Posted by
Peter and Helen Evans on Saturday, March 28, 2009 11:40:15 AM
According to this article there is nothing more
frightening to an Orthodox Christian than to "die peacefully in our sleep".
I. Making Decisions at the End of Life in a
Post-Traditional Culture: Finding One’s Way
to God
Orthodox Christianity offers orientation in the
cosmos. More precisely, it leads us away from our
passions and purifi es our hearts so that we can be
illumined by the uncreated energies of God and
come into union with Him.1 Contemporary man
fi nds himself bereft of such orientation. Both his
life and his death tend to be trivialized, reduced
to what can make sense without any recognition,
much less experience, of transcendent meaning,
purpose, and obligation. As a consequence,
much refl ection on end-of-life decision-making
gives priority, if not exclusive attention, to comfort
care, death with dignity, and the preservation
of personal autonomy until death. All of this is
done without ever asking the foundational question,
What was life really all about? much less the
foundational spiritual question of how I should
and can repent from a life that was poorly lived so
as fi nally to turn in repentance to God. Properly
directed care at the end of life is care that focuses
on repentance. To talk about end-of-life decisionmaking
and not to place centrally the urgent issue
of repentance is to miss the target completely.
Care at the end of life should offer a fi nal opportunity
to the dying person to fi nd orientation. That
is, end-of-life care must bring the dying person to
repentance through a recognition of how the holy,
indeed, God, defi nes the meaning of the right, the
good, and the virtuous. Good end-of-life care cannot
be the product of a secular or philosophical
bioethics. It must be the proclamation of a living
theology. Orthodox Christianity teaches how
to become oriented in life and to achieve a good
death. What is important to be said cannot be
stated adequately in secular terms.
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Care At The End Of Life:
What Orthodox Christianity Has To Teach
II. Against the Grain of Secular Culture: Remembering
That One’s Religion Is Not a Personal
Matter
We live in a world that increasingly accepts passive
euthanasia in the sense of withdrawing or
withholding treatment with the intention to bring
about an earlier death. More and more, this world
accepts not only active euthanasia (for example,
the use of analgesics to hasten death), but also
physician-assisted suicide and blatant voluntary
active euthanasia. All of this is exactly what a bad
death is about: it is focused on the willful control
of the end of one’s own life, rather than on
humility and repentance. Orthodox Christianity
brings a quite different message. Orthodox Christianity
teaches repentance, conversion, and the
importance of turning to God. It surely does have
concerns with the good, with justice, and with
protecting life. But these concerns are set within
concerns for the holy. Orthodox Christianity is not
against making the world better; indeed, it knows
that in the end the world will be made better after
Christ comes in judgment (Revelation 21). In the
meantime, the Orthodox Church must remind the
world that the fi rst Orthodox Christian convert to
enter heaven was the thief on the cross, who did
no good thing save to repent and convert (Luke
23:39–43). The thief had no opportunity after his
conversion to accomplish anything worthwhile.
Literally at the end, however, he turned to holiness,
which holiness is personal: the triune God.
Orthodox Christians, too, realize that truth is not
propositional, but personal. Because of his conversion,
the thief on the cross had a good death.
Orthodox Christianity has to teach fi rst and foremost
that we should turn to that Truth and, in so
turning, we will come to know holiness. This fact
of the matter, that truth exists and is personal,
should orient our lives and our deaths, and should
direct all end-of-life decision-making. It should
help us to see the death of the thief as the icon of
a good death.
The personal character of the truth is one
of the central distinguishing marks of Orthodox
Christian theology. To begin with, those who are
theologians in the strict sense are not those who
merely know about God, but those who know
God: they are holy Fathers. At least half of the
great Orthodox theologians of the twentieth century
were not academicians; many never attended
a university. Yet they had noetically experienced
God. They had come to know God.2 This is why
the Orthodox Church rarely, and only for rhetorical
purposes, gives proofs for the existence of
God. Otherwise, such endeavors would be something
like a wife developing fi ve proofs for the
existence of her husband with whom she lives.
Offering such proofs would be a hint that she is
alienated from her husband, that she no longer
experiences his presence. Because we experience
God, we do not believe in his existence as one
might believe in a philosophical proposition. His
presence is realized in our lives and in our deaths.
For this reason, instruction in how to die well is
not derived from manuals and treatises, but from
accounts of the lives and the deaths of saints. We
look to the models of proven successful dying.
This point of attention always directs us beyond
the good towards the holy.
Because it is central to understand the good,
the right, and the virtuous only with reference
to God, Orthodox Christianity refuses to accept
the dilemma that Plato (428–348 B.C.) develops
in his dialogue, Euthyphro. In response to the
question as to whether the good is good because
God approves of it, or whether God approves of
it because it is good, Orthodox Christianity realizes
that the good, including the good of a good
death, can never be understood adequately apart
from God. It is something like not being able to
understand the orbits of the planets without reference
to the sun. Orthodox Christianity refuses
to reduce theology or moral issues to natural-law
refl ections or discursive philosophical analyses
and arguments. It focuses instead on the kind of
person we should be for eternity. It does this in
the face of a Truth that it is absolute and enduring:
the Persons of the Trinity.
In contrast, spiritual character-building in our
contemporary culture is frequently regarded as a
do-it-yourself task, like the assembly of a meal in
a cafeteria. The result is that one examines various
moral and religious positions as if they were
dishes from which one could sample and choose
on one’s own, composing in an aesthetic and willful
fashion one’s own life and one’s own death.
Orthodox Christianity, in contrast, reminds persons
that they must rightly orient their life-anddeath
choices through ascetically directing their
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lives to the meaning of the universe, Who is God.
Orthodox Christianity is thus not simply pro-life,
but pro-life directed to God, which direction in
our lives and deaths is only achieved through
ascetic struggle. One can only have a rightlyordered
ethic of life through turning rightly to
God. The good cannot be understood apart from
the holy. A philosophical analysis and refl ection
will never be enough.3 Orthodox Christianity, as
a consequence, does not offer an ethic of life,
but a way of rightly and theologically living one’s
life. There can be no adequate understanding of
rightly directed decision-making at the end of life,
absent an adequate theological orientation.
Although life in general, and dying in particular,
are ascetic struggles, one should note that
Orthodox Christianity recognizes the importance
of pain control and comfort care. In particular,
Orthodox Christianity has from the beginning appreciated
that pain and distress can bring the dying
to temptation and despair, thus leading them
away from a wholehearted pursuit of salvation.
St. Basil the Great (329–379) therefore notes
with approval that “with mandrake doctors give
us sleep; with opium they lull violent pain.”4 Indeed,
twice in each Liturgy, the Church prays for
“a Christian ending to our life, painless, blameless,
peaceful, and a good defense before the fearful
judgment seat of Christ.”5 This prayer emphasizes
the goodness of a death that is painless and
peaceful. In so doing, however, it does not lose
sight of the great offering to God made by the
death of martyrs. In all these cases, a blameless
death is like the death of the thief, repentant and
marked by confession of Christ. As a result, there
is nothing more frightening than the prospect of
dying peacefully in one’s sleep without warning,
without a fi nal opportunity for prayer and repentance.
In summary, with regard to decision-making
at the end of life, there must be a focus on God,
and this can require withholding and withdrawing
treatment when such would distract from turning
wholeheartedly to God. The focus remains on
wholeheartedly aiming at repentance.
III. Seeing the Big Picture
Life lived fully within the horizon of the fi nite and
the immanent has a trivial character in contrast
to a life lived in recognition of God. So, too, does
end-of-life decision-making remain radically misdirected
and incomplete, no matter how much it
might be embedded within a concern for death
with dignity or directed by an ethic of life. Set
within the horizon of the fi nite and the immanent,
refl ections on one’s death and decision-making at
the end of life highlight creature comforts for a
creature who thinks of himself as about to go out
of existence. One is blind to the earnestness of
taking advantage of fi nal opportunities rightly to
orient one’s life towards the future beyond death,
that is, to God. Orthodox Christianity has the task
of pointing out this big picture: the signifi cance of
death and the nature of the truth. As to the latter,
Orthodoxy reminds the world of Who this Truth
is. Only oriented to the Triune God can one in the
end understand the meaning of life, the signifi -
cance of death, and the goal to which one should
direct one’s decisions at the end of life.
Rt. Rev. THOMAS Joseph
Bishop of Charleston, Oakland and the Mid-Atlantic
(Endnotes)
1 The fi nal stage beyond illumination (theoria or union with
God) is what is achieved by true theologians. “The mystical
and perfecting stage is that of the perfected ones, who
in fact become the theologians of the Church” (Hierotheos,
Bishop of Nafpaktos, Orthodox Spirituality, trans. Effi e
Mavromichali, [Levadia, Greece: Birth of the Theotokos
Monastery, 1994], p. 50).
2 “The theologians of the Church are only those people who
have arrived at a state of theoria, which consists in illumination
and theosis. Illumination is an unceasing state, active
day and night, even during sleep. Theosis is the state in
which someone beholds the glory of God, and it lasts as long
as God sees fi t” (John S. Romanides, Patristic Theology,
trans. Hieromonk Alexis [Trader], [Goldendale, Washington:
Uncut Mountain Press, 2008], p. 50).
3 Orthodox Christianity has an attitude towards philosophical
refl ection like that of St. Paul’s:
“Where is the wise? Where is the scribe? Where is the disputer
of this age? Did not God make foolish the wisdom of
this world? For since, in the wisdom of God, the world knew
not God through its wisdom, it pleased God through the
foolishness of the preaching to save those who believe. For
indeed, Jews ask for a sign, and Greeks seek wisdom, but
we proclaim Christ Who hath been crucifi ed; to the Jews,
on the one hand, a stumbling block, and to Greeks, on the
other hand, foolishness” (1 Cor 1:20–23). This Pauline insight
is often reinforced by the Fathers. One might consider
the rather critical things St. John Chrysostom has to say
regarding secular Greek philosophy. See, for example, his
fi rst Homily on the Gospel of Saint Matthew and his second
Homily on the Gospel of Saint John.
4 St. Basil the Great, “The Hexaemeron,” Homily 5, §4, in
Nicene and Post-Nicene Fathers, Second Series, eds. Philip
Schaff and Henry Wace (Peabody, Massachusetts: Hendrickson
Publishers, 1994), vol. 8, p. 78.
5 The Liturgikon (Englewood, New Jersey: Antakya Press,
1989), pp. 281, 299.
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