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Bioethics: themes: Transplants and Euthanasia
The "Biosciences or Life Sciences", ie branches of science
whose object of research is the phenomenon of life, the cell
and the micro-organisms to animals and man himself, and the
corresponding Biotechnology, has seen enormous growth in
the last four decades. Their achievements are many. For
example organ transplantation, artificial insemination, cloning,
genetically modified foods, etc.
Many of these achievements are beneficial to humans, for
example organ transplantation save lives and allow survival in
peoples, who have problems with their vital organs, artificial
insemination allows infertile couples to have children. Genetic
engineering with the intervention on human genes promises to
anticipate and treat diseases etc. But there are some people
who argue that the application of new techniques, such as
cloning, with some cases of artificial insemination, organ
transplantation from deceased donors, etc are not beneficial
and at last create dilemmas. Also (1) in the area of abortion (a
hot topic today) either with pills or some ways of contraception,
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which are in fact ways of abortion and (2) the area of
euthanasia, i.e. medically assisted suicide or murder, human
patients on advanced equipment on the pretext of their relief
from physical pain, are considered by many to be immoral and
therefore unacceptable.
But even in cases of scientific achievements, which are
considered beneficial, there is always the risk of abuse or
excess (παράχρηση).
If everything requires on standard or judgment on criteria for
what is good or bad, where one stops and the other begins,
surely these matter : more in the sensitive areas of
Biosciences and Biotechnology. Moreover, it is always the
case that "the end does not justify the means," or as Saint
Gregory the Theologian says “the good is not good when not
well is accomplished " «Το καλόν ου καλόν όταν μη καλώς
γένηται».
The questions and dilemmas of people with regard to these
new scientific discoveries and their applications, led to the
emergence of the Bioethics industry. Bioethics is called to set
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boundaries between the positive and negative impacts of
Biosciences and Biotechnology in our lives, to introduce
selection criteria, through the many and varied roads opened
up, taking into account the will of God and human values that
must be held to, and to create resistance to the growing
pressure to apply to the lives of any new inventions or
discoveries.
Today, in front of the large and astonishing achievements of
Bioscience and Biotechnology, the world remains ecstatic.
Many people are turning to the Church seeking answers to
unusual questions that arise. Few years ago there was no
problem, because in fact these issues did not exist.
A few years ago, before the 1950’ respirators had not been
invented. Thus there was no dilemma as to when to
disconnect that respirator.
Previously there was no availability of kidney transplantation.
It was inconceivable, therefore to think about questions
regarding the rights and wrongs of kidney transplant from
either living or deceased donors.
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we were not wondering if permitted or under what conditions
allow reception of kidneys or other organs from deceased or
living donors.
Finally, let me refer to the ambition of the Italian Doctor
Sermpio Kanavero to be able to transplant the head of a man
in the body of someone else. This project sets not only
scientific, but also ethical issues. Organ transplantation is
now a routine procedure. But the transplantation of an entire
head, would be unprecedented in scientific annals.
The head will come from the thirty years old Russian
programmer Valery Spirintonof, suffering from the Werdnig
Hoffman disease (this disease causes muscle atrophy and
paralysis with no treatment available so far). The body
belongs to a patient who is brain dead. I will not refer to the
scientific problems raised, if the transplantation will be
succesful, but to moral issues, since the goal of the Italian
doctor, is to move, with this experimental transplantation, a
step forward to man’s immortality.
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Wealthy clients (rich people) have already approached Dr.
Kanavero to ask him if indeed this transplant could make them
immortal (Fileleftheros, Cyprus daily newspaper dated 29 May
2015, page 15).
It is not easy for any human being, as true believers, to find,
without guidance, answers to these unusual questions in the
Bible. In the Bible are contained in general immutable
principles, the will of God, which remains the same and
unchanged since the creation of the world and will continue to
remain so forever. The Bible was written for the people of the
past and for the people of today and tomorrow. It was relevant
In primitive times technologically, is valid in the internet era, as
well as in astrophysics and space exploration. It is aimed both
the illiterate and at scientists. It is not possible, therefore, to
find specific answers to specific problems of each era.
It is obvious that it is with painstaking work, of the clergy,
theologians and Christians scientists, to study intensively the
Bible and in prayer, to find, by God's will, answers to the
burning questions of our time.
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A basic principle that we find many times and in various ways
of expression in the Bible, is the respect and protection of
human life, the command "You shall not murder" (Exodus Cap.
20.13). If, therefore, in any method used by Biosciences,
there can be destruction of human life at any stage, then it is
obvious that the method is against God's will.
Another basic principle expressed in God's commandment in
the Bible is the "you shall not commit adultery” (Exodus 20.14).
The intrusion of a third party, in one way or another, in the
relationship of husband and wife (ανδρόγυνο) is unacceptable
from the Christian standpoint. A technique therefore in
assisted reproduction, which would use foreign sperm, and not
his own, or a foreign egg, not his wife’s, even if this does not
involve bringing together people, would introduce a third
person in the privileged relationship between husband and
wife and child procreation. Is this compatible with God's will
as expressed in the Bible and our Holy Tradition?
Christ, addressing the characteristics of love, stressed many
times that this should be given without expectation of
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reciprocation. It is natural, therefore, outside the Christian
conditions, if someone will offer, for remuneration or for similar
consideration, a member of his body for transplantation. This
is because the motive would not be love alone.
Basic teaching of our Church is that God created man free.
It is one of the elements of "in God's image" (Genesis 1, 27)
creation. Therefore, any attempted intervention on human
genes would alter some elements of the personality of man in
order to make a man - robot, contrary to the free will of man
and is morally reprehensible.
Based on the fundamental Christian principles, examples of
which I mentioned above, I would like us to go through,
separately, various headings-chapters and see how Orthodox
Bioethics are applied particularly in transplantation and
Euthanasia. For both of these issues, amongst other bioethical
issues, the Church of Cyprus discussed and took decisions in
February 2002.
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Transplantations
I turn first to the objections of some people who have,
regarding the general question of transplantation, i.e. whether
they can be acceptable to the Church.
Some people wonder, whether in attempting an extension of
life this is the true aim of transplantation - intervene in the
work of God.
Is this acceptable? they ask. Is this why our Lord Jesus Christ
came on earth? Just for the extension of our life on earth?
The issue relates to the use of doctors and medicines, which
is positively by the Church. The Old Testament instructs
"Honour the physician" (Wisdom of Sirach Chap. 38.1) and
proclaims "The Lord created medicine out of the earth”
( Sirach 38,4). Christ of course did not intend to extend the
lives of people on earth, but to renovate and to make incorrupt
(αφθαρτίσει). But the extension of earthly life does not
contradict this view. Christ, himself with the miraculous cures
He made and Resurrection He brought about, extended the
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life of some people and gave the message of ultimate abolition
of corporal corruption.
Another question, raised by some other people, is whether a
human being who took the gift from God of his body which
body includes of course the various organs which can be
donated to others, thereby posing a risk to himself. They refer
also to St Paul who says “ You are not your own, for you were
bought with a price” (Cor. 6, 19,20).
Supporting their position that the body is not our property, they
also refer to St Peter who says: “You know that you are
ransomed from the futile ways inherited thinks like silver or
gold, but with the precious blood of Christ” (I Peter 18,19).
To this question, of course, there is a satisfactory answer: The
donation of an organ from a living donor should not endanger
his own life. But, even if his life be endanger, this should not
be considered sinfulness (εφάμαρτο), since this is neither
suicide nor an act of euthanasia. If by this donation other
people, would be saved and this benefit was the expression of
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a disinterested love, this practice would transform into an act
of self-sacrifice. This would be the application of what Christ
said: "No one has greater love than this, to lay down one’s life
for one’s friends" (Jhohn 15,13 )
Others, ask themselves, how is it possible to find justification
in terms of Christianity, by donating a part of our body to
another person, when we "anticipate resurrection of the dead".
Our bodies, they say, would in that case be 'truncated' at the
Second Coming of Christ.
Here the question is due to the ignorance of the basic
principles of Christianity: In the resurrection " we await the
new heaven and a new earth” (II Peter 3, 14), and therefore
new, incorruptable (αφθαρτοποιημένα) bodies.
Then every body will be changed (αλλαγησόμεθα).
(I Corinthians 15, 51,52). All people, even those who currently
have a disability, will be renovated, both internally and
externally.
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There will then be a new creation and all missing parts of the
human bodies would be restored.
It seems, therefore, that these questions and many other
related ones do not create problems or dilemmas, which
would deter transplantation from the outset.
From the above it seems that in the case of transplantation,
except the principle "thou shall not kill" (yourself or another, in
order to benefit a third party), as we saw earlier, other basic
Christian principles on which one could rely upon includes
"love your neighbour as yourself" (Mathew 19,19, 22,39), “do
not let your left hand know what your right hand is doing”
(Mathew 6,3) and without expectation of reciprocation of love
as given meaning (νοηματοδοτήθηκε) by Christ.
Indeed, any tissue and organ supply, to have value from a
Christian perspective, must be accompanied by selfless love.
The Gospel is clear: "If you love those who love you, what
credit is that to you? For even sinners love those who loves
them. If you do good to those who do good for you what credit
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is that for you? For even sinners do the same. If you lend to
those from whom you hope to receive what thanks is that for
you? …….. But love your enemies do good, and lend,
expecting nothing in return "(Luke 6, 32-35).
If you offer a part of your body for transplantation, anticipating
similar move by relatives of the recipient when you need, or if
you expect other recognition, for the Church that has no value,
it is not an expression of unconditional love. The restrictions
imposed under the laws of some States for keeping the
identities of both donor and recipient to remain secret, is
accepted by the Church because, again, Jesus says: “do not
let your left hand know what your right hand is doing” (Mathew
6,3)
Also, to be meaningful this offer, it must always be guaranteed
the freedom of the donor. The offer is not blessed when "out
of sadness or from need". "For God loves a cheerful giver”
(II Corinth. 9, 7)
Hence, the restrictions placed by governments and institutions
and strict controls to prevent the commercialization of supply
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of organs for transplantation, not only find acceptance by the
Church, but express it’s basic principles.
For the problem of certification of death to remove organs
from deceased donors, I mention only what the Holy Synod of
the Church of Cyprus as well as the Holy Synod of the Church
of Greece decided: “that although the provision of organs for
transplantation is medically recommended and reasonably
and morally fully justified, we should not load with guilt those
who for various reasons do not wish either when alive or after
dead, offer body parts for transplantation. The Church blesses
the one who wishes to become a donor for transplantation, but
for the one who has difficulty in becoming a donor, the Church
understands and respects him”.
Euthanasia
The issue of euthanasia also presents moral dilemmas.
Certainly euthanasia is not a phenomenon of our time.
In recent years, however, it appears with ever growing
dimensions, due to the progress of medicine and technology,
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which have enabled life support by mechanical means and
delay the death process. Many people, in other times, without
this mechanical support, died "naturally" and so the question
and dilemma of Euthanasia did not arise.
But what is euthanasia?
Euthanasia is the act which selects and offers death as the
best solution to the drama of an insufferable life. In the
subjective dimension, that is, evaluated as redemption from an
intolerable situation, which can not be called life. (Vasiliou T.
Yioultsis, "Euthanasia and Koinonikoithikes Effects" in
"Orthodoxy and Science", in November 1997, 3rd edition p.
66).
Euthanasia is considered active or positive, when there is
direct intervention causing death (e.g. lethal injection or other
medicine), and passive or negative, when appropriate
treatment is not given or withdrawl of supportive life
technology (e.g. disconnect the patient from the ventilator or
failure to provide oxygen for him), so that underlying condition
leads to death. In all its forms of euthanasia is classified as
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voluntary when there is consent or strongly requested by the
sufferer, so we would characterize such as assisted suicide;
and non-intentional, when applied without the consent or
against the will of the patient. Then we can speak of murder.
Euthanasia is not a phenomenon of our time. Already by the
4th century b.c. the famous Hippocratic oath included the
following “I will neither give a deadly drug, to anybody who ask
for it nor will I make a suggestion to this effect "ουδέ
υφηγήσομαι ξυμβουλίην τοιήνδε…" (Hippocratic Oath).
That is a physician will not grant a lethal drug to anyone, even
if requested, nor would suggest such advice. In general,
Hippocratic Oath refers to a doctor who will help a patient to
improve his quality of life and not to a doctor who will assist a
patient to improve death procedure. On the other hand
Seneca, the famous Roman Stoic philosopher, supporting
Euthanasia, writes “as I would choose the ship, in which I will
travel, and the house in which I am going to live, so, I would
choose the death of my exit from life. (Emmanuel
Panagopoulos' Euthanasia and today's International Reality
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"in" Orthodoxy and Science ", in November 1997, 3rd edition
p.55).
In the last thirty years euthanasia appears constantly to be
growing, especially in the so-called post-industrial societies of
the Western world, and seems not to worry, at least for the
moment, the countries of the so called third world.
In the growth of the euthanasia issue there are two main
contributory factors.
First acceptance and legalization of abortion in most countries
of the world. Euthanasia follows a path parallel to that of
abortion. Supporters of both phenomena are the same groups
that are pushing for legalization, and using the same
methodology and the same arguments. (Ibid, p.62).
The second factor in the growth of euthanasia is the huge
advances in medicine and technology, which have enabled life
support by mechanical means, and have also led to the
extension of life. People, in other times, without this
mechanical support, died "naturally" and so the problem of
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euthanasia, did not arise.
There have been many polls on the issue of euthanasia. It is
characteristic that all indicate high levels of acceptance.
Several States in America have accepted and know the case
of the doctor Jack Kevorkian (Dr Death), in the state of
Michigan, who, since 1990, "helped" at least 19 people to end
their lives with a simple device of his own design. (John Breck
«The sacred gift of life» st. Vlado miro's Jeminery Press, 1988
p. 206). In Europe, the Netherlands since 1993 legalized
euthanasia, defining the "conditions and the procedure for the
exercise of euthanasia without the risk of persecution." More
recently, in 2000, the Dutch Parliament decided clearly, even
with 104 votes against 40, the full legalization of euthanasia.
(see Magazine Metropolis of Veria, Naoussa and Campania
"Pavlios Word" Issue 36, October-December 2000, p. 10-11).
The United Kingdom has not legalized euthanasia, but it is a
common secret that this is widely used in many hospitals and
clinics in the country. It is almost certain that in the coming
years more and more countries will be brought to legal
acceptance of euthanasia.
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There are many and various reasons that prompt patients to
seek termination of life. Although it is generally held that
unbearable physical pain or fear of pain is the leading cause in
resorting to euthanasia, according to a survey only 5% chose
euthanasia because of pain.
According to the same survey, the most important reason for
60% of those who chose euthanasia, is the patient's right to
die with dignity and the perception that it is not worth waiting
until the end for the inevitable death. (Newspaper
"Kathimerini", October 12, 1995). Although various reasons
are given for the choice of euthanasia, all I think, can be
summarized in one idea: The quality of life (as perceived by
everyone) is now the measure of the value of life. Life, is not
considered in itself as a value or even supreme good.
At the same time there has been a notable change. It appears
that the main purpose of medicine instead of the protection,
support and maintenance of life has shifted towards the
accommodation of the patients or his surrounding family
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member, considering individual autonomy and “freedom” to be
more worthy of respect than the value of life.
Moreover there is, nowadays, a tendency to use euthanasia
by our materialistic society to become rid of certain groups,
because they are considered a liability (elderly, children with
genetic diseases, psychiatric patients, etc.). (Leonard J. Veber
«Who Shele Live» in Qualify of Life, The New Medical
Dilemma »New York 1990 p. 111-118).
If we want to examine the issue more deeply and from the
perspective of the Church, we would give the reasons for
recourse to euthanasia, as the projection of the individual will
on the one hand and the lack of metaphysical reference on the
other.
This lack of metaphysical reference manifests as infidelity, as
doubting the existence or the role of God in the whole creation,
as ignorance or rejection of the relationship of God with the
mystery of life. By this logic, life is valued as a set of chemical
and physical processes with man considering that he holds
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absolutely proprietary rights over his biological existence.
(Vasiliou T.
Yioultsis, ibid p.22). It is natural that such a view
of life is conducive to despair during peak moments of pain,
removing even if there was a faint hope of afterlife, reduce
endurance and fortitude. Death is treated as redemption and
exit from the torment of pain. The forfeiture of life does not
seem, in these circumstances, to be a sin or even a moral
dilemma.
But there are two major questions - moral dilemmas in which
every Christian is called upon to answer:
a) Has anybody the freedom to end his life, to seek, ie,
euthanasia? What are the proprietary or interventionist rights
to our life?
b) Have we the right to decide on the "formal" end of the life of
a man, even if scientific opinion considers that he is in a
situation from which he can not recover?
In these dilemmas for us, is not difficult, to give the right
answer, since the Christian Moral problem of human life is
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linked morally and metaphysically with God and not with the
sufferer/prisoner. The morality that is inspired by the
Orthodox Tradition refuses to accept rationalization or
relativization of the blessing of life. That would be a
devaluation of human dignity. The Orthodox Tradition refers
life to the supreme authority of God, and accepts his will of the
course and adventures. It tries, within the limits of the humanly
possible, to understand the meaning of suffering, explores his
relationship with sin and the fall.
The Orthodox Church sees human being - as every test - as
"an accomplice to salvation," and sometimes evaluates him
"as more valuable than health."(ως κρείττονα και αυτής της
υγείας), (as kreittona and that of health).
The Orthodox Church acknowledging human weakness and
understanding human illness, prays to God, in certain
situations for rest those who suffer
The Christian prays, begs God but does not decide on life and
death. He refuses to substitute God. Pain in the Orthodox
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tradition is a participation in the "sufferings of Christ". (John
Breck ibid p.22).
Euthanasia, whatever form it takes, is for the Church morally
unacceptable, because God is the Lord of life and death, "he
measured times for those who live, and tissue death times,
descended into Hell and standardized bound in weakness,
and dismisses the dynasty. "( The Third genuflection of
Pentecost). Therefore he who brings about death voluntarily,
regardless of motivation, commits murder whether it is another
person or suicide, if for himself.
+ METROPOLITAN CHRYSOSTOMOS OF KITION