OFFICIAL STATEMENTS
Basic
Positions of the Ethics of Assisted Reproduction (11.1.2006)
Basic
Positions on the Ethics of Euthanasia (6.11.2002)
Brief
Presentation on Human Genetics
at the European Parliament (9-10.7.2001)
Basic
Positions on the Ethics of Transplantations (10.12.1999)
HELLENIC
REPUBLIC
THE HOLY SYNOD
OF THE CHURCH OF GREECE
BIOETHICS COMMITTEE
14 IOANNOU GENNADIOU - 115 21 ATHENS
GREECE
BASIC
POSITIONS ON THE ETHICS OF
ASSISTED REPRODUCTION
(11.1.2006)
A. Introduction
1. The field of technologically
assisted reproduction, or more correctly stated, of artificial fertilisation,
is of utmost importance both psychologically and socially, and bears great spiritual
significance. Contemporary reproductive techniques can fulfill the expectations
of sterile couples and satisfy their profound need for parenthood. Although
this may strengthen the unity of marital life and increase the feeling of fulfillment
and harmony of family life, at the same time, it could generate unprecedented
problems of an ethical, medical, psychological, legal and social character.
These problems are the result of the mechanization of the most personal and
profoundly spiritual and sacred act. Their magnitude and variety depend on the
applied methods, on the conditions under which these are implemented and on
the related uncontrollable possibilities and unavoidable consequences.
2. Assisted reproduction
constitutes undoubtedly one of the most impressive achievements of medicine
and biological sciences bearing significant social consequences. It is connected
with the birth of a new human being, an event that is welcomed with special
admiration, awe and joy. At the same time, however, the problem of the degree
of quality of life of this new human being and its parents cannot be ignored.
For the Greek Orthodox Church, the quality of life of a human being does not
only include biological or psychological integration and social well-being,
but also the possibility of spiritual development. This spiritual dimension
bestows on man a sense of psychosomatic harmony and the prospect of his existential
fulfilment.
B. Basic theological
positions
3. The Greek Orthodox Church,
by embracing and cultivating our conscience, stresses and safeguards the vast
possibilities and infinite perspectives that the grace of God offers to man.
Therefore, in no way can the Church be considered as a formalised authority
that seeks to regulate or police our life. Her objective is not the imposition
of rules and prohibitions upon our lives, but the creation of a criterion that
leads to the knowledge of truth that will make us free. (Jn 8:32).
4. The Church has a deep
knowledge of human nature and weakness to which She is very understanding and
compassionate. However, She also wishes to protect the sacredness of our person;
to inspire the need for God along with the desire for childbearing; to offer
the integrity of Her truth along with Her philanthropy; to present the precision
of God's will along with Her dispensation.
5. A basic element of Orthodox
Christian anthropology is the recognition of the sacredness of the existence
of man who unites with his existence the tangible and intangible world. The
objective of man, who is made in God's image, is to become "after His likeness"
(Gen 1:26), namely to attain theosis and sanctification. Having this ultimate
objective, man works, creates a family, cultivates the arts and sciences, organises
societies. For this reason, when someone deals with man, even more so when he
experiments with man, he performs a sacred act and thus ought to act with fear
of God and respect.
6. Man is not the cause
of his own existence. Every reference to the beginning of his life should be
made with awe and not with hubris. We either regard God as the provider of life
and draw near Him with fear, or we ignore Him and act as if we were gods ourselves.
The price of such hubris, however, is very high.
C. The significance of
man's psychosomatic coalescence
7. Every human being has
an immortal and eternal soul, which is closely connected with his body. The
psychosomatic coalescence is temporarily disrupted by the biological death and
is reinstated with the resurrection of the bodies in the kingdom of God.
8. The biological beginning
of man also marks his birth as a psychosomatic entity with the inherent potential
of "becoming a child of God" (Jn. 1:12). Fertilisation, together with
biological life and entity, attribute to man his existence, his being, his soul.
9. The soul is not placed
inside the body but it is born with it. The soul comes into being along with
the body.
Actually, Saint Gregory
of Nyssa speaks extensively on the simultaneous birth of soul and body. "But
as man is one, the being consisting of soul and body, we are to suppose that
the beginning of his existence is one, common to both parts, so that he should
not be found to be antecedent and posterior to himself, if the bodily element
were first in point of time, and the other were a later addition; ...and in
the creation of individuals not to place the one element before the other, neither
the soul before the body, nor the contrary". (On the making of man,
EPE 5, 206)
10. Every human being that
is conceived has a beginning but has no end. The beginning, namely the conception
of each human being, constitutes an event of unique importance for the Greek
Orthodox Church. The godly destination and the perspective of the eternal kingdom
bestow to the moment of conception a uniqueness that transcends the boundaries
of biological identity and ephemeral life.
D. The need for motherhood
11. The desire to have children
is natural and sacred. The Church discerns in this desire God's plan to create
man so that he become a partaker of His blessedness. Saint John Damascene writes:
"Since, then, God, Who is good and more than good, did not find satisfaction
in self-contemplation, but in fits exceeding goodness wished certain things
to come into existence which would enjoy His benefits and share in His goodness,
He brought all things out of nothing into being and created them, both what
is invisible and what is visible. Yea, even man, who is a compound of the visible
and the invisible. And it is by thought that He creates, and thought is the
basis of the work, the Word filling it and the Spirit perfecting it."
(Concerning the creation. EPE 1, 142)
12. The anatomy, physiology,
the monthly period, the hormonal balance and the overall psychology of the female
sex are oriented towards motherhood. During pregnancy, the woman experiences
and manifests to the utmost degree the characteristics of her sex and nature.
The basic function of the female body to which the entire female existence is
directed is the reproductive function. The woman exists anatomically, physiologically
and sentimentally for the embryo, the pregnancy and childbearing.
13. Equivalent to the need
for motherhood is also the need for fatherhood. For this reason, the Church
acknowledges that sterility and childlessness can become an unbearable cross
that often creates intense mental distress, social difficulties and, sometimes,
insoluble problems affecting the harmonious coexistence of the spouses. Sterility,
apart from being characterized as a biological imperfection, is regarded by
the Church as an expression of God's will or even a blessing in the form of
a trial.
14. Moreover, the Church
acknowledges in every human being his infinite spiritual possibilities along
with his natural identity (biological, psychological etc). Therefore, She is
clearly set against the notion that infertility constitutes a type of disability
or an incurable social weakness. Oftentimes, couples that have difficulty in
having children have a well-defined spiritual orientation and are especially
productive in various fields of social and spiritual life.
15. Observing the recent
progress of science and technology, the Church realizes that people's desires,
which were only dreams of the past, may now acquire justifiable hopes. She welcomes
this prospect with great enthusiasm, but, at the same time, She perceives that
technological progress often transforms desires into needs and thus makes the
struggle for spiritual freedom harder.
16. The consequence of this
mentality is the following paradox: although the desire of fertile couples to
have children is seriously fading, the need of infertile couples to have children
becomes psychologically and socially imperative. The problem becomes more acute
in closed societies, where social pressure has a negative impact. However, infertility
sometimes acts as nature's safety valve so that couples that would have difficulty
in raising children are freed from this heavy load. Oftentimes, when the latter
insist and finally have children, they also come face to face with insoluble
problems.
17. The contribution of
the Church and clergy would be essential in eliminating unhealthy viewpoints
and unjustified social pressures. Simultaneously, they could assist in cultivating
the belief that while the birth of a child is a blessing -and indeed a great
one- infertility does not degrade spouses, neither does it harm their relationship
or abolish their marriage.
18. The persistent effort
to overcome sterility conceals the risk to transform the natural and sacred
desire for childbearing into a stubborn will that is set against the will of
God. Every attempt to cure sterility ought to leave room for the humble acceptance
of a probable failure.
19. Although the beginning
of every human being as God's image originates from human will, it is also the
will of God. Contemporary technology is a great blessing of God to man, if it
is used with prudence and respect; at the same time, however, it could give
man the possibility to oppose God's will as this is expressed through His natural
laws. In this case, man can either hinder the realization of God's will, or
he can insist on doing his own will even though God refuses to consent.
20. The purpose of every
newborn person is neither to adorn the life of his/her parents nor to add to
their wealth in this life or become their biological and psychological extension.
He/she belongs to God and is intended for eternal life. He/she is a gift of
God to the parents for this earthly life. He/she is born first in order to express
God's kenotic and communal love; secondly to live in truth and lastly to satisfy
sentimentally or socially his/her parents.
21. For these reasons, the
conception of every human being should constitute an asserted expression of
God's will and not the exclusive result of man's decision. In other words, every
human being should be the fruit of the humble and free compliance of his/her
parents' will with the will of God. The greatest gift of God to man is free
will; the most dangerous threat to man is his own human will.
E. The sacredness of
human beginning
22. The way that life begins
is sacred: physiologically speaking, the exact moment of the beginning of life,
within the context of physiology, is unknown to man. This event is performed
secretly. It reflects the most intense expression of love between spouses and
honors the human body in the best possible way. The reproductive function is
also sexual. It is the only autonomous function of the human body. It is the
par excellence psychosomatic function that requires the participation of both
genders.
23. Modern technology introduces
us to the logic of sexual intercourse without reproduction and of reproduction
without sexual intercourse. The dynamism of technology takes the beginning of
life out of the warmth and darkness of the maternal body, out to the coolness
and transparency of the test tube. It replaces the unknown moment with the accurate
knowledge of this sacred beginning. It abolishes the uniqueness of the spouses'
presence by substituting them with the medical staff. During the sacred moment
of human beginning the parents are not together; they are not even present.
The child is "manufactured" by doctors and nurses. It is not conceived
by the parents. Moreover, it may not have the parents' genetic material since
a third person, the donor, may have been used.
24. Sperm is obtained in
ways that are neither natural and nor ethical. It results from orgasm without
normal sexual intercourse, a fact that insults the sacredness of the reproductive
function. However, when the aim is childbearing, this act cannot be considered
as a sinful act of sperm loss, provided it is performed in ways that do not
disgrace human dignity. Nevertheless, it requires special sensitivity and attention.
F. Status and nature
of the embryo
25. The embryo has both
a human beginning and a human perspective. Its cells, genetic material, morphology
and physiology are entirely human. Moreover, its potential to develop solely
into a perfect human being, and nothing else, confirms its human nature.
A fertilised egg cannot
be fertilised again with another sperm. The characteristics of a new human life
have been irrevocably determined. The fertilization is final and irreversible.
26. The sperm comes from
the father while the egg comes from the mother. Yet, the embryo acquires its
own identity right after fertilisation. The embryo belongs to its parents as
far as their responsibility and obligation of its protection is concerned -they
were the ones who wanted it and created it- but it is independent in regards
to the right of its developmental integration so it can express its own volition.
27. A human being in all
stages of its development, -namely as zygote (1),
blastocyst, few-weeks old embryo, nine-month fetus, newborn infant, young child,
teenager, adult, elderly- has the same perfect human identity. From the very
beginning of conception, the embryo is not simply a fertilised egg; it is a
perfect human being in regards to its identity, and is constantly being perfected
as per its phenotypic expression and development.
G. Spiritual status of
the embryo
28. All of the above lead
to the conclusion that the beginning of man's biological life is identified
with a unique event of utmost importance: the birth of a new soul. In every
embryo, along with the cellular multiplication, which indicates the growth of
its body, and the transmission of the inherited characteristics, which form
its person, another process is also carried out: the birth and development of
its soul. With its soul the embryo will pass from the condition of human "clothing"
to the state of the "garment" of divinity, from time to eternity,
from decay to incorruptibility, from the physical resemblance to its parents
to the spiritual likeness of God. Within
the embryo, the image of God humbly exists.
29. Just as the development
of man's body requires a nine-month biological preparation, namely pregnancy,
the process of his ensoulment and the manifestation of his soul also require
a certain time; it begins with conception and is completed thereafter. The more
complete the process of man's biological development, the greater the degree
of manifestation of the soul's functions. According to saint Gregory the Theologian,
as the body grows and becomes perfect, the wisdom, prudence and virtue of the
soul is progressively being unfolded (2).
30. The encounter of the
Theotokos with Elisabeth and the leaping of the embryo-St. John (Lk. 1:41),
after recognizing the embryo Jesus, refer not only to the embryo's biological
mobility, but also to the spiritual expression of the soul within the embryo.
31. Similar passages in
the texts of the Old Testament speak about significant spiritual events that
occurred in the lives of important persons (David, Isaiah, Jeremiah) "from
the womb", indicating that the embryonic status constitutes a stage of
human evolution during which the grace of God acts upon man.
Moreover, Apostle Paul in
his Epistle to the Galatians, claims that his calling dates back to the period
of his gestation; "But when he who had set me apart before I was born,
and had called me through his grace" (3).
Therefore, God calls, sanctifies, designates and nominates prophets and apostles
from their embryonic age.
32. Conception is not only
considered a major event but it is also blessed and sacred. The Orthodox Church
underlines her faith in the sacredness and significance of conception by honouring
and celebrating the conceptions of the persons involved in the divine economy.
At first, on March 25, the mystery of the conception of the Lord on the day
of the Annunciation of the Theotokos; on December 9, the conception of the Theotokos
and, finally, on September 23, the conception of Saint John the Forerunner.
H. The ethical rights
of the embryo
33. The rights of an embryo
emerge from the fact that the embryo is a person under development; it is an
entity, which depends on and results from of the will of third persons and is
unable to take care of and defend itself.
34. The first one is the
right to human identity. The embryo has the ethically indisputable right to
show its own identity and develop its personality. We should not be the ones
to decide about its nature and status; instead, we ought to give the embryo
itself the opportunity to reveal it to us; to prove that it is a human being
and display or the traits of its body and soul, which differentiate and distinguish
it from any other human being. Science and society must protect this right.
35. The second right is
the right to life. The embryo's natural course of development is the same as
that of every human being. We should acknowledge its right to life, and protect
and care for the embryo itself. The embryo should reach its own status of autonomous
life under the best possible circumstances. The sole aim of its existence should
be its life, not the experiment (experimental embryos), or surplus embryos (spare
embryos), or waiting under freezing conditions (frozen embryos). The fact that
for thousands of embryos the warm maternal womb has been replaced by the frozen
environment of a freezer, and the potential for life by the prospect of experiments
and death, undermines human value and violates the right to life.
36. The third right is the
right to eternity. The embryo has the prospect for immortality. Since the moment
of its conception it is destined to pass to the life of eternity. This reveals
the right of God to repeat His image in man.
I. Problems of in vitro
fertilisation
37. All of the above prove
that modern IVF techniques have ethical and spiritual parameters that compel
the Church to keep Her reservations that are based on the four following points:
a) The conception of man
through contemporary techniques is asexual in the sense that it lacks the sacredness,
safety and reassurance of marital sexual intercourse. Man is no longer being
born naturally but he is being "manufactured" artificially.
b) Contrary to the embryos
and sperm, the eggs cannot be easily frozen. Therefore, the regular practices
facilitate the retrieval of eggs, the fertilisation of which leads to the problem
of surplus embryos and frozen embryos.
c) The fact that fertilisation
is performed outside the maternal body and in the absence of parents creates
infinite choices of unnatural and unethical fertilisations that are accompanied
by serious problems.
d) IVF offers vast possibilities
of pre-implantation genetic processing and intervention (invasion) bearing serious
consequences.
38. Asexual conception deprives
the moment of man's psychosomatic beginning of the atmosphere of the spouses'
intense love and their complete psychosomatic union. The law of God designates
that each human being be born out of profound marital love and not just out
of the artificial union of genetic cells (gametes). The fact that man has "his
being borrowed" is incompatible with his demand to determine by himself
the beginning of his own being; namely, to detach the creation of his existence
from his parents' loving relationship and process it in medical laboratories
according to his personal preferences and choices.
39. An immediate consequence
of IVF is the creation of "surplus embryos". The Church rejects this
term because She cannot accept that there are surplus human beings whose fate
is determined by third parties. Each human being -and therefore each embryo-
possesses the uniqueness of personhood, the sacredness of God's image and the
need of other persons to be in communion with it.
40. The so-called "surplus
embryos" are preserved in a frozen state (cryopreservation) so as to be
used in the future by the natural parents; or to be donated to other "parents";
or to experiment with; or to be used for organogenesis so as to cover transplant
needs; or, finally, to be destroyed. The Church cannot give Her blessing for
any of the above. Christian Orthodox anthropology and theology cannot justify
the existence of embryos that are independent from the pregnancy procedure.
Each embryo constitutes the image of God and should be given the chance to become
like Him.
41. The freezing of embryos,
however, is combined with other insurmountable problems. For example, for how
long is it legitimate to preserve embryos in a frozen state? Or, what will happen
in case of the parents' divorce or death, or, if their parents neglect them?
Is it better to destroy them or donate them to another couple? Who is responsible
to choose the worse between two evils?
42. In vitro fertilization
provides novel possibilities bearing ethical and social consequences that are
hard to define. Thus, for the first time the idea of sperm and egg donation
and the reproductive potential of surrogate mothers appear to be practically
feasible. This may lead to the weakening or questioning of the relationship
between parents and child; or to the unequal relationship between the two parents
and the child -since one of the parents is natural while the other one is a
stepmother or stepfather-; or to the intervention of a surrogate mother (4)
in the sacred relationship between the genetic parents and the child; or to
the creation of brothers or sisters unknown to each other; or to the risk of
unknown incestuous relationships, etc. Basically, every form of heterologous
assisted fertilisation (5)
degrades the concept of motherhood and fatherhood. Moreover, the requirement
of a third person's intervention in the sacred procedure of human reproduction
-and therefore in the mystery of marriage-, makes it impossible for the Church
to adopt such a practice.
43. The biological participation
of only one spouse in the birth of his/her child reminds us of an adoption case.
However, it differs since one of the parents is the natural parent and the other
one is the stepparent. On the contrary, embryo donation seems to be like a typical
adoption case.
44. The transfer of extra
embryos in the womb so as to increase the success ratio often results to multiple
pregnancies. In these cases, when we suggest a "selective reduction of
the number of embryos" for the success of the pregnancy, we actually mean
the destruction of living embryos; the Church will never consent to such an
act.
45. Heterologous fertilisation
sometimes is identified with adultery; however, it is different since an extramarital
relationship is not required, which is mainly the reason why adultery is characterised
as sin and unethical act. Therefore, on the one hand, the Church ought to maintain
Her reservations in regards to heterologous fertilisation, but on the other
hand She ought to avoid its being considered as adultery.
46. The potential of childbearing
by a surrogate or substitute mother (6)
could have a positive side, since in this way childbearing is accomplished with
love. However, since the developing bond with the embryo during pregnancy is
an essential and indispensable part of motherhood, as well as of embryonic development,
the continuing relationship between surrogate mother and embryo is unjust towards
the genetic parents. Moreover, the interruption of this relationship is also
unjust towards the surrogate mother, but most of all towards the child. For
this reason, but most of all due to the fact that family unity is disrupted,
the Church has difficulty in giving Her blessing to such a deviation from the
natural pregnancy procedure.
47. In vitro fertilisation
also gives the opportunity to unwed mothers to have children. The Church ought
to reject this alternative, because, on the one hand, it implies that children
be born out of unwed parents, and, on the other hand, it is unfair for the child
to grow up without a father.
The practices of fertilisation with the sperm of a deceased husband and of frozen
embryo transfer after the husband's death fall within the same category.
48. The same applies to
the pregnancy of older women. This type of conception focuses on the woman's
egoistic desire to have a child, even though chances to care for the child throughout
its developmental stages are limited by nature. The child will offer the joy
of its birth to its parents, but it will have limited possibilities to profit
from their physical presence and almost none to enjoy the peak of their youthful
age. Childbearing by older women constitutes a narrow-minded will and is unjust
to the newborn child.
49. Invasive fertilisation
techniques give the opportunity to homosexual couples to have children. The
Church should by all means express Her opposition to this option, because it
is not only a physical abnormality, but also an ethical perversion, bearing
destructive psychological consequences upon the child and society.
50. Prenatal testing is
connected with the application of in vitro fertilisation. When prenatal testing
aims at a therapeutic or preventive operation and implantation thereafter, then
it is compatible with classic medical perception. However, at present, not only
are these cases very few, but they also carry all related IVF consequences.
Actually, when the tests are positive -namely, when a genetic disorder has been
diagnosed- then almost always it results in the interruption of pregnancy.
Moreover, prenatal testing
could also lead to selection of special traits (i.e. gender, colour of hair
or eyes, etc.), or even to destruction of embryos bearing undesired traits;
consequently, it may generate a eugenic perception of life.
Although prenatal testing
forms a modern diagnostic method that is very promising, the Church ought to
maintain Her explicit reservations.
51. Reproductive cloning
abolishes the natural procedure of conception; in essence, it undermines the
male gender since it puts an end to its participation and role in reproduction.
It also affects the mother's participation since she does not offer her genetic
material. Finally, it disrupts the balance between the two genders, offends
the sacredness of the person and constitutes more an insult than an achievement.
52. Intracytoplasmic Sperm
Injection (ICSI) is a method that improves the results of artificial invasion
in reproduction, but at the same time it limits even more the role of natural
selection -that many times operates protectively - since fertilisation of the
ovum is not effected within the sperm environment with many spermatozoa but
with a pre-selected spermatozoon.
The fact that presently
it is impossible to diagnose in advance probable genetic disorders in spermatozoa
-the selection of which is done only with biological criteria- results in the
substitution of nature in regards to its responsibility for the creation of
genetically ill embryos. This constitutes one more reason for having ethical
reservations concerning ICSI.
53. Although these practices
are not explicitly eugenic in their expression, they are eugenic in their perception.
They do not manage to stop the emergence of disability, but usually they "eradicate"
the disabled person. When the disability cannot be differentiated from the disabled
person, it seems that the only solution is the latter's death at his weakest
and most sacred and sensitive stage and expression of his life. The suggested
"therapy" appears to be the destruction of the unhealthy embryo.
54. The removal of the gametes'
fusion (7),
namely of conception, out of the maternal body, offers immense possibilities
for genetic interventions that may alter fatally human species both biologically
and socially (on a biological basis and in terms of social expression) and are
to a great extent uncontrollable. The combination of the inability to impose
control mechanisms with the vast possibilities for genetic interventions may
prove to be destructive.
J. The role of technology
55. Undoubtedly, modern
technology has greatly contributed to health research and promises even more
achievements. This is considered an exceptional blessing from God. Nevertheless,
its irrational use threatens to desacralize man and treat him as a machine with
spare parts and accessories.
56. Although man regulates
technology, he could ultimately be governed by it, unless he is prudent. He
may be easily enchanted by technological achievements, and consequently become
subjugated by them. He risks destroying his own freedom in the name of the freedom
of scientific and technological progress that aim at expanding human dominance
over nature.
57. The use of technology
and human intervention, to the extent that it safeguards and assists in the
sacredness of human fertilisation, is not only acceptable but also desirable
and pleasing to God. However, technological progress is not considered successful
when it imposes choices contrary to nature, affects family unity, interrupts
the cooperation of spiritual and natural laws and replaces God. Success is not
only the discovery of a new revolutionary technique within the wide context
of genetic engineering; it is also the effective confrontation of numerous problems
(genetic, psychological, social, ethical, financial, etc.) that emerge from
an irrational practice, particularly in the field of invasive fertilisation.
58. The Church is not afraid
of changes, neither is She against novel discoveries. Nevertheless, She firmly
rejects disrespect for creation and the human person as well as desecration
of the institution of family. Fertilisation forms the holy altar of life; therefore,
entering inside it, requires respect and fear of God.
K. Financial interests,
psychological consequences
59. The new techniques of
assisted reproduction often defile the parents' pure desire to have children
with uncontrollable financial interests of physicians, clinics and companies
(i.e. the high cost of gonadotropins (8)
may eventually become the basic reason for which ovulation induction by the
administration of hormones is preferred to the collection of ova during the
natural cycle). Therefore, it is advisable not to resort to these techniques
hastily or under the influence of psychological pressure coming from persons
with relevant interests.
60. Moreover, changing the
act of donation into a practice of trading, which is very easy and basically
uncontrollable, tends to downgrade the sacred character of reproduction to an
act of financial transaction and, thus, turn love into a business agreement.
61. When the methods of
assisted reproduction started being applied, the eventual psychological problems
of the conceived embryos were unknown and unpredictable. Although the parents'
psychological need was taken into consideration, the probable negative overtone
in the embryo's psychology was ignored, a fact that devalues the embryo's life.
Orphans, adopted children and children of divorced parents usually present problems
of adaptation and psychological balance. It is possible that the various IVF
applications, particularly when they include heterologous procedures or donors,
may create human beings with congenital or hereditary mental disturbances or
diseases. This constitutes one more unfavourable factor that prevents the Church
from accepting unreservedly in vitro fertilisation.
62. Consequently the progress
of genetic technology raises a relevant question: is there any psychological
impact due to the fact that children will be able to know the method of their
conception, as well as whether they were born out of sperm or ovum donation.
There is high probability that the child may experience serious identity crisis
and problems of socialisation; particularly when it is informed that it is not
the carrier of its parents' genetic characteristics and does not know its genetic
parents; or when it realises that it has a different degree of kinship with
his parents or has two or eventually even three mothers, etc. These problems
become even more intense in case there is a crisis within the family unity and
there are legal matters pending.
63. Parents may also present
similar psychological problems, particularly when it concerns heterologous fertilisation
techniques, disputes over parental rights and relationships, unsuccessful methods
of artificial fertilisation and abrupt loss of hope and anticipation.
L. Legislation
64. In general, modern legal
perception seeks to harmonise and balance the common prevailing principles in
a country with the individual civil rights. Recently, two new laws were voted
in our country. Firstly, the law on "medically assisted human reproduction",
(L. 3089/2002) and secondly a law that adjusts practical details (the operation
of Assisted Reproduction Centers, Gamete and Embryo Banks, etc.). The spirit
of the first law - which actually has an impact upon the second law- is the
most "progressive" in Europe, as its writers claim. The law avoids
systematically and insistently to name the embryo by its name (instead, terms
such as "reproductive material" and "fertilised egg" are
used which obviously are vague, inaccurate, disrespectful and wrong). It makes
no reference to the child's rights and interests; it accepts hetorologous fertilisation
in its various forms; it adopts single motherhood and accepts the birth of children
with the deceased father's sperm. Moreover, it introduces surrogate motherhood
and allows embryo experimentation. Despite the publicly expressed reservations
and objections of the Church, it basically undermines the institution of marriage,
weakens the family bonds and alters the character of family ethics.
65. The main cause of the
conflict of interests concerning assisted reproduction is found in the relationship
between parents and embryos. Furthermore, embryos are unable to support their
right to express their will. As a result, the probability of legalising unjust
acts is so high that it obliges the Church to express Her reservation and restraint.
66. We are unable to predict
accurately the legal nature of the inheritance status and biological perspective
of the embryos in case the parents die prior to implantation. Moreover, the
difficulty to determine the form of authority and rights upon the frozen embryos
in case of divorce indicate the perplexity and difficulty of the emerging problems.
Ultimately, the only solution to these problems is the destruction of the embryos,
which, of course, is an unacceptable act.
67. It is absolutely necessary
to enact specific laws based on the principles of bioethics and deontology that
will facilitate and protect the application of the basic invasive fertilisation
techniques. The contribution of the Church to this end is essential. She ought
to present on each occasion Her official position that consists of specific
proposals and legislative adjustments that are not unrealistic theories. In
fact, almost all of them, partly or wholly, are included in the applicable laws
in most European countries.
M. Spiritual perspective
68. The Church embraces
pain, illness and disability within the context of man's fall. At the same time,
however, She respects medicine. Although She blesses every ethically acceptable
medical human attempt to restore health, She entrusts the final outcome in each
different case to God's love for every person separately. The epitome of Her
mentality can be found in chapter 38:9 of the book of Sirach: "My son,
when you are sick do not be negligent, but pray to the Lord, and he will heal
you." She faces everything with patience, humility and faith. She does
not differentiate trials from the love of God, but views them as opportunities
for salvation and sanctification.
69. The Church avoids specific
rules or excommunications when dealing with bioethical matters, including those
concerning assisted reproduction. Basically, She leaves them open, while, at
the same time, She indicates the direction and ethos of approaching each specific
case. She does give a generalised definition of God's will, but offers everyone
the opportunity to detect it in his or her own life.
70. Furthermore, She regards
the birth of each human being within the context of the mystery of marriage.
Consequently, She also feels that the mystery of human beginning ought to occur
within an atmosphere of a monogamous, heterosexual intercourse blessed by the
mystery of marriage, of a union in "one flesh" (Eph. 5:31). A conception
that takes place in a laboratory instead of the maternal body and through a
procedure other than the spouses' intercourse is definitely deprived of the
mystery's character.
N. The counterproposal
of the Church
71. The sanctification of
man is not only effected through childbearing. The Church blesses childbearing,
but, at the same time, She also acknowledges the wholeness of childless marriages.
Biological sterility may become the cause of rich spiritual fertility for the
spouses, when they accept humbly God's will in their life. On the contrary,
when the desire to have children becomes a stubborn will, it reveals spiritual
immaturity.
72. The Church ought to
exercise Her influence so that the erroneous social perceptions on sterility
be eradicated and the indiscreet pressures from the family environment towards
the sterile couples be limited. She ought to help sterile couples realise that
an inadequacy in such a vital sector of life is usually accompanied by numerous
opportunities in other fields that wait to be fulfilled. Our happiness and calling
are not accomplished by forcing nature or by persisting in our wills, but by
taking advantage of our possibilities.
73. The sterility problem
of certain couples could be solved with the prospect of adoption. The Church
should recommend the improvement, promotion and simplification of adoption.
In this way, the pain of many sterile couples will be soothed, the danger of
an unsuccessful pregnancy will be limited and human volition will be subdued
to the way of love.
74. Suggesting to infertile
couples to adopt and give birth to "surplus embryos" whose origin
is unknown to them is a matter for further examination. In this way, some embryos
are saved and the mother may experience the pregnancy bond with the child. Moreover,
the child that will be born will feel more related to the parents rather than
being adopted. Nevertheless, problems concerning the child's unclear biological
identity may emerge, which are absent from standard adoption cases.
O. Pastoral guidance
75. Most faithful as well
as confessors ignore some very crucial details concerning the issues of modern
reproductive technologies. Consequently, there is an imminent need for a thorough
update on all aspects. Knowing the methods of assisted reproduction as well
as the Church's basic positions will significantly help the parties interested
confront sensibly the relevant issues.
76. The Church can neither
recommend assisted reproduction as the solution to the problem of sterility,
nor is Her role to approve resolutions. Nevertheless, it is Her duty to confront
this reality that has emerged irrespective of Her will or desire, on the basis
of Her spiritual dispensation and not on the basis of Her theological precision.
Thus, when asked, the Church ought to give the ethos of Her teaching with clarity
and freedom.
77. Taking into consideration
all of the above as well as the fact that present-day parents are not only found
under pressure before the great challenge of reproductive techniques, but also
have limited endurance, faith and inner strength, the Church could suggest the
following steps concerning the spiritual guidance of Her flock:
a. She ought to express
and put into practice Her love and understanding. Her word should be filled
with spirit and truth but also be sympathetic and compassionate.
b. She should express the
tremendous importance of the need to preserve the sanctity of marriage; namely,
to leave room for the energy of God's grace. Usually, trials and deprivation
form unique opportunities for confirming God's presence in our life.
c. She ought to be informed
regularly and thoroughly of the new methods and detect the ethical and spiritual
problems that they usually create.
d. The Church should clarify
that She finds it difficult to bless the practice of assisted reproduction (unnatural
and asexual conception, surplus embryos, pre-implantation genetic intervention
and modification, etc.) and adopt policies foreign to Her spirit.
e. When childbearing disturbs
the normal family order (unwed mothers, fertilisation with deceased husband's
sperm, childbearing by older women, heterologous fertilisation techniques, surrogate
motherhood, etc) it is evident that the Church cannot possibly agree.
f. The Church should eagerly
suggest adoption as an alternative to those couples that are unable to accept,
for various reasons, their sterility problem. If this is not possible, then
She could accept, within the spirit of Her dispensation, fertilisation techniques
that do not involve surplus embryos, or include any form of donation or embryo
destruction. For example, the Church could accept homologous intrauterine insemination,
thus considering the couple as suffering from a common illness, provided both
spouses are in agreement and the entire procedure is carried out with the aforementioned
ethos. She could also accept assisting the reproduction procedure by using only
the parents' gametes and fertilising as many embryos as will be implanted.
78. Spiritual fathers ought
to preach to the faithful, with humility and faith, the need to resort to more
natural and spiritual ways of living. It is a fact that the present way of living,
the tension and stress, the distrust between people and other related factors
are considered responsible for the rise of infertility to very high levels.
The Church proposes a non-secularised perception on life that guarantees simplicity,
peace, abstinence and mutual trust between spouses. She does not oppose resorting
to medical help, but, at the same time, suggests that we render our life into
the hands of God.
79. Liturgical and personal
prayer, spiritually guided participation in the Church's mysteries, cultivation
of love, asking for the saints' intercession, humble pilgrimages, etc., constitute
the Church's long-established means that should be brought back to the lives
of the faithful.
80. When the Church asks
couples to avoid certain reproductive techniques that increase hopes for childbearing,
at the same time, She ought to inspire trust in the will of God and introduce
the faithful to the experience and the different logic of prayer and miracles.
81. The Church indicates
the way of precision but treats pastorally the falls of Her children, when,
for various reasons, on the one hand, they are unable to implement Her teaching
and, on the other hand, they sincerely repent.
82. Moreover, the Church faces the issue of human reproduction within a broader perspective. Thus, although having children constitutes a gift and a blessing from God, the parents ought to focus on a much more important fact; along with their own perfection in Christ, they should concentrate on the proper upbringing of their children and their development and progress in Christ, so that one day they may say "here am I, and the children God has given me". (He 2:13).
1. Zygote:
the first cell emerging from the fertilisation of the egg by the sperm.
2. Saint
Gregory the Theologian, Theological Poems, 1st Book, Vol. I, Dogmatic Poems,
On the soul, PG 37.453-454).
3. Gal 1:5.
4. Surrogate
mother: The woman who bears the embryo when the genetic mother is unable to
do so.
5. Fertilisation
performed with donation of sperm, egg or even of an embryo.
6. Substitute
or surrogate: The woman who bears the embryo when the genetic mother is unable
to do so. In case the egg comes from the mother we refer to her as a "surrogate
mother". If along with her womb she also donates the egg than we refer
to her as a "substitute mother".
7. Gametes:
the genetic cells, the spermatozoon for the male and the ovum for the female.
8. Gonadotropins:
hormones administered to stimulate ovulation
HELLENIC
REPUBLIC
THE HOLY SYNOD
OF THE CHURCH OF GREECE
BIOETHICS COMMITTEE
14 IOANNOU GENNADIOU - 115 21 ATHENS
GREECE
BASIC
POSITIONS ON THE ETHICS OF
EUTHANASIA
(6.11.2002)
A. Introduction
1. On November 28, the Dutch Parliament voted for the legalisation of euthanasia.
On May 16, 2002, the depenalisation of euthanasia was abolished in Belgium and
later on it was also abolished in Australia and certain states in the US. In
the past years, it has been the topic of discussion among legislative bodies,
competent committees, the mass media, conferences and public debates.
The dilemma of euthanasia
has begun to surface in daily clinical practice. There is great risk that this
newly-emerged issue may affect our consciences and alter our ethical criteria.
Quite often, people's sensitivities are guided by a logic and perception that
demand the legalization of euthanasia or in the best case justify it, even though
officially most countries still react to its enactment.
2. The modern social way of thinking, being primarily rationalistic, easily
sacrifices the respect for life and death in the name of hedonism and self-interest.
Consequently, there is an imminent need on the part of the Greek Orthodox Church
to express Her position on the matter.
3. By the term euthanasia we mean the hastening of the death of a person, who
suffers or will suffer from an incurable and painful illness, with the active
or passive assistance (omission or action) of a third person. The ill person,
who may be either conscious or unconscious, should have expressed explicitly
his wish that his life be terminated.
B. Life and death in
the Orthodox theology and tradition
4. Our life constitutes the supreme gift from God, the beginning and end of
which depends entirely on Him: "in his hand is the life of every living
thing" (Job 12:10). It is within biological life that man's free will
finds its full expression, encounters the grace of God and thus his salvation
is being realised.
Every effort to determine the limits of life solely on the basis of human volition,
decision or capability deprives life of its sacred character.
5. Man was created immortal by grace. Immortality is his natural state of being.
However, pain, decay and death were introduced into the world through sin. Death
was permitted by God so that evil does not become immortal.
6. Biological life does not determine the entire destiny of man. Man was created
by God, having a body and a soul in unbroken unity, which is, however, broken
by the event of death. Although the body is dissolved by death, the soul is
preserved so as to be united once again with the resurrected body.
7. The great importance of this present life is judged in connection with the
potential for man's theosis and salvation through repentance. Without spiritual
life, the preservation of man's biological life loses its importance; it lacks
meaning and is entrapped by death.
8. From the moment of his conception, man experiences death, either through
physical changes due to age, sickness, or through the loss of a loved one. Death
and its consequences are surpassed through Christ who defeated death by His
death (by death has he trampled down death).
9. Death is an event that is not only connected with the end of biological life,
but also with the whole existence of man. Since life is prolonged after biological
death, the way in which one lives and dies affects his eternal existence.
10. The contemporary secularised position on euthanasia views death as a right,
and not as an event that transcends man; as something that can be determined
within time, and not as a moment that is determined by God. Respect for our
God-given life requires that it be protected in any way possible. This is expressed,
on the one hand, by trying to preserve the quality of life, and on the other
hand, by attempting to prolong life. According to the Orthodox Christian teachings,
in no way can the duration of life and the moment death be determined by human
rights.
C. The meaning of pain
11. The Church acknowledges the weakness of human nature. Consequently, She
embraces those who are ill, in pain and affliction and compassionately asks
for deliverance "from all affliction, wrath, danger and necessity,"
and prays that the end of life may be "painless, shameless, peaceful"
(1) and
that in certain cases patients in the agony of death may soon be reposed (prayer
for those is agony of death).
12. Nevertheless, She recognises that behind every pain there is a blessing.
Pain in human life, as well as any other trial, is "a collaborator to man's
salvation" and oftentimes is "even better than health itself"
(2) for
that purpose. Natural as well as existential pain is beneficial because it widens
the limits of existence. Pain could form a means of ascesis in humility, patience
and love, and can become an opportunity for preparing ourselves for eternity.
13. We do not pursue pain. However, when it occurs we ought to try in every
way to cope with it. In case it persists or remains incurable, enduring it with
patience, faith and hope proves to be both beneficial and supportive. The positive
or negative impact of pain depends greatly on man's personal stance towards
it. Learning to bear even the most difficult circumstances in life constitutes
the best preparation for dealing with pain.
D. Medical treatment
of pain
14. Contemporary medical science is in a position to confront successfully most
forms of pain with the proper analgesic treatment. For this reason, it is imperative
that physicians be constantly scientifically trained and updated. At the same
time, however, the care of the medical and nursing staff as well as the relatives'
support is inestimable to the patient when dealing with pain.
15. In case patients do not respond to therapy, it is advisable to administer
sedatives. Love compels us to alleviate the patient in every way possible. We
should not allow patients to be in pain by depriving them of the required dose
of sedatives. Perhaps, it is better to pass away while sleeping.
The Church welcomes and blesses the attempts of physicians who relieve through therapeutic methods the patients' pains until the last moment of their earthly life.
E. Consequences of modern
medical technology
16. Modern medical technology has greatly contributed to curing various diseases.
At the same time, however, the intrusion of technology in medicine produces
unprecedented forms of death or conditions of painful survival incompatible
with life that lead to new dilemmas and bring forth unanswered questions.
17. Medical advancement may cause tragic and problematic living conditions,
which give rise to the following question: is it permitted to shorten the life
of a human being, or is it more correct to prevent his death. Medical and pharmaceutical
technology does not only prolong life but often it also delays the very process
of death.
18. On the other hand, despite the impressive progress of diagnostic and preventive
medicine, no one can ever be certain about the incurable character of a disease.
There is always the possibility for an erroneous medical appraisal, or for an
unforeseen outcome of the disease, or even for a miracle.
F. The medical mission
19. Since the years of Hippocrates, the medical mission was identified with
the provision of therapy and offering of life, and was incompatible with any
participation in causing death. According to his famous oath, the physician
promises that "he will never give anyone a deadly medicine, even if
he asks for it, nor will he advise him to take it".
20. In case the physician cannot provide a cure, he can help the patient by
trying to alleviate his pains, relieve him of his ailments, ease his agony and
assist him in enduring his trials, so that he can live the last moments of his
life with dignity
G. Social and psychological
causes of euthanasia
21. The more profound reason that makes euthanasia a very popular and widely
discussed subject is the fact that nowadays a purely materialistic, transient
and hedonistic perception and practice prevails. In addition, health has acquired
a strong financial character and man is regarded on purely mechanistic and ephemeral
terms.
22. Our modern consumerist society regards terminally ill people as persons
unable to participate actively in society and, therefore, they are considered
to be unproductive for the advancement and development of the social system
as well as a hindrance to other people's well-being and happiness. This is why
society's willingness to support terminally ill individuals is limited.
23. Moreover, we cannot overlook the psychological causes that lead someone
to request euthanasia. These usually are: despair due to natural discomfort,
cowardice before natural pain, disappointment due to the weakening of physical
strength and the fear that he may become a burden to his/her relatives.
24. If the patient could ascertain that one or all of the above could be alleviated
by the love and concern of physicians, nurses, relatives and friends, he/she
would not easily chose euthanasia. This is something that contemporary society
should take into consideration.
25. The request for euthanasia usually comes from individuals that are in a
state of depression. This means, firstly, that the conditions under which they
ask for euthanasia do not guarantee the soberness of their decision; and secondly,
that it would be possible for the same individuals to desire a different outcome
for their future, following proper psycho-therapeutic support and treatment.
The incurable and painful illness affects the patient's mental balance to such
a degree that we could allege that it is almost impossible for the patient to
express his will lucidly and with correct judgment.
H. Social consequences
of euthanasia
26. The implementation of euthanasia vests physicians and relatives with extra
authority and rights which have uncontrollable consequences. The description
of the patient's condition depends on the physician. The decision depends on
the relatives whose motives could at times be ambiguous. Their character, mentality,
and mood at the specific moment, as well as their philosophical and religious
beliefs, or even their personal interests could play a decisive role in someone's
decision to request to shorten his life.
27. So far the physician's role has been to support people in their struggle
for health and survival. His active involvement in the procedure of hastening
death injures gravely the relationship between physician and patient and alters
the value of life as the utmost good.
28. The so-called "right to death" that legally protects euthanasia
could develop into a threat for the life of patients who are unable to respond
financially to the demands of their therapy and hospitalisation. Our autonomy
is limited by the fact that we are social entities.
29. In essence, by opening the way to euthanasia, on the one hand, illegal interests
are facilitated and, on the other hand, the preconditions for a racist and eugenic
society are created, in which the healthy, young, wealthy and successful will
be given priority. When our behavior towards our ill fellowmen is based only
on the logic and ethics of committees, resolutions and rights and lacks love
in Christ, then it leads to the debasement of man.
30. The implementation of euthanasia in certain countries creates the risk of
causing direct side effects and problems to other countries, one of which is
the so-called "death trading" that helps the illegal transportation
of those people who wish to bring an end to their life (for example, the Netherlands
and Switzerland).
J. Legal remarks on life
31. The value of man has an absolute character and its basic expression, which
is human life, is absolutely protected, irrespective of its quality and the
will of its bearer. In other words, the right to take an end to one's life is
not recognised.
This is documented by provisions
that penalize participation (encouragement or assistance) in suicide (article
301 of Penal Code) or homicide with the consent of the terminally ill patient
(article 300 of Penal Code); moreover, the consent of the patient to a dangerous
or serious physical damage does not negate the punishable act.
32. The probable upgrading of the right to end one's life to an absolute degree
will eventually affect the system of absolute protection of life and will open
up the way to other persons' rights, such as relatives or physicians when the
right to end one's own life cannot be exercised.
33. If euthanasia of the "dying patient", namely the hastening of
the expected death is legalised, it will form the starting point for the legalisation
of euthanasia of "the terminally ill patient" whose death is not always
that close. In this case, the state becomes involved in judgements and choices
on assessing the value of the given life.
34. The penal code of Greece is considered as one of the best and most complete
in Europe. Let us leave it the way it is. Articles 300 and 301 of Penal Code
can form a satisfactory guide for every case of euthanasia.
35. The objection of the physician to the "persistent and significant"
request of the patient for euthanasia is inviolable. The so-called right to
life of a person cannot lead him to demand to be killed by his physician.
I. The proposal of the
Church
36. The deeper spiritual causes that lead to a positive viewpoint on euthanasia
usually lie in extreme materialism; man's spiritual poverty; the consideration
of pain and disease as misfortune or injustice; the belief that life is not
sacred and that it is only connected with external and physical beauty and financial
prosperity; and the consideration of death as a fatal event and not as an intermediate
stage of man's course.
In such a society, concepts
such as sacrifice, patience, perseverance and endurance are unknown, while those
of mercy, compassion and sympathy are misinterpreted.
37. While euthanasia is justified in a secular sense as "dignified death",
its active form constitutes assisted suicide, namely a combination of murder
and suicide. For this reason, it is considered a decadent social phenomenon
of human debasement.
38. The moments of life that are connected with its beginning and end, as well
as the moments of our trials, weaknesses and pain conceal a unique sacredness
and constitute a mystery that ought to be deeply respected by the relatives,
physicians, nursing staff and the entire society. If we handle these moments
spiritually by praying, they may generate humility and the seeking of God, and
offer man the opportunity to experience God's grace and witness a miracle.
39. Moreover, these moments favour human relationships, the communion of love,
and the manifestation of compassion and mercy. When certain patients demand
euthanasia, they actually ask us in return to express our love and our wish
to remain close to us. During these moments, one can experience both the grace
of God and the love of others.
40. The Church acknowledges the illness of human nature and that "death
is better than a miserable life and eternal rest than chronic sickness"
(Sirah 30:17). Consequently, She is very understanding towards those who break
down before unbearable pain and death. Her word of truth is always philanthropic
and Her philanthropy is rich with the truth.
41. Love by nature is not just an emotion, but it is partaking in the pain and
the cross of our fellowmen. To love someone does not mean to free him from the
burden of life. It means to carry the weight of his pain or offer him our own
life, or even more so, offer him the truth and love of God. Love is understood
only in truth.
42. The Orthodox Church believes in the immortality of the soul; the resurrection
of the body; the eternal perspective and reality of man; in pain as "the
marks of Lord Jesus" on our bodies (Gal. 6:17); in trials as causes
and opportunities for salvation; in the prospect of growing loving communion
and mutual support. Therefore,
a. She proclaims that our life is exclusively in the hands of God and that everything
that happens to us is in our own interest and we have no right to correct the
plan of God, and
b. She rejects every death resulting from human decisions and choices as being
an insult to God -no matter how "good" it may be called. Moreover,
the Church condemns as unethical and insulting for the medical profession, every
medical act, which does not contribute to the prolongation of life, but, instead,
provokes the hastening of the moment of death.
We, human beings, ought
to pray, not to decide about life and death.
43. The Church proposes the transcendence of death as an alternative to the
contemporary form of euthanasia that hastens and provokes death. Good life and
good death (euthanasia) for the Church mean life and death with meaning and
perspective. When the choice of death comes from the denial of God's will it
is considered a sin. On the contrary, when yearning to die springs from the
love of God, it constitutes a unique blessing and an exceptional virtue "my
desire is to depart and be with Christ" (Phil 1:23).
44. The Church's tradition includes many examples of saints who did not wish
to resort to doctors or medicines for therapy, but instead they totally relied
on God's providence. Nevertheless, there are some ascetics who resorted to the
use of medicine or other medical means, but then considered their act as a deviation
from the road of perfection.
This fact does not imply
the Church's ambivalent position on the matter, but indicates Her absolute respect
for man's freedom and the significance of his innermost intention.
Therefore, behind the patient's
words we ought to discern the deeper state of his soul that interprets his wishes
and choices. When an ascetic refuses therapy in a hospital and instead retreats
to his hermitage, he does not desire euthanasia. On the contrary, when someone
that has no hope or patience refuses medical support and assistance, then he
culpably shortens his life span.
45. The provision of medical attendance and therapy, from a legal viewpoint,
does not constitute an independent medical right but only an obligation, to
the extent that the patient requests it. Moreover, the occurrence of death caused
by the "omission" of a suggested treatment due to the refusal of a
fully conscious patient to receive medical assistance does not constitute homicide
or participation in suicide. Nevertheless, the doctor has the moral obligation
to assist the patient to consent to the effort being made to keep him alive.
46. In case the patient is unconscious but can be cured, the physician is obliged
to assist in keeping him alive in every way he can.
47. When the patient is
unconscious and there is definitely no hope for treatment, then the conscience
of the physician and the relatives replaces the patient's conscience. This is
why there is an imperative need for a refined conscience on the part of the
physicians. Sometimes, the physician, based on his knowledge, sense, experience
and love for the patient as well as his faith in God, feels that he ought to
avoid the use of aggressive means that do not provide therapy to the patient,
but instead make him suffer. In this case, the physician cannot be considered
unethical.
48. The use of medical intervention
should be extended to the point where the emerging complications and additional
problems alleviate the patient's pain and do not prolong his suffering. God
is the one Who allows pain; therefore, it should be neither generated nor intensified
by medicine. The prolongation of life and alleviation of pain should coincide
with the volition of God; it should not become an end in itself.
49. The doctor should neither
be led to nor consciously act to prolong artificially the natural limits of
life through exaggerating therapeutic means. For these may result in the loss
of the patient's dignity, which in turn may affect his immediate environment
financially as well as psychologically.
50. The following cases
are found on the narrow line between passive euthanasia and active euthanasia:
a. When artificial support
is already being applied without the prospect for recovery, is it allowed to
interrupt nutrition by a positive action?
b. Painkillers are consciously
administered that eventually hasten death.
In the first case, the positive
action burdens our conscience with guilt for participating in the patient's
death, while in the second case, the absence of the immediacy and certainty
of the occurrence of death does not burden our conscience. Actually, the patient's
relief is immediate and certain.
51. It is not possible to
justify active euthanasia and, therefore, neither is its legalisation under
any conditions ethically permissible.
Politicians and legislators
cannot appoint themselves as managers of life and death.
52. The growth of healthy
relationships of love and communion strengthen human beings so that they may
confront death and pain. Consequently, they also assist in dealing with trials
and transforming them from a personal agony to an opportunity for healthy sharing
and communion.
53. In case a patient is
in a state of panic and is tempted to request euthanasia, the Church may give
him hope and comfort through Her consoling words, Her effective prayer, the
sacrament of Holy Oil and Her love which are stronger than the fear of pain
and desire of death. Then, euthanasia will not only be absent from the Church's
way of thinking, but it will also be excluded from the patient's choices.
54. During moments of crucial decisions and trials, the Church should not wait for the patients to ask for Her support. She ought to go near them by making her presence felt discreetly and effectively in the hospitals. Therefore, on the one hand, She should support the institution of hospital chaplaincy and, on the other hand, proceed to the organisation of volunteer groups in hospitals aiming at the spiritual support of terminally ill patients. If neglect leads to euthanasia, then love, support and true hope intensify the love for life.
1.
In almost all services of the Orthodox Church (Vespers,
Matins, Divine Liturgy etc.).
2. Saint Gregory Palamas. (1985). Thessaloniki: EPE (Greek Fathers of the Church) Vol. 9, p. 264.
HELLENIC
REPUBLIC
THE HOLY SYNOD
OF THE CHURCH OF GREECE
BIOETHICS COMMITTEE
14 IOANNOU GENNADIOU - 115 21 ATHENS
GREECE
Brief
Presentation on Human Genetics
at the Public Hearing with the Civil Society
European Parliament, Brussels
July 9 and 10, 2001
The Holy Synod of the Church
of Greece warmly welcomes the greatest and probably the most significant discovery
of human science and technology: the decoding of human genome.
The Orthodox Church embraces everything that constitutes a human attainment
on the cognitive level, particularly if it is associated with the progress of
health, the relief of pain, and the hope for better living conditions. She admires
the achievement, supports the thirst for knew knowledge and rejoices the anticipation
of revolutionary progress in diagnostic, preventive and therapeutic medicine.
Nevertheless, the Orthodox Church has a deeper sense of her spiritual obligation
to protect man as an icon of God, than she has of her social mission to safeguard
a better earthly future for humankind. We realize that along with the great
promises, genetic revolution includes dangers that are based on the fact that
knowledge is less than our ignorance; prudence more scarce than our unreasonable
desire; and values are weaker than interests. Therefore, when scientific discovery
is not combined with respect towards man but is accompanied by arrogance, is
prompted by financial interests and serves selfish perspectives, the effect
of science may be proved harmful upon humankind.
The fact that our scientific knowledge is inadequate justifies our inability
to pre-estimate exactly the consequences of our achievements. The errors in
estimating a timetable for the entire attempt, in determining the exact number
of genes, in understanding the mechanisms and effectiveness of gene therapy
may also excuse an erroneous appraisal regarding the apparent dangers on our
biological entity, social stability and the safeguarding of ethical parameters.
The Orthodox Church understands this inability and observes progress with prudence
and a sense of responsibility and calls for our attention so that the human
genome be protected in every possible way from all kinds of interests and profits,
financial exploitation, eugenic orientation and arrogant dominance. The genome
by itself does not give value to man, neither does the achievement of its decoding;
rather, it is man who gives value to his genome.
On the other hand, ethics is not just binding rules, laws and regulations; it
is mainly an expression of a healthy ethos, according to which man can grow
and act by choosing freely his own ways. The Orthodox Church is never assertive
on human conscience by imposing strict commandments and restrictive rules or
by providing people with recipes of behavior. Instead, she interprets and expresses
human conscience by respecting divine values, man's freedom and the sacredness
of the human person.
It seems that the possibilities that genetic engineering offers bring us closer
to eugenic threat, to racist dominance, to embryo experimentation, to the submission
of man's free-will and to the unknown consequences of life planning.
In general, we could stress that our responsibility towards future generations,
towards the rights and dignity of man, the value and freedom of the human person,
the free progress and research and the preservation of social stability makes
us deny categorically every act which reduces man to a genetic parameter or
a deterministic unit, as well as any form of racist discrimination based on
eugenics. At the same time, it obliges all of us to work for the prevalence
of respect for man upon every form of research objectives and achievements,
for the confidentiality of genetic information and for the protection of the
genome from any kind of abuse.
Moreover, we consider necessary the formation of independent Committees of Bioethics
and Deontology and the commitment of all countries to promote education and
updating on Bioethics and relevant discussions, which must definitely be open
to the various religious trends.
If research is not based on respect for time, respect for God's creation, respect
for natural imperfections and disabilities and respect for the unprotected embryos,
we believe that the genetic profit will be much less than the respective cost.
The oscillation between enthusiasm and high hopes, on one hand, and fears and
threats, on the other, leads to extremes and unjust opinions concerning the
truth. The Orthodox Church prefers to wait, to be alert and prudent. Every scientific
or technological achievement is characterized as positive not only if it promotes
health, but mainly if it cultivates respect for man. Humankind will certainly
find the mechanisms to be protected against the probability of biological disorder;
ultimately, physical health will improve. The question is what mechanisms will
humankind find in order to defend itself against the threats of socio-psychological
disorders. The Church adds to this question her skepticism on the fact that
an eventual genetic explosion may disturb the balance between soul and body
or lead to the amputation of man's free will and eternal perspective and the
downgrading of his divine dimension. It would be tragic if we finally end up
knowing the secrets of our biological genome and ignore the basic functions
of our spiritual potential. Perhaps, genetic prevention is ultimately better
than gene therapy.
HELLENIC
REPUBLIC
THE HOLY SYNOD
OF THE CHURCH OF GREECE
BIOETHICS COMMITTEE
14 IOANNOU GENNADIOU - 115 21 ATHENS
GREECE
BASIC
POSITIONS ON THE ETHICS OF
TRANSPLANTATIONS
(10.12.1999)
I. General Principles
1) The Church of Greece
regards transplantations, and everything related to man's health and his struggle
against death, with special compassion and understanding. She comprehends both
the magnitude of the problem and the potentials of transplantations, along with
Her great obligation towards society, the medical act, the recipient and the
potential donors. She wishes both to help the recipient and respect the donor.
2) The criterion of church
ethics on transplantations is spiritual. If something harms the soul or undermines
spiritual principles, the Church of Greece rejects it unreservedly. On the contrary,
if the scientific achievement is compatible with the theological tradition,
teaching and experience, She faces the ingenious discovery with the clarity
of Her spiritual originality. She has no connection with rationalistic scholasticism
nor does She give way to political expedience or identify with secularisation.
The Church of Greece protects
and supports everything that transcends individualism and dependence on biological
life and joins people with a bond of mutuality and communion, as well as everything
that proves the predominance of spiritual life over biological survival. But
She also stands with respect and special sensitivity before the mystery of life
and death as well as before the psychosomatic union of man.
II. Special Principles
4) Transplantations transform
the drama of the recipient into hope for life. The Church of Greece could bless
transplantations within the context of Her philanthropy, under the indisputable
condition, however, that during the transplantation process the conscience of
the donor is being protected and spiritual principles are not violated in the
least.
5) All reasoning behind
the acceptance of transplantations on the part of the Church of Greece is based
on three principles:
a. The Church of Greece senses Her philanthropic duty towards the recipient - who needs to live-, but She realises more the importance of Her role by the side of the donor - who can offer freely. For no reason and in no way does She sacrifice respect towards the donor to the need of the recipient's survival. The goal is not for the recipient to live, but it is for the donor to give. The recipient receives parts from a mortal body; the donor gives from his/her immortal soul. The spiritual benefit of the donor is greater than the biological gain of the recipient to the same extent as the soul is superior to the body. "It is more blessed to give than to receive." (Acts 20:35)
b. Donation of organs must
always be effected with the "conscious consent" of the donor; namely,
the donor must knowingly, freely and voluntarily consent to the removal of his/her
organs, in case, he/she is diagnosed as brain-dead. The donor should act as
a benefactor.
c. The Church of Greece
can adopt transplantations only within an atmosphere of mutual love and communion,
a self-sacrificing mentality, and as exodus from our egoism and pathological
love for life, but never with a utilitarian logic, which alienates the "donor"
from the act of his donation. Therefore, transplantations are regarded, in general,
as a possibility to transmit life to certain people, but mainly as an opportunity
to transfuse spiritual ethos to society.
III. The Role of Medicine
6) Medicine looks after the rehabilitation or improvement of man's health and the prolongation of his life. Theology does not impede medicine in its effort to achieve this goal, but it also acknowledges its relativity. In parallel, it projects certain conditions for the proper development and exercise of medicine. These conditions are two: the respect for the human person and the benefit of our fellowman.
7) Medical science and
research should be exercised within the context of medical and bioethical deontological
rules that protect man as a person. The doctors should also work with humility,
feeling that they are instruments of God in the service of human beings.
IV. The Right to Donate
Organs
8) Life is a gift from God
that is not granted to us in order to experience our egoism and our possessiveness,
but it is offered to us so that we can offer it in return with love. The best
way of returning our life to God is to offer it, out of love, to our fellowman,
"you cannot be otherwise saved but through your neighbor" (Saint
Makarios the Egyptian).
9) Self-offering constitute
the spiritual basis of the ethics of the Church of Greece on the subject of
transplantation. The words of the apostle St. John "by this we know
love, that he laid down his life for us; and we ought to lay down our lives
for the brethren" (Jn. 3:16), dissolve every doubt that the offering
of our life, and, consequently, the donation of our body, are acts of suicide
or euthanasia; instead they can form expressions of "greater love"
about which the Lord Himself speaks to His disciples at the last covenant: "greater
love has no man than this, that a man lay down his life for his friends"
(Jn. 15:13). If the offering of life is the "greater love", then
the offering of organs is a "minor", yet blessed act of love. The
above biblical references transfer the ethical problem of transplantations from
the scholastic determination of brain-death to the respect and expression of
the free will.
10) Even if brain-death
is not identified with the final separation of the soul from the body, as some
people claim, when someone wishes to offer his/her organs, along with his/her
organs he/she would also offer his/her life. His/her act would not only include
the element of offering but also the one of self-sacrifice.
11) The Church of Greece favours and encourages the offering of one of the twin organs (kidneys) or tissue (skin, bone marrow, or blood) by a living donor.
V. On Brain-death
12) The Church of Greece
respects and trusts medical research and the clinical act. For this reason,
even if She is not qualified, She could accept the internationally unanimous
view that brain-death is identified with the irrevocable biological end of man.
Brain-death constitutes a final and irreversible destruction of the brain and
a state of total loss of sense and consciousness. In the state of brain-death,
the respiratory function is maintained only artificially, and the termination
of artificial ventilation leads to an almost immediate interruption of the heart's
function.
13) Artificial support of respiration succeeds in temporarily retarding the process of decomposition of the body, but not of the departure of the soul.
14) Brain-death should,
by all means, be differentiated from the vegetative state, which oftentimes
is called clinical death. In this state, the brain stem functions and, most
of the times, artificial ventilation is not required.
15) Since, in rare cases, there is a danger of carelessness, error or even disrespect towards death, the Church of Greece, along with the majority of physicians, nurses and competent social carriers, demands the accurate compliance with the internationally accepted criteria for the diagnosis of brain-death. Therefore:
a. A documented and explicit
ascertainment of the causes of brain-death is required.
b. The certification of
brain-death should be made on the basis of the existing clinical and laboratory
criteria by a committee of experts without any reliance on the transplantation
teams.
c. The criteria of brain-death are not adequate if they are only clinical. Laboratory criteria should be added (CT-scan and electroencephalography) so that the cessation of the function of the brain stem as well as of the cortex be confirmed. When there is no apparent cause of brain damage, the tests should be repeated for more accurate confirmation even if this type of delay leads to the loss of the organs.
d. Biochemical examinations
should be performed prior to brain-death tests, which should present normal
findings (not urea or electrolytic disorders). Also, in order to confirm the
brain-death condition, the tests should be run at least 24 hours after the moment
of its occurrence and should be video recorded.
16) The inquiry of whether
a person is a donor or not (namely, whether he has signed a consent) should
be performed after the final diagnosis of brain-death, so that the inquiry is
as impartial and uninfluenced as possible.
17) According to the above-mentioned
statements, the organ donation of brain-dead patients as well as the sober and
conscious decision of a healthy person to offer one of his/her organs to a suffering
fellowman, as an act of love and altruism, is in accordance with the teachings
and ethos of the Church of Greece.
VI. On Conscious and
Presumed Consent
18) Donation presupposes
the "conscious consent" of the donor to his/her act. Anything that
"presumes" his/her volition constitutes an intervention in his/her
free will and, therefore, it is not possible to be accepted.
19) The "conscious
consent" constitutes an act of self-denial and love, which connects the
donor with the event of his/her death, that actually occurs in a tragic way
and in a relatively young age. Also, it contains the virtues of altruism, of
denial of his/her natural rights, of trust and care for other people, of self-offering
and the overcoming of one's attachment to this earthly life.
20) The Church of Greece,
in exercising her pastoral ministry on transplantations, may secure a number
of organs and, in this way, contribute to the survival of a respective number
of men and women (depending on the percentage of success of the transplantation
operations). However, with the prerequisite of conscious consent, She does not
only address the actual donors, but also the potential donors.
The donor may benefit others
through his/her offering, but mainly benefits himself/herself through his/her
act of consent. He/she saves biologically the recipient and spiritually works
for his/her salvation.
21) The consent is not a matter of secondary importance that could be overshadowed by any other act (i.e. a census, the issuing of identity card, etc.). Its declaration should be free and absolutely conscious; it should form a fruit of mature thinking. For this reason, it is good to be expressed independently of any other social act, provided that there is also a correct and unforced updating on the subject.
VII. On the Consent of
Relatives
22) The Church of Greece,
under certain terms and according to a spirit of dispensation as well as within
the perspective of sacredness of family bonds and the pursued cultivation of
interpersonal relationships, could also accept the substitution of the donor's
volition by the one of his/her relatives, provided, of course, that it is not
set against his/her own will. The care for our relatives constitutes an expression
of faith (1 Tim. 5:8) and the inherent obligations towards them a proof of sacred
family rights.
For the relatives, the donor's life and the price of his/her body may have greater
value than they have for himself/herself. Given that family love exists, the
decision on the donation of the other person's body may be even harder than
the one on the donation of our own body. In this sense, the real donors are
the relatives.
23) Since in society and in our era, all kinds of interests, especially financial interests, often defile even the most sacred relationships, the law should provide for the avoidance of all suspicion of transplants' commercialisation on the relatives' part.
24) It would be preferable
if, during the procedure of signing the consent, the donor grants beforehand
to his/her relatives the right to donate his/her body.
VIII. The Reservations
of the Church of Greece
25) The development of communication
technology and computer sciences (internet, electronic filing with a wide range
of data and limited potential of checking) on one hand, and the spiritual poverty
of modern societies on the other, can lead to abuse, exploitation or sacrifice
of transplantations for the sake of great financial interests. Therefore, the
Church of Greece ought to protect the institution, the act and the persons involved
from a probable profanity (hasty diagnosis or carelessness in applying the brain-death
criteria, commercialisation of human organs, selection of recipients on the
basis of racist criteria, violation of waiting list, etc).
26) In order to avoid violations of waiting lists, it is good to keep an electronic registration file of the donors, which will be checked by a flawless central mechanism.
27) The international and
Greek legislation, in order to protect transplantations from the threat of commercial
transactions, request the anonymity of the recipient and the donor and prohibit
the organ donation to a friend or relative designated by the donor (kidney transplantations
from a living donor form an exception). This alone is not necessarily set against
the ethics of the Orthodox Church.
28) The Church of Greece
cannot consent to the removal of organs from infants with congenital anencephaly.
Such donors are very rare, a fact that limits the hopes of infant-recipients.
Nevertheless, since the anencephalic infants are not deprived of the stem, they
are not brain-dead, and since they are deprived of a conscience, they are not
able to consent - and, naturally, no one can make a presumption. This creates
a legal impediment to the removal of the organs. Moreover, society should reject
every utilitarian consideration of these infants. The need to respect them does
not allow their passage through this world to become entirely utilitarian.
29) In regards to the probability
of the use of artificial organs or xenografts (genetically processed organs
from animals), as well as of cloning products, the Church of Greece will present
in due time Her positions and viewpoints, since research does not have any explicit
results at present and its course is not clear.
30) With the loose international ethics on euthanasia and the tendency for its legalisation, there is danger, in the immediate future, that transplantations may be associated with euthanasia. Therefore, individuals who will choose this method of terminating their lives will probably become organ donors. This is one more reason why the legislation on transplantations should be founded on a highly spiritual basis.
IX. Criticism on the
New Law on Transplantations
While the Church of Greece accepts the idea of transplantations, She is unable to agree with the recent legislation on transplantations in our country, which is dominated by a utilitarian perception and narrow-minded rationalism. The only way of protecting the ethics and practice of transplantations from the probability of their abuse is for the relevant legislation to be explicit, thoroughly studied, spiritual but not utilitarian.
31) In the recently voted
law, the legislator interprets the "non-refusal" of the relatives
as "consent of the donor" (Article 12, par. 4). The organs are removed
not when the relatives "consent", but when the relatives "do
not oppose". It is not possible for transplantations to be based on a "non-refusal"
of the relatives, when we are all struggling for the "consent" of
the donors.
32) The lack or inability
to find the relatives could be interpreted as "non-refusal". In this
case, every foreigner, illegal immigrant, unknown deserted person, or gypsy,
etc, who is diagnosed brain-dead and whose relatives are not found in Greece
or it is impossible to locate them, or any person found alone in a hospital
after a car accident whose relatives are unaware of his/her condition should
be automatically considered as a donor. Should we add to the tragedy of these
persons' loneliness the arbitrary removal of their organs? The law of the "non-refusal"
constitutes a blackmail of the conscience.
33) The "consent"
has no relationship to the "non-refusal". "Giving something that
is mine" is entirely different from "taking away from me something
that belongs to me". In the second case the volition of the state and society
substitutes the expression of personal freedom.
34) The state has no right
to intervene in the private sphere of the citizens' life. Such an act is opposed
to articles 2, par. 1 (on respect and protection of human dignity) and 5, par.
1 (on free development of the individual's personality) of the Greek constitution.
35) Moreover, the state
cannot oblige the citizen to express his/her opinion without securing his/her
right not to express it. What are the consequences if the citizen refuses to
express his/her volition?
36) The substitution of
the term "brain-death" by "necrosis of the brain stem" is
considered medically ambiguous and philosophically suspicious. The reconfirmation
of the irrevocable cessation of all brain functions (brain stem and cortex)
is required.
37) The legal termination
of the artificial ventilation of a brain-dead individual who is not a donor
(Article 12, par. 6) is spiritually and ethically anti-deontological. The law
should protect the doctor who, for reasons of his/her conscience, does not wish
to terminate the artificial ventilation and, surely, not punish him/her (Article
20, par. 1).
38) The difficulty of the
relative to consent to the donation of the body, which is due to personal, sentimental,
religious or philosophical reasons, should be absolutely respected and not be
dealt with by the threat of interrupting artificial ventilation (Article 12,
par. 6).
X. Pastoral Options of
the Church
39) On the basis of the above principles, the Church of Greece should struggle for the prevalence of Her principles and Her positive influence on the transplantation policy; moreover, She should create Herself a spiritual tradition on transplantations oriented towards the need to donate organs. In this way, the finding of organs and the promotion of transplantations will not constitute a pursued goal but a natural result.
40) The Church of Greece
can organise educational programmes for donors aiming at the cultivation of
significant virtues among Her faithful (remembrance of death, self-offering,
sacrificial mentality, etc). Thus, She will give a witness of her ethos to society
in a contemporary manner.
41) The Church of Greece
does not sacrifice the truth nor subjugates the person. If someone desires to
become a donor, She blesses him/her. If he/she has difficulty in doing so, She
sympathises with him/her. This is the protection of the person. Her spirit is
not subdued to the need for transplantations, but serves the respect of the
person, mainly the person as a donor.
42) Furthermore, She respects
and fully understands the natural desire of these patients, who by receiving
organs desire to prolong the length of their biological life, believing that
this event may contribute to the fulfilment and achievement of the purpose of
their existence.
43) Due to the spiritual
importance of the act of donating organs of our body, it is suggested that the
hospital priests read an appropriate prayer or perform a sacred act (anointing
with holy oil, or blessing by crossing, etc.) prior to the donation.
44) A relevant spiritual
education may also take place for the preparation of the recipient so that he/she
does not feel as the well-favoured recipient of an organ, but as the blessed
recipient of love and the grace of God.
45) Conclusively, the pastoral ministry of the Church of Greece towards donors, recipients and doctors should be of one through which God is praised in all these ways. Thus, human beings will become spiritually integrated and the disease or prolongation of life will form a condition of fulfilling the deeper purpose of their creation.
XI. Suggested Church
Policy
46) It is a common belief
that the role of our Church in the development of transplantations in Greece
is significant. Transplantations are perhaps one of the few issues for which
the state has the immediate need of the Church. This creates essential rights
and great obligations on the part of the Church of Greece.
47) Given the fact that transplantations may easily lead to the misuse and violation of fundamental ethical principles and values and that there is a great difference in the ethos and approach between the secular and ecclesiastical perception of the issue, the Church of Greece is very careful in Her actions and prudent in Her words.
48) In cooperating with
the state, the Church of Greece places explicit terms so that She differentiates
Herself from secular decisions and acts, that have an entirely different spirit
and purpose. The probability of organising a donor's day or a campaign to support
transplantations, aiming at collecting the greatest possible number of organs,
will be decided by the Church alone, provided there is a definite guarantee
of respect for Her principles and terms.
49) The absence of an official
Church position on the issue led to an arbitrary acceptance or rejection of
transplantations by specific competent or incompetent persons of the Church
of Greece. This has created confusion, sometimes also discord, between the faithful
and the theological world.
In the present stage, the
Church of Greece proclaims explicitly but in a low tone that, within the context
of the afore-mentioned theological principles, She could accept the idea of
transplantations, and through them exercise Her pastoral ministry and transmit
Her spirit and ethos.
Moreover, She will provoke
a dialogue and create educational opportunities for the faithful (seminars for
spiritual fathers, homilies, etc), and She will try to cultivate a spirit of
understanding, agreement and wide acceptance of Her basic theological positions
among the faithful so as to erase every unjustified negativism. A third step
will be the issuing and circulation of informative pamphlets, explaining Her
positions, or even the organisation of a conference open to the public, through
which She will proclaim Her viewpoints to our society.
A final move will be the issuing of an encyclical letter which will express the essence of the Church positions and proposals and will formulate with clarity the outline and practice of the Orthodox Christian ethos in regards to transplantations.
50) Concerning the new
law, the Church of Greece differentiates Her position without passion but with
discretion and clarity so that She neither harms transplantations nor demotes
the importance of Her viewpoints. Simultaneously, She has publicized Her position
on the points on which She has reservations and objections. Also, She is ready
for immediate legal interventions and will request amendments and legislative
improvement that will safeguard the principles of Her logic and will permit
Her essential support.
51) An indispensable term
for cooperating with the state is for the latter to understand that it is overburdened
with an immense obligation to protect transplantations legislatively and practically
from every form of dishonesty, utilitarianism or financial exploitation and
to secure the scientific expertise, updating and training of competent doctors
and carriers. In this way, the donor will not become a victim of depraved interests,
disrespect or scientific carelessness and ignorance.
52) Moreover, the medical
community and the state ought to help in imposing and establishing legislatively
the most accurate criteria of brain-death, the application of which should be
strictly checked.
53) The founding of trustworthy centers of transplantation is necessary. These will provide the appropriate scientific and technological base so that the removal of the organs from the donor and then their transplantation to the appropriate recipient will be effected with the highest percentages of success and fewer losses.
54) The Church of Greece
will see that Her representatives participate in scientific medical conventions
on transplantations in order to update Her knowledge and present Her principles.
55) Finally, Her role and
representation in the National Organisation of Transplantations will be central
and active and not just figurative or secondary. Her purpose is to make the
centers of transplantations operate as much as possible on the basis of Her
own principles of respect, freedom and love for the human person.