"PRINCIPLES OF ORTHODOX BIOETHICS"

Archim. Nikolaos Hatzinikolaou
Chairman of the Bioethics Committee
of the Holy Synod of the Church of Greece

"Values and Principles for Building Europe"
The Holy Synod of the Church of Greece
_______________________

Hotel Divani Caravel
Athens - Greece, May 4-6, 2003

A. INTRODUCTION

I wouldn't like to disappoint you in any way. My homily will not give replies to the numerous and significant questions of bioethics, for this is neither feasible nor is it our own responsibility or a task of the present moment. It is the responsibility and exclusive task of the Holy Synod. Besides, if we hurry to speak, we will deprive ourselves of the right to learn. Our learning period is not over yet.
Therefore, the aim of this homily is to serve as a means of becoming acquainted with the mentality of the Bioethics Committee of the Church of Greece. In fact, it will not be comprehensive, but will specifically focus on certain characteristics that determine the outline of Orthodox Bioethics, as well as on just one principle to which no reference has been made so far; the principle of the fear of God that leads to the beginning of true wisdom that we need so much: "the fear of the Lord is the beginning of knowledge". (1)
The term bioethics is being used more and more often during the past years demonstrating, in this way, the struggle of societies against their achievements.
The truly impressive scientific achievements of genetics and medical technology generated enthusiasm for man's capabilities and great optimism for the improvement of health and the quality of life. At the same time, however, problems emerge from scientific progress because science is very creative, invasive and intervening. Firstly, it is creative for it gives birth to unprecedented conditions of living. Terms such as stem cells, cloning, prenatal and preimplantation diagnosis, genome, proteinome or brain death are either relatively novel or have acquired an unpredictable wide meaning and significance. The attempt to determine the exact moment of the beginning and the end of life seems to generate a great deal of speculation; while it is practically necessary, it appears to be quite arbitrary.
Moreover, science is also invasive; it has changed our nutrition; it has affected the environment, the biosphere, the ecosystem, and the air we breathe. In the form of technology, science has also intervened in the human body by replacing our organs. It reforms genes, modifies functions, changes human physiology, controls behaviour. Medical diagnosis and therapy have become extremely technological and are guided by financial motives. We observe all this with awe and admiration, but also with caution and reservation.
Through the science of bioethics, modern man tries to find safe ways of survival as biological species, forms of harmonious social co-existence, conditions of ecological and environmental protection and, naturally, legal formulations that will safeguard the balances between the various -mainly financial- interests.

B. THE NEED FOR THE ORTHODOX VOICE

For the Church, all of the above are necessary, legitimate and interesting; however, they constitute forms of a one-dimensional speculation with an ephemeral and earthly character. Their focal point is not man as a person but societies as civil groups, legal entities and expressions of self-interest. For this reason, they do not look for the truth and values that can inspire us, but for legislative adjustments and consensus that will protect us.
Society tries to prove human omnipotence through the biological perfection of man, while the Church faces the grandeur, sacredness and destiny of man through the respect for the image of God. Thus, while science tries to create human beings limited by time and space, the Church is working on the eternal person of man who is made "for a little while lower than the angels" (2), who has the seal of immortality since his very beginning and whose natural space is the kingdom of God that has already begun.
Often, advisory groups and bioethics committees, namely official bodies that try to set limits and terms upon scientific research and technology within society request the word of the Orthodox Churches, given that biomedical research has touched upon very sensitive aspects of human existence.
At the same time, the faithful resort to the clergy to discuss specific dilemmas and problems of every day life that are persistent and often unsolvable. The Church that embraces every detail of our life cannot remain silent. Within the context of Orthodox faith, She is obliged to provide some answers or point at certain directions.

C. THE CHURCH OF GREECE AND BIOETHICS

If problems such as respect for free will, the mystery of life and death, the coalescence of soul and body, the spiritual and deterministic expression of the soul, the sacredness of the body and creation, the laws and forms of biological life, the balance between truth and philanthropy, find an answer, they will enlighten the dilemmas emerging from transplantations, reproductive technologies, gene therapy, cloning, research on human genome, etc.
For this reason, five years ago the Holy Synod of the Church of Greece decided to form a Bioethics Committee that will be responsible to study and elaborate on the bioethical issues within the light of the Orthodox tradition and theology. Moreover, the first Center for Biomedical Ethics was founded in Greece, having a library with a rich collection of books, periodicals, articles, resolutions of political and social organisations, as well as a website and an electronically equipped convention center. Every specific bioethical issue is thoroughly examined by way of specialized studies, seminars, meetings with experts on all relevant fields, i.e. physicians, biologists, geneticists, legal advisors, sociologists, psychologists and theologians; by keeping updated on the positions and resolutions by other religious or civil committees, as well as an inter-orthodox dialogue and communication, so that we can express and formulate the Orthodox viewpoint after a comprehensive study and thorough understanding of the related problems and dilemmas. (3)

D. PRINCIPLES OR LIMITS?

Usually, people expect the Church to set certain limits between what is permitted and prohibited, and impose protective restrictions; in other words, to act as a brake to the development of science. On the contrary, we feel that the Church is the steering wheel.
As we try to study the influence of contemporary medical technology on the human body and its reference to human beings, to the body and soul, the perishable and imperishable element of human entity, it is natural to be looking for certain limits. Up to what point can technology intervene in the human body? What is logically and ethically permissible and what is forbidden?
Before setting the limits, we ought to study the principles that rule contemporary research, for limits are not always distinct within the context of values. Nor is it right to appraise institutions and sciences on the basis of barriers and limits, but rather on the basis of principles and freedom. The essence of bioethical speculation is not found behind the limits, -namely, what is permitted or prohibited- but behind the principles -namely, how and why we act. The principles determine the correct directions and the necessary limits. The role of bioethics is to reveal the truth, not to replace freedom.
Although a great deal is being heard about threats, dangers, apocalyptic consequences and destructions, we believe that the emergence and progress of genetics, biotechnology and, generally, of medical technology may prove to be more of a blessing than a nightmare. The bioethical challenge does not only lead to the emergence of unprecedented social problems, fears, dilemmas or impasses. When the achievements along with the problems are interpreted on the basis of Orthodox theology, one comes face to face with human grandeur -what man can achieve-, the sacredness of the person as the image of God -what he should not do-, and the projection of the eternal perspective on time. One can ascertain the visibility of the soul and the distinctiveness of its potential.
Nevertheless, the extent of our biomedical capabilities along with the scarcity of principles, the crisis of values and the more general disorientation of modern societies justify the necessity of caution, prudence and explicit deontological formulations that are not based on sickly fears but on refined spiritual values.
Consequently, Orthodox bioethics is not ethical guidelines but theological word; it is not bioethics of limitations but bioethics of principles.

E. SPIRITUAL BIOETHICS

The rapid development along with the occasional metaphysical hopes that it raises generates arrogance and brings man as close as ever to the role of God, but as far away as ever from His resemblance. (4) If the spirit of materialism, eudemonism and love of life that prevails in our societies is placed next to these elements, one can realise the need for non-conventional bioethics. This fluctuation between the blessing of God and disrespect for His holy person, between the discovery of the secrets of God's image and its desecration, between the improvement of biological life and the degrading of its social expression determines the essence of spiritual bioethics. Its basic elements are the following:

A. Contemporary biotechnological research and perception is based on four axes: economy, environment, the gift of life and the human person. We have always been interested in economy; we tend to neglect the environment, find pretexts for protecting life and guiltily overlook the human person. Spiritual bioethics provides knowledge of the human person that we lack so much.
When we say that we must protect the person, we basically mean that four of its elements should remain lively and active in man. The first one is the need for God, namely, the sense of being related to Him, the second one is the perspective of eternity, the third one is free will and the last one is the harmonious balance between soul and body. Anything that hurts or damages these elements is considered non-ethical.
So, if some cause or stimuli paralyzes the godly need or chokes the eternal perspective, it is considered non-ethical from the Christian point of view. Similarly, whatever regards man as a machine and subdues him to determinism, it becomes ethically suspicious, for it inactivates human free will. The degeneration of man to a machine and the priority of the body and man's biological dimension, in general, over his soul, when accompanied by arrogant declarations -a frequent phenomenon nowadays- may lead to destructive resolutions and applications and total devaluation and desecralization of man.

B. Life and health do not constitute a commodity or simply a human right, but a priceless divine gift. Therefore, life and health are not viewed on the basis of economy and interests, or logic and assertion, but on the basis of their sacredness and respect. Bioethics of this kind is neither set against science nor does it believe in the committees' potential.
As the Bioethics Committee of the Church of Greece, we display our viewpoint after processing it thoroughly and struggle in every decent way to present our mentality and way of thinking to the faithful and demand from the state to enact laws that promote human values. We mainly try to convey to Christians the following message: despite the eventual illicit "facilitations" of the laws, they can make decisions that are viewed by contemporary society as the most difficult to put to practice and hard to understand, provided that these promote the human person. The course towards the truth does not need the approval of the majority or any legislative adjustments.

F. THE CHARACTERISTICS OF ORTHODOX BIOETHICS

1) Orthodoxy does not focus on the individual; it does not view man as an individual with specific actions, rights and obligations. It focuses on the person. Each human being is understood as a relationship and communion. The person is not autonomous but is tied to his family, his fellowmen, God and the wider society within the Church.
I will mention an example from the field of transplantations. The secular transplantation ethics is based on human rights, on the right for life and death, or on the right of a person to donate the organs of his body as he himself judges. Laws do not include the possibility of the relatives' disagreement towards such an act. It is practically impossible to apply these laws to the Orthodox countries. Feelings and personal judgment, at these difficult moments, transcend all laws. For this reason, we, as the Church, say that the consent should also be granted by the family. (5) We believe that the relatives' consent is stronger than personal volition, for the first one confirms the relationship, while the second one is based on a right.

2) The Orthodox perception has no relation to scholasticism. We are not interested in scholastic replies to specific questions that by nature constitute inscrutable mysteries. Before the vast number of bioethical issues, the truth does not present an accessible and absolutely conceivable wholeness. Therefore, the mentality of perfect and adequate answers that are offered directly on all subject matters is indicative of an impermissible pride and disrespect towards the mystery of the unknown. The sense that often as our knowledge increases at the same time the field of the unknown is also expanded leads us, on the one hand to the need of experiencing an enlightening humility and, on the other, of seeking expressions of our free will, instead of secure replies.
Hence, when questions such as: are the products of cloned embryos human beings with a soul? Or when exactly is the soul placed inside the body? Or what is the relationship between soul and body during the various stages of embryonic development? are raised, the reply is that we do not know and, therefore, ought to stand with awe before these dilemmas and not rely on the overconfidence of certain replies or resolutions. We respect embryos from the moment we perceive or even suspect that they possess human identity, not because they are something great that we adequately know, but because they conceal a mystery, which will always remain unknown.
The same thing applies to death. Theologically, we do not define death as the cessation of the heart or as the death of the brain. The separation between soul and body occurs under conditions that transcend our cognitive ability. The physicians know only when the body dies, not when it is separated from the soul. This is a mystery and will remain a mystery forever. That is why we never hurt a dead body. We simply burry it, not upon ascertaining its biological death, but when its decay and decomposition obliges us to do so. The only exception is when it can be offered with the relevant consent of love so as to grant life to other people. Love as "a still more excellent way" (6) transcends all hesitation or rational argumentation.

3) Orthodox mentality is not conservative. It does not fear mistakes or anything unknown and new, because it does not need the safety of correctness. The entire Orthodox anthropology is based on the fact that man can discover God through his own mistakes and repentance, and not by avoiding his mistakes. The tradition of the Christian East is not dominated by the scholasticism of correctness and the mentality of infallibility. Oftentimes, our statements on the delicate bioethical issues are quite open, not in the sense of irresponsibility, but in the sense of humility and freedom. Prayer and God's enlightenment lead to the truth more than the knowledge and judgment of the experts. Humility and patience that emerge from the reconciliation with our insufficiency constitute the best guarantee of the fact that every problem and dilemma is dealt with the greatest possible respect.
Consequently, the Church is very cautious in studying and formulating Her bioethical statements but very lenient in Her pastoral practice.

4) I will conclude with a fourth characteristic. The teaching of the Church is expressed through the commandments and God's will in our life. We often consider that there is a specific reply to every question -namely God's will- that the Church knows; it applies to everyone and She imposes it on the life of Her faithful. According to our tradition and experience, "the will of God" is not something irrelevant to everyone's person. The purpose of the Church is not to teach or, even more so, to impose the will of God -God never imposes His will. Her aim is to help us detect it within us and then apply it in our own life. God offers to every person, at each specific moment, under every circumstance, a variety of possibilities that express His volition and form the so-called will of God, which is different from our own egotistical will. It does not exist so as to limit our freedom, but rather to activate and enliven it. Our own will abolishes our freedom and subdues it to our egoism; however, the various expressions of God's will assist us in discovering our free will as the utmost endowment.

F. CONCLUSIONS

I believe that the potential of Orthodoxy to give a witness of respect for the human person to Europe that still seeks its identity is not insignificant. Secular bioethics is limited to temporal and earthly man who weighs 70 kilos without a soul, living just for 70 years without eternal perspective or is sustained by 70 Euros per day without joy and fulfillment. Orthodox bioethics discovers the sacredness of God's image through the dilemmas, and through man the mystery of God.
Let me word it in a different way. Europe tries to unite people within time; however, the Church's purpose is to unite them with God forever. Perhaps the biggest mistake of our times is that instead of reaching God, we try to reach one another without Him.
The ancient Greeks used to say: "It is better to prevent than to cure". When the effects and consequences of biomedicine are negative, they don't provide cures. Moreover, the problems of bioethics appear so suddenly and are so perplexed in their nature that they can neither be foreseen by human logic nor be legally restricted or practically prevented. The Orthodox proposal is not to impose laws or designate the limits. Instead, it is to return to the principles and spiritual values that do not degenerate man to an ephemeral biological entity, but elevate him to an eternal person; to return to the early Christian principles, to the true roots of Europe. Then, we do not only "cure" the biomedical "insult" or prevent it. We transform biomedicine from a threat to a blessing.

1. Prov. 1:7.
2. He 2:7.
3. We hope that within 2003, the Church of Greece will be in a position to present through the aforementioned procedure official statements on most of the contemporary bioethical issues.
4. Last month, James Watson "the father of DNA" stated: "we are products of our genes and no one but us has the right to "take care" of us or impose upon us behavioural rules… The states should stay away from genetics… society cannot dictate the way people should use technology". Furthermore, a few years ago, his partner, Francis Crick, said: "No newborn child ought to be recognised as human unless it undergoes certain tests regarding his genetics gifts… If it fails these tests, it loses the right to life".
5. How is it possible for the relatives to accept the sudden loss of all hopes just because the law says so? They are the ones who pay the bills and are called to admit the death of their loved one through the doctor's confirmation and not by personally ascertaining it (the patient seems to be breathing, or to be in coma, or in a vegetative state, he is still warm etc.).
6. 1Cor 13:31.