According to the anthropology of the Orthodox Church, cessation of brain activity does not indicate the separation of the soul from the body. Therefore, there is no justification for identifying it with death.
According to church anthropology, the soul as a special entity fills the entire human body, being present in all its parts. The brain is not its container, but its organ. Brain death means the cessation of obvious manifestations of the soul, but not necessarily its separation.
Translated by Kimberly Gleason
The origins of organ transplantation date back to ancient times. Skin grafting was done in ancient Egypt. However, it is only in our time that attempts to transplant vital organs and tissues of the human body have been crowned with success.
The first successful kidney transplant occurred in 1954, the first successful heart transplant in 1967. In the future, organ transplantation — a method that is not content with symptomatic therapy, but eliminating the very source of the disease, became widespread and aroused enthusiasm throughout the world.
Organ Transplants: A Search for Earthly Immortality?
The reason for this euphoria was not only the obvious advantages of transplantology, but also the fact that it saw the embodiment of the dream of modern man to achieve earthly immortality. And therefore it would not be an exaggeration to say that in the ensuing hype lies the danger of distracting a person from the ultimate goal of his existence and from his most important tasks. And if we take into account the fact that the number of lives that can be rescued by organ transplants cannot even approach one thousandth of the number of lives killed by abortions, it will become even more obvious that transplantation can hardly be considered a panacea for the salvation of humanity.
Excessive belief in organ transplants focuses a person’s interest only on his physical health, at the same time giving him the illusion of a kind of earthly immortality, as already mentioned. The pursuit of such “immortality” cannot be combined with the expectation of eternity and the belief in victory over death in Christ. This means that the Church cannot set as its goal the propagation of slogans like “Give and save,” which, moreover, easily acquire consumer and commercial coloring. Such a position would mean pledging and giving in to the trends of the times.
In the church's vision, biological life and biological death are not opposed to each other, but interrelated. It is not by chance that, by its very nature, life and death always go hand in hand and are two sides of one whole. Life unfolds toward death. Death is present in every phase of life. First of all, death is a transition from one phase of life to another: from temporary life to eternal life. This view not only deprives death of its tragedy, but also gives rise to the possibility of a positive attitude towards it. Both man and animals are equally susceptible to biological death. It is not necessary for a Christian to see in death only a destructive principle. He can accept death in good faith, having received eternal life by it.
And just as bodily death can be the beginning of spiritual life, so too, bodily illness can serve as mental health. From this, however, it does not follow that we must neglect bodily health and life. It is not without reason that church anthropology, which proclaims the psychosomatic integrity of a person, positively assesses not only mental, but also physical health. This is evidenced by numerous church prayers for the health of the soul and body. The church has always blessed and still blesses medical care for the sick.
Modern medicine, despite its amazing successes, is a reflection and development of humanistic anthropology, once rejected by Orthodoxy due to the fact that it imprisons a person in the dungeon of his arrogance and mortality. The interest of such an anthropology to a person is limited to its biological functions, and life is reduced to a biological existence. And often it is noted that where such medicine reigns alone, God is expelled.
Despite all of the above, one should not neglect the meaning of medicine, which is a gift of God, for a person who is in a weak physical or mental state. Christ himself came into the world as a healer of souls and human bodies. The manifestation of the kingdom of God was noted, among other things, by the healing of the sick. The numerous miracles of healing of the sick, performed by the saints, are considered signs of the special Grace of God. It is significant that among the healings there were those in which a new organ was given to a person, such as when the Lord healed a blind person from birth (John 9:1-7), as well as those in which an organ was transplanted, such as a leg transplant to a patient, carried out by saints Cosmas and Damian. Finally, physical illness is in many ways similar to mental illness. And therefore, the healing of bodily ailments can be treated as a model for spiritual education and healing of a person. With bodily illness, it is necessary to refrain from junk food, and with mental illness, it is necessary to keep the commandments of the Lord.
Nothing prevents a Christian from seeking medical help and seeking it from the most qualified doctors. But regardless of whether he relies on the help of doctors or not, the Lord’s purpose should remain his goal and good for his soul. He is called to strive to do this in any of his actions, as the apostle Paul said: “Whether you eat, or drink, or whatever you do, do everything to the glory of God”. So, the believer, if necessary, resorts to doctors and to the achievements of medicine, without relying, however, on them entirely.
Medicine concerns itself with the preservation and improvement of people's health. Being engaged in this, it cares about the extension of a person’s life. The church does not interfere with medicine in such an endeavor, however, it understands well all its relativity. At the same time, the Church also expresses her views on a person and on his life, offering a person not a way of survival, but a life conquering death. Note that the Church's ascetic tradition prescribes the moderate use of medicine and medicine in order not to fall into the sinful desire to make a cult out of life. Naturally, this primarily concerns the ascetic monks. However, any Christian should not completely reject such an approach, because the pursuit of asceticism should be part of his life. And this striving is combined with the spiritual maturity of the believer, naturally leading him to the desire to give more, not to take. Obviously, this also applies to the issue of organ transplantation.
Organ transplantation includes a wide range of procedures and covers a wide variety of forms. It begins with blood transfusions, that is, with the transfer of liquid, then proceeds to the transplantation of parts of double organs, and ends with a liver or heart transplant. In recent years, gene-modified bone marrow cells have been transplanted in gene medicine to treat diseases such as cystic fibrosis. In addition, tissue transplantation can be carried out from one part of the body to another one in the same person, and organs and tissues can be transplanted from one person to another. Finally, an organ donor can be either alive or dead. Various church and theological circles express legitimate fears, or categorical objections, to the human right to participate in such actions. And these objections, of course, are especially strong in the case of a transplant of a vital organ — such as a heart — carried out only after the death of the donor.
Arguments Against Organ Transplants
In addition, a Christian not only can, but must also observe the will of God, as expressed in His commandments. Acting according to the will of God, it always has as its goal eternal life, even if the path to it lies through death. A distinctive feature of Christian anthropology, which made a revolution in the views of man, was that the true life of man is viewed through the prism of death. The question arises: becoming donors of the tissues and organs of our body, do we keep the commandments of Christ, the essence of which conveys the commandment of love for God and man, and do we follow His example?
Christ taught self-sacrifice and sacrificed himself for peace. He feeds people with His Body and Blood, of course, not in order to lengthen their earthly life, but in order to renew them and lead to imperishability. However, by performing miracles, He extends the earthly human life. Thus, He condescends to our weakness. His purpose was not miraculous healing, but the liberation of man from sin: “But to let you know that the Son of Man has the power on earth to forgive sins,” He says to the paralytic, “I say to you: stand up, take your bed and go to your house” (Mark 2:10-11).
The miraculous healings and resurrections from the dead, which Christ did, are at the same time signs of the coming of His Kingdom. If these signs do not lead a person in the right direction, they lose their meaning. Similarly, the Church is called to act, showing signs of her love for a person, while not forgetting her main goal. And the main goal of the Church is not the temporary deliverance of man from biological death, but his final liberation from the fear of death and from death itself. For the Church, “to make death despised is much more important than to be set free from death”.
Of course, constant aspiration for the most important goals does not mean there is any contempt for less important issues. The Church operates not only with acrivia (severity), but also with economia (condescension). In itself, theology can not be economia, but economia has its own theological rationale. Voluntary donation of bodily tissues or organs as a result of disinterested love, is an act that certainly inspires respect and requires a serious and delicate pastoral attitude. It is hard not to admire the act of a man who gives his kidney or eye out of love, in order to bestow life or sight to his neighbor. And it is all the more admirable when a donor is ready to sacrifice his life for the life of his neighbor. Of course, in this case we are dealing with true greatness of spirit, which is revealed in its theological perspective, and not just the act of inclusion on the lists of voluntary donors.
Scientific and Ecclesiastical Definitions of Death
In heart transplantation, an accurate definition of death becomes crucial. The church refers to the death of a person as the separation of the soul from the body. Modern medicine often identifies the death of a person with the death of the brain. Thus death, from the standpoint of the mechanistic anthropology of modern medicine, is defined as an irreversible cessation of brain activity, accompanied by a final loss of consciousness. If an irreversible cessation of brain activity can be established at a purely biological level, then the final loss of consciousness cannot be reduced only to biology, because according to church anthropology, consciousness is inseparably connected to the human soul.
According to the anthropology of the Orthodox Church, cessation of brain activity does not indicate the separation of the soul from the body. Therefore, there is no justification for identifying it with death. According to church anthropology, the soul as a special entity fills the entire human body, being present in all its parts. The brain is not its container, but its organ. Brain death means the cessation of obvious manifestations of the soul, but not necessarily its separation.
However, according to modern medical anthropology, which reduces the soul to mental phenomena or mental actions, brain death is identified with a final loss of consciousness. Thus, it becomes obvious that the controversy over brain death is reduced, ultimately, to confusing the concepts of the essence and energy of the soul. For church anthropology, the soul is a special entity and energy. In contrast, for modern medical anthropology, the soul is just energy. Thus, if, according to medical anthropology, stopping the brain is identified with a final loss of consciousness, then for church anthropology it comes down to stopping the manifestation of its energy.
Ultimately, death as a separation of the soul from the body does not cease to be a sacrament. It is impossible to say with certainty that it coincides with the death of the brain. It may coincide with, it may precede, or it may even follow the death of the brain. People who survived clinical death and returned to life, felt the separation of the soul from the body and left many stories about the unforgettable experience of going beyond the limits of their bodies. This can be considered evidence of the possibility of separation of the soul and body before brain death. Other people returned to life after cardiac arrest and the temporary cessation of cardiac and respiratory activity. This means that the cessation of cardiac and respiratory activity is not the final and irreversible separation of soul and body. What can be argued about the separation of soul and body in cases of artificial maintenance of respiration and cardiac activity? The question remains unanswered.
The Perception and Appreciation of Man as an Image of God
Any kind of organ or tissue donation is a peculiar act of self-sacrifice. Despite this, it is unreasonable to liken this act to the sacrifice of Christ. Christ sacrificed His Body and Blood in order that people would receive not temporary, but eternal life, the acquisition of which can be accompanied by the sacrifice of temporary life. The temporary life should not be separated from eternal life and become independent. However, excessive attachment to temporary life dulls the desire for eternal life. “For whoever wants to save his soul will lose it, and whoever loses his soul for my sake will find it” (Matthew 16:24 / Mark 8:35). “He who loves his life will lose it, and he who hates his life in this world will keep it for eternal life." (John 12:25).
In other words, he who loves his life loses it. He who is able to renounce his life in this world preserves eternal life. This evangelical pathway, in which Christ was in conflict with everyday human logic, undoubtedly lies on a different plane with respect to transplant logic. Notwithstanding the foregoing, the mercy and courage required for voluntary organ donation do not lose their meaning. One can not ignore the need for pastoral support for people experiencing serious health problems.
The concerns raised by some people about the destruction of the posthumous integrity of the bodies of organ donors are clearly scholastic. Man is not identified with his body, with his soul, or simply with their mixture or with their composition. However, there is something that surpasses and unites in itself all this, which is not contained in any way in any of them and is not defined in any way in any of them. A person created in the image of God is always perceived and evaluated through the image of God. These insights and evaluations apply simultaneously to all of humanity, to each individual person and to his individual activities. Despite any separation of matter and spirit, body and soul, individual and society, people who are the image of God and who are keeping the commandment of love, are with God (who is love), and together they form the one body of the Church of Christ.
In the categories of this multifaceted and developing anthropology, every drop of blood given out of love for one’s neighbor is a common sacrifice of the whole person. In this case, the scholastic search for the consequences that donation of organs or tissues may have for the posthumous integrity of the body loses its meaning. At the same time, however, it becomes apparent how incompatible with this anthropology is the mechanistic view of man and the examination of the tissues and organs of his body as medical raw materials or spare parts.
The Orthodox Approach
The Orthodox approach to all the problems of our time must be accomplished on the basis of the measure of perfection, the fullness of which we find in Christ. This measure, which every Christian should see in front of him, should not, however, be turned into a sword, which infects the weak in the faith. Without a doubt, Christian perfection exists for all and should not be hidden from any believer. But human weakness is also inherent in everyone and it is impermissible because of it to blame anyone. The church infinitely appreciates human freedom and, in the name of its preservation, is able to exhaust all the depth of its condescension.
The church says its decisive "no" only in those cases when the freedom of a person is infringed and its holiness is defiled. It is impossible to justify when people are forced against their will to become donors of organs or tissues, either before or after death. The human body must be holy. And this holiness of both the living and the dead body should be respected. The body can not be regarded as medical raw materials or as a warehouse of spare parts.
It cannot be assumed that a person has agreed to be a donor, or that he has given consent, merely because there is no documented refusal to be a donor. The standards for establishing informed consent need to be raised considerably higher than this.
Finally, there is no justification for treating brain death as an absolute criterion for determining the actual moment of death. Orthodox Christians understand that death is the mystery of the separation of body and soul, and a biological measurement of brain activity is insufficient for establishing this.
Orthodox theology does not usually establish once and for all formulated rules of behavior when solving various everyday problems, but it does offer basic guidelines. This is done not out of love for ambiguity and double language, but out of respect for truth and personality. If quantum mechanics, considering matter, uses two mutually exclusive concepts (wave & particle) as complementary, and requires us always to take into account the position of the observer, then how can a one-dimensional mechanistic approach to a person and his health be considered satisfactory? The same objective fact can have two diametrically opposite values for a person. The truth of things does not fit into the framework of external rules.
Just as depriving oneself of life can become either the highest manifestation of love (self-sacrifice), or else an act of selfishness, cowardice, and an extreme degree of despair (suicide), so the transplantation of organs or tissues can become either the highest manifestation of love, or else the manifestation of contempt, turning man into a mere commodity.
It can be a victory over death through the voluntary acceptance of death, or it can be the full acceptance of transience with a simultaneous disappearance of everything spiritual. Orthodox theology cannot accept the transplantation of organs or tissues from person to person, or even the usual blood transfusion, as a mere mechanistic procedure. It can, however, accept it as an act of service to one's neighbor, and self-sacrifice. Therefore, it does not consider the problems of transplantation from the point of view of pre-established casuistic rules, but individually approaches each case based on the criterion of selfless love and respect for the individual.
Translated by Kimberly Gleason