ICU – At the Border between Life and Death 19 August 2017
1) Life and death transcend us as an instant, as a process and as events.
2) The closer we get to actually creating life purely through artificial means, the easier it makes it for us to take it away, to decide its end. We consider it our own responsibility.
3) In the end, the problem of the value of life refuses to go away. When does life acquire value. Is it a value in itself? If it’s of value because God gives and takes it, when we now intervene crucially at the beginning and drastically at the end- often changing its form- how does this impact on its value?
4) Our love is expressed either as the aspiration to spare our neighbour pain or as the desire to extend our time together as much as possible. The sticking point as regards euthanasia makes for an internal clash of love. The crisis stirs the delicate conscience of any doctor.
5) Committees are required not to define ethics in a spiritual manner, what is good and evil, but to ensure against misconduct and stop people being unscrupulous, by stating what’s allowed and what’s forbidden. This is why they should be strict, in general.
Axes of Orthodox Ethics
It is my impression that we’ve been unduly affected by the Western concept of Christianity, which is characterized by intense natural anthropocentrism and worldliness. This means that biological life is considered a superior value and, perhaps, the supreme good.
The Orthodox concept sees people more through their eternal perspective and within the context of their potential glorification. In terms of this logic:
1) Within the context of theological anthropology, our life is a supreme gift from God, the beginning and end of which are in his hands and his alone (Job 12, 10). It is the place where self-determination finds its expression, where the grace of God encounters people’s free will and where there salvation is worked out. Every death that is the result of human decisions and choices- however “good” that might be called- should be rejected as “hubris” against God. This is why every medical action which does not contribute to the extension of life but causes a hastening of the moment of death should be condemned as unethical and an affront to the medical vocation.
2) On the other hand, the exhaustive effort to delay the moment of death when this is at the door is shown to be inhumane casuistry and lack of spiritual faith.
When we attempt to offer life to someone, in the best case we’re attempting to give them control over their movements, thought and consciousness. In the worst, the hope that perhaps they’ll acquire this over time. If our conscience tells us that there’s no hope, then we’re not extending life, but we’re preventing death as a blessing, as a relief. Then we’re offering life not as a gift but as torment and torture. And our own intervention says more about our lack of faith or our difficulty in intervening in the dilemma as doctors or relations with love and faith.
In a recently published book which deals with the life of a contemporary ascetic saint, Fr. Païsios of the Holy Mountain, it is reported quite clearly that as soon as felt he was no longer able to pray, he told the doctor to stop the treatment .
In this instance, we see the holy elder refusing further medical support, with the result that the moment of death was probably brought on earlier. Since the Elder was unable to pray, he didn’t need any more time. He had need only of eternity. His biological life had ceased to have any value. It was replaced by the expectation of his departure.
This is not a selfish desire for relief on the part of a person, but a humble confession that the end of biological life defines the beginning of true life .
This multi-dimensional attitude to pain and death is not due to an unclear position, but demonstrates absolute respect for human freedom and the uniqueness of every person. The deeper condition of each soul gives voice to its wishes and defines its choices.
3) People derive their personal value not from their individual interests or rights, but from the fact that they were made “in the image and likeness of God”. Any intervention in their lives is permissible only insofar as it does not disrespect this feature of theirs.
4) The contemporary dilemmas into which we have been brought don’t have clear answers. Our relationship with the unknown, which is engendered by our acquired knowledge and progress, may teach us the deepest truths, provided we stand before it with humility and respect.
5) Active euthanasia has the characteristics of the barbarity of murder. And the so-called passive form has the element of abandonment. The Church is opposed to both. Where it sees the need for dialogue is the rejection or termination of non-invasive therapy. Because on occasion that course of treatment doesn’t cure, but torments without cause and hinders the blessing of death. The crisis which then occurs is then entrusted to the conscience of the doctor. This is why the role of the Church is, perhaps, not so much to give instructions for the dilemma, so much as to refine consciences; to provide guide-lines rather than take a decision. Because it gives light, it doesn’t steal freedom. The decision and the weight of responsibility rest with each of us. The responsibility and purview of the Church isn’t to protect us from our mistakes but to teach us from them. This is why it doesn’t punish our errors, but forgives them and teaches us through them. Vice is punished, but a mistake isn’t.
6) Apart from a refined conscience, what is required is also a sense of responsibility for our actions as doctors. Carrying out contemporary medicine in the Units demands clear thought, a delicate conscience, audacity and decisiveness.
7) Love is the greatest value in life, but when our love is compared to our life. What happens when it’s compared to the life of someone else? Can we, out of love, shorten it for them?
It appears that someone else’s life is of greater value than our love, because it’s linked to their freedom, which, because it’s someone else’s, is worth more than our love, precisely because that’s ours. A drop of someone else’s freedom is worth tons of our love.
The greatest love is the sacrifice of our life, but freedom is even greater than love. It’s the thing that gives life to love.
11. Hieromonk Isaak, Βίος Γέροντος Παϊσίου του Αγιορείτου, Holy Mountain, 2004, pp. 346-7. He writes:
“Although he submitted humbly to the instructions of the doctors, one day he called a doctor and told him:
‘We’ll stop the treatment now’.
‘Now it’s your turn to do as you’re told. Tell them to stop. I can’t do a thing now. Yesterday I wanted to pray on my knees and couldn’t. I can’t see anyone. My mission’s over. That’s it. You’ll leave me here’.
Later he asked
‘Can I have a little water or strained water-melon? Nothing else. And please: come one more time and then don’t come again’.
‘The last time I saw him’, says Dr. Blatzas, who was in charge of the case, ‘seven days before he fell asleep in the Lord, it seems I looked worried. I’d often wondered whether what we were doing for the patients was right. He said: Listen, Yorgos, everything went as it should have. You’ve earned your pay. Don’t worry. I wanted you to know that, when you want me, I’ll be there’”
12. Phil. 1, 23.