The most frequent medical-moral question today has to
do with what is called "life preserving intervention"—commonly known
as "heroic" or "extraordinary" attempts to either revive or
keep a dying person alive. This is an area in which priests are seldom consulted
by family or doctors; yet, because it has to do with the passage from this life
to eternity, priests must be involved.
When medical personnel speak of life preserving
intervention, they usually mean one of two things: either omission or
affirmative action. For example, should we allow a respirator to breathe for
our patient, or not? Should we allow for continued artificial hydration and
nutrition, or not? In theological terms the same questions can be phrased
thusly: is the patient's life being medically prolonged in order to restore the
patient to health? Or, in order to try to defy the natural order? This question
applies to even simple and commonplace methods as well as what are considered
"extraordinary" methods of intervention.
Three tests are now in use I for deciding upon either
omission or affirmative action in prolonging life:
(1) The
"subject objective test," when either the patient can act as his own
entity or someone with a power of attorney can act for him.
(2) The
"limited objective test," where there is trustworthy evidence of the
patient's own will and testament. (Some states now permit a "Right to
Death" contract, but since each state's laws are different, pastors should
be aware of what the law allows in their home state and whether or not any of
their spiritual children have drawn up such a contract.)
(3) Another
medical/legal way of looking at this is what is called "Best
Interest." It may take on various meanings— for instance, what is called
"medical good": can a cure be achieved, or is intervention only
prolonging the inevitable? Or, "Best Interest" can mean that there is
a patient preference about what is being done to him medically; this, however,
is often so subjective that it usually isn't considered to be "admissible
best interest."
"Human as human" is still another way of
looking at the question of what should be done to and for a dying patient. This
means that one must know the value system of a patient. For example, if a
doctor knows that his critically, perhaps terminally ill patient is an atheist
who sees absolutely no value, no "quality," in pain or suffering of
any kind, he may decide not to artificially prolong that person's life. (On the
other hand, a believing Christian usually sees some purifying and refining qualities
in a certain amount of suffering.) Professionals believe that this is an
important way of preserving the capacity that we, as humans, have.
Sadly, a priest is often brought to a patient's
bedside when all of these questions have already been answered—usually only by
the medical personnel without even consulting the family, much less a
clergyman. The priest arrives only just in time to give the last sacraments, if
indeed he is even notified in time for this. This is not always the fault of a
doctor or hospital, however. Often the family does not ask questions, does not
want to be involved in decision-making at this time, because they are either
emotionally paralyzed at the realization that Mother or Father may now be
dying, and/or so spiritually illiterate that they simply "don't know what
to do."
The point is: someone is going to make the decisions;
better that it be a concert between medical staff, family, patient (if
possible), and priest. And of these, the priest should be the most important advisor, for 4 usually only he can give
the vital spiritual theological input; only he will know if the patient is
properly prepared for death and eternity—and if he is not yet prepared, it may
indeed be appropriate for "extraordinary" measures to be taken, if only
to insure the repentance of the dying patient before death occurs.
What are some spiritual guidelines about health, sickness,
medicine, and dying that pastors should be teaching their flocks while they are
in good health?
We read in the Epistle of St. James these words, which
are also repeated at the end of the Divine Liturgies of St. John Chrysostom and
St. Basil: Every good gift and every perfect gift is from above and cometh down
from the Father of Lights. One of the gifts we continually pray for is that of
good health. Another gift given from above is medical knowledge for the
treatment of sickness. And yet, we seldom remember that there is a causal
effect between sin and sickness in our lives. St. Paul wrote: Wherefore, as by
one man [Adam] sin entered into the world, and death by sin; and so death
passed upon all men, for that all have sinned. (Rom. 5:12). And: For the wages
of sin is death; but the gift of God is eternal life through Jesus Christ our
God. (Rom. 6:23). Therefore, there is a general relationship betweensin and
sickness—not to say, however, that a specific sin brings about a specific
illness.
Because illness is the result of our fallen, sinful
human nature, St. James instructs us:
Is any among you afflicted? let him pray.
Is any merry? let him sing psalms. Is any sick among you? Let him callfor the
elders of the church; and let them pray over him, anointing him with oil in the
name of the Lord. And the prayer of faith shall save the sick, and the Lord
shall raise him up; and if he has committed sins, they shall be forgiven him.
Confess your faults one to another, and pray onefor another, that ye may be
healed. The effectualfervent prayer of a righteous man availeth much. (Jas
5:13-16).
When St. Basil the Great was asked if going to a
doctor and taking medicine was in keeping with piety, he replied: Every art is
God's gift to us, making up for what is lacking in nature ... After we were
told to return to the earth from which we had come [at the time of the Fall]
and we were joined to a pain ridden flesh that is destined to die, and made
subject to disease because of sin, the science of medicine was given to us by
God in order to relieve sickness, if only to a small degree.
Therefore, we may certainly have recourse to
physicians and medicine; when and how often we go to a doctor thus becomes a
matter of common sense so long as we don't forget that no one can be cured
without God. He who gives himself up to the art of healing must also surrender
himself to God, and God will send help. The art of healing is not an obstacle
to piety, but you must practice it with fear of God. (Sts. Barsanuphius and
John).
As a priest I have visited many people in hospitals
and nursing homes; I have seen (as every priest has) both a proper and pious
use of medicine, and its abuse.
For example, one young mother of four children was
hooked up to machines to purify her blood, remove waste products, empty the stomach,
help her breathe, and administer six different medications. She had been
through exploratory surgery and also had a bone marrow transplant. All of this
was done in order to stabilize her body functions and help her to recover.
Indeed, after ten days or so, the problem had been successfully diagnosed and
treated, and she was released.
These complex procedures had been followed in order to
restore her health, not to prolong her life with no hope of improvement. It was
truly a pious use of medicine.
At the same time, I was visiting a 96-year old
parishioner in a nursing home. For several months he had been bedridden with
bedsores, slipping in and out of consciousness. When he began to die, the
doctors revived him and put him on artificial nutrition and hydration with NG
tubes. This enabled him to "live" (or, rather, continue dying) for a
few months. Then, with the onset of pneumonia and because of poor circulation,
his feet developed gangrene. The doctors decided that his feet and lower legs
should be amputated.
Even though he had signed forms much earlier
requesting that no such "extraordinary" attempts be used, the staff
felt that artificial feeding and amputation were to his "benefit."
His free will had been removed and the decision-making process was now in the
hands of strangers. By Gods mercy, he died just hours before the amputation was
to take place.
This was a case, it seems to me, where there was no
obvi¬ous hope of restoring this man's health. What was done was only to unduly
and cruelly prolong the act of dying. Only a generation ago he would certainly
have died in peace; some time before all these "options" became a
topic of consideration by the medical staff.
We must never forget, in this "brave new
world" created for us by medical science, that our bodies are temples of
the Holy Spirit. It is only in this context that we can decide, with the help
of our spiritual father and medical advisors, what is best for our bodies and
souls. If we decide to prepare the soul for the death of the body, then so be
it. If we should care for the body for the sake of the soul, then so be it. But
whatever is done must be what is spiritually best—and that will take some time,
prayer, and consultation.
We ought not to fear death, yet we must pray for a
Christian ending to our lives, painless, blameless, with a good defense before
the dread judgment seat of Christ.
Orthodox Heritage Page 8 Vol. 13, Issue 01-08
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