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The Orthodox Christian Tradition

Religious Beliefs and


Healthcare Decisions
By Stanley Samuel Harakas

he Orthodox Christian Church identifies itself


T with the Church of the first eight centuries of the
Christian faith tradition. It considers Pentecost, the
descent of the Holy Spirit upon the Apostles (Acts 2),
to be its organizational and ecclesial beginning. It
attempts to maintain through almost twenty centuries
of Church life the beliefs, practices, worship, organi­
zation, ethos, and ethical stances of the original reve­
lation in Jesus Christ, the Apostolic tradition, and the
The Individual and 3
the Patient-Caregiver Relationship mind of the One, Holy, Catholic and Apostolic
Church of the ancient Christian Creeds.I
Family, Sexuality, and Procreation 4
The sources of its teaching are found in the Old
Genetics 6 and New Testaments and in what it calls Holy
Organ and Tissue Transplantation 7 Tradition, the consistent memory and proclamation of
revelation in Jesus Christ as they have been lived and
Mental Health 7 experienced throughout history. The Church believes
Medical Experimentation and 9 that the Tradition has responded to new questions
Research through the centuries, but always within and by
Death and Dying 9
means of "the mind of the Church," in a way that
remains consistent with the original deposit of faith.
Special Concerns 10 Among the authoritative sources for interpreting
the teaching of the Church are the Scriptures as
understood and interpreted in Holy Tradition. The
Ecumenical Council is the highest agency for such
interpretation; within the council, the Bishops of the

@ Church meet to address problems and conflicts, pro­


viding doctrinal and theological definitions of the
faith. Ecumenical Councils (of which seven were held
Part of the MReligious Traditions and i between 325 and 787 A.D.), have, for example,
Healthcare Decisions" handbook series ~ defined the Church's beliefs regarding the Trinitarian
,~~ published by the Park Ridge Center ~ nature of God (Father, Son, and Holy Spirit) and the
'-1 for the Study of Health, Faith, and Ethics ~ divine and human natures of the one Person, Jesus

THE PARK RIDGE CENTER


Christ. Ecumenical Councils have also issued "English:' The canonical local Orthodox
canons that provide practical guidance regarding Churches form the Orthodox Church worldwide
Church administrative issues, ethical and moral and are in communion with one another. There
questions, matters of spiritual discipline, and are also "noncanonical" Orthodox Christians
other challenges facing the Church. who are served by priests not in communion
Issues not addressed by Ecumenical Councils with a canonical Church. Many Orthodox
are taken up by Church Fathers recognized as Christians tend to he ethically conservative and
holy persons, mostly bishops and monks, whose cautious in the use of technology, hut not
writings embody "the mind of the Church?' opposed to it in principle.
They are perceived as saintly exemplars of the The Orthodox Church honors the human
Orthodox faith whose teachings interpret effort to understand the created world, acknowl­
Scripture and Holy Tradition and provide guid­ edging science and technology as gifts from God
ance in addressing new issues, such as those hut not as exclusive sources of moral and spiri­
raised by new medical technologies. tual truths.
The one Church of the first eight centuries
was divided into Eastern and Western parts in
the tenth century, in what is known historically FUNDAMENTAL BELIEFS
as "the Great Schism?' The Church in the west­ CONCERNING HEALTH CARE
ern Mediterranean eventually became known as
the Roman Catholic Church, which split again The Orthodox Church regards human life and
about five hundred years later with the emer­ well-being as gifts from God, who is the creator
gence of Protestantism. The Church in the and sustainer of life as well as the prime source
Eastern region eventually became known as the of healing. Concurrently, however, God has ()
Orthodox Church. For this reason the Orthodox endowed humanity with many abilities and tal­ .
Christian Church is sometimes called the ents and the freedom to use them. According to
"Eastern Orthodox Church," which sees itself as the Church, humanity has sinned by misusing
distinct from Western expressions of Christianity its freedom and violating its appropriate rela­
due to its own documented historical continuity tionship with God, fellow human beings, the
from Apostolic times. self. and the rest of the created world. The
Worship is the centerpiece of Orthodox Church's mission is to proclaim and embody
Church life, and sacramental life is at the core God's forgiveness of sin and to call all people to
of Orthodox experience, including the sacra­ repentance so that they may avail themselves of
ments of baptism, Chrismation (confirmation), that forgiveness and restore their relationship
the Eucharist, marriage, and the healing sacra­ with God. What follows is not instantaneous per­
ment of holy unction, though all of Church life fection, hut a process of spiritual and moral
is often characterized as "sacramental:' growth. The means of growth offered by the
Organizationally, the Church worldwide is Church-prayer, worship, sacramental life, spiri­
organized into various ecclesial bodies, many of tual and ascetic practice, philanthropy, love, and
them national in derivation. Some are headed mutual forgiveness and support-are considered
by Patriarchs and thus are called patriarchates. spiritually therapeutic.2
Other Orthodox Church bodies are headed by The Church perceives the healing of physical
leaders titled Metropolitans or Archbishops. illness by the medical professional as a God-
Persons may belong to Orthodox Churches des­ given art which, when appropriately and proper­
ignated as "Greek," "Russian," "Antiochian," ly used, serves God's purposes and helps restore
"S erh"ian," "Roman1an,
. " "Bulgar1an,. " an d even people to ~ no~al level of human func~oning, c··)
.•
"Japanese," "Ugandan," "American," and so that their spmtual and moral growth m com- · ··

2 THE ORTHODOX CHRISTIAN TRADmoN: RELIGIOUS BELIEFS AND HEALTIICARE DECISIONS


munity can continue. The work of the medical Christian life, is rooted in the affirmations of the
professional is honored as long as it does not faith, understood both as a worldview and as a
obviate God's healing and redemptive work. personal commitment in the community of the
Thus, when seeking healing, most Orthodox Church.
Christians turn to both modem medicine and The ethics of the Church are embodied in the
the spiritual resources of their ancient faith. Holy Scriptures and Holy Tradition, both of
There is no essential contradiction between which are understood as witnesses to God's rev­
them.3 elation. In particular, these teachings are found
The Orthodox Christian views suffering as a in the decisions of Ecumenical Councils and
consequence of our broken and sinful condition other recognized councils, Church canons, the
that comes to human beings in various ways: Church's liturgical and sacramental life, the
through human mortality, personal sin, and evil writings of Church Fathers, the encyclicals of
prevalent in society and nature. Orthodoxy calls local hierarchs and synods, the theological and
for efforts to be made to reduce or eliminate ethical teachings of theologians, pastoral guide­
mental or physical suffering. However, it also lines, and the full clergy and lay "consciousness
views suffering as potentially redemptive, if of the Church," when understood as guided by
understood and accepted in the framework of the Holy Spirit. The Father Confessor or spiritu­
spiritual growth toward God-likeness. The suf­ al father is an important figure in contributing
fering of Christ, along with that of the saints and to moral decision making. Nonetheless, all
martyrs, provides the Orthodox Christian with Orthodox Christians are considered free in mak­
models of salvific suffering.4 ing moral choices. The Tradition guides and
directs, but does not coerce, though ecclesial
consequences can follow what the Church
I'\ ORTHODOX CHRISTIAN regards as improper decisions.s

" MORALITY AND ETHICS

Eastern Orthodox Christian ethical teaching,


understood as the "ought" aspect of the

THE INDIVIDUAL AND THE PATIENT-CAREGIVER RELATIONSHIP

A ccording to the teaching of love and phi­


lanthropy that permeates the Gospels, each
person, regardless of his or her role, ought to
daughter of God whose well-being God has
entrusted to the caregiver. Created in God's
image and likeness, the patient should be treat­
relate to others as one sharing in communion ed with respect and love. Furthermore, as a per­
with all others, and with concern for their son endowed with capacities of seH-determina­
neighbor's weHare. The Orthodox Church has tion, each patient is his or her own healthcare
long applied this teaching to the healing profes­ decision maker. The Orthodox Christian patient
sions.6 Medical caregivers are expected to place should be informed regarding his or her condi­
patients' well-being ahead of personal interests. tion and alternatives. Together with the health­
They are expected to exercise professional care team, pastor and family, the patient should
I'\. integrity and competency with compassion and be allowed to choose freely between healthcare
W loving concem.7 The patient is seen as a son or alternatives.

THE PARK RIDGE CENTER 3


CLINICAL ISSUES and confidentiality. Informing patients of their
medical condition, however, depends in large
Self-determination and informed consent part on the personal circumstances mentioned
Generally, the Orthodox Church chooses to above. These circumstances may also play a role
speak of "personhood" rather than "individual­ in maintaining appropriate confidentiality.
ism." In therapeutic situations, decisions ought
not to be arrived at individualistically. Proxy decision making
"Personhood" implies networks of relationships, The Orthodox Church teaches that preparing for
not self-limited decision making. While each death is primarily a spiritual responsibility.9 The
person is responsible for his or her own deci­ Church's daily services guide the prayers of the
sions, many considerations need to be taken into faithful: "That we may complete the remaining
account in medical decision making. Depending time of our life in peace and repentance, let us
on the circumstances of a person's life (age, ask of the Lord?' Worshippers also pray: "For a
maturity, ability to comprehend and/or to deal Christian ending to our life, painless, blameless,
with various medical options), patients should peaceful and a good defense before the fearful
be provided with as much spiritual, religious, judgment seat of Christ, let us ask?'10 It is not
ethical, and medical information as possible so surprising, then, that with the rise of extraordi­
that the patient, in the context of family, pas­ nary methods of prolonging life, the Orthodox
toral counsel, and concerned medical staff, may have developed their own forms of advance
make proper and enlightened self-determined directives. These directives usually stipulate that
decisions.a Wherever possible and to whatever in the case of incapacity, a close relative may
extent needed, then, healthcare providers should make medical decisions on behalf of the patient.
assist patients in understanding the circum­ The directives may also indicate that when the
stances and choices about their treatment plan. patient's condition is terminal, they have been
spiritually prepared for death through the sacra­
0 '
~

Truth telling and confidentiality ments of Holy Confession and Holy Communion,
In this larger context, medical professionals, and all reasonable hope for recovery is exhaust­
religious/ ethical advisers and family members ed, the person may properly ask to be allowed to
should exercise their obligations of truth telling die. 11

FAMILY, SEXUALITY, AND PROCREATION

T he Orthodox Church considers marriage a


sacrament. Just as the celibate or monastic
life is a high calling for those called to it, so is
which combines these values in a stable rela­
tionship, asks that the newly married couple live
in unity so that "they may see their children's
married life. The purposes of marriage reflect children round about their table like a newly
the Church's theology of communion. The mul­ planted olive orchard?' Should the couple not be
tiple purposes of marriage include spousal love able to have children, the Church emphasizes
and mutual support, the meeting of sexual needs the values of unity, love, and growth toward holy
as an expression of love, the procreation and God-likeness by the spouses.12
nurture of children, the creation of family life
and character development, and the cultivation ,:.\;:j
:

of Christian virtues. The marriage sacrament,

4 THE 0RTIIODOX CHRISTIAN 'fRADmON: RELIGIOUS BELIEFS AND HEALTIICARE DECISIONS


CLINICAL ISSUES AND PROCEDURES spousal ovum and sperm would also he accept­
able means to aid in procreating, provided that
Contraception all fertilized ova he used in implantation.17
While Orthodox Christians hold differing views On the other hand, any- form of AID is per­
on contraception, the majority in the United ceived as an unwarranted intrusion in the spiri­
States view it as an acceptable practice on the tual, moral, psychological, and physical unity of
condition that spouses use it to postpone or the married couple by a third, unrelated party.is
space the birth of children. The form used, how­ Similarly, since death ends the personal physical
ever, should not produce an ahortion.13 Married relationship of spouses, the Church does not
couples who deliberately refuse to procreate not condone continuing physical relationships
because of health issues hut for hedonistic rea­ through various methods of postmortem concep­
sons are understood to violate one of the major tion (for example, the implantation of frozen fer­
purposes of marriage. tilized ova).19 One reason given for this prohibi­
tion is the moral, relational, social, and spiritual
Sterilization confusion that such practices provoke. For simi­
Sterilization-other than for documented health lar reasons, the Orthodox Christian Church also
reasons-is also considered morally unaccept­ fundamentally opposes all forms of surrogate
able. Orthodox literature treats sterilization as a motherhood.
moral equivalent to seH-murder, in that life is
negated.t• Disease treatment ofpregnant
women I abortion
New reproductive technologies A pregnantwoman who becomes ill should he
The Holy Tradition of the Orthodox Church treated for her illness, with concern for the well­
does not, of course, refer directly to new repro­ being of her developing child. Since the
ductive technologies. Nevertheless, a number of Orthodox consider the implanted embryo
Orthodox writers have addressed them. These already human from its conception, the issue of
authorities generally maintain a powerful respect therapeutic abortion is a weighty one.20 Under
for life as a gift from God, leading to the almost normal circumstances, the Orthodox Church
absolute opposition throughout Orthodox history teaches that abortion is wrong and should he
to abortion. They furthermore support the avoided. However, in the case of a genuine
Orthodox Church's view of procreation within threat to the life of the mother or an ectopic
marriage as the proper expression not only of pregnancy, the Church makes room for some
their physical sexual relationship, hut also of choice, advising a prudence in consultation with
whole spiritual, familial, and social all parties involved. Serious consideration, how­
relationships.is ever, should he given to the preservation of life.
The cases of Artificial Insemination by
Husband (AIH), Artificial Insemination by Prenatal diagnosis and treatment
Donor (AID), and various forms of postmortem The Church encourages prenatal diagnosis and
conception serve to illustrate how the wholeness treatment of the fetus where this would improve
of faith and life in the marital relationship the health and life potential of the child to he
inform hioethical decision making. Generally horn.
speaking, the Orthodox Church views AIH as
contributing to the fulfillment of the purpose of Care of severely handicapped newbf>rns
procreation in marriage.16 Similarly, in vitro fer- Aborting a developing child because of physical
B\. tilization procedures and Gamete Intrauterine abnormality is not approved by the Orthodox
V Fallopian Transfer (GIFT) procedures using Church. Rather it views such exceptional chil-

THE PARK RIDGE CENTER 5


dren as human beings in their own right, reasons-are considered to he murder and are
deserving care and love. Abortions of "conven­ therefore proscribed.
ience"-those performed for hedonistic or social

GENETICS

0 rthodox theological anthropology holds the


dignity, integrity, and uniqueness of each
human person in very high regard. According to
CLINICAL ISSUES AND PROCEDURES

Genetic testirig and counseling


Scripture, human beings are created in the Genetic testing and counseling consequently
"image and likeness of God:' Some thinkers in properly take place when it is determined that
the Eastern Christian patristic tradition distin­ conception may result in fetal defects arising
guish the terms "image" and "likeness:' The for­ from genetic causes. Among Mediterranean
mer refers to all that distinguishes humanity Orthodox peoples, for example, the blood dis­
from the balance of creation, including intellect, ease thalassemia afflicts significant numbers of
creativity, language, moral sense, and personal the population. The Church thus counsels peo­
self-determination. The latter is understood as ple in high-risk groups to he tested so that mar­
the developmental potential of fallen human riage choices can he influenced by the presence
beings to grow in communion with God (divine or absence of thalassemia traits. Should treat­
grace or theia charis), toward God-likeness (the
doctrine of divinization or Theosis). Thus, each
ment he available to provide therapy for a fetus
in the womb-treatment that would not he undu-
0,'
human being is not only free, hut also called to ly threatening to the life of the mother or fetus-
become fully human through a life of repen­ the therapeutic rule would allow but not require
tance, renewal, spiritual struggle, and growth. In such treatment.22
this calling, humanity reflects the cosmos as a
microcosm, in which the spiritual and material Sex selection and selective abortion
dimensions coalesce to give human beings a Sex selection violates the integrity of the con­
priest-like identity with the potential to manifest ceived person. Males and females, though differ­
the fullness and goodness of God's creation. ent according to gender, are considered spiritu­
The Orthodox Church believes that people ally and morally equal before God. Given the
should never he treated merely as objects. stance of the Orthodox Church on abortion,
Medical science should do its work with caution selective abortion for purposes such as gender
and respect for the patient's psychosomatic per­ selection or to elminate multiple conceptions is
sonhood. The main criterion guiding medical also considered morally unacceptable.
practice in forming the dividing line between
what is ethically acceptable and what is not is Gene therapy
the therapeutic intent and use of medical tech­ Gene therapy remains a problematic issue within
nology for the person under treatment.21 the Orthodox Church. Procedures that correct
disabilities or illnesses, such as diabetes, as well
as therapies that help people conceive, are
acceptable. The problem lies in the lack of med­
ical knowledge, particularly regarding germ line
experimentation. Such experimentation should
c;
6 THE ORTHODOX CHRISTIAN 'fRADmON: REIJGIOUS BELlEFS AND HEALTHCARE DECISIONS
." not take place for the purpose of gene therapy
until much more is known about the conse­
quences. The Orthodox Church advises extreme
caution on this matter. Furthermore, only in the
apy be considered acceptable. Eugenic purpos­
es-creating "superior beings" or animal/human
chimeras-are morally repulsive and should
never he practiced.23
case of truly therapeutic purposes can gene ther-

ORGAN AND TISSUE TRANSPLANTATION

I n light of the Orthodox Church's position on


the wholeness of human beings, the church
teaches that the human body should be respect­
gibility for transplants. Among the ethical crite­
ria are fair procedures that address the complex
issues related to greater need and waiting time­
ed and honored. Three doctrines affirm this procedures that do not involve judgments of
position: creation of the body by God; the incar­ "greater worth" of one person over the other.
nation of Jesus Christ; and the expectation of The development of such procedures should he
the body's resurrection at the Second Coming. coupled with education to increase the number
Together, they underscore the integrity of a per­ of potential donors, and implantable devices
son's bodily life. The resulting moral require­ limiting the need for transplanted organs. The
ments include the prohibition of murder and Orthodox Church views the commercialization
care for the health and well-being of each per­ of transplantable organs as a grave and unac­

•'
son's physical existence.
An Orthodox Christian should not be pres­
sured to violate personal convictions if they do
not wish to donate an organ or receive an organ
transplant, following the provision of adequate
ceptable danger.

Donor issues
Orthodox ethical teachings caution that medical
professionals should reduce risks to willing
information. Nevertheless, Orthodox Christians organ donors. Cadaver donations should respect
may legitimately accept the donation of a dupli­ the integrity of the human body for burial pur­
cated organ if the motivations of love and con­ poses. As for obtaining organs from aborted
cern for the welfare of the donor are genuine fetuses or from anencephalic newborns, the
and the decision is not coerced. Certain organs Church requires that people, including aborted
may he transplanted at death, so long as the newborns, should be valued in their full human­
body remains intact for Orthodox burial rites. In ity, not merely as sources of body parts. The
some predominantly Orthodox nations, the Church warns against the use of organs or tissue
Church has supported organizations that foster supplied by the most helpless and vulnerable of
the practice of organ transplantation as an the human race. Decisions on this matter should
expression of philanthropy and Christian love. he weighed with utmost sensitivity.

CLINICAL ISSUES AND PROCEDURES

Recipient issues
Ethical and scientific criteria (e.g., tissue match­
• ing and organ rejection determinations) must be
adhered to when making decisions regarding eli­

THE PARK RIDGE CENTER 7


MENTAL HEALTH

0 rthodox tradition understands humans to


be in a state of brokenness. Human beings
are created in the image of God but are also in a
health caregivers, so long as these professionals
respect the religious and moral integrity of their
patients.25
fallen and sinful condition of separation and
broken relationship with God, neighbor, self,
and environment. All are, in some measure, CLINICAL ISSUES AND PROCEDURES
"less than fully human." Compared to the
Roman Catholic Church, the Orthodox Church Involuntary commitment
speaks less of guilt and more of darkened intel­ Given the nature of mental illness in which self­
lect, distorted emotions, weakened will, and the understanding and self-knowledge may be
unredeemed condition of human existence. With severely distorted, every effort should be made
such brokenness come physical illnesses, social to help the patient accept therapy. Only in
disruptions, and mental imbalances. extreme cases and only within a range of pre­
The impulse toward human self-determina­ defined conditions biased toward the protection
tion may intensify these conditions of broken­ of the mentally ill should medical caregivers
ness. Choice is sinful inasmuch as human resort to involuntary commitment. The approval
choice accentuates the development of illness. of a parent, guardian, or other person whose pri­
Abuse of alcohol or other mind-altering drugs is mary concern is the welfare of the patient is
likewise sinful. Decision making about such called for.
behaviors reflects a spiritual struggle against the
human sinful condition as well as the exercise of Psyclwtlierapy and beliavior modification
virtue in growth toward God-likeness (theosis).
However, choice and self-determination cannot
All therapy should strive for maximum coopera­
tion by the patient in the healing process. Thus,
0

in themselves control a situation that has methods used by psychotherapy and behavior
become addictive. A tendency or propensity modification regimens should strive for the
toward alcoholism is a case in point. patients' conscious and willed participation.
Similarly, mental illness can be understood as
an expression of brokenness. In such cases, the Psyclwpliarmacology
Church teaches that the God-given arts of thera­ Many illnesses, such as those caused by chemi­
py ought to be applied.24 While treatment of cal imbalances in the brain, can only be treated
mental illness is viewed as a legitimate dimen­ pharmacologically. Even in these cases, the
sion of the healing arts, the Church does not assent, response, concerns, and self-assessments
endorse any particular psychological theory. In of the patient should be respected within the
many cases, such theories are in stark contrast framework of the professional responsibilities of
with the theological and spiritual presupposi­ the mental healthcare provider.
tions of Orthodox Christianity, and are often
rejected by the patient or the patient's family. Electroshock and stimulation
As always, the Church prays for the restora­ Radical invasive therapies such as electroshock
tion of health to the mentally ill and offers should be discussed with the patient and family
sacramental life to those seeking healing. only as a last resort. The impact of such thera­
Nevertheless, in the face of intractable symp­ pies is powerful, bypasses much of the individ­
toms of mental illness, the Orthodox Church ual's self-determination, and may have lasting
encourages family members to seek the aid of harmful consequences.
psychologists, psychiatrists, and other mental

8 THE 0RTIIODOX CHRISTIAN TRA.omoN: REIJGIOUS BEIJEFS AND HEALTHCARE DECISIONS


MEDICAL EXPERIMENTATION AND RESEARCH

with the above criteria.


T he Church may approve medical experi­
mentation on humans if the experiment is a
last therapeutic resort and is applicable to the
However, the Church considers experimenta­
tion or research on embryos, fetuses, and chil­
health and well-being of the patient.26 dren to he inappropriate because informed con­
When experimentation involves populations sent cannot he obtained. In such cases, the sub­
other than the individual, for example through ject is treated as an object.
blind testing, those involved must he informed Only people capable of choosing to partici­
of the nature of the experiment and the risks pate in experiments after being fully informed of
involved. The interests of the researcher are potential consequences should he allowed to
subordinate, especially when the subjects' health participate. Though the use of deceased fetal tis­
and well being are in danger. sue may he acceptable, Church doctrine suggests
that the preservation and display of dead human
embryos violates proper respect for the dead.
CLINICAL ISSUES AND PROCEDURES Animal experimentation is not prohibited as
long as the experiments are necessary to test
Orthodox tradition understands that developing drugs, surgical procedures, or other medical pro­
medications and procedures often requires tocols. Animal experiments should he conducted
experimentation, and sanctions it in accordance humanely and designed to minimize pain.

DEATH AND DYING

0 rthodox Christian faith is rooted in the


redemptive and saving work of Jesus
Christ's incarnation, teaching, healing, and­
person will experience the life of Heaven or Hell
as communion with, or separation from, God in
eternity. The Orthodox approach to death is illu­
most important-in His death and resurrection. mined by the centrality of the resurrection of
Death is understood to he a consequence of the Jesus Christ in worship. The chief Orthodox
fallen and broken condition of creation. Still this Easter hymn proclaims "Christ is risen from the
condition does not minimize. the tragedy and dead, by His death destroying Death, and to
burden of death.21 those in the tombs, He gives life!"
On the other hand, Christ's death and resur­ Physical death, then, is not so fearsome as
rection are seen less as a juridical payment for spiritual death. That physical death should he
human sin than as a victory over the power of properly opposed through a healthy lifestyle is
sin and death. Much of the Church's liturgical reflected in the oft-repeated blessing: "Many
life is inspired by the resurrection of Christ and Years!" But when death approaches, Orthodox
celebrates its renewing, hope-giving and Christians live "in the hope of the resurrection:'
redemptive power.
The Orthodox believe that when a person
dies, he or she enters into a condition known as CLINICAL ISSUES AND PROCEDURES
"Partial Judgment"-a foretaste of one's future in
eternity. The Second Coming of Christ will coin­ Determinirig death
cide with a General Judgment in which each Orthodox Christians once determined death by

THE PARK RIDGE CENTER 9


the cessation of heart activity and breathing. Autopsy and postmortem care
Recent Orthodox thinkers do not object to The dead body is treated with respect and hon­ ()
defining physical death in terms of brain death. ored as a "temple of Lord:' Autopsies should be
Generally, the Orthodox recognize death as the performed only when the family is given a clear
cessation of higher human capacities concurrent reason and freely accepts it. Family members
with the demise of the cerebral cortex, even may object to routine autopsies in order that
though lower brain stem activities may remain.28 their loved ones may rest in peace but when a
Opinions differ regarding the continuation of clear reason is given for the autopsy, most clergy
food and hydration. Food and water should be and families will allow it. Most Orthodox
offered to patients as long as they can take it by Christians in the United States do not object to
mouth. Some feel that unconscious, dying per­ embalming procedures.
sons should be fed intravenously; others do not.
In any case, hydration should be continued so Last rites, burial, arul mourning traditions
that pain control medications can also be Orthodox last rites consist of sacramental recon­
administered. ciliation (Holy Confession and/or Holy
Communion). The priest should be called to
Suicide, assisted suicide, and euthanasia perform them before the patient loses con­
Since the earliest years of the Christian tradi­ sciousness. Cremation is prohibited; however,
tion, suicide has been defined as a sin; ethically, should a non-Orthodox spouse or relative plan
it is understood as self-murder. The Church cremation for the deceased, family members and
views renewed acceptance of suicide in western the parish priest should be apprised, discussions
European culture as a return to values and and decisions should be made before death. An
world views contrary to Christian teaching. All Orthodox funeral may be prohibited if crema­ ')
forms of assisted suicide are understood as the tion is planned, depending upon the jurisdiction V
unjust taking of human life. to which the deceased belonged.
Euthanasia is similarly considered a form of Most Orthodox expect a Church funeral
murder.29 On the other hand, long-standing litur­ emphasizing the vanity of this world, the impor­
gical practice in the "Rite At The Tearing Away tance of eternal life with God, and the expecta­
of the Soul" actually prays for God to release a tion of resurrection at the Second Coming in a
suffering terminal patient into death. The spirit of hope and peace.31 Burial in Church­
Church, then, distinguishes between taking a life owned cemeteries or in Orthodox sections of
and allowing a person to die.30 larger cemeteries is standard procedure. _
Memorial services are usually conducted in
Churches on the fortieth day following death
and on the sixth month and annual anniver­
saries thereafter.

SP·ECIAL CONCERNS

Dietary concerns, use of drugs, kinds of foods) on a weekly (Wednesdays and


blood transfusions Fridays) or periodical basis (Advent Lent of forty
The Orthodox Church maintains a strict stan­ days before Christmas, and Great Lent and Holy (·•··
dard of fasting (i.e., abstinence from various Week before Pascha of about fifty days). ~-

10 THE 0R11IODOX CHRISTIAN TRAomoN: RELIGIOUS BELIEFS AND HEALTIICARE DECISIONS


Abstinence may range from simply not eating Liturgi,cal and pastoral concerns
meat to avoiding fish, eggs, dairy products, or At the birth of a child, the Church offers special
oil. Individual Orthodox Christians follow these prayers for mother and child. Often the priest
dietary rules or not, according to their own judg­ will visit the new mother and child soon after
ment. In any case, the Church relaxes fasting they are allowed visitors. In cases when a new­
rules in cases of illness. Nevertheless, some born is in danger of death, not only the priest
Orthodox may insist on fasting even when hos­ but any Orthodox Christian-for that matter, any
pitalized.32 other person-may baptize the child with the
The Church raises-no objections in principle words, "The servant of God [name of child] is
to using prescription drugs or blood transfusions baptized in the name of the Father and the Son
as therapeutic measures. and the Holy Spirit. Amen." Should the child
live, a priest conducts the rest of the baptismal
AIDS service at a later date.
Behaviors that lead to AIDS, such as drug use
and promiscuous sex, are judged immoral both Pain control and palliative care
in themselves and in reference to their conse­ In nearly every clinical situation, efforts should
quences by the Orthodox Church. There are also be made to control pain for suffering patients. In
cases where no such behavior has caused the the case of dying patients with no hope of
transmission of the illness, such as HIV trans­ improvement, the ministry of a parish priest is
mission from mother to child, in which the encouraged. This usually includes prayer,
infected person is morally innocent. In any case, administration of the sacraments of Holy
people suffering from HIV infection or the AIDS Confession and the Holy Eucharist, and the cul­
condition should be treated with the compassion tivation of a climate of mutual forgiveness and
A
v and care due all persons suffering from illness. love. The patient must be conscious for this to
Thus, care for AIDS patients is counseled by the take place. Afterward, the dying patient should
Church; several diocesan-based, Orthodox-spon­ be provided palliative care with high levels of
sored organizations provide education and sup­ pain control.
port to people with AIDS and their families.
Foregoirig life-sustainirig treatment
Personal piety As long as there is reasonable hope that medical
Icons are revered in the Orthodox Church as treatment can be in some measure therapeutic,
"Windows on Heaven" and are considered the Orthodox Church supports vigorous medical
means through which the believer may com­ intervention. However, when no therapeutic ou~
mune with the person or event represented on it come can be expected, the next goal is palliative
by praying before it, touching it, or kissing it care. As long as the patient can sustain life with
reverently. Icons may represent Christ, the minimal mechanical means, providing comfort is
Theotokos (Mary, the Mother of God), or a the indicated course of treatment. Only when all
patron saint. Orthodox patients may bring holy reasonable hope of self-sustaining life is lost and
icons to be placed near their hospital beds, and the dying process has been definitively diag­
they should be handled respectfully. Some nosed can the ongoing life-sustaining mechani­
Orthodox may also bring prayer books or cards cal treatment be reduced or discontinued.
with them for daily prayers. Prayer times should An Orthodox priest may visit the hospital to
be left uninterrupted except in unusual circum­ offer prayers for health and well being of the
stances.33 patient. One of the sacraments of the Church is
Holy Unction, a healing sacrament that may be
conducted in abbreviated form at the bedside.

THE PARK RIDGE CENrER 11


When the priest comes to the hospital to hear a , In some parishes, the family will request that
confession and/or to administer Holy the body not he moved until the priest arrives to r
~:·
Communion, a table is useful and privacy appre­ conduct a brief bedside prayer service. This is a
ciated. time of prayer and spiritual comfort. Privacy
should he respected.

NOTES

1. For general introductions to the Orthodox Church., in 3. Stanley Samuel Harakas, Health and Medicine in the
increasing order of detail, see Anthony Coniaris, Eastern Orthodox Tradition. (New York: Crossroad

0 .,
Introducing the Orthodox Church; It& Faith and Life. Publishing Co, 1990). Reprint edition, Minneapolis,
(Minneapolis, MN: Light and Life Publishing Co., MN: Light and Life Publishing Co., 1996. ,I
1982); Thomas FitzGerald, The Orthodox Church.
4. Ibid., pp. 45-56.
(Westport, CT: Greenwood Press, 1995); Kallistos

Ware, The Orthodox Church. (New York: Penguin


5. For a foundational treatment of Eastern Orthodox

Books, 1993).
ethics see Stanley Samuel Harakas, Toward
Transfigured Life: The Theori.a ofEastern Orthodox
2. In addition to the above, see Vladimir Lossky,
Orthodox Theology (Crestwood, NY: St. Vladimir's
Ethics. (Minneapolis, MN: Light and Life Publishing
Co., 1983). Orthodox ethical life and decision making
Seminary Press, 1978); John Karmiris, Synopsis of the
is inseparable from the cultivation of the spiritual life.
Dogmatic Theology of the Orthodox Catholic Church.
Two introductions are: Lev Gillet, A Monk of the
tr. George Dimopoulos, (Scranton, PA.: Christian
Eastern Church, Orthodox Spirituality. (Crestwood, NY:
Orthodox Editions, 1973); Vladimir Lossky, The
St. Vladimir's Seminary Press), and Hierotheos Vlachos,
Mystical Theology of the Eastern Church. (London:
Orthodox Spirituality: Birth of Theotokos Monastery
James Clarke and Co., 1957). John Zizioulas, Being as
(Levadia, Greece: 1993). A collection of writings on
Communion (Crestwood, NY: St. Vladimir's Seminary
Orthodox monastic spirituality beginning in the fourth
Press, 1985). Jaroslav Pelikan, "The Spirit of Eastern
century and extending to the nineteenth century is The
Christendom (600-1700) vol. 2 of The Chri&tian
Tradition: History of the Development of Doctrine, Philokoli.a: The Complete Text Compiled by St.
(Chicago: The University Chicago Press, 1974). The Nikodemos of the Holy Mountain and St. Makarios of
theological and ethical implicati<>ns of Christian love
Corinth. G.E.H. Palmer, Philip Sherrard, Kallistos
are addressed fully by Vigen Guroian, Incarnate Love: Ware, eds. and trans. (London: Faber & Faber, 1979),
vol. I; 1986, vols. II, III; and 1995, vol. 4.
Essays in Orthodox Ethics. (Notre Dame, IN:

University of Notre Dame Press, 1988). The ecclesial


6. S<>me examples can be found in Demetrios J.

dimensions of teaching and church life for ethics are


Constantelos, Byzantine Philanthropy and Social

dealt with by Guroian in his book Ethics After


Welfare. New Brunswick, NJ.: Rutgers University Press,
Chri&tendom: Toward An Ecclesial Chri&tian Ethic. 1968. See also his articles: "Physician-Priests in the (• .....
(Grand Rapids, MI: Eerdmans Publishing Co., 1994). Medieval Greek Church" Greek Orthodox Theological ~

12 THE ORTHODOX CHRISTIAN TRADmON: RELIGIOUS BELIEFS AND HEALTIICARE DECISIONS


Review, vol. xii, 1966-1967, 141-153 and "'The 19. Breck, in his The Sacred Gift of Life, ibid., provides
Interface of Medicine and Religion in the Greek and the best treatment among Orthodox ethicists on the
-c~
., the Christian Greek Orthodox Tradition," Greek issues related to post-mortem conception, pp. 179-180.
Orthodox Theological Review, vol. xxxiii, 1988, pp.
20. John Kowalczyk, An Orthodox View ofAbortion.
1-18. Also, Timothy Miller, The Birth of the Hospital
(Minneapolis, MN: Light and Life Publishing Co.,
in the Byzantine Empire. Baltimore, MD: Johns
1977).
Hopkins University Press, 1985; and Dumbarton Oaks
Papers, Number Thirty-Eight, 1984, Symposium on 21. Panagiotes Nellas, Deification in Christ: The Nature of
Byzantine Medicine, ed. John Scarborough. the Human Person. (Crestwood, NY: St. Vladimir's
Washington, DC: Dumbarton Oaks Research Library Seminary Press, 1987); Vladimir Lossky, In the Image
and Collection, 1985. and Likeness of God. (Crestwood, NY: St. Vladimir's
Seminary Press, 1975).
7. Harakas, Health and Medicine, ibid., sec. 6, "Human

Dignity in Caring and Curing:'


22. John T. Chirban, Thalassemia: An Interdisciplinary
Approach. (Lanham, MD: University Press of America,
8. John T. Chirban, Personhood: Orthodox Christianity
1986).
and the Connection Between Body, Mind and Soul.
(Westport, CT: Bergin & Garvey Publishing Co., 1996); 23. The best Orthodox treatment of gene therapy to date
Harakas, Toward Transfigured Life, ibid., ch. 9, is found in John Breck's section "Genetic Engineering
"Ethical Decision Making:' and Procreation: The Manipulation of Human Life,"
in The Sacred Gift ofLife, ibid., pp. 190-202.
9. Nicholas P. Vassiliadis, Mystery ofDeath, tr. Peter

Chamberas. (Athens, Greece: 0 Sotir Publishing


24. Aspects of mental health as they address moral, theo-
House, 1993). logical, and psychological concerns are treated in an
interdisciplinary fashion from an Orthodox Christian
10. The Divine Liturgy of Saint John Chrysostom: A New
perspective in John T. Chirban, ed., Healing: Orthodox
Translation by Members of the Faculty of Hellenic
Christian Perspectives in Medicine, Psychology and
College/Holy Cross Greek Orthodox School of Theology
(With Greek Text). (Brookline, MA: Holy Cross Religion. ( Brookline, MA: Holy Cross Orthodox Press,

0 Orthodox Press, 1985), "The Petitions" pp. 14-16.


1991), and John T. Chirban, ed., Health and Faith:
Medical, Psychological and Religious Dimensions.
11. Stanley Samuel Harakas, Living the Faith: The Praxis (University Press of America, Lanham, MD., 1991).
of Eastern Orthodox Ethics. (Minneapolis, MN: Light
25. Vlachos, lllness and Cure of the Soul in the Orthodox
and Life Publishing Co., 1992), pp. 129-130.
Tradition. E. Mavromichali, trans. Levadia, Greece:
12. Demetrios J. Constantelos, Marriage, Sexuality and 1993; Philotheos Faros, "Mental Patients and Verbal
Celibacy: A Greek Orthodox Perspective. (Minneapolis, Communication of the Religious Message," Theologia,
MN: Light and Life Publishing Co., 1975); John vol. 42, 1972, pp. 603-606. Stanley Samuel Harakas,
Meyendorff, Marriage: An Orthodox Perspective. (St. For the Health of Body and Soul. (Brookline, MA:
Vladimir's Seminary Press, Crestwood, NY: 1984). Holy Cross Orthodox Press, 1980), pp. 32-33.
13. See John Breck's insightful chapter, "Procreation and 26. Harakas, Living the Faith, ibid., p.127.

the Beginning of Life," Ch. 3 of The Sacred Gift of

Life: Orthodox Christianity and Bioethics. (Crestwood, 27. Vigen Guroian has provided a contemporary approach
NY: St. Vladimir's Seminary Press, 1998). to the issues of death and dying that is rooted in the
traditions of Orthodox Christianity in his book, Life's
14. Harakas, Living the Faith, ibid., p. 134. Living Toward Dying: A Theological and
Medical-Ethical Study. (Grand Rapids, MI: William B.
15. Breck, The Sacred Gift of Life, ibid., pp. 175-202.
Eerdmans Publishing Co., 1996). Of particular value
16. Harakas, Health and Medicine, ibid., pp. 141-142. for this discussion is chapter five, "Caring For the
Dying in the Christian Faith:'
17. Breck, The Sacred Gift ofLife, ibid., p. 182.
28. G. A. Larue, ed., Euthanasia and Religion: A Survey of
18. Stanley Samuel Harakas, "Embryo Fertilization the Attitudes of World Religions to the Right to Die.
Outside the Womb," Contemporary Moral Issues (Los Angeles: The Hemlock Society, 1985). Includes
Facing the Orthodox Christian. (Minneapolis, MN: two articles by Orthodox authors Thomas Hopko and
0 . Light and Life Publishing Co., 1982), pp. 88-92. Stanley Harakas on Euthanasia .

29. Harakas, "Health and Medicine," Ibid., p. 157.

THE PARK RIDGE CENTER 13


30. Harakas, "Health and Medicine," Ibid., p. 157. 33. Non-Orthodox Christians might find Henri J.M.
Nouwen's Behold the Beauty of the Lord: Praying
31. Marangos, "Shared Christian Praxis: Approaching the
With Icons, (Notre Dame. IN: Ave Maria Press, 1987),
Orthodox Funeral Service," Greek Orthodox
of interest. A similar book, written by an Orthodox
Theological Review, vol. 29, 1984, p. 195-206.
Christian, James Forest, is Praying With Icons.
32. Archimandrite Akakios, Fasting in the Orthodox (Maryknoll, NY: Orbis Books, 1997).
Church: Theological, Pastoral and Social Implications.
(Etna, CA: Center for Traditionalist Orthodox Studies,
1990).

BIBLIOGRAPHY

Archimandrite Akakios, Fasting in the Orthodox Church: Orthodox Tradition," Greek Orthodox Theological
Theological, Pastoral and Social Implications. Etna, Review, vol. xxxiii, 1988.
CA: Center for Traditionalist Orthodox Studies, 1990.
Demetrios J. Constantelos, Marriage, Sexuality and
John Breck, The Sacred Gift of Life: Orthodox Christianity Celibacy: A Greek Orthodox Perspective. Minneapolis,
and Bioethics. Crestwood, NY: St. Vladimir's Seminary MN: Light and Life Publishing Co., 1975.
Press, 1998.
Philotheos Faros, "Mental Patients and verbal
John T. Chirban, Personhood: Orthodox Christianity and Communication of the Religious Message," Theologia,
the Connection Between Body, Mind and Soul. vol. 42, 1972.
Westport, CT: Bergin & Garvey Publishing Co., 1996.
Thomas FitzGerald, The Orthodox Church. Westport, CT:
John T. Chirban, ed., Thalassemi.a: An Interdisciplinary Greenwood Press, 1995.
Approach. Lanham, MD: University Press of America,
1986.
James Forest, Praying With Icons. Maryknoll, NY: Orbis
Books, 1997.
0 .

John T. Chirban, ed., Healing: Orthodox Christian


Vigen Guroian, Incarnate Love: Essays in Orthodox Ethics.
Perspectives in Medicine, Psychology and Religion.
Notre Dame, IN: University of Notre Dame Press,
Brookline, MA: Holy Cross Orthodox Press, 1991.
1988.
John T. Chirban, ed., Health and Faith: Medical,
Vigen Guroian, Ethics After Christendom: Toward An
Psychological and Religious Dimensions. Lanham,
Ecdesial Christian Ethic. Grand Rapids, MI: William
MD:University Press of America, 1991.
B. Eerdmans Publishing Co., 1994.
Anthony Coniaris, Introducing the Orthodox Church: Its
Vigen Guroian, Life's Living Toward Dying: A Theological
Faith and Life. Minneapolis, MN: Light and Life
Publishing Co., 1982.
and Medical-Ethical Study. Grand Rapids, MI: William
B. Eerdmans Publishing Co., 1996.
Anthony Coniaris, The Philokalia: The Bible of Orthodox
Spirituality-Addressing Orthodox Spirituality to the
Stanley Samuel Harakas, For the Health ofBody and Soul.
Brookline, MA: Holy Cross Orthodox Press, 1980.
Average Lay Person. Minneapolis, MN: Light and Life
Publishing Co., 1998. Stanley Samuel Harakas, Contemporary Moral Issues
Demetrios J. Constantelos, "Physician-Priests in the Facing the Orthodox Christian. Minneapolis, Light and
Medieval Greek Church," Greek Orthodox Theological Life Publishing Co., 1982.
Review, vol. xii, 1966-1967. Stanley Samuel Harakas, Toward Trans.figured Life: The
Theoria of Eastern Orthodox Ethics. Minneapolis, MN:
Demetrios J. Constantelos, Byzantine Philanthropy and
Social Welfare. New Brunswick, NJ.: Rutgers
Light and Life Publishing Co., 1983.
University Press, 1968. Stanley Samuel Harakas, Health and Medicine in the
Eastern Orthodox Tradition New York: Crossroad
Demetrios J. Constantelos, "The Interface of Medicine and { :
Religion in the Greek and the Christian Greek Publishing Co, 1990. Reprint edition, Minneapolis, v
MN: Light and Life Publishing Co., 1996.

14 THE 0RTIIODOX CHRISTIAN TRADmON: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS


Stanley Samuel Harakas, Livi-ng the Faith: The Praxis of Nicholas P. Vassiliadis, Mystery of Death, tr. Peter
Eastern Orthodox Ethics. Minneapolis, MN: Light and Chamberas. Brookline, MA: Holy Cross Orthodox
Life Publishing Co., 1992. Press, 1993.

Stanley Samuel Harakas, "Eastern Orthodox Christianity" Hierotheos Vlachos, Orthodox Spirituality: Birth of the
entry in Warren Thomas Reich, Ed., Encyclopedia of Theotokos Monastery. Levadia, Greece, 1993.
Bioethics, Rev. Ed. New York: Macmillan Library
Hierotheos Vlachos, lliness and Cure of the Soul in the
Reference/Simon & Schuster Macmillan, 1995.
Orthodox Tradition, tr. E. Mavromichali.
John Karmiris, Synopsis of the Dogmatic Theology of the
Kallistos Ware, The Orthodox Church. New York: Penguin
Orthodox Catholic Church, tr. George Dimopoulos,
Books, 1993.
Scranton, PA: Christian Orthodox Editions, 1973.
John Zizioulas, Being as Communion. Crestwood, NY: St.
John Kowalczyk, 1977, An Orthodox View ofAbortion.
Vladimir's Seminary Press, 1985.
Minneapolis, MN: Light and Life Publishing Co., 1977.
A Monk of the Eastern Church (Lev Gillet), Orthodox
Larue, G. A., et al Euthanasia and Religion: A Survey of
Spirituality. Crestwood, NY: St. Vladimir's Seminary
the Attitudes of World Religions to the Right to Die.
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Los Angeles: The Hemlock Society, 1985.
Bioethics Yearbook: Volume 1: Theological Developments
Vladimir Lossky, The Mystical Theology of the Eastern
Church. London: James Clarke and Co., 1957. in Bioethics: 1988-1990; Ed. Andrew Lustig, et. al..
Dordrecht: Kluwer Academic Publishers, 1991.
Vladimir Lossky, Orthodox Theology. Crestwood, NY: St.
Vladimir's Seminary Press, 1978. Bioethics Yearbook: Volume 3: Theological Developments
in Bioethics: 1990-1992, Ed. Andrew Lustig, et. al..
Vladimir Lossky, In the Image and Likeness of God. Dordrecht: Kluwer Academic Publishers,
Crestwood, NY: St. Vladimir's Seminary Press, 1975.
The Divine Liturgy of Saint John Chrysostom: A New
Frank Marangos, "Shared Christian Praxis: Approaching Translation by- Members of the Faculty of Hellenic

C)'
. '
the Orthodox Funeral Service," Greek Orthodox
Theological Review, vol. 29, 1984.
College/Holy Cross Greek Orthodox School of Theology
(With Greek Text). Brookline, MA: Holy Cross
Orthodox Press, 1985.
John Meyendorff, Marriage: An Orthodox Perspective. St.
Vladimir's Seminary Press, Crestwood, NY: 1984 (third Dumbarton Oaks Papers, Number Thirty-Eight, 1984
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Panagiotes Nellas, Deification in Christ: The Nature of the


Hunwn Person. Crestwood, NY: St. Vladimir's
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Henri J.M. Nouwen, Behold the Beauty of the Lord:


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,,
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"'
University Chicago Press, 1971, 1974

THE PARK RIDGE CENTER 15


Introduction to the series

R eligious beliefs provide meaning for people


confronting illness and seeking health, par­
ticularly during times of crisis. Increasingly,
substitute for discussion of patients' own reli­
gious views on clinical issues. Rather, they
should be used to supplement information com­
health care workers face the challenge of provid­ ing directly from patients and families, and used
ing appropriate care and services to people of dif­ as a primary source only when such firsthand
ferent religious backgrounds. Unfortunately, information is not available.
many healthcare workers are unfamiliar with the We hope that these booklets will help practi­
religious beliefs and moral positions of traditions tioners see that religious backgrounds and beliefs
other than their own. This booklet is one of a play a part in the way patients deal with pain, ill­
series that aims to provide accessible and practi­ ness, and the decisions that arise in the course of
cal information about the values and beliefs of treatment. Greater understanding of religious tra­
different religious traditions. It should assist ditions on the part of care providers, we believe,
nurses, physicians, chaplains, social workers, and will increase the quality of care received by the
administrators in their decision making and care patient.
giving. It can also serve as a reference for believ­
ers who desire to learn more about their own tra­
ditions.
Each booklet gives an introduction to the his­
tory of the tradition, including its perspectives on
health and illness. Each also covers the tradi­
tion's positions on a variety of clinical issues,
with attention to the points at which moral
0 .

dilemmas often arise in the clinical setting. Final­


ly, each booklet offers information on special
concerns relevant to the particular tradition.
The editors have tried to be succinct, objec­
tive, and informative. Wherever possible, we have
included the tradition's positions as reflected in
official statements by a governing or other formal
body, or by reference to positions formulated by
authorities within the tradition. Bear in mind
that within any religious tradition, there may he
more than one denomination or sect that holds
views in opposition to mainstream positions, or
groups that maintain different emphases.
@
THE PARK RIDGE CENTER
The editors also recognize that the beliefs and l'OR 1111!. STUDY or HML111. fMnl, MID emics
values of individuals within a tradition may vary 211 e. Ontario•Sulte 800•Chlcago. Illinois 60611-3215
from the so-called official positions of their tradi­ http://www.prchfe.org

tion. In fact, some traditions leave moral deci­


sions about clinical issues to individual The Park Ridge Center explores and
enhances the interaction of health, faith,
conscience. We would therefore caution the read­
and ethics through research, education, and
er against generalizing too readily. consultation to improve the lives of
The guidelines in these booklets should not individuals and communities.

THE ORTIIonox CHRISTIAN TRADmoN: REucrous BEIJEFS AND HEALTIICARE DECISIONS

©1999 The Park Ridge Center. All rights reserved.