The Sacred Gift of Life: Orthodox Christianity and Bioethics



by Fr. John Breck (St. Vladimir’s Seminary Press, 1998)

This chapter is made available by permission of the Press. Introduction

(pages 5-18) 1. The Sacredness and Sanctity of Human Life 2. Facing Moral Dilemmas 3. Biomedical Ethics as a Theological Discipline The glory of God is a living person and the life of tbe person is the vision of God."

-St. Irenaeus Abba Lot went to see Abba Joseph

and said to him, `Abba, as far as I

can I say my little office, I fast a

little, I pray and meditate, I live in

peace and as far as I can, I purify

my thoughts. What else can I do?"

Then the old man stood up and

stretched his hands towards heaven.

His fingers became like ten lamps of

fire and he said to him, "If you will,

you can become all flame!" -Joseph of Panephysis "Ascend, brothers, ascend eagerly,

and be resolved in your hearts to

ascend and bear Him who says:

Come and let us up to the

mountain of the Lord and to the

house of our God, who makes our

feet like hinds’ feet and sets us on

high places, that we may be

victorious with His song." -St. John Climacus The Sacredness and Sanctity of Human Life Orthodox Christianity affirms that life is a gift freely bestowed by the God of love. Human life, therefore, is to be received and welcomed with an attitude of joy and thanksgiving. It is to be cherished, preserved and protected as the most sublime expression of God's creative activity. God has brought us "from non-being into being" for more than mere biological existence. He has chosen us for Life, of which the ultimate end is participation in the eternal glory of the Risen Christ, "in the inheritance of the saints in light" (Col 1:12; Eph 1:18). In the language of the Eastern Church Fathers, this transcendent destiny or telos of human existence is expressed as theosis or "deification." To the patristic mind, God in his innermost being remains forever transcendent, beyond all we can know or experience. An unbridgeable gulf separates the creature from the Creator, human nature from divine nature. The Orthodox teaching on theosis nevertheless affirms that our primal vocation or calling is to participate in divine life itself, to "ascend to the house of our God," where we shall enjoy eternal communion with the three Persons of the Holy Trinity. How does Orthodox teaching resolve this tension between the absolute transcendence of God and his accessibility in the life of faith? We can answer the question, briefly and schematically, in the following way. From the inner mystery of his absolute "otherness," the total inaccessibility of his divine nature or being, God reaches out to the created world and to his human creatures, to save, restore and heal all that is sinful and corrupt. By means of what St. Irenaeus called his "two hands"-the Son and the Spirit- God the Father assumes and embraces human life, filling it with his attributes or energies" of love, power, justice, goodness and beauty. Thereby he opens the way for our ascension into the realm of his holiness, where those who live and die in Christ join with the saints of all ages, to offer their worship of praise and thanksgiving before the divine glory and majesty. Human life, therefore, finds its ultimate fulfillment beyond death, in the boundless communion of "righteousness, peace and joy in the Holy Spirit" that constitutes the Kingdom of God (Rom 14:17). Yet the apostle Paul, like the evangelist John and other New Testament authors, speaks of the Kingdom as a reality that is presently accessible to us: the Kingdom is "among" us, "in our midst" or even "within" the depths of our being (this is perhaps the meaning of entos in Lk 17:21). Although its fullness can only be known after our physical death, our present 1ife within the Church offers us a very real foretaste of the ineffable joy to come. "Righteousness, peace and joy" are qualities St. Paul believes should characterize the ecclesial community on earth as well as life within the eternal "communion of saints." In the Gospel of John, Jesus speaks to those who are tempted by apostasy: tempted to reject their commitment to him and to lapse back into Judaism. He addresses them in the present tense, in the midst of their immediate, present-day experience: "Truly, truly I say to you, he who hears my word and believes him who sent me has eternal life and does not come into judgment, but has passed from death to life" (Jn 5:24). From this perspective the Kingdom of God is not merely the object of our future hope. It is a present reality, inaugurated by baptism and nourished by communion in the Body and Blood of the glorified Lord. It is a "sacramental" reality that radically transforms our understanding of the origin and the ultimate destiny of human existence. Life is now experienced as an ongoing pilgrimage marked by inner struggle. It becomes at its heart an askesis or spiritual warfare between, on the one hand, sickness, sin and death, and on the other, wholeness, sanctity, and eternal blessedness. It is this struggle, and its ultimate victory, that constitute the "life in Christ." Created by God as the most sublime expression of his divine love, we are called to enjoy everlasting communion with him in the fellowship of those who reflect through all eternity his radiant sanctity. Yet like those saints who have gone on before us- the myriad of martyrs, "confessors" and other holy people who have "fought the good fight" and emerged victorious we can only attain to divine sanctity through the exercise of faithful stewardship, offering "ourselves and each other and all our life to Christ our God." Admonishing members of the church in Corinth who were tempted to give in to the lure of fornication, the apostle Paul asks rhetorically, "Do you not know that your body is a temple of the Holy Spirit within you, which you have from God?" Then he makes the startling assertion: "You are not your own; you were bought with a price. Therefore glorify God in your body!" (1 Cor 6:19-20). Christian stewardship demands that we "render unto God that which is God's." As the parable of the talents makes clear, stewardship of this kind involves not mere caretaking, but the bearing of fruit: rendering to God what is his, with interest, for the glory of God and the salvation of his world. Created in the divine image and called to assume the divine' "likeness" by becoming "perfect" as our heavenly Father is perfect, Christian believers assume, as an inescapable aspect of their life and calling, an arduous, ascetic struggle against demonic powers of sin, death and corruption. Bearing the cross of Christ daily, they embark on an inward pilgrimage that leads, through continual repentance, from death to life and from "glory to glory," to attain at the end everlasting communion with God. This is their God-given vocation, just as it is their unique source of ultimate meaning and personal value. It is this sublime vocation that confers upon human existence its sacredness or sanctity. It alone endows human life with eternal value, from conception, through physical death, to resurrected existence in the Kingdom of God. Accordingly, any reflection on the moral issues that shape and influence human life must presuppose an anthropological perspective, faithful to the Church's Tradition, which acknowledges and honors that sanctity. To speak of the sanctity or sacredness of human lift is also to speak of "personhood." One is truly a person only insofar as one reflects the "being-in-communion" of the three Persons of the Holy Trinity. This is a much misunderstood concept in present-day America, where the "person" has been thoroughly confused with the "individual," Individual characteristics distinguish us from one another, whereas authentic personhood unites us in a bond of communion with each other and with God. We can truly claim to be persons only in so far as we embody and communicate to others the beauty, truth and love that unite the three Persons- Father, Son and Spirit-in an eternal tri-unity. The Trinitarian God is thus the model, as well as the source and ultimate end, of all that is authentically personal in human experience. It is as personal beings that we bear the ineradicable image of God; in fact, that image determines our personhood. Yet we are fulfilled as persons, and thus actualize within ourselves authentic sanctity, through the arduous work of ongoing repentance and ascetic struggle that leads to personal growth in the divine likeness. The "sacredness" of life, in other words, is intrinsic to our very nature; yet it is "actualised," made concrete and effective in daily existence, through our ceaseless effort to affirm and preserve an authentic "sanctity" or holiness of life. Acquisition of sanctity therefore, requires our active participation, a "synergy" or cooperation with divine grace that involves "putting off the old Adam" and "putting on the new." St. Paul expresses the dynamic quality of this ongoing inner conversion in these terms: "Put off your old nature which belongs to your former manner of life and is corrupt through deceitful lusts, and be renewed in the spirit of your minds, and put on the new nature, created after the likeness of God (ton kata theon) in true righteousness and holiness" (Eph 4:22-24, RSV). "Sacredness" and "sanctity' are often used synonymously to speak of the divine origin and purpose of human existence. In light of what we have just stressed, however, it might be preferable to speak of our life as "sacred" by virtue of its created nature that embodies and gives expression to the divine "image." The life of every person is "sacred," insofar as it is created by God with the purpose of participating in his own holiness, and possesses the capacity to reflect the presence and glory of God from its depths. (However much that capacity may be diminished by sin and willful rejection of God, Orthodox anthropology affirms that the divine image can be obscured but never eradicated; there is no "total depravity," however morally depraved a given individual may in fact be.) "Sanctity," on the other hand, would refer to the personal or "hypostatic" qualities that one attains through ascetic struggle against temptation and sin, as well as through the acquisition of virtue. Sacredness would thus be considered as a function of "nature" and sanctity, as a function of "person." Christian existence is nevertheless paradoxical: although our personal struggle, our "spiritual warfare," is indispensable and unavoidable in the life of faith, its fruits depend entirely on the grace of God. Orthodoxy insists that a "synergy" between God and his human creatures is essential to the work of sanctification, of attaining "sanctity." Still, sanctity remains a gift, wholly unmerited and wholly unattainable by our own efforts. While the quest for sanctity requires a profound sense of responsibility on our part, the fruit of that quest is produced by God alone. As "it is no longer I who live, but Christ who lives in me" (Gal 2:20), so it is not I who achieve holiness, but rather the "Spirit of holiness" (Rom 1:4) who dwells in me and who alone works out my salvation. Endowed with "sacredness" from its conception, human life thus finds its ultimate sense, its deeply "spiritual" meaning, in the quest for "sanctity" or holiness. This distinction between sacredness and sanctity is useful, and it conforms to Orthodox anthropology. Modern ethical discourse nevertheless tends to confuse the terms. This is especially evident in the impassioned discussions between those who represent either a "sanctity of life" or a "quality of life" perspective in assessing moral issues. There has been a tendency in recent years to oppose these two perspectives, setting "sanctity" and "quality" over against each other in an unresolvable tension. Proponents of the "sanctity of life" principle, according to a popular caricature, will want to preserve biological existence at all cost, irrespective of the degree of suffering endured by the person concerned. "Quality of life" proponents, according to the same caricature, strive above all to avoid debilitating pain and suffering. Therefore they favor procedures such as "abortion on demand" and "physician-assisted suicide," to assure control over the "quality" of life experienced by a pregnant woman or a terminally ill patient. In reality, the former position represents a philosophical view known as "vitalism." This is a form of bio-idolatry that by its very nature violates the "sanctity" of life, since God-given life is ultimately fulfilled beyond the limits of biological existence. And insofar as the radical "quality of life" position places the avoidance of mental and physical pain above every other value, it deprives human lie of its innate God-given value, purpose and destiny. We shall return to this issue later on in our discussion of euthanasia and the "quality of life" debate that has received so much attention from ethicists during the last decade. For the present we should stress only this point. Rather than set the "sanctity of life" and the "quality of life" in opposition to each other, we need to see the two as complementary. Christian experience knows that pain and suffering are potentially redemptive. While certain levels of physical or emotional anguish can appear to be "dehumanizing," even those who suffer intractable pain are in the hands of God and can experience his loving care and mercy. It is precisely these gifts of divine love and mercy that assure the true quality of human life in any condition or circumstance. Similarly, it is the free gift of God's own holiness that suffuses human life with authentic sanctity. If both the sanctity and the quality of human life are seen to derive from divine grace, then the opposition reflected in the current debate is simply false. The true "quality" of personal existence is defined by its attainment of "sanctity"; and authentic "sanctity" derives only from a particular "quality" of life, conferred by knowledge of and participation in the loving mercy of an infinitely compassionate God. This complementarity between the quality of life and the sanctity of life is possible because human life by its very nature is "sacred." Its origin, purpose and ultimate end are given and determined by God alone. Once again, "sacredness" and "sanctity" need to be distinguished, the former referring to the essential goodness and infinite value of human life created in the divine image, and the latter to the arduous yet blessed struggle of the human person to attain and reflect the divine likeness. Facing Moral Dilemmas These introductory remarks are intended to provide us with a framework for considering some of the most difficult ethical questions that we as Christian people have to face today. It has often been pointed out that "Christian ethics" is a Western category. "Eastern" Orthodoxy, on the other hand, traditionally focuses on "moral theology," which is basically traditional ascetic theology: exposition of the interior struggle toward sanctification through the grace and transfiguring power of the indwelling Holy Spirit. The new discipline of Orthodox Christian ethics has come into being to help us as pastors and lay people to deal effectively and faithfully, in the light of authentic "living Tradition," with moral dilemmas raised in modern technological societies. Its aim is above all to develop criteria that will enable us to make good, right, just and appropriate moral choices: choices that conform to the will and purpose of God for ourselves and for the world in which we live. Today's world is one that poses radically new and extraordinarily difficult ethical dilemmas for all of us. This is particularly true in those areas where modern technology has created problems and possibilities that were never envisioned or addressed by either Scripture or patristic tradition. A few examples will suffice to illustrate the problem. 1. Prodigious developments in the area of biomedical technology have raised new questions concerning such matters as procreation and the meaning of "parenting," terminal life-support and euthananasia, together with the burning issue of physician-assisted suicide. Introduction into this country of the French manufactured RU-486 pill is opening the way to do-it-yourself abortions, and other combinations of available chemicals will soon permit a woman to abort an embryo or fetus in the privacy of her own bathroom. Extra-uterine conception has become routine, and its consequences in the realm of sexuality are dramatic. If the pill separated sex from procreation, in vitro fertilization (IVF) has separated procreation from sex. As a result, the covenantal, unitive value of conjugal relations, as a means of participating in God's own creative activity, has been largely obscured. Marriage is no longer perceived as an eternal bond of mutual faithfulness, responsibility and devotion. Prenuptial contracts, live-in experimentation and quickie divorce are becoming increasingly the norm. We should hardly be surprised, then, at the exponential growth in ersatz homosexual "marriages," teen-pregnancies with single-parenting, and prime-time sexual exploitation. Then again, respirators, dialysis machines and other routine instruments of modern medicine pose awesome questions regarding the allocation of limited resources and the selection of those who will receive and those who will be denied treatment. Medical advances such as antibiotics, ventilators and vital organ transplants have made it possible to sustain biological existence almost indefinitely, even when the patient is in a deep coma or "persistent vegetative state" (PVS), conditions that in former generations would have allowed the terminally ill to pass quietly into the hands of God. (Only the oldest of us remember when pneumonia was welcomed as "the dying man's friend.") Each of these areas involves us in ethical dilemmas: "hard choices" made necessary by advances in biomedicine. Consequently, it is incumbent upon us as members of the Body of Christ to reflect together with medical professionals and theologians, to determine proper uses and limitations of modern medical technology 2. A second area of grave ethical concern is that of genetic engineering, and particularly the "human genome initiative." The ability to identify and restructure genetic material has created the possibility to manipulate life, both human and otherwise, at its most fundamental level. One frightening consequence of these developments is the inevitable reaction of insurance companies, which will refuse to pay for the support of a child that could have been determined in utero to be "genetically defective" and therefore subject to legal abortion. Another potential danger concerns genetic manipulation in the interests of "eugenics," which seeks genetic improvement of the human species. Negative or therapeutic eugenics promises to prevent or cute diseases that up to now were either severely debilitating or lethal. Positive or "innovational" eugenics, which would enhance positive traits and capacities, proved disastrous in the hands of the Nazis and bodes little better for our own day. Some are asking: If we can create new life forms in agriculture and lower animals, why shouldn't we improve the human stock by increasing intelligence, physical strength, and the like? The dilemma, of course, lies in deciding precisely which characteristics will be deemed appropriate to what the eminent Protestant ethicist Paul Ramsey so aptly described as "fabricated man." In the modern world, where competition is a dominant force in motivating human behavior and one’s survival often depends on "one-upmanship" while protecting oneself from physical threat and emotional stress, the criteria for determining which "qualities" should be enhanced in the human species are not likely to be determined by reference to the Ten Commandments or the Sermon on the Mount. 3. The Church is laced with equally grave problems created by the popular media and the computer-based explosion of information. The so-called "information superhighway" offers a remarkable potential for good, making possible interactive education, jobs done at home rather than at a distant workplace, and access to global interconnected resources. But that same superhighway can lead directly to the undermining of social and spiritual values: for example, TV mind-control, which means conformity to the lowest common denominator; or the power of the media concentrated in too few hands, leading to increasingly "managed" news; or the airing of grievances over the Internet, in violation of the most elementary rights of privacy; or the growing interface between universities, the military and business, resulting in a "military-industrial-academic complex" which is highly detrimental to academic and personal freedom. A consequence of no little significance of this information explosion is that it focuses all of our attention and resources on technology as such, as we see so dramatically today in our secondary schools and universities. Together with "computer centeredness" goes a corresponding decrease in appreciation for philosophy, art and literature. To write a program today is vastly more important, and lucrative, thin to write a poem. This is a tragic state of affairs that has seriously diminished our capacity for creativity and has led to a severe spiritual crisis, both individual and collective. Consequently, it needs to be treated as a "bioethical" issue of the first importance. 4. Modern psychology has also led to developments which must be judged both good and evil. On the one hand, it has provided us with new and important insight into specific behaviors traditionally attributed to "the will acting in freedom." For example, we now recognize that alcoholism is a disease rather than the product of a "weak will"; that chronic anger is often an expression of suppressed rage resulting from childhood abuse; and that certain forms of criminality, and many cases of suicide, result from imbalances in the brain's neurotransmitters. In addition, insights provided by the study of psychology have led to the production of drug therapies that have significantly improved the quality of life for people who suffer from what in former generations were wholly debilitating mental diseases. The negative consequences of our fascination with modern psychology are basically spiritual. By stressing the neuro-chemical correlates of various antisocial behaviors - from alcoholism, through child abuse, to suicide - psychological explanations of out behavior can very well lead to sheer relativism and to the rejection of personal responsibility. The primary question provoked by much modern psychology is the one raised many years ago by Dr. Karl Menninger: "Whatever became of sin?" If Orthodox Christians are to overcome their traditional suspicion of the science of psychology, it cannot be at the expense of minimizing our awareness of the power of sin and the importance of responsibility in our personal and social affairs. Biomedical Ethics as a Theological Discipline These are just some of the contemporary issues that have led theologians and philosophers, as well as members of the medical and legal professions, to create the field of "bioethics." The term itself is unfortunate, since it is so easily distinguished and divorced in the popular mind from considerations developed in the traditional discipline of moral theology: considerations grounded on the premise that human lift is indeed a sacred gift, whose meaning and end can only be described by the vocabulary of asceticism, sanctification, illumination, perfection and deification. [1] In the chapters that follow we focus on a number of specific issues in human life, from conception to death. One of our primary concerns is with the discipline of medical ethics and its attempts to address problems that have arisen with recent advances in biomedical technology. Before we turn to those Issues, however, it is necessary to indicate why, fiorn an Orthodox point of view; medical ethics needs to be understood and developed as a theological discipline. Generally speaking, "ethics" studies human behavior. It is normally regarded as a descriptive science that attempts to discern and analyze the underlying principles and values that govern human conduct. "Moral theology," on the other hand, is usually considered to be prescriptive: it proposes the "oughts" that shape the moral life in response to God's commandments and purposes as they are revealed in Scripture and other sources of Holy Tradition. To speak of specifically "Christian" ethics, however, complicates the matter, since it suggests that the purpose of the field is not only to analyze our behavior but to propose a cure for our moral illness, our sin. In common usage, then, Christian ethics and Christian moral theology are virtual equivalents, since the act of making ethical judgments involves by its very nature a striving toward sanctity or holiness. This is true as well with regard to the relatively new discipline of medical or "biomedical" ethics. The expression could refer simply to the way physicians and other health care specialists treat patients. As such it would either be purely descriptive (analyzing the values, motives and intentions of the medical team); or, if it ventures into the realm of prescription (how the team should behave and why), its moral directives would be governed by the ethicist's own philosophical outlook. "Christian medical ethics," on the other hand, if it is in any sense "orthodox," presupposes a value system grounded in certain truths, or rather in "the Truth' that has revealed itself and continues to reveal itself within the Church, meaning the all-embracing reality of God's presence and purpose within creation. Orthodox ethics, and particularly medical ethics or bioethics that deals specifically with issues of life and death, is based on at least the following presuppositions: 1) God is absolutely sovereign over every aspect of human existence, from conception to the grave and beyond. This conviction is well expressed in a popular morning prayer, attributed variously to St.Philaret of Moscow (d. 1867) or to spiritual fathers of the Optino Monastery: "Teach me to treat all that comes to me throughout the day with peace of soul and with firm conviction that thy will governs all... in unforeseen events, let me nor forget that all am sent by thee." The divine imperative to "Choose life!" is fulfilled by loving the Lord, obeying his voice and cleaving to him (Dt 30:19); that is, by offering ourselves in total surrender to his sovereign authority and purpose. That authority is precisely what requires Orthodox Christians to reject "abortion on demand," active euthanasia, and any procedure that means taking life (and death) into our own hands. 2) The Holy Trinity- characterized by "community and otherness," by essential unity and personal distinctiveness -~ should serve as the model or icon of every human relationship. Bound together by our shared humanity in the communion of the ecclesial Body, yet serving one another with differing spiritual gifts, we are called to "responsibility": to respond to one another with a self-giving love that reflects the boundless love of the -three Persons of the Godhead, shared among themselves and "poured into our hearts by the Holy Spirit" (Rom 5:5). 3) Growth in the moral life is only possible insofar as we experience the "eschatological tension" of eternal life present in our midst. "The hour is coming and now is," when the sole meaning and value of human existence is to "worship the Father in Spirit and truth" (In 4:23-24). Christian ethics is essentially "teleological"-in the profoundly biblical biblical sense - with its focus on realizing in the here and now the beauty, truth and perfection of life in the Kingdom of God. What do these three principles or presuppositions imply with regard to medical ethics? Given the climate in which we live today, the following points stand out. Health and wholeness have ultimate meaning only within the perspective of God's eternal purpose, the divine economy to be fulfilled at "the second and glorious coming" of Jesus Christ. Medical care, therefore, should serve not only the proximate goal of restoring or improving bodily health; it should strive to provide optimal conditions for the patient's spiritual growth at every stage in the life cycle. This means curing disease; but it also means, particularly in terminal cases, easing pain and distress by any appropriate means in order to allow the patient, through prayer, -confession and communion, to surrender him/herself into the hands of God. "Medical heroics" result all too often from the prideful attempt on the part of caregivers to avoid "failure," defined as "losing" die patient to death. Such hubris is responsible for a great deal of unnecessary suffering on the part of patients and their families, and it represents idolatry of the worst sort insofar as the medical team assumes the role of God. Then again, matters of "informed consent" and "patient's rights" need to be evaluated in the light of the Gospel's teaching on freedom and responsibility. Some Christian ethicists today are suggesting that our unity in the Body of Christ implies a mutual commitment that in certain cases transcends the need for informed consent and transforms the self-centered notion of personal "rights" into the self-giving gesture of care offered to others in love. While this raises the specter of the "slippery slope towards paternalism in a stark and perhaps dangerous way, thus potentially jeopardizing patient autonomy and the very principle of informed consent, the theological vision behind the suggestion is profoundly "evangelical." It recognizes that from the point of view of health care, ultimate meaning and value in life lie not in the mere preservation of biological existence, but in the total surrender of self to the loving sovereignty of God. And it grounds personal relationships - between doctor and patient as between the medical team and the patient's family - in the ultimate relationship of love, trust and mutual devotion shared by the three Persons of the Holy Trinity. Modern medical technology has performed wonders for which many of us will be forever grateful. But like any human invention, that technology and its application must be subject to constant reevaluation and judgment in the light of Holy Tradition. To paraphrase a well-worn maxim, "ethics is too important to be left to the ethicists." At its core, Christian ethics is a function of the worshiping, serving Church. This means that the work of doing ethics is a communal, ecclesial work for which each of us is responsible. Just as each Christian is called to be a theologian by offering self and the world to God in prayer, each is called to be an ethicist, a "moral theologian" in the proper sense. Informing ourselves of the issues, discussing them in family, parish and on the job, and taking a stand, both public and personal, that reflects our understanding of the Gospel and of God's imperative in out life, we can faithfully and usefully serve the many dedicated health care professionals who live to serve us, while providing them with the guidance and discernment they seek. Thereby "medical ethics" can be restored to its proper place as a theological discipline that serves the glory of Christ and the spiritual health of the members of his Body. [2] Before we consider specific biomedical issues, it should prove useful to spell out in greater detail the theological presuppositions that govern our making of moral decisions. With this in mind, chapter one develops several of those Orthodox dogmatic teachings, noted in this introduction, that bear especially on issues of life and death. Its purpose is to offer the reader a particular perspective, a vision of God's presence and purpose in creation and human existence, that provides the rationale for the specific moral judgments reached in the following chapters. Above all, it aims to ground in Holy Tradition the conviction that human life is indeed a sacred gift: one to be received with profound gratitude and offered back to the Author of Life as a "sacrifice of praise." + [1]. For highly perceptive analysis of "bioethics in the ruins," resulting from the "content-less moral vision" of so many of its current practitioners, see the introduction of H. Tristram Engelhardt’s The Foundation of Bioethics, 2nd ed. (New York: Oxford University Press, 1996), pp. 3-31. This is a valuable contribution by a leading medical ethicist whose entry into the Orthodox Church led to a thoroughgoing revision of the first edition of this work. It is one of those rare books whose endnotes are as informative as the text. [2] Edward B. Anderson, M.D., raises in a perceptive and provocative way the very question. "Is There an ‘Orthodox Medical Ethic/’" Ephiphany Journal 12/3 (Spring 1992), 13-17. He answers the question with a qualified negative, pointing out quite rightly that the Church has never proposed "an overarching system of medical ethics." In a few deft strokes he then offers opinions on a variety of bioethical issues including abortion, reproductive technologies, contraception, organ transplants, sexuality and euthanasia. In so doing, he is obeying an intuition common tho those Orthodox who are interested in ethical issues and feel called to express their views to others: to interpret, insofar as possible, the theological (ascetic, mystical, liturgical) tradition of the Church, in an effort to guide the moral conscience of the faithful. As he well recognizes, such guidance (including that offered in this book) needs to be constantly submitted to the "mind of the Church," beginning with the judgment of our bishops and qualified theologians. If there is indeed "an Orthodox medical ethic," its content can only be provided by Holy Scripture, together with the sacramental and liturgical experience of the believing community: provided, that is, by God himself. Consequently, although it may reach some of the same conclusions as found in a system of religious or secular "ethics," the ethics of Orthodox Christians is grounded in a very different presupposition. In Dr. Andersen’s words, "the answers to the medical ethical problems that each Orthodox Christian may encounter in his lifetime will best be answered in the courses of his own spiritual labors."