Bioethics and Social – Approaching the boundaries of medicine

1. Quotation marks

In recent years, health sciences have made great progress, long-standing medical problems have been solved, new drugs have been discovered, new therapeutic methods have been applied, medical technology has been developed, great importance has been given to specialization and the work of doctors has become more effective. Research is in constant evolution, while "science is possessed by uncertain faith, never by illusory certainty."*1 At the same time, unprecedented ethical dilemmas arose, which are difficult to overcome by doctors MONASTERY. To address them, the assistance of politicians, philosophers, lawyers, theologians, religious ministers, sociologists, geneticists, biologists, etc. was sought. This is also evident from the way in which bioethics committees are formed on a global scale.

This article will focus its problematic on the following questions: How does medicine and theology see man and define his health? Is it appropriate, and if appropriate, can limits be set on the research and practice of medicine? How is the physician's personality formed and what role does it play in this delimitation? Is it because society has unlimited expectations from medicine and absolute trust in science that it exerts some peculiar pressure on physicians for treatment at any moral or other cost? Do all patients have access to new medical methods to restore their health? What proposals could be formulated in order to formulate ethical criteria in the field of medicine?

2. Health and illness

Starting from the first question, it should be noted that health is a precious good. This is why the Church prays "for mercy, life, peace, health and salvation"*2 of all people. However, health cannot be absolutized and become an end in itself. Moreover, many people in world history suffered from some physical or mental illness, but this did not prevent them from distinguishing themselves and excelling in various fields. For the theology of the Church, health is placed in a broader context. In parallel with physical health, mental and spiritual health are of great value. Human passions, for example, are characterized as diseases of the soul, which have a spiritual origin and physical consequences. Saint Isaac the Syrian writes: “Passions are illnesses of the soul, incidental and inherent in nature, and derived from health itself.”*3 According to the theology of the Fathers, the passions*4 are characterized as an “unnatural” state, while virtues are “natural”. When this dimension is not highlighted and passions are considered as normal functions, confusion is created for the psychosomatic view of man. Let us mention as an example the passion of self-love, which is directly related to what in modern language is called narcissism. Self-love is “the passionate and unreasonable friendship towards the body”*5. This gives rise to anger, resentment, and insolence.*6, avarice, gluttony and vanity. There is a great difference between the reasonable care of the body and its idolization, which is done in various ways and instills self-love. Also, it is one thing to take healthy and easily digestible food and another to gluttony, overeating, debauchery and drunkenness, which also lead to physical diseases.

Modern civilization, but to a certain extent modern science too, sees man in a one-dimensional way. With this view, physical health is absolutized. Its spiritual nature is ignored or not taken seriously. The human body loses its sacredness and is treated mechanistically. It has been pointed out that: "Anthropology, on which modern medicine is founded, is essentially foreign to Christianity."*7This statement may seem excessive, but if one considers the fragmented nature of modern scientific knowledge and the inability to provide satisfactory answers of a universal nature about life and death, pain and illness, one understands the need to resort to another kind of perspective.

3. Medicine, bioethics and sociology

Medicine as a science naturally prioritizes objective knowledge, which has an absolute character. And while in other so-called “positive sciences” the prioritization of objective knowledge does not seem to directly contradict the person, in medicine, which is called upon to deal with people personally, its prioritization has a direct impact on the correct view of the person. This is sometimes felt in the medical community, and thus speaks of a personal approach to patients. It is often said that: “There are no diseases but specific patients.” This perception is closer to the theology of the Church, which deals, if necessary, with the pastoral problems of people in a person-centered and individualized manner.

The issue becomes more complex with the development of biotechnology*8With this, medical dilemmas increase and often become insurmountable. Thus, bioethics was born, in order to contribute to the removal of the deadlocks created by the new conditions for practicing medicine.

It should be noted at this point that the field of bioethics is vast and concerns three levels:*9, the personal, the natural and the social. First of all, it deals with human problems on a personal level: medically assisted reproduction, prenatal testing, preimplantation genetic diagnosis, gene therapy, improvement interventions, therapeutic upgrades, experimentation on human embryos and embryonic cells, transplants, determining the beginning and end of life, euthanasia, suicide, genetic counseling, palliative medicine are the main ones.

Bypassing the level of nature, which is enormous, it should be briefly mentioned that the issues that arise at the social level are equally large, because they have a political, legal and economic dimension. Some of these are: health policy which is directly linked to social justice in the field of health, the use of information technology and the formation of a personal data base, the patenting of human life, informing public opinion about the risks of using new technologies especially in reproductive processes, the biotechnological inequality between developed and underdeveloped countries or even the lack of basic medicines and vaccines in third countries.* 10 etc.

It should also not be forgotten that bioethics and the social sciences themselves, - especially sociology as a geometer of social reality - are not in a position to offer their best services for determining the limits of medicine. They can certainly help from their own perspective. However, they cannot dictate to medicine its limits, which it must ultimately study itself based on a) the principles of Hippocrates, b) the Aristotelian mean, c) the principle of the person, d) Christian anthropology and e) the patristic tradition.

4. The philosophical background

In the Hippocratic texts, it is stated that it is not possible for someone to know medicine if they do not know "what a human being is", what are the causes of his creation, what is the relationship with what he eats and drinks, but also what are his habits and his special characteristics.* 11 At the same time, great importance is attributed to the personality of the physician. "For the physician is a philosopher and an equal to the god", who is distinguished by "non-love of money, modesty, blushing, suppression, glory, judgment, quietness, response, cleanliness,...absence of demons, divine superiority".* 12 It seems that the doctor needs a broader humanitarian education and spiritual cultivation, in order to perform his work with mental clarity.

The concept of the Aristotelian mean can also help in formulating criteria for determining the limits of medicine. Aristotle, in addition to the four general virtues of justice, prudence, courage and wisdom, speaks of the principle of mean not in the mathematical sense of the term, (i.e. half of 100 is 50), but of practical philosophy, that is, of perfection. Meanness is the balance – symmetry, which lies between two extremes* 13. For example, arrogance and pettiness are vices, while modesty is a meanness - virtue. Between audacity and cowardice lies the virtue of courage-manliness. Between impulse and inertia lies prudence. Between ecstasy and apathy lies sobriety. Meanness is the overcoming of deficiency and excess, not something moderate! In terms of its quality, it is in a way an extreme. The definition of virtue as meanness is of particular importance for our topic, since Aristotle arrived at it taking into account medical thought.* 14"Doing right" is connected to person, time, extent, purpose and manner.

This concept is adopted by the Fathers of the Church as perfection and balance and not as mediocrity. Saint Gregory the Theologian writes: “Virtue lies in the middle of evils, like a rose in the cold and the bitterness of thorns.”* 15A related term in the theology of the Church and a fundamental pastoral principle is discernment.

5. Elements of Christian anthropology

The knowledge of Orthodox Christian anthropology also contributes to the search for the limits of medicine. Man was created “in the image and likeness” of God, possessing reason and free will. He comes from the creative love of God and that is where his final destination lies. Every movement that interrupts communion with the source of life leads to the path of death. The Creator “formed the body from the earth, and gave it a rational and intellectual soul through the intimate breath, as if it were a divine image,” writes John of Damascus. And he continues, “for ‘in the image’ means the intellectual and free will, and ‘in the likeness’ the likeness of virtue as much as possible.”* 16. And there is divine harmony and unity between soul and body. As has been aptly pointed out, "man is not a machine that works or turns off, but a spiritual organism with juices of feelings and blood of principles, ideas and values. His life is not a chemical equation with symbols and parameters, but a mystery with grace and indeterminacy"* 17. In the Church, the Christian experiences transformation and sanctification through the sacraments as a single psychosomatic entity. He is saved as a member of the body of Christ and in communion with other people. Even his death is not an irreversible loss, but a continuation and upgrade to another level.

6. The contribution of Basil the Great

Basil the Great, who had a weak body and at times could not move easily* 18, while at one time he was unable to sleep and was "on the border between life and death"* 19, developed an enormous pastoral and social work and bequeathed us a writing work of timeless scope. The illness did not hinder him and perhaps “facilitated” his work. He also knew not only the medicines prepared from herbs, but also the chemicals, “those found from metals”. His contribution to the search for the limits of medicine is particularly useful, since he himself had first studied medicine, was a patient and was interested in the ethics of people according to Christ.

The following question was asked to Basil the Great: Is it consistent with Christian piety to use medical drugs?* 20 In response, he states that, after the fall, God bestowed medicine, like the other arts, to serve as an auxiliary to the illness of human nature. And it is not right, because some do not use medicine well, to avoid the benefit that comes from it. However, he also points out the danger of extremism, which can be done in two ways. Either by basing the hope of health only on doctors, calling them saviors, or by avoiding all medical care.* 21 This position of Basil the Great is reminiscent of the Aristotelian mean.

The Christian accepts as a blessing from God the goods provided by medical science and connects them with gratitude to God and the care of his soul. Connecting physical with spiritual health, Basil the Great cites the example of Christ, who sometimes healed by making clay and urging people to wash in the pool of Siloam, sometimes he granted health immediately by his own will, while in other cases he left the sick to struggle with their illnesses, so that they would become “more patient” in the face of temptation.* 22 This is a kind of pedagogy, which also concerns the method of treatment. It is characteristic that Basil the Great invokes sound reason for the acceptance of painful medical methods, noting at the same time that not all diseases require medical help. Thus, he attributes great importance to the spiritual benefit that can come from the disease and the use of medicine. And he concludes: “…and when we bring in a doctor, when reason permits, we do not abandon our hope in God.” He also notes that medicine contributes to the abstinence and spiritual exercise of patients, since “it cuts off pleasures, and gluttony, and variety of diet, and the care of strange spices, as unprofitable.” In any case, “either we are ever indebted to the prescriptions of medicine, or we give up, the goal of pleasing God is preserved.”* 23

7. Designing criteria for defining the boundaries of medicine

a. For the Orthodox Christian tradition, there is an interdependence of physical, mental and spiritual health. Every passion and sin, whether as a failure, or as a violation of the divine will, or as a transgression of the natural order, erodes the innermost being of man and has repercussions on physical health.

b. Doctors know in principle their insurmountable limits. They can cure diseases, relieve physical pain, perform surgery and administer analgesic drugs, prolong life. However, they are unable to defeat death. Especially those who are in the ICU or who attend terminally ill patients confess that often by fighting for life and losing it, they experience the feeling of failure. If this is combined with the pain, often the anger and rage of relatives, the burden that falls on the backs of doctors is unbearable.

c. Medicine based on the Hippocratic texts, the Aristotelian mean, the principles of modern bioethics and taking into account Christian anthropology as well as the patristic tradition can set its own limits each time. The personality of the doctor, his Christian or even human conscience also plays an important role. Thus, he cannot be a "rational liberal"* 24 and neutral in relation to the cultural and spiritual tradition of the place. It also leaves room for the healing grace of God and cannot overlook the Christian faith of the patients.

d. Medical research that is also linked to other disciplines is difficult to control. It is probably unlimited. Neither the principles of modern bioethics are sufficient, nor are state laws and regulations, no matter how strict they are. The matter becomes more complex when there is also an economic parameter to the issue. Nevertheless, based on what has been said and what has been implied above, the doctor as a therapist and researcher can formulate criteria to exercise his work for the benefit of man as a person.

e. In our days, the amazing power of “social networks”, of healthy relationships between people and their effects on health is emphasized by leading scientists Christakis and Fowler. They write: “Our health does not depend only on our own biology, nor only on our own choices and actions. It also depends, literally, on the biology, choices and actions of those around us… We are not only affected by the health and behavior of our partners and friends, but also by the health and behavior of hundreds or even thousands of people in our wider social network. Most people know little about how public health is protected. And what we do know, we think of in very individualistic terms”,* 25 That is, lovers of self. Therefore, it becomes clear how valuable the diffusion in society of selfless love, social responsibility and solidarity, mutual assistance, mutual respect, brotherhood, understanding, tolerance, condescension and the priority of the collective over individual interest, but also of ardent faith in God who "works miracles".

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*1 (...) N. Matsanioti, "Research at the beginning of human life", Church and Bioethics, the reason for science and the reason for religion, published by the Orthodox Center of the Ecumenical Patriarchate, Champéry 2008, p. 26.
*2 (...) Extensive, Divine Liturgy.
*3 (...) Isaac Syrou, Reason 83, ed. I. Spetsieris, p. 317.
*4 (...) On evil and passions see G. I. Mantzaridis, Ethics II, Pournara Publishing House, 22009, p. 59 et seq.
*5 (...) Maximus the Confessor, Chapters about love, 3,8, PG 90, 1020A. Philokalia II, p. 28.
*6 (...) Theodoros of Edessa, Psycho-Benefits Funds, 93 Philokalia I, p. 322.
*7 (...) G. I. Mantzaridis, "Theological issues of transplants", Church and transplants, Special Synodal Committee on Bioethics, published by the Ecumenical Council of the Church of Greece, Athens 2001, p. 254.
*8 (...) See Jeremy Rifkin, The Age of Biotechnology, Genetic Commerce and the Dawn of a Brave New World, translated by A. Alavanou, published by "New Borders" - A.A. Livani, Athens 1998.
*9 (...) G. Hottios, What is bioethics?, Vrin, Paris 2004, p. 10 et seq. See also the study by Eleni Kalokerinou, “The influence of ancient Greek thought on modern bioethics”, in the collective volume, Bioethics: Ancient themes in contemporary problems, ed. Mark G. Kuczewski – Ronald Polansky, Greek ed. Eleni Kalokerinou, Greek trans. M. Katsimitsis, Travlos Publishing House, Athens 2007, p. 527 ff.
* 10 (...) Eleni Kalokerinou, ibid., pp. 551-552.
* 11 (...) Hippocrates, About ancient medicine, 20, 1-36, introduction - translation - comments Damianos Tsekourakis, Barbounakis Publishing House, Thessaloniki 1994, p. 76.
* 12 (...) Hippocrates, About beauty 5, Hippocrates, Medical ethics, Nosology, transl.- introduction- comments, D. Lypourlis, Zitros Publishing House, Thessaloniki 2001, p. 114.
* 13 (...) Aristotle,. Nicomachean Ethics II, 6,1107a 2 ff.
* 14 (...) See G. Mantaridis, Ethics I, Pournara Publishing House 22004, pp. 37-38.
* 15 (...) Gregory the Theologian, Moral Tale 2, Mortgages of Virgins, 2, 2 PG37,594A.
* 16 (...) John Damaskinos, An accurate version of the Orthodox Faith, 26, Pournaras Publishing House, edited by N. Matsoukas, Thessaloniki 1976, p. 152.
* 17 (...) Archimandrite N. Hatzinikolaou (Metropolitan of Mesogaia and Lavreotiki), "Spiritual ethics and pathology of transplants", Church and transplants, Special Synodal Committee on Bioethics, published by the Ecumenical Council of the Church of Greece, Athens 2001, p. 289.
* 18 (...) Letter R, Eusebius, Bishop of Samosata, PG 32,504C.
* 19 (...) Letter to the Reverend Bishop of Samosata, PG 32, 580A.
* 20 (...) M. Vasiliou, Boundaries across the width, 55, 3, PG 31,1044B etc.
* 21 (...) M. Vasiliou, ibid., 55, 3, PG 31,1048B.
* 22 (...) M. Vasiliou, ibid., 55,2, PG 31, 1045BC.
* 23 (...) M. Vasiliou, ibid., 55,4, PG 31, 1052BC.
* 24 (...) See Elenis Kalokerinou, ibid., p. 547.
* 25 (...) N. Christakis-J. Fowler, Connected, Katopro Publishing House, translated by D. Xygalatas-N. Roumbekas, Athens 2010, pp. 179-180.