with stumbling blocks that need constantly to be

removed through repentance,

fasting, confession,

and

ascetic dis-

know that the love of God is stronger than death mercy of God will enable them in the end to share

cipline, they also

and that the fully

and

eternally in Christ's victory over death.

To an Orthodox found

in death,

believer, the

is

only sense, the only meaning, to be

given by what

ment and ongoing purification. it is

lies

It is

beyond. This includes judg-

a process that never ends, yet

one that culminates in what Tradition

participation in the very

life

of

God

calls theosis, eternal

himself. This

is

what the

young man had in mind when he answered the question. Why did you become Orthodox?

"I

order to learn to die well." the

became Orthodox," he

To

die well

is

most realistic goal any of us can have. or by God's grace,

effort,

it

replied, "in

the deepest desire and It

can take a lifetime of

can be granted in the

last

moments of

our biological existence. In either case, a "good death" desire,

the

and

what we most

fervently long for, because a

means by which we joy-filled

Most

attain hereafter

communion with the

God

an

is

what we

good death

is

everlasting, blessed,

of love.^

of our contemporaries dismiss this kind of talk as "pie in

the sky bye

and bye."

It's

a convenient illusion

we have created in

order to deal with the terror of death and the distress that so often leads us there.

The multitudes of near-death experiences

^Stanley Harakas summarizes this point as follows:

—

^with a

"The only *good death'

Orthodox Christian is the peaceful acceptance of the end of his or her earthly life with faith and trust in God and the promise of the Resurrection" (Stanley Harakas, Contemporary Moral Issues [MinneapoHs: Light and Life, for the

1982.], 176).

216

Care in the Final Stage of Life

tunnel opening out onto beautiful vistas

with

filled

brilliant light,

and the welcoming appearance of deceased loved ones

—are

dis-

missed as the product of brain chemistry, a purely neurological reaction to the snuffing out of Ufe. This leaves us with

little

more

than Dylan Thomas's refusal to "go gentle into that good night"

and

his cry to "rage, rage against the

The Church has never

said anything definitive about near-death

experiences,

and rightly so. They are,

death

So

itself.

dying of the light!"

after

all,

near death and not

how do we know?

What we do know, however, is what has been handed down since Jesus' own death and the death of the earliest Christian martyrs. It is

the truth that death

of our biological rebirth,

ment

is

not an end but a beginning. The end

not an end at

life is

all

but the marking of a

one that began with our baptism and comes to

in the eternal

declares in

Romans

communion 6.4,

fulfill-

of saints. As the apostle Paul

our real death occurs when

we

die

and

are buried with Christ in the baptismal waters of regeneration. It is

from there that we

rise

up "in newness of Hfe" to embark on

a journey, an adventure of mind, body, and soul, that will lead, like Christ's

paradise.

own

journey, through suffering

To some,

this

may be pie

in the sky.

of believers, including countless martyrs willingly,

even gladly,

it is

who

reality itself. It

is

the biblical witness, attested to by the saints

of each of us by the prayer

—

To untold

millions

gave up their

lives

a reality revealed by

—^whose knowledge

own and we offer up

of such things vastly surpasses our life

and death and into

confirmed in the constantly, both

personally and within the liturgical community, for those

who

have preceded us into the place that only weak and inadequate poetic images can describe: a place of brightness, a place of

217

STAGES ON life's WAY refreshment, a place of repose, where sighing have passed away.

This

is

all

sickness, sorrow,

^

^

Church and perhaps the

the faith of the

and

Christian's

most

When I'm at peace with myself and the world it's my belief and my hope as well. At other times, I

fervent hope.

around me,

have to admit,

I

can find myself in a suffocating black fog of

doubt. Occasionally in those times,

I

find myself, too, staring at

the face of Christ depicted in an icon, and begging with tears, "Please, please, let

ization that the

it

be true!" Consolation comes with the real-

doubt I often experience

is

invariably linked with

a depressing level of fatigue, discouragement, anger, or frustration. Light begets light.

When the light is there,

the devil takes his leave, and faith that indeed

it is

Euthanasia:

—

true

The question remains

^the fragile

by some miracle,

but sure conviction

restored.

is

A Good

—

Death?

as to

how we can best care for and accom-

pany those who are preparing, knowingly or unknowingly,

make that final journey. though,

it is

we speak of specific forms of care, address an issue that takes up as much

Before

necessary to

space in today's newspapers as

This

is

it

does in the

the issue of euthanasia, not only

its

latest ethics journals.

definition but also

its

farther than

we

application in countries that have ventured a

have

to

little

down the proverbial slippery slope.

The term

euthanasia, as

we know,

originally signified a

"good

death" (ev-thanasia). Today, in the minds of most Orthodox and

many This

other Christians,

is

it

signifies

because the expression

is

218

an action

now

just short of

murder.

used to designate

direct.

Care in the Final Stage of Life

active intervention, usually

pose

to hasten death in

is

critically

ill

on the part of a physician, whose pur-

what

are purportedly the interests of a

or dying patient."^ Because

quite rightly so) to basing our

ning with the Ten

we

are accustomed (and

moral choices on Scripture, begin-

Commandments, we

instinctively recoil

from

an action of this kind, taking it to be a direct violation of the order not to

kill.

Our opposition to procedures that hasten death is only intensified by what we are presently observing ij

in England, Belgium,

and the

Netherlands, where euthanasia has become publicly accepted policy.

As long

those countries tion.

as they follow certain guidelines, physicians in

may practice

euthanasia without fear of prosecu-

This strikes most of us as a wanton abandonment of tradi-

tional values in health care,

whose primary aim

for

more than

I

two millennia has been the Hippocratic concern harm," to cure rather than to

made I

more bleak by

The

kill.

to

"do no

entire picture has

been

recent revelations that

Dutch physi-

cians have been routinely practicing euthanasia

on newborn

all

infants

the

whose

quality of

life is

so compromised by disease or

deformity that, to the doctors' eyes,

it

seems hardly worth

living.

I

Here certain absolutes

definitely

have their place. Orthodox

I

Christianity cannot be anything but pro-life

when

it

comes to

i-

Vihe.

Roman

Catholic "Declaration on Euthanasia," issued by the Congre-

gation for the Doctrine of the Faith follows: itself

"By euthanasia

is

on

May

5,

1980, defines euthanasia as

understood an action or an omission which of

or by intention causes death, in order that

all

suffering

may in this way

be eliminated. Euthanasia's terms of reference, therefore, are to be found in the intention of the will and in the methods used." (Text reproduced in the

National Catholic Bioethics Quarterly

i,

219

no. 3 [2001]: 433.)

STAGES ON life's WAY matters of abortion, and the same holds for euthanasia. The

Church recognizes that a fundamental "killing"

and

"letting die,"

between

difference exists

between deUberately taking a

life

and

allowing a patient to succumb to disease or trauma without being subjected to medical heroics. In the experience of

some

their physicians, however,

comes a point where unavoidable choices

there

what

in health-care

"mercy

killing."

easy for us to reject the very idea of such a solution.

We may

strategies lead perilously close to It is

and

patients

believe that pain

prove

management and

is

called

overall palliative care can

dying patient through the

last

days

and hours of earthly life. Any medical professional who has

dealt

sufficient to ease every

intensively with terminal patients, though,

knows

these measures are not always successful.

dilemma that we need to recognize and take ically

and morally. Where does this lead us

And

full

well that

therein

seriously,

lies

a

both med-

in today's debate over

euthanasia?

"Hard

cases

make bad

law," they teach in law school, and the

same holds true in the field of medicine. Yet hard cases exist, cases in

which pain and associated

trolled,

distress

with the result that the patient

Orthodox Christians suffering of those

affirm that

who

cannot be adequately conis

pressed to despair.

Some

we should not try to paUiate the

are wasting away with debilitating

nesses or other infirmities, since

it

ill-

allows them to "share in the

sufferings of Christ." That's easy to say

when it's someone else or

someone else's loved one who is going through the agony. Certain degrees of suffering can indeed be redemptive, as attest.

Nevertheless,

fering borne

no one can

fully appreciate the

by another person. Some patients are

220

many

saints

depth of sufafflicted

with

Care in the Final Stage of Life

a level of intractable physical pain and consequent psychological

and

spiritual

anguish that for most of us

is

unimaginable and

would be unbearable. They may have intestinal tumors that cause them to vomit

their

own

fecal matter, or their lives

sumed by a desperate and unrelieved To

on

declare

though

it

may

struggle simply to breathe.

principle that they should bear their anguish as

were God's will that they

suffer

ologically obtuse. Christ, the eternal

world's suffering, and by

it

is

irresponsible

he has destroyed the power of death specific

vocation to

drink the cup of their physical agony to the bitter dregs.

set

it

The

in

its

Most of

we need to avoid gUb pronounce-

however, do not. Therefore

ments about the value of

and the-

Son of God, has borne the

and corruption. Some people may have a

us,

be con-

suffering, not to

deny that value but to

proper perspective and acknowledge

its

proper

limits.

subject of euthanasia, then, arises especially in a limited but

significant

number of

cases in

which terminally

ill

patients are

experiencing a level of pain and distress they can no longer cope with. There

is

a time to Uve and a time to die, and both need to

be respected. Yet this raises the question as to just how, from a Christian moral perspective, the dying person ately

accompanied and

assisted

may

be appropri-

through that terminal phase.

Medical technology has made prodigious advancements years. Ventilators, dialysis machines,

MRIs, and

example, have improved and extended the of grateful patients. In

many

lives

antibiotics, for

of vast numbers

cases, however, that

same technol-

ogy has merely prolonged the dying process, and there terproductive.

extend the

monary

life

in recent

it is

coun-

A surgically implanted pacemaker can significantly and functioning of a cardiac

resuscitation

patient. Cardiopul-

(CPR) practiced on an elderly person

221

who

STAGES ON life's WAY has suffered a major heart attack, on the other hand, often does httle

more than produce cracked

ribs or restore

deprived brain to a level of existence that

(CPR has produced an important of acronyms: "If you've opted for

monia That to

can

in a dying patient

cure, however,

DNR, don't call EMS!")^ Pneu-

easily be cured

often

merely vegetative.

caveat that extends the string

means that the

some other pathology,

is

an oxygen-

patient

today by

must

antibiotics.

finally

succumb

more distressful and more painful.

A ventilator can be lifesaving in cases where a lung has collapsed or a curable disease

is

attacking a person's respiratory system. But

used on a patient dying of

Lou

Gehrig's disease),

it

focation and prevents

ALS (amyotrophic

lateral sclerosis, or

merely increases the anguish of slow suf-

what Orthodox

Christians pray for every

day: a painless and peaceful end to their earthly existence.

General recognition of the quandary

we

often find ourselves in

thanks to the very real marvels of modern medical technology has led the public, as well as medical professionals, to

an important

conclusion regarding end-of-life care. In terminal cases the length of survival

is

measured

(in

which

in terms of days or hours),

it is

appropriate to withhold or withdraw Ufe support and to allow the dying process to complete

its

course. Often referred to as

"passive euthanasia," this procedure in fact conforms thoroughly

both to the Hippocratic Oath and to the will of

^DNR:

a "do not resuscitate" order, often inscribed on the chart of a hospi-

talized, terminally

EMS: is

ill

patient (and too often ignored by the medical team).

the emergency medical service, which in

carrying an officially sanctioned

form

God as we know

most cases

DNR order)

is

(imless the person

legally obligated to per-

CPR on live but nonbreathing victims of stroke, heart attack, or other

traumas, even

when

they have been deprived of oxygen for

and have suffered severe and

irreversible

222

damage

many

to the brain.

minutes

Care

it

in the Final Stage

of Life

from Scripture and the tradition of the Church.

patient's

need to find reUef from his or her suffering,

edges the limits of technology in achieving cures, and patient to complete his earthly journey with as dignity as possible.

When

it

it it

acknowl-

allows the

much peace and

medical intervention in terminal cases

neither palliates nor cures but merely process,

respects the

It

draws out the dying

becomes unacceptably burdensome and should be

dis-

continued. In such situations, passive euthanasia (as regrettable

and misleading as that expression happens to

be)

is

morally

acceptable, even obligatory.^

But what of "voluntary active euthanasia"? ingness

VAE implies the will-

on the part of a terminally ill patient to accept direct inter-

vention by the physician, with the specific aim of hastening death.

With VAE, both the patient's death

disease or

patient

more quickly than

trauma were

left

Here, as happens so often,

oughly polarized on a that

no such

^The

Roman

its series

the

and the doctor intend to bring on the

to run

we

it

would occur

its

naturally

as a society have

is

the

course.

become

critical issue. Pro-life voices raise

active intervention

if

thor-

the claim

morally permissible, including

Catholic "Declaration on Euthanasia" expresses this point in

of "clarifications*':

means used,

it is

"When

inevitable death

is

imminent

in spite of

permitted in conscience to take the decision to refuse

forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar

cases

is

not interrupted. In such circumstances the doctor has no reason

to reproach himself with failing to help the person in danger." tion

is

Moral

taken by Orthodox

ethicists.

A similar posi-

See especially Harakas, Contemporary

166-^6; and N. Hatzinikolaou, "Prolonging Life or Hindering Death? An Orthodox Perspective on Death, Dying and Euthanasia," Issues^

Christian Bioethics 9, nos. 2-3 (2003): 187-201.

223

STAGES ON life's WAY where the doctor prescribes or other-

physician-assisted suicide,

wise makes available to a patient medication that the patient

self-

administers in order to bring on death. Right-to-die advocates, on

make

the other hand, insisting that

please.

we have

As with

absolute claims to individual autonomy, the right to end our lives

when and

as

we

the abortion debate, the issue of euthanasia has

led to a nuance-free "dialogue of the deaf."

In trying to find a suitable approach to the

surrounding terminal care, people

who

most vexing questions

deal with dying patients

often have recourse to the "principle of double effect." This principle attempts to guide ethical decision-making in situations

where an action deemed necessary will inevitably, yet foreseeably, result in

some wrong or

evil as

a secondary consequence. For

example, a mastectomy will inevitably leave massive scar yet despite this

unwanted and yet foreseen consequence, a malig-

nant lump in the breast clearly

justifies

the decision to operate. In

would be appUed

the case at hand, the principle of double effect to help discern

tissue,

what

actions

may

be morally taken to relieve the

suffering of a dying patient and to help that patient reach the end

of his or her

life

in peace.

The

principle

is

usually expressed in

terms of four conditions:

1.

The

action

itself,

independent of

its effects

quences, must be inherently good or at

or conse-

let^st

morally

neutral.

2.

The

evil effect

must not be the means

for producing

the desired effect.

3.

That

evil,

even

if

foreseeable,

224

must not be intended.

^

Care in the Final Stage of Life

4.

The

action that produces the evil effect

must be pro-

portionate, both to the need addressed by that action

and to the

evil that results

shoot a pesky

fly

from

(We should not

it.

with a shotgun or guillotine some-

one to cure a headache.)

The

principle of double effect recognizes that actions often pro-

duce results that are both good and to determine

conditions,

is

applied in an effort

what action may be performed, and under what

when

good

the

effect

expected of the action will be

unavoidably accompanied by some ple

evil. It is

useful insofar as

it

evil

consequence. The princi-

provides a framework for dealing with

ambiguous moral choices.

It

often falters, however,

sider the third condition: that the evil action

when we con-

may be foreseen but

must not be intended. In cases of terminal illness,

it is

unreasonable and unrealistic to

expect that a physician, acting in good conscience and in the best interests of the patient, will

fering

end

in death,

not also desire that the patient's suf-

sooner rather than

later.

That

desire will

inevitably affect the doctor's intention. For example, in patients

who

are in the end stage of

life

and who are enduring excruciat-

ing, intractable pain, the physician will

the dosage of

normally opt to increase

morphine or other opiates

patient's suffering as

much as possible.

in order to relieve the

Yet beyond a certain

level,

morphine can repress the respiratory system and hasten death. miis has

recently been called into question, however.

Uative Sedation at the

End

John

F.

Peppin, "Pal-

of Life," Christian Bioethics 9, nos. 2-3

(August-December 2003): 343-55, cites studies that demonstrate the contrary: "High or low dose or rate of change in the opiate dose has been found to have no effect on survival of terminal patients" (348). The same is true

225

STAGES ON life's WAY The physician and the

patient thus find themselves in a dilemma.

Even if they are both philosophically opposed to euthanasia, they

may deeply desire that the suffering end in the only way possible: by the

patient's death. It

is

imreasonable to expect that the doc-

tor will be able to suppress that desire as he augments the dosage

of opiates, simply to avoid in his or the patient's

proxy—

^the

ing an act that will bring

—or that of the patient

own mind

idea that he

is

intentionally perform-

on death more quickly than

were not performed and the patient were allowed

if

the action

(obliged) to suf-

fer until the bitter end.

A proposed solution to this dilemma has recently received a great deal of pubUcity.

It is

the matter of "palliative sedation" (PS; also

called "terminal sedation").^ In those cases in

agement

is

which pain man-

inadequate to alleviate the patient's agony,

it is

possi-

ble to induce a state of semiconsciousness or unconsciousness in

which pain

is

The French

minimally perceived or no longer experienced.

Society for the

Accompaniment of

PalUative Care^ has published studies

on PS

the Dying and

that clearly define

with the use of opioids. (This entire issue of Christian Bioethics to euthanasia articles

and physician-assisted

from a

suicide

is

devoted

and contains many informative

variety of Christian perspectives.)

^Palliative care, of

terminal phase of

which PS

life,

is

one aspect,

is

directed

toward persons

in the

with the intent to alleviate pain and other symptoms,

both physical and psychological, through appropriate medication and other therapy.

It

should seek a balance between decreasing pain while preserving

consciousness.

aim

It

can involve the use of radiation and chemotherapy, whose

in terminal cases

is less

to heal than to relieve suffering.

To my mind,

it

should include as well appropriately supervised and administered uses of medical marijuana, where no other therapies prove ^Societe Frangaise

d'Accompagnement et de Soins

226

effective.

Palliatifs (SFAP).

Care in the Final Stage of Life

ethical modalities of the practice. Its

members are fully aware of the

danger of "clandestine euthanasia," as they are of the need to administer sedatives only to the degree necessary to relieve acute suffering

—and then only

in patients

who are at the end stage of life.

This means that the condition of each patient must be considered to be unique, |i

demanding case-specific treatment. The medical team

begins by determining whether the patient

is

actually in a terminal

phase because of the irreversible breakdown of some

vital respira-

I

tor)^ cardiovascular,

or neurological function. In cases of acute dis-

||j

tress (a catchall

term for various forms of unrelenting pain and

suffering), sedation

may be called for in order to lessen to the degree

necessary a level of physical and psychological agony the patient finds intolerable. This f

can mean inducing a

from

which the patient can be awakened by a voice or simple stimulus. In

more

can mean inducing a coma, either

difficult cases, it

tory or prolonged until the patient dies. latter protocol,

however, only

to assuage unbearable pain

wanting.

i^Midazolam death

is

is

the

recommended

imminent), because

and

and

The caregivers resort to this

every other available

suffering has been tried

method

and found

proxy has given informed consent.

reversibility, short half-life effect,

when

transi-

And of course, it is permissible only in cases in which the

patient or the patient's

I

state of light sleep

solubility in

it

sedative used in terminal cases (in

which

meets the basic criteria of ease of use

and

(two to four hours), dose-dependent sedative

water that allows for various means of administraSFAP, ^Premiere joumee d*actualites medicales en on October ii, 2002 at the Pfizer Laboratories,

tion. See the report of the

soins palliatifs,'" (held

23-25 avenue du Docteur Lannelongue, ys66S

Paris cedex 14), including

the report by Veronique Blanchet, M.D., ""Situations extremes,

symptomes

incontrolables et place de la sedation,"^ 217-22. She includes in her bibliog-

raphy N.

Chemy and

R. K. Portenoy, "Sedation in the

Management

of

Refractory Symptoms: Guidelines for Evaluation and Treatment," Journal

of Palliative Care (1994): 10:31-39.

227

STAGES ON life's WAY When it is properly administered, PS does not hasten the patient's death, at least not appreciably. the patient

may

still

And the

often-expressed fear that

experience pain even under sedation seems

unfounded, given the evidence to the contrary provided by MRIs,

PET

scans,

and other

data.^^

Some

objections to PS have been

raised because the usual practice, once the patient

withdraw or withhold food and will die of

hunger or

thirst,

fluids.

is

sedated,

is

to

Concerns that the patient

however, are also unfounded. The

average patient placed under palUative sedation dies not from the sedation

itself

to four days.

but from the underlying pathology, within two

As long

as

mucous membranes

in the patient's

are properly hydrated, effects of withholding food

body

and Uquid are

negligible.

However

effective

PS may be

in addressing

pain and distress in terminal patients,

must

first

be

made

it is

problems of severe

clear that every attempt

to provide adequate pain

management

short

of sedation. Different patients perceive pain differently. For many, it is

complicated and intensified by psychological

sion. In

such cases,

relief

may well

stress or depres-

be provided by

common tran-

quilizers or mild sedatives that allow the patient to

conscious. This in that

it

is

remain

of particular importance for Christian patients,

allows them to complete critical end-of-life tasks such as

personal sharing with loved ones, seeking forgiveness, making a final confession,

and receiving the Holy Eucharist.

The point we need to recognize

is

that these cases of acute, unre-

lieved pain are largely responsible for the increase in patients'

demands

for physician-assisted suicide

iiPeppin, "Palliative Sedation," 344-45.

228

and euthanasia.

Care in the Final Stage of Life

Although improvements have been made in recent years, our medical schools are notorious for their failure to prepare their students in the crucial matter of addressing pain, particularly in the terminally

and

spiritual

ill.

This

a medical problem, but

is

problem of the greatest importance.

erinarian "put

He

its sides,

sick animal that he in his eyes,

that for

he said

had cared

my suffering father."

and the

if

only

moral

as the injec-

touched the dog's open eyes

moved by

the loss of this very

for over the years. Then, with tears

quietly, "I

him. Other ways,

tell

obviously

also a

When the vet-

down" our dog recently, he watched

tion took effect within seconds.

and stroked

it is

wish so much

I

could have done

There are other ways,

we have

intelligence to develop

I

wanted to

the wisdom, the courage,

them wisely and use them with

compassion.

It is

time for the Church, through

ties,

and publications to address the

its

hierarchy, parish

communi-

issue of end-of-life care

a renewed focus and a genuine sense of urgency.

It

with

would seem

appropriate for our Orthodox physicians, together with those of their colleagues (i)

who share their views, to take the following steps:

urge medical schools to include in their curricula an adequate

number of courses on pain management and discuss

paUiative care; (2)

among themselves and the general public,

in all appropri-

ate venues, the morality of practices such as terminal or palliative

sedation, in an effort to reach a consensus that conforms to the

mind of the Church;

(3) militate peacefully yet forcefully against

the immoral expediency of active voluntary euthanasia cian-assisted suicide;

and

ate settings, engage in

(4) in their parishes

and physi-

and other appropri-

open and serious debate about the best

way, both medically and

spiritually, to

229

accompany dying patients

STAGES ON life's WAY in the final stage of

life,

and

intolerable suffering

and

pain.^^

Orthodox

particularly those ^

tives

experience

,

Christianity cannot accept the solution of active

euthanasia, however popular that solution society.

who

We

may

be in any given

need to identify viable, morally acceptable alterna-

by which physicians and the

rest of us

can accompany dying

persons and assure them a peaceful and painless end to their

To determine those

alternatives, however, requires

the part of everyone concerned illness

and death.

It

—and we are we

requires that

seek, in

in prayer, a discernment that ultimately only

Care for the dying is a profoundly

all

an

lives.

effort

on

concerned with

mutual debate and

God can provide.

spiritual matter. It is

one of the

most important yet most neglected aspects of the Church's ministry.

the

However we may

first

decide with regard to specific protocols,

task of that ministry, like the physician's primary respon-

sibility, is

to

"do no harm." As many dedicated medical profes-

sionals have pointed out,

always possible to care.

it is

It is

not always possible to cure, yet

that single-minded focus

it is

on compas-

sionate care that will enable us

most appropriately and most

effectively to offer the life of the

dying patient into God's loving

and merciful safekeeping. ^^Two

articles

provide excellent resources for this kind of shared reflection:

Camahan Hinshaw, "A Christian Ending to Our Life," St Vladimir's Theological Quarterly 44, no. i (2000): 61-82; and Daniel B. Hinshaw, "Spiritual Issues at the End of Life," Clinics in Family Practice 6, no 2 Qune 2004): 423-40. The authors, botii physicians, and members of an Ortiiodox parish in Michigan, have done extensive work in Daniel B. Hinshaw and Jane

the area of palliative care. See as well the useful

and informative

of articles by Vigen Guroian, Life's Living toward Dying:

Medical Ethical Study (Grand Rapids, MI: Eerdmans, 1996).

230

collection

A Theological and

Care in the Final Stage of Life

Care for the Permanently Incapacitated Just

how

is

that compassionate care to be given to patients

are not terminally

ill,

who

trauma are

yet because of sickness or severe

permanently unresponsive to external stimuli and therefore are incapable of any conscious interaction with the world around

them? This

is

a question

we need

to raise, particularly in light of

recent highly publicized cases of patients persistent or

PVS

is

permanent vegetative

who

are trapped in a

state (PVS).^^

a condition, often referred to as brain death, brought

by severe and

irreversible

leaves the patient with

damage

on

to the cerebral hemispheres.

It

no capacity for self-awareness or ability to

relate to others. Since the brain

stem

is

intact,

however, auto-

nomic and motor reflexes function normally. (The brain stem regulates basic

and heart

rate.

brum and nerve cate,

body

lum and

The

left

and

right hemispheres

make up

the cere-

are covered by the cortex, the familiar gray layer of

cells that

and

functions, including breathing, blood pressure,

pray.

enable us to think, create, remember,

communi-

Other portions of the brain, such as the cerebel-

the limbic system, handle

more

primitive functions,

including the fight-or-flight response, balance, and sleeping. the cortex that

makes

and the capacity

It is

possible our higher functions of thought

for personal relationships. If the cerebrum,

permanently destroyed, then

including the cortex,

is

that personal identity

is lost.

While the soul

is

the

life

we can

say

principle of

few months as perdeemed impossible, it is labeled permanent. Because of the connotations of "vegetative," there is a move on currently to change the designation to "post-coma unresponsiveness" ^^Some

clinicians refer to this condition during the first

sistent.

Beyond that point, when recovery

(PCU).

231

is

STAGES ON life's WAY the entire organism, death of the cerebrum indicates that the soul, in Hturgical language, has "left the body"^"^

such

is

and the person

as

dead.)

Because the brain stem and portions of the limbic system function,

still

PVS patients experience ordinary sleep-wake cycles and

often emit sounds that can be misunderstood as attempts to speak. In fact, in such patients there

is

no cognition and no

ception of stimuli, indicating that the cerebrum

ing

its vital role.

persisted for

Where

is

no longer play-

this so-called vegetative state

more than a few months,

there are

per-

has

no documented

cases of recovery. (The term vegetative refers to the condition;

does not imply that the patient

PVS, then, between

is

is less

brain dead, even

their actual state

Since prolonging the

life

affords

no discernable

burden,

many

if

than human.)

it

A person in

a distinction can be

drawn

and a condition of deep coma.^^

of a

PVS patient by means of life support

benefit but merely imposes a continued

medical professionals today argue that

administered nutrition and hydration

may

artificially

be withheld or with-

drawn, providing the patient has given informed consent to the procedure through a living will or via a proxy with durable power of attorney.

The much-publicized

illustrates just

how

important

case of Terri Schiavo, however,

it is

that a proper diagnosis be

made when a patient is thought to be in a persistent or permanent vegetative state.

^"^As

we pointed

out in the preceding chapter,

state that the soul separates

from or has

left

it

would be more accurate to

the flesh.

^^For a medical description of the condition, see The ed.

(Rahway, NJ: Merck Sharp and

Dohme Research

232

Merck Manual, 17th Laboratories, 1999).

Care

in the Final Stage

of Life

Schiavo was diagnosed as being in PVS, and after a great deal of legal wrangling, her

husband succeeded in having her feeding tube

removed. Nearly two weeks

later,

on March

dehydration. Although the autopsy

3 1,

showed

2005, she died of

that her brain

had

been irreversibly damaged, Terri had nevertheless displayed clear

and

signs of responsiveness to the presence of her family

were recorded on film.

signs that

was not

was

severely brain

was

that in fact

tion

to the events that

sions.

left

if

The matter would

justification.

she had declared in a living will, prior

her disabled, just what kind of care she

and when she became unable to make medical

deci-

She could have stipulated, for example, that unless she were

terminally

tained

properly

the case, then Terri's death by forced dehydra-

have been quite different

if

is

damaged but not brain dead.

was devoid of any moral

wanted

seems, in other words, that she

in a true vegetative state as that expression

defined. She If

It

priest,

ill

or verifiably brain dead, she would want to be main-

on food and water. Or if a

suffering

situation arose in

which she was

from severe and chronic pain, she could have expressed

the desire to be allowed to die, not by euthanasia but as a result

of the underlying pathology. Absent such a will, the courts and

her husband were able to euthanize her by mandating removal of her feeding tube.^^ Since the early 1980s,

it

has been clinically established that with-

holding food and hydration from terminally

who are actively engaged in the dying process It

ill

patients

—can be

—

^those

beneficial.

allows the buildup of nitrogen wastes that produce azotemia, a

natural analgesic,

and can enable the patient to

^^See the article "Maggie, Terri in Christ series,

slip into

and the Problem of Life-Support,"

www.oca.org, posted on July

233

i,

2005.

a

coma

in the Life

STAGES ON life's WAY and die peacefully.

On the other hand, continuing to provide food

and water through intubation patient's sense of pain

and

in terminal cases

suffering,

can increase the

without offering a propor-

tionate benefit. ^'^

Whatever

Terri Schiavo's actual condition at the time of her

death, the question raised by her case

is

whether it

is

ever morally

and medically appropriate to remove food and hydration from a patient in PVS. Such patients are not, in the strict sense, terminally ill;

they are not actually dying, even

recovery. Provided with food

when

there

is

and water, they can

or even years. Yet their physical existence

is

no chance

live for

for

months

preserved only by life-

support technology and they remain in a state of permanent unconsciousness.

If

that technology were not available, such

would quickly

patients

die, since

they are incapable of feeding

themselves or of being fed orally. Catholic moral theologians have long debated whether providing nutrition

and hydration to

patients in

PVS

ordinary or extraordinary means.

If

ment

latter,

is

ethically

mandatory;

against benefits, life

it

may

if

the

on the

into the area of

the former, then such treatthen, weighing burdens

be morally appropriate to withdraw

support and allow the patient to

laration

falls

subject in

die.

Pope John Paul

March 2004 made

it

II's

all

dec-

clear that he

located the providing of food and water in the realm of ordinary

means, and therefore

it is

morally obUgatory in cases of PVS.

Many Catholic ethicists, however, feel otherwise. They argue that there

comes a point in a person's life when administering artificial

i^See the discussion

on "Nutrition and Hydration

Breck, Sacred Gift of Life, 234-39.

234

for the Terminally

111*'

in

Care

nutrition

in the Final Stage

of Life

and hydration merely hinders the patient from attaining

what we request in our Orthodox prayers: a "peaceful separation of soul and body," "a painless, blameless, and peaceful" end to earthly

life

and the passing on of the person to the ultimate end

of human existence, which

is

eternal

communion with God in the

kingdom of heaven. In light of those prayers

and the Orthodox perspective on the

mystery of death, we need to have as our primary concern the best interests of the patient.

No one wants to lose a beloved friend or

family member. Accordingly, often pressure) to if it

we

do everything possible to ward

means preserving a minimal

ficial

means.

the interests

face a strong temptation (and off death, even

level of existence

by purely

arti-

We need to ask, though, whether such actions serve and well being of the

patient, or

from our own reluctance to accept the

whether they derive

loss associated

with death

and to surrender the person into the hands of God. This raises the question of the quality of the patient's Ufe. Often the decision to provide or withhold nutrition

made on

is

the basis of a subjective judgment as to whether the

patient's existence

is

worth preserving. The

nately been polarized between those hfe criteria"

(life is

served at

all costs)

tions"

that Ufe

(if

and hydration

who

argue for "sanctity of

inherently sacred, therefore

and those who argue

is

issue has unfortu-

deemed worthless or

no obligation to preserve

it

must be pre-

for "quality considerapointless, then there

is

it).

way of raising the question, however, is false and misleading. human life is inherentiy sacred, and it is precisely that sacred-

This All

ness that invests

it

with

its

ultimate

235

and

indelible quality. This

STAGES ON life's WAY means die."

again, however, that "there

Death

Death

itself

a time to live and a time to

is

in a paschal perspective

is

no longer "the

has been destroyed, and **we are given

last

life."

enemy."

From the

time of our conception until the end of our physical existence, the very purpose of our being is to allow the Holy Spirit to work within us the transformation from a body of death to

physical death into the fullness of

When

a person

is

in the

^then,

life

kingdom of God.

—^when the soul

—

in Christ, a

again,

it

is

struggling to

may be morally permissi-

even obligatory, to withhold nutrition and hydration in order

that death

beginning

may come naturally, as a regretted end but a blessed to a new order of existence. Can we say the same of

patients in PVS,

All

life

actually dying

separate from the flesh ble,

life

and endures through and beyond

that begins in the present age

who,

technically, are

not terminal?

we can conclude, it seems, is this. Where it can be determined

with certainty that brain death has occurred and there chance for recovery other than through God's

own

intervention (which can occur at any point), then able to conclude that artificial nutrition

means of

life

it

no

miraculous

seems reason-

support, including

and hydration, may be morally withdrawn or withheld.

In cases of

PVS

or deep coma, however, this procedure can be

judged morally acceptable only to the degree that itively

is

estabUshed that the condition

is

it

can be defin-

irreversible, that the cor-

tex and hemispheres of the brain are indeed dead; and that the

organism

is

functioning only because the brain stem

Many medical professionals

today would

death" (including the brain stem) as the

insist

intact.

on "whole brain

final criterion for deter-

mining whether the person is actually dead.

236

is still

It

seems, nevertheless.

Care

in the Final Stage

that an adequate measure

is

"death of the brain as a whole"

whole brain."

rather than "death of the

irreversibly destroyed, then there

consciousness.

The body

respect.

is

no

If

the cerebrum has been

possibility for

The soul does not reside in the

brain-dead adult, though, born.

of Life

is

is

brain, to be sure.

without question fully

human and worthy

the child,

and to allow the

to provide

for the sake of the parents than for

child to die

where death of

occurred and there

is

person indeed

is

from

critical

no chance

means of extraordinary

for

its

condition.

The same

portions of the brain has

improvement (other than by

divine intervention). In such cases, the

struggling to expire, to release the last breath

their body, to allow the soul to separate

artificial life is

is

who is unable to perceive any positive or negative stim-

true in cases

from

of

The most appropriate and compassionate treatment the

warmth and comfort (more

is

A

comparable to an anencephalic new-

medical team can offer an anencephalic child

ulus),

any form of

from the

flesh,

and

support merely impedes that necessary process. This

a time not for medical solutions but for prayer.

acknowledge the

limits of

It is

a time to

medical intervention, to celebrate the

Hfe that has crossed the threshold of death,

and to surrender the

person into the waiting arms of God.

The final judgment in all such cases needs to be made not by distinguishing ordinary from extraordinary means but by weighing the possibilities for cure.

Where

further medical intervention

is futile

and merely hinders the person in his or her struggle to die, then such intervention should be judged to be abusive rather than beneficial.

Medical heroics in such a case are morally inappropriate. Yet any decision to remove nal cases such as PVS,

life

support, particularly in nontermi-

must be taken as the

237

fruit

of ardent and

— STAGES ON life's WAY disinterested intercession

mean

we should

that

on behalf of the

patient. This does not

expect that an answer to the question

regarding appropriate treatment or nontreatment will be written

on the

wall.

It

means

that

members of

the church

community

including the family, friends, and insofar as possible the medical

team

—

offer the patient to

God

through ceaseless intercession,

asking for both clarity and charity in making what could be their final decision

regarding that patient's future and well being.

In the final analysis, everything depends

our primary concern

is

on our motive. Where

for the ultimate healing

the person in question, then we can

and salvation of

make decisions, even in a state

of uncertainty and confusion, with the confidence that God, in his

time and in his way, will cle that leads life

from a dying

life

for that person the paschal mira-

through physical death, and into

beyond.

Accompaniment

An

work

elderly

dren,

who

in tlie Final

widow becomes

Stage of

Life

fear the onset of Alzheimer's disease or

form of dementia, gradually

Her

increasingly disoriented.

some other

find themselves unable to take care

of her basic needs. Reluctantly, they decide to place her in a for assisted Uving.

intensive-care

home

A few months later, she has to be moved to the

wing of the home, and the children

prospect of losing her. ical

chil-

What

face the

kind of care can they and the med-

personnel offer to accompany this

and most compassionately through the

woman most final stage

of

effectively

life?

The needs such patients present are often spiritual as much as medical. If this

woman

is

a beUevec,

it is

238

important for the family to

Care

in the Final Stage

of Life

establish close contact with her parish priest

chaplain. In addition, they need to

and with the

facility's

pay constant attention to

mother's spiritual and psychological states. As difficult as

their

it is, it is

important to address the matter of dying in a calm yet direct way.

Does she end?

If

or anxiety at the thought of reaching her

feel fear

she were

there tasks

undone that she would

still

she

would want

she

would

order,

if

it is

whom she needs to

important to ask

she has Usts

Has

she

wants to be buried

made in,

And

determine

and

would want

like to

others to perform in

funeral plans, chosen the clothes she

to donate

v^? Does

she

want

to be

any viable organs to other

has the family contaaed the funeral director to

—before the

crisis

of death occurs, with

all its

tensions

—^which coffin they will buy and how much the funeral

grief

home

will be involved in the process of her burial? (FamiUes are

free to

make

their

funeral industry

is

ovm

choices and arrangements, although the

reluctant to admit the fact.)^^

More important than any of these for ongoing signs of

^

her practical affairs are in

and revised her

embalmed? Does she wish persons?

if

be reconciled?

drawn up of possessions she would

distribute or charitable acts she

her name.

accompUsh, people

plan? Are there people whose forgiveness she

like to

again,

like to

to speak with, or gatherings of friends and family

wants to seek and with

Then

life's

coming weeks or months, are

to die within the

questions, however^

compassion and

love.

As an

is

the need

elderly person

^Excellent resource material for helpiag a family deal with fmieral

and

other arrangements following a death can be found in Lisa Carlson, Caring for the Dead: Your Final Act of Love (Hinesburg, VT:

Upper Access, 1998).

For the Funeral and Memorial Societies Association: www.funerals.org/ famsa; 1-800-765-0107.

239

STAGES ON life's WAY on

loses his grip

reality, forgets

names and

faces,

and becomes

increasingly immobile, his world shrinjcs in size, sometimes

unbearably. Bedridden and ailing, he very often loses any sense of

meaning to his existence and, consequently, any sense of hope. We cannot provide those values for him; preaching at simply not helpful.

What is

"You don't need

ence:

psalms,

if

the person

is

helpful

is

this stage is

a loving and attentive pres-

to be afraid; I'm here."

inclined to listen, or

We

can read

we can simply sit and

hold his hand.

If

dementia

is

a problem, or simply failing mental capacity,

important to engage the patient in various intellectual

activities.

Recent studies have confirmed that dementia in the elderly nificantly

no improvement was found

increased their level of physical activity.

and the

in patients

The mind

like. Sig-

who

itself

simply

must be

engaged. Sometimes the person can achieve this alone. often

it

may no

is sig-

reduced by mental exercises: doing crossword puzzles,

reading, playing musical instruments, singing, nificantly,

it is

requires participation

on the part of

others.

The

More

patient

longer be able to do the Sunday Times puzzle or play

Scrabble, but even such simple activities as reading stories to

grandchildren or strumming a guitar can lead to marked

improvement

^^See

J.

in

mental alertness and capacity.

Verghese et

Elderly,"

al.,

"Leisure Activities and the Risk of Dementia in the

New England Journal of Medicine

348, no. 25 (June 19, 2003),

cited in the National Catholic Bioethics Quarterly 3, no.

4 (Winter 2003): 800. This latter reference discusses the "Bronx Aging Study,** which showed

that mental activity

among

geriatric patients generates neurogenesis,

strengthening existing synaptic connections in the brain.

240

Care in the Final Stage of Life

As

the person's infirmity progresses

unresponsive, to go

is

we

and she becomes increasingly

should remember that one of the

the ability to hear.

One

evening

I

last faculties

room

entered a hospital

woman who was comatose and clearly announced my arrival to her, spoke a few

to visit an elderly

dying.

Her brother

gentle

words

made no

into her ear, then stroked her forehead. She

response whatsoever. Her eyes were closed and her breathing was

had already passed

shallow. She looked, in fact, as though she

away.

I

put on a

stole,

took her hand

then began reading from the

Psalter.

in

mine

When

utes later

and closed the book, she squeezed

no other

sign of Ufe, but

with

us, as

over, sat

we were with

on the

was

it

her.

was

I

was cold

finished a

as ice),

few min-

my hand. There was

clear that she

As

side of her bed,

I

(it

was

still

there,

leaving, her brother

and waited

still

came

a cou-

until she died

ple of hours later.

That experience reminded ered from a

coma and can

me

of other patients

who

have recov-

repeat entire conversations held at the

foot of their bed by family

members or

the doctors

and

nurses.

Oblivious to the fact that comatose patients can often perceive

sounds and comprehend speech, these people spoke of the patient's illness, or her prognosis, or her personality in

ways they

would never have done had she been obviously conscious.

In

order to avoid such gaffes but also to accompany someone appropriately,

an important rule of thumb to remember

is

that unre-

sponsive, comatose patients might well be listening.

In an article cited earlier. Father

(now Bishop) Nikolaos

Hatzinikolaou offers two complementary statements that need to be kept in mind by those ill

with faith and hope.

who wish

"Artificial

to

accompany

support

241

is

the terminally

justifiable

only

when

STAGES ON life's WAY it

offers therapy, prospect for

patient";

and "Hope

life

and hope

for recovery to the

in the resurrection to eternal

life is

incom-

parably superior to the desperate struggle for the prolongation of earthly life."20

These are principles grieving family members need to keep

mind

as they attempt to offer effective

in

and appropriate care to a

dying patient. Hospice workers recognize that the dying person usually aware of their condition

response

is

for the family to

terminally

acknowledge the

reality of the situa-

Many people are reluc"bad news" of a diagnosis with someone who is

In

ill.

and that the most appropriate

and to the patient.

tion both to themselves

tant to share the

is

some

cultures, including Russian,

usually

it is

considered inappropriate or even cruel to share with the patient the fact that they have an incurable disease. This

Orthodox Christians

especially, sufficient

time

is

is

a mistake. For

needed to pre-

pare oneself in the face of impending death. This includes time to

and to

what remains of it to God. As

take stock of one's

life

we noted

means seeking forgiveness and

earlier, it

offer

communion. For

making confession, and

receiving

enough time

stitch together, as

is

needed to

ent as the person

moves

deprive a terminally

her of a precious

only

when

the

ill

gift.

ineluctably

it

gift,

of

all

this,

were, past and pres-

toward God's

patient of that time

That

reconciliation,

to deprive

is

however, can

announcement of some grave

future.

fulfill its

illness is

To

him or

purpose

accompa-

nied by ongoing gestures of care and compassion. Tell the patient the truth, but

An

tell it

with love.

important element in preparing for death

living will or other

advance

directive.

Like a

is

preparation of a

DNR order, a Uving

^^Hatzinikolaou, "Prolonging Life or Hindering Death?": 191, 195.

242

Care

can

will

member

easily

in the Final Stage

of Life

be overlooked or ignored, unless a proxy

(a

family

or friend with durable power of attorney) takes the

tiative to bring the patient's

ini-

wishes to the attention of the medical

team. Another aunt of mine was confined to an elder-care wing of the local hospital for rated, she

One

many

years.

As her condition

deterio-

had "Do not resuscitate" marked on her medical chart.

day, trying to get out of bed, she

fell,

became unconscious,

and suffered serious injury to her back and head. The doctor and nurses ignored the

DNR order,

bedridden and semicomatose.

son could have intervened. rection

would have been

for living wills

If

she had

And

named a proxy, that per-

her very real hope in the resur-

fulfilled

decade in a near vegetative

Forms

and she spent the next ten years

without her having to spend a

state.

—^which specify what

sort of treatment

we

—

we become terminally ill are available in most hospitals and in many law offices. We should all fill one out, then their conditions should be made known, verbally or in writing, to those who might find themselves in a position to make wish to have when and

life

if

and death decisions on our

trusted friend, a family doctor,

A person who has

behalf: parents or children, a

and the parish

priest.

entered the terminal stage of

appropriately cared for by medical professionals in palliative care. This istered

is

most often and most

life

can be most

who are trained

effectively

admin-

through some form of hospice program: in the hospital, in

a residential

facility,

or at home. Hospice programs offer a much-

needed alternative to the typical "American

way

of death," in

which so often inappropriate and expensive therapies come into play (and often to prevent a lawsuit rather than to cure or relieve the patient). Because hospices accept only those patients

243

who are

STAGES ON life's WAY in a tenninal state, their

medical teams have generally learned

effective techniques for pain critical diseases

management^ even with the most

such as cancer or ALS. They have learned that

narcotics can be administered without creating addiction.

(Though why should addiction even be cases?)

And

a

concern

members

they can usually prepare the family

grief that will

inemably follow the death of

in terminal

their loved one.

Returning to the question of nutrition and hydration cases,

we

food and

in terminal

find ver\' often that patients diminish their iatake of fluids

toward the end and

finally refuse

This should not be a cause for alarm.

and

for the

It

them

altogether.

can be a grave mistake

a serious injustice for the attending physician or nurse to rein-

sen a feeding tube the patient has pulled out on the tion that the person

doing

so, the

reacting to irritation or

is

the choice to die by refusing food

seek rehef by

assump-

suicidal. Before

doctor needs to determine clearly the motivation

behind the patient's action. Some terminally

make

is

false

some other means such

ill

patients in fact

and water; rather than

to

as medically assisted suicide.

In these cases, such a decision can be entirely appropriate. There

comes

a point

when food no

the body's progress death.

The decision

longer nourishes and merely hinders

toward a peaceful and

at this stage of life to refuse

death to come more quickly than choice for suicide.

relatively painless

It is

it

food and to allow

other\\Hse

would

is

not a

an appropriate response to the inevitable

deterioration of bodily existence

and should be respected

as such,

both by the medical team and by the Church.

A final word needs to

be said about those

a loved one, especially

when

those

who

who

grieve the loss of

bear that grief are chil-

dren. Typically, as death approaches, the adults in a family

244

Care in the Final Stage of Life

become anxiously preoccupied with making arrangements the funeral

and dealing with

A

children are ignored.

someone he loves

is

their

young

impending

child

may

loss.

Very often the

be well aware that

on the threshold of death and

son will disappear forever from the children, the reaction

is

for

child's

life.

that the per-

young

In very

often one of self-reproach, as

if

they

themselves were responsible for the sickness or accident that taking the loved one away.

Once the death

children feel can easily be

compounded by

sense of abandonment. "If she

left

me,

I

occurs, the grief these guilt,

and also by a

must have done some-

thing wrong." Guilt, abandonment, but also anger:

she leave

It is

me?

It's

is

"Why

did

who

are

not fair!"

of the utmost importance, therefore, that children

facing the loss of a person close to

them be comforted and guided

throughout the process leading up to and following the death.

There are children's books that attempt to soften the blow and do so very effectively. Others, replete with pretty drawings of butterflies

that die, then puppies, goldfish,

successful.

make

pets, are

much

less

Attempting to send a soothing message, they in fact

a travesty of death and

all

forget that for a Christian, death into God's

and other

good

creation,

that surrounds is

it.

We

must not

an enemy, a violent intrusion

whose consequences

are a tearing apart

of a person's being and the crushing weight of sadness borne by

those

who

Yet set in

grieve.

its

Death

is

an awesome and frightening mystery.

proper perspective,

occurrence, tragic yet

filled

it

can be received as a wondrous

with hope.

As an older person or a young

sibling

is

dying, the family

bers can transform the situation for the child

mem-

from one of bewil-

derment and tension into an opportunity for sharing the deepest

245

STAGES ON life's WAY convictions of their faith.

They can speak

to the child about the

reaUty of death in terms the child can grasp. Avoiding frightening details of the

dying process or of burial, they can convey to the

child the love they themselves have for the person

who has passed

on, and confirm that person's continuing, unbroken love for the child.

They can use

realistically

They can

the occasion, in other words, to

lift

the child,

but lovingly, out of despondency and give him hope.

offer

him the assurance

that God's love

stronger than death, that our ultimate hope

is

is

indeed

in the resurrection

already accompUshed by Christ, and that they, together with the

departed loved one, are even ciful

and compassionate

now held in the embrace of our mer-

Father. This

is

nothing other than the

message of the gospel, and the occasion of a death is an ideal time for introducing the child to the

most poignant elements of that

message, which speak of suffering, death, and

The

life

beyond.

way are many and varied. They differ with from growth in the womb to the moment of death.

stages along Ufe's

each person,

They can be marked by tragedy as well as by joy: by abortion, violence, addiction, tle things, acts

and

illness,

but also by

creativity, delight in

of charity, and shared love. As

to a close, especially

when

sickness

ration provide the appropriate

Ufe's* journey

and gradual physical

amount of time, we

That stage

is

what

gives

deterio-

and focus,

meaning to

providing direction and hope to our very being.

246

comes

find ourselves

called to prepare in a special way, with special intensity

for the stage to come.

lit-

it all,

— Care in the Final Stage of Life

Without that hope, we can wallow

in a "slough of despond,"

experiencing our daily existence as a living death. This dition so

is

the con-

common among our contemporaries, good people who

have never really heard the paschal promise of Christ's victory over

sin,

death,

meaning to

life,

and corruption. For them, there a point driven

home

ultimately

is

repeatedly by

no

news reports

of terrorism, war, genocide, corporate corruption, and natural disasters. If fill

no

distraction,

the time, space,

to depression

and

no consuming passion,

and prospects of

finally to despair.

is

adequate to

their existence, they give in

This attitude, this pathology

so widespread in our day, led an acquaintance not long ago to

compose a

little

poem that

bears the

title

"One Dark Night."

Maybe we should see the world as war And us as litter on a scorched and bloody field Strewn thickly with the nameless dead. Lonely corpses stripped of every shred

Of purpose, hope Splintered bones

or joy.

and

rotting flesh

Nothing more, nothing more.

This sad vision

is

shared by

many people, and

not only those

who

God as a matter of principle. It reflects the depression and loneliness that so easily wound those who have abandoned

have rejected

hope or never had it to begin with. The only meaningful reply to that tragically distorted perception of things has to be

way

of viewing the world and our

Christian tradition envisions

life's

life

within

it.

found

That

in another is

the

movement, from stage to

way

stage,

from conception to the deathbed, as it leads toward fulfillment in the presence of

God and in communion with the Holy Trinity.

247

STAGES ON life's WAY The

apostle Paul, obliged to fight his

and without,

own demons,

both within

gives us a glimpse of that final stage of our Uves in

a quotation that no bibUcal scholar has ever been able to identify. In his First Letter to the Corinthians (2.9), he speaks of a coming

glory that "no eye has seen nor ear heard, nor the

human

heart

has conceived." Yet this glory and this fulfillment, he declares, are precisely

"what God has prepared

248

for those

who

love him."

quotations used Ch.

1:

Bob Dylan, "The Times They Are A'Changin"; Archi-

mandrite Sophrony, Saint Silouan the Athonite (Crestwood, NY: St Vladimir's

Ch.

2:

Seminary Press, 1999), 434.

Martin Buber,

I

and Thou (New York:

Scribner's, 1958),

106.

Ch.

3:

Donald DeMarco, Foreword to Jerome Lejeime, The Con-

centration

Ch.

5:

Can (San

Francisco: Ignatius Press, 1992),

The Wisdom of St Isaac the

Brock (Oxford:

SQL Press,

Syrian, trans,

ix.

by Sebastian

1997), 19.

M. Nouwen, Our Greatest Gift: A Meditation on Dying and Caring (New York: HarperCollins, 1994), 103. Ch.

7:

Henri J.

249

BOSTON PuBLiC -.BRAPv

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