On the Question of Life-Preserving Intervention

Dear friends,

The most frequent medical-moral question today has to do with what is called "life preserving intervention"--commonly known as "heroic" or "extraordinary" attempts to either revive or keep a dying person alive. This is an area in which priests are seldom consulted by family or doctors; yet, because it has to do with the passage from this life to eternity, priests must be involved.

When medical personnel speak of life preserving intervention, they usually mean one of two things: either omission or affirmative action. For example, should we allow a respirator to breathe for our patient, or not? Should we allow for continued artificial hydration and nutrition, or not? In theological terms the same questions can be phrased thusly: is the patient's life being medically prolonged in order to restore the patient to health? Or, in order to try to defy the natural order? This question applies to even simple and commonplace methods as well as what are considered "extraordinary" methods of intervention.

Three tests are now in use for deciding upon either omission or affirmative action in prolonging life:

(1) The "subject objective test," when either the patient can act as his own entity or someone with a power of attorney can act for him/her.

(2) The "limited objective test," where there is trustworthy evidence of the patient's own will and testament.

(3) Another medical/legal way of looking at this is what is called "Best interest." It may take on various meanings--for instance, what is called "medical good": can a cure be achieved, or is intervention only prolonging the inevitable? Or, "Best Interest" can mean that there is a patient preference about what is being done to him medically; this, however, is often so subjective that it usually isn't considered to be "admissible best interest."

Often the family does not ask questions, does not want to be involved in decision-making at this time, because they are either emotionally paralyzed at the realization that mother or father may now be dying, and/or so spiritually illiterate that they simply "don't know what to do."

The point is: someone is going to make the decisions; better that it be a concert between medical staff, family, patient (if possible), and priest. And of these, the priest should be the most important advisor, for usually only he can give the vital spiritual theological input; only he will know if the patient is properly prepared for death and eternity--and if he is not yet prepared, it may indeed be appropriate for "extraordinary" measures to be taken, if only to insure the repentance of the dying patient before death occurs. What are some spiritual guidelines about health, sickness, medicine, and dying that pastors should be teaching their flocks while they are in good health?

We read in the Epistle of Saint James these words, which are also repeated at the end of the Divine Liturgies of Saint John Chrysostom and Saint Basil: "Every good gift and every perfect gift is from above and cometh down from the Father of Lights." One of the gifts we continually pray for is that of good health. Another gift given from above is medical knowledge for the treatment of sickness. And yet, we seldom remember that there is a causal effect between sin and sickness in our lives. Saint Paul wrote: "Wherefore, as by one man [Adam] sin entered into the world, and death by sin; and so death passed upon all men, for that all have sinned." (Romans 5:12). And: "For the wages of sin is death; but the gift of God is eternal life through Jesus Christ our God" (Romans 6:23).

We must never forget, in this "brave new world" created for us by medical science, that our bodies are temples of the Holy Spirit. It is only in this context that we can decide, with the help of our spiritual father and medical advisers, what is best for our bodies and souls. If we decide to prepare the soul for the death of the body, then so be it. If we should care for the body for the sake of the soul, then so be it. But whatever is done must be what is spiritually best--and that will take some time, prayer, and consultation.

We ought not to fear death, yet we must pray for "a Christian ending to our lives, painless, blameless, with a good-defense before the dread judgment seat of Christ."

(Source: Orthodox Heritage Magazine, by the Brotherhood of St. Poimen)

With sincere agape in His Holy Diakonia,
The sinner and unworthy servant of God

+Father George