Tuesday, November 27, 2018

The Views of Orthodox Theology on Bioethical Issues (1 of 6)

By Metropolitan Hierotheos of Nafpaktos and Agiou Vlasiou

1. Introduction

I have been involved for many years with bioethical problems arising from contemporary genetic issues concerning the beginning of biological life, its prolongation and its end. The outcome of this involvement was my book Bioethics and Biotheology, which was published in Greek.

This book attempts to give a brief presentation of the genetic problems, from the point of view of molecular biology and genetic engineering, and after each chapter the theological view of the Orthodox Church on each issue is briefly set out.

This is an English translation of the theological views of the Orthodox Church on bioethical issues, which have been taken from the above-mentioned book. The English translation is by Sister Pelagia.

2. The Beginning of Life

    a) Mapping the Human Genome

    1) In general, the Orthodox Church does not reject scientific discoveries. It accepts their results, which can have a positive effect and benefit people. Of course, as the Fathers of the Church teach, there is no conflict between theology and science, because they have different aims and roles. Science attempts to improve the conditions of human life, because after the fall human beings put on the ‘garments of skin’ of corruptibility and mortality. Theology, however, leads people to communion with God and to deification.

    What is more, there are scientists who are aware of the presence of God in nature. For example, Aris Patrinos, a co-ordinator of the Human Genome Project in the USA, said in one of his talks:

    “All of us who took part in the Human Genome Project [considered that] this success was like touching God. Even some of us who had said that they were atheists were in awe when we came so very close to having this first glance of the book of life, written in a language that until now was known only to God. Although we have this book, and we may perhaps know some of the words and perhaps some of the letters, we still do not have a good knowledge of what it says, and it will take decades. Perhaps through this success we will find ourselves nearer to God.”

    Also, some scientists sense that the more research progresses, the more questions arise. Aris Patrinos, whom we mentioned above, said characteristically in an interview in the periodical Popular Science that the more our knowledge of biology increases, the more “our ignorance increases. The function of life is so complicated that we may perhaps never manage to make it deterministic. There is a huge element that, however much progress we make, we will never surmount.” Scientific theories continuously develop and change. For this reason the Church, on the one hand, lays down basic theological principles for humankind, but, on the other hand, it follows scientific research calmly, discreetly and unhurriedly, because today’s discoveries may possibly be overturned.

    2) God’s existence-bestowing and life-giving energies, which patristic theology calls logoi (‘inner principles’), exist within creation, and therefore within DNA. These are the inner principles of beings. According to St Gregory Palamas, the whole of creation participates in God’s existence-bestowing energy; animals and plants participate in His life-giving energy as well as His existence-bestowing energy; human beings participate not only in the previously mentioned energies, but also in His wisdom-imparting energy; and the saints and angels participate additionally in God’s deifying energy. God directs history and creation towards a purpose, and human beings co-operate in various ways in this process. This is what is meant by the term ‘synergy’ in theological language. Consequently, if human beings are able to do something in creation and develop scientific knowledge, this is due to God’s existence-bestowing, life-giving and wisdom-imparting energy. In any case, human beings cannot create something out of nothing.

    3) It is significant that, from the information available so far, there appears to be only a small difference in the number of genes between man and irrational beings. For centuries, long before the study of genes, our Tradition has considered that what defines a human being is the fact of being in God’s image and progressing towards God’s likeness. This is called the hypostatic principle. What bestows worth on man is the soul that animates the attached body. It is not genes but the nous and free will that give rise to all the differences between human beings and the rest of creation, and between one human being and another

    4) Science hopes in the future to cure various diseases by means of gene therapy, but it cannot defeat death permanently with human means. The time will come when the human being will die. This means that from the moment human beings are conceived they have death and the genes of ageing within them. Thus death is a disease of nature.

    5) There is mutual interaction between genes and the environment. Genes are influenced by the environment, and the environment is influenced and shaped by human beings. At the same time, culture, our role models and ideals, but above all God’s grace influence and shape us. Human beings are not victims of determinism, necessity and oppression. They have freedom and can act positively or negatively.

    6) Before the fall, the first-formed human beings lived like angels. After their fall, corruptibility and mortality entered into humankind. This is how the Fathers interpret the fact that Adam and Eve put on garments of skin. With His incarnation Christ assumed the mortality and passibility of human nature in order to conquer sin and death. After His Resurrection He deified human nature, and His risen Body was incorruptible. Subsequently, through the Mysteries (Sacraments) of the Church, human beings receive the deified Body of Christ and overcome the laws of corruption and immortality, and the fear of death, and their bodies become the dwelling-place of the Holy Spirit. Within Christians, through the holy Mysteries, there is spiritual DNA, which to a great extent cancels out the coercive effects of biological DNA.

    7) According to Orthodox Tradition, life is the gift of God to man. The important thing, however, is how man makes use of this gift, and particularly what meaning he ascribes to his biological life. Human beings do not live simply to indulge in pleasure and to enjoy their biological life in various ways, but to be united with Christ, to participate in God’s purifying, illuminating and deifying energy, to conquer death and to live for ever with the Triune God.

    8) The deciphering of DNA may pose another bioethical problem in the future. If there are major advances in biomedical research, it will be possible to foresee some illnesses which are likely to affect babies before and after birth. This will give rise to bioethical dilemmas, as it will pose the problem of whether to kill the newborn or unborn baby, if, of course, these illnesses are incurable. If this happens, humankind will enter an era of eugenics and euthanasia, with a society composed solely of healthy people. This is unacceptable to the Orthodox Church.

    9) On the day when this great discovery, the mapping of the human genome, was announced, a newspaper wrote something profoundly significant: “The identity [of life] has been found; the meaning is being sought.” Today people are in need of the meaning of life, the answer to the question of why they are alive and what the purpose of life is. Unless this question is answered, however many years are added to their biological life, it will be a tragic existence.

    Medical science by its very nature fights against death, but without overcoming it. So any success in medical science, although it may bring people rest and relief from suffering and various kinds of misery, nevertheless also reveals its failure to overcome humankind’s greatest enemy, which is death. As we are very well aware, death is overcome by the grace of God, which is offered in abundance within the Church. The relics of the saints show this transcendence of death.

    10) Consequently we welcome the new discovery, the mapping of the human genome, in the hope that it may benefit humankind by enabling many new cures to be found. Ultimately, however, we believe that the “medicine of immortality” is Christ, Who can give meaning to biological life, to illnesses, suffering, and even biological death.

    b) Cloning

    The Orthodox Church deals with the problem of cloning from its own theological, ecclesiastical and anthropological perspective. In any case, Orthodox theology is both simple and great. It has high aims and uses simple means, with God’s energy and man’s synergy, to achieve them. These simple theological views are as follows:

    1) There is a difference between what is created and what is uncreated. God is uncreated and human beings, like all creation, are created. Everything uncreated and created has energy, as a being without energy is inconceivable. The difference, however, is that the energy of uncreated things is uncreated, and the energy of created things is created.

    The uncreated energy of God exists within creation, even within DNA. This means that the existence-bestowing and life-giving uncreated energy of God is inside cells. However much science develops, it will never be able to remove the difference between created and uncreated. And however much progress scientists make in human knowledge, they will never be able to be the same as uncreated God, because scientists process existing genetic material and cannot create new genetic material. God created the world from nothing, whereas human beings create things from existing material.

    2) A couple may have many children, but they each have their own personality and character. Scientists may perhaps be able, using the same genetic material, to create people who are outwardly similar, but they will each have their own personality. In fact, if they grow up in different environments with different traditions, they will be completely different characters and personalities, because they will be influenced by the culture in which they live and will accept the traditions and role models that they encounter. Even when people grow up in the same surroundings, they each develop their own personality, as happens with identical twins.

    3) Cloning human beings raises important theological issues. It should be emphasise here that, although scientists may be able, by intervening in cells, to cure some illnesses using gene therapy and cell therapy, even if so far this has not achieved the desired degree of success, ultimately it is impossible to do away with human mortality and corruptibility. The time will come when the human being will die. It may be possible to extend life and postpone death, but one day death will come. From the moment we are conceived by means of our father’s sperm and our mother’s ovum, we inherit death and corruption. Consequently, the problem is not how to live longer and postpone the hour of death, but how to overcome death. This is the most basic problem of humankind. And this is achieved through the sacramental life of the Church, by which we are united with Christ, Who is the medicine of immortality.

    4) The Holy Synod of the Church of Greece says in a press release on this subject (17 August 2000):

    “Our knowledge with regard to the consequences of cloning is very limited, and the possibilities of being able to evaluate our actions in advance are even more limited. For this reason, every decision about applications of, and experiments with, cloning must be made with extreme caution, common agreement, and great respect for human values. There is an obvious danger of making human beings into objects and using them as material.

    Also, cloning could lead to an economic, or unrestrainedly mercenary and manipulative, attitude to human beings. And the fate, dignity and future of human beings could be handed over to governments or corporations with unethical and selfish aims, or for imprudent and trivial use.

    Who can assure us that a society that legalises today – and it is now the law – what it prohibited yesterday will not legalise tomorrow what it prohibits today? So who can safeguard us from the danger that ‘therapeutic’ cloning may become the intermediate step to ‘reproductive’ cloning of human beings?”

    5) The profound purpose of the Church today is to help people to solve their existential questions about what life and death are. This is something that neither science nor philosophy nor technological progress can offer. The most tragic thing is that, the more technology and research increase, the more pressing these existential questions become. The Church should make this its priority, rather than concentrating all its attention on the social and biological level.

    6) If God permits the cloning of a human being, we do not know exactly what the result will be. There is no doubt, however, that in such a case it will be a created being that will be subject to corruption.

    Within the Church, however, we speak of another kind of ‘cloning’ that science cannot provide. Through the incarnation of Christ the created was united with the uncreated. Therefore every human being was given the possibility of experiencing the union according to grace of his created nature with the uncreated energy of God in Christ Jesus. The saints had the experience of becoming gods according to grace, because uncreatedness and immortality entered them, and they experienced eternal life starting from this biological life. The problem, therefore, is not “the transfer of the nucleus of a somatic cell”, but God’s entry into us. Such an experience gives meaning to human life.

    c) Stem Cell Research

    1) As has been repeatedly stressed, Orthodox theology has never wished to place obstacles in the way of scientific research that aims to benefit humankind. All the scientific successes that have contributed to the health of human beings began with many years of research. Science itself, however, ought to set limits and a framework within which research should be conducted. The science of bioethics performs this task.

    2) There is no problem with research on the stem cells of adults for the purpose of benefiting the sick. The physiological renewal of many bodily tissues, such as the skin, the blood cells, and so on, relies on stem cells.

    3) Research on embryonic stem cells poses serious pastoral questions and wider ethical dilemmas. The theological problems arise from the fact that, in order to obtain embryonic stem cells, scientists destroy the blastocyst, and consequently kill the fertilised ovum (embryo) in the first days of its development, before the stem cells have been differentiated. This causes a serious theological problem, because, according to Orthodox theology, the soul exists from the beginning of conception – the doctrine of “the existence of an autotelic human entity from the first moment of conception” – as the embryo “receives a soul immediately upon conception”, according to Christological teaching. The Orthodox Church does not accept the theory about “the process of receiving a soul”. This is the reason why there are feasts relating to conceptions, such as the feast of the Conception of St John the Forerunner (23 September), the feast of the Conception of the Theotokos (9 December), and the feast of the Annunciation of the Theotokos, which celebrates the conception of Christ (25 March). The Orthodox Church cannot accept the view that during the first fourteen days after conception research on fertilised ova and interventions can be carried out freely, with the result that the blastocyst, which has a soul, is destroyed.

    Because some people refer to “genetic material” after fertilisation, it should be pointed out that even scientific terminology refers to an embryo or foetus, the only distinction being that an embryo is at a very early stage, whereas a foetus is more developed. One of the pioneers of research on embryonic stem cells, Gerhart, responded to the view held by some people that the result of research cloning is not an embryo but an ovum (genetic material), stated: “I assert that it is an embryo; I do not think that anyone believes that it is simply an ovum.”

    The Holy Synod of the Church of Greece, in its press release of 17 August 2000, says on this subject:

    “Our Church expresses its categorical opposition to performing experiments on human embryonic cells. Such experimentation entails the destruction, not of embryonic cells, but of human embryos.

    The view that the human person begins to be formed from the fourteenth day after conception may provide British scientists with an alibi, but, being scholastic in origin and not scientifically based, it constitutes a subjective belief and an arbitrary opinion. The Church and the Christian conscience accept the human being as a person with an eternal and immortal aspect from the moment of his conception.

    The distinctions between people are constantly increasing. Everything points to the fact that our societies are now openly ‘eugenic’ and racist. However, the attempt to improve life cannot involve the destruction of millions of human beings at the embryonic stage.”

    4) In addition, the attempt by doctors to differentiate an embryonic stem cell in accordance with their own preferences poses a theological problem, because the blastocyst is destroyed. This must be seen from the point of view that human beings cannot be regarded as laboratory animals from their conception, nor as workshops for ‘living spare parts’ for the benefit of a few, usually wealthy, people who want to live longer.

    It is a different case when progenitor cells are taken from the umbilical cord or from adults, provided that this is not done deliberately (abortions) or exploited commercially.
    Today scientists try to avoid the ethical dilemmas that arise from destroying the blastocyst by devising other methods of producing embryonic stem cells. Because these efforts are still at an early stage, the Church can wait until research is completed. It seems that the new methods do not provoke the same serious ethical dilemmas, but it cannot be excluded that new bioethical problems may arise.

    5) From everything set out above, it is clear that the phenomenon of expediency dominates and is being increasingly cultivated, as reproductive technology, in vitro fertilisations, are being promoted, not so much to enable childless couples to have children, as to enable scientists to take the ‘surplus’ fertilised ova, which will be in the freezer for their research.

    6) The basic danger that concerns us is the possibility of scientists allowing a human being to develop in their laboratories. It is possible that the being who will be produced may be a chimera or hybrid (for example, human-animal) with terrible consequences.

    I do not know whether God will allow the production by human cloning in a laboratory of a being with a human body, but without a soul. This does not happen now because man’s life is linked in a mysterious way with his soul. However, the soul and body owe their existence to God’s creative energy with the synergy of the parents (Fr. John Romanides); and according to St Maximus the Confessor, the body and the soul come into being in different ways – although this happens simultaneously at the moment of conception – since the soul is formed ineffably from the divine and life-giving inbreathing, and the body consists of existing bodily matter. For these reasons, the possible case in which God, for our chastening, allows a separation between the soul and life, and the creation of a chimera or hybrid seems tragic.

    These are all serious theological problems and they should cause scientists, and people in general, intense concern.

    d) Reproductive Technologies

    1) According to the teaching of the holy Fathers of the Church, the conception of a human being is not exclusively an act of nature, but the work of God’s Providence through human beings. The theological principle of synergy applies here: God acts and human beings collaborate.

    2) The reason why a couple wishes to have children by any means or method whatsoever should be investigated from the pastoral point of view. In most cases, apart from some exceptions, this is connected with their insecurity in life, a lack of meaning, and the failure to achieve their theological purpose, as defined by the Church.

    3) Up to a point one can use scientific achievements in order to have children. The words “up to a point” mean that human dignity must be preserved, and one’s life must be consistent with God’s will. For example, surrogate motherhood, the use of sperm or an ovum from a donor (heterologous fertilisation), the use of sperm after the death of the woman’s husband or partner, and so on, cannot be accepted by the Orthodox Church, because the principle that “the end justifies the means” must not prevail, and because many theological, pastoral, legal and social problems arise. The Orthodox Church, therefore, can only accept ‘by economy’ for its members homologous insemination and homologous fertilisation that does not leave surplus embryos and is not associated with selective reduction of the embryos inside the womb.

    4) It is clear that there is a serious problem, from the Orthodox point of view, with regard to in vitro fertilisation. With the method of medically assisted human reproduction, many eggs are fertilised and many embryos are produced. Some of these are implanted in the mother’s womb; the remainder are kept frozen in special banks, to be supplied to other mothers wishing to have children, or they are used for research purposes, or they are killed. The embryos that have been implanted in the womb are also selectively reduced. Furthermore, there is the inherent danger of eugenics, in other words, selecting the best fertilised ova and choosing their sex. None of these things are acceptable to Orthodox theology.

    5) The Orthodox Church is against artificial intervention in fertility (abortions). We shall look at this point below. In addition, although the antenatal check solves some problems, it also creates theological and ethical dilemmas, as some diseases that are detected cannot be treated, at least until now (although some interventions can be carried out within the womb). In most such cases, therefore, the antenatal check leads the couple to seek an abortion, which is unacceptable to the Orthodox Church. This excludes those cases in which the antenatal check enables medical experts to prepare to deal with the problems once the child is born.

    6) When facing such circumstances, we cannot distance ourselves from our basic aim, as defined by the Church, which is to progress from being in God’s image to being in His likeness, in other words, deification. No human achievement or success can replace or be a substitute for this deepest purpose of man.

    e) Development of the Embryo and Abortions

    1) The human being receives a soul immediately upon fertilisation; the soul exists “from the first moment of conception.” The soul does not exist without the body, nor the body without the soul. At the moment of fertilisation the soul is created by God. The Orthodox Church does not set a limit of fourteen days or a few weeks and months, in order to justify interventions in blastocysts or other interference with embryos prior to that.

    Conception takes place through God’s energy and human synergy. St John Chrysostom writes that conception is not the outcome and result of nature and intercourse, but of God’s Providence. He writes: “Bearing children has its origin from above, in God’s Providence, and neither woman’s nature, nor coming together, nor anything else at all is sufficient to bring it about.”

    The conception of a human being and the union between soul and body are a mystery. St Gregory the Theologian, rebuking those who think that they can understand God with their reason, states that is unthinkable that we should comprehend rationally the essence of God or the manner of existence of His hypostases, especially as it is impossible for us even to understand how man’s soul is united with his body. He says that it is impressive how we are first moulded and originally composed in nature’s workshop, how we are finally formed and completed, and how we desire food and are nourished. He asks who it was who led us instinctively to the first springs, which are our mother’s breasts, and the sources of life. St Gregory the Theologian marvels as he considers his own construction and that of the whole human race, as regards the elements of which we are composed; how we move; how the immortal was mixed with the mortal; how we drift downwards and at the same time are borne upwards; how the soul is confined in the body; how the soul gives life to the body and at the same time shares in its sufferings; how the mind is both circumscribed and boundless, and how, although it stays within us, it nevertheless observes everything with rapidity and ease. And he marvels as he studies the organs and members of the body, and the harmony that exists between them.

    2) The Christian woman who is pregnant regards the embryo inside her with great respect. She feels that it is a gift from God to her. She waits with longing for it to be born. She prays for it from the moment of conception, and she lives life in the Church. In this way the Christian upbringing of the child begins from the embryonic stage.

    3) Abortion, according to the teaching of the Church, is murder, and murder of a defenceless human being. The embryo has a soul, which expresses its energy as the embryo’s body and organs mature. The Fathers of the Church have laid down Canons that forbid abortion. St Basil the Great writes in his second Canon: “The woman who has deliberately procured an abortion is subject to the penalty for murder.” And he goes on to say that among us there is no distinction between a formed or unformed embryo, because we respect the human being from the first moment of conception. He also writes that, when an abortion takes place, this not only has consequences for the embryo that was going to be born, but also for the woman who thought of it and did harm to herself, because many women die during such procedures.

    4) The couple should face whatever difficult circumstances arise during pregnancy with faith in God’s Providence, prayerfully, and with discussion with an experienced and discerning spiritual father. There are some parents who avoid having antenatal checks, because they create many ethical and spiritual dilemmas that they cannot face, unless a Christian medical specialist indicates a particular reason for such a check. In any case, there is the possibility of treatment by surgical interventions inside the womb, as mentioned earlier, or it may be possible to diagnose an illness and to make the necessary preparations in advance for appropriate action after the birth. The antenatal check is helpful in such cases.

    Ultimately, whatever may happen in this respect, the Christian woman who is pregnant faces the situation with prayer and faith in God. We know, of course, that whenever an unfortunate choice is made and a sin is committed, the mercy and love of God can put everything right through sincere repentance and confession. The Church is a spiritual hospital and the Clergy are spiritual physicians who treat people by the power and energy of God.