In very general terms, "ethics" studies human behavior. It is 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 typically 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 ethics." The expression could refer simply to the way doctors 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 directiveness 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.
In the limited space available here, I would like to recall in the briefest terms a few of the foundational truths that guide Orthodox moral reflection and note their importance in the field of medical ethics. Each of these could be developed at book-length. What follows is merely an indication of the way Christian medical ethics must be informed and guided by the church's theology.
Orthodox ethics, and particularly medical or bio-ethics that deals specifically with issues of life and death, is based on the following presuppositions:
1. God is absolutely sovereign over every aspect of human existence, from conception to the grave and beyond. The divine imperative to "Choose life!" is fulfilled by loving the Lord, obeying His voice and cleaving to Him (Deut 30:19); that is, by offering ourselves in total surrender to His sovereign authority and purpose. It is precisely that authority that 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 both images and conveys the love of God in Jesus Christ.
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" (Jn 4:23-24). Christian ethics is essentially "teleological," 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:
1. 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 care-givers to avoid "failure," defined as "losing" the 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.
2. 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" in a stark and perhaps dangerous way, the theological vision behind the suggestion is profoundly "evangelical." It recognizes that from the point of view of healthcare, 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 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 re-evaluation 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 theological discipline. 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 our life, we can faithfully and usefully serve the many dedicated health-care givers who live to serve us, while providing them with the guidance and discernment they seek. And 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.