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Moral Theology — Topic 15. Moral Aspects of the Sacraments_ Chrismation, Health, Illness, and Death.

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Moral Theology — Topic 15. Moral Aspects of the Sacraments_ Chrismation, Health, Illness, and Death.

Already in the Old Testament, health is perceived as part of God’s plan, since the world was originally created good and the Creator continues to care for it. This allows us to view the Old Testament perspective on the world as deeply optimistic. At the same time, after the Fall, the world is filled with suffering and disease, which is why health is often viewed not in and of itself, but against this backdrop, more often as the result of healing. The most common term associated with health is rapha—“to heal, restore, repair.” God, addressing the people after the Exodus from Egypt, says: “I am the Lord, your Healer” (Ex 15:26). At the same time, terms related to suffering and sickness in the Old Testament are significantly more diverse. Most of the words are related to the root hul (Deut. 7:15), which means “pain,” though there are also many specific terms. In addition to obvious illnesses, old age and death arise as a result of separation from God, so that life itself is sometimes viewed as full of fear, sorrow, and despondency. It is limited to a span of 70–80 years and always ends in death. The sicknesses and sufferings that appeared in the world after the Fall are part of a broader problem: a separation from God and a life that contradicts His plan. Accordingly, even in the Old Testament, spiritual health and a return to the Creator are primary, the result of which should be the restoration of physical life in its fullness.

Nevertheless, the people of the Old Testament are not without hope. Moreover, this hope is revealed to them not only through their descendants, in whom their lives continue, but also in the hope of the coming Messiah, who “took upon himself our infirmities and bore our diseases” (Isaiah 53:5). Death will be destroyed, and “the Lord God will wipe away the tears from all faces” (Isaiah 25:8). In this regard, it is necessary to pay attention to the concept of peace ( ; שָלוֹם; ; šālôm) , which, on the one hand, signifies holistic physical and spiritual well-being, but in an eschatological perspecti , signifies the blessed fullness of life in God, the fulfillment of God’s plan for humanity. Given that the Fall itself is a phenomenon of a spiritual nature, spiritual health is perceived as a higher value than physical health.

In the New Testament, the primary term associated with health is σῴζω, meaning salvation, healing, and restoration of wholeness. The Messiah comes as the Savior of all life, not just physical life. At the same time, the restoration of physical health is associated with the more specific terms θεραπεύω, meaning treatment and the provision of medical care, as well as the term ἰάομαι, to treat, heal, and restore. Illnesses (ἀσθένεια, νόσος) are undoubtedly mentioned, but almost always in the context of healing. It is particularly noteworthy that the healings performed by Christ are, first, directed toward everyone (Matt. 8:16) and, second, concern all diseases and infirmities (Matt. 4:23). There is not a single instance in the New Testament in which the Savior refused to heal a person or failed to cure any illness. Responding to the pleas of the sick, Jesus Christ Himself, in the Garden of Gethsemane, asked for the opportunity to avoid suffering, thereby legitimizing such requests and making them entirely acceptable for everyone. Desiring health is not a sin, and asking God for it is not a sign of lack of faith. For example, the Apostle John the Theologian writes: “Beloved, I pray that you may prosper in all things and be in health, just as your soul prospers” (3 John 1:2). The Church follows this same logic in its liturgical prayers. At the same time, believers are called to trust in the Savior, not to demand healing at any cost, and not to despair if they do not receive what they have asked for. In this earthly life, the Lord reserves the right to limit illness to the extent that it is beneficial for the person himself. He does not refuse to help the Apostle Paul, who prays to Him for deliverance from a thorn in the flesh, but He also does not grant him complete healing, explaining this by the apostle’s spiritual benefit: “My grace is sufficient for you, for My power is made perfect in weakness” (2 Cor 12:9). God accepts prayers for health, but the spiritual realm remains His priority. Overall, the foundation of the New Testament’s optimistic view of the world is the certainty that Christ “will transform our lowly body to be like His glorious body” (Phil 3:21).

Finally, the Holy Scriptures quite clearly endorse a healthy lifestyle, as well as the blessing of medical practice and the creation of medicines. As something a person is called to do on their own, the necessity is pointed out to

· to eat in moderation and at the proper time (Prov 23:2, Eccl 10:17);

· purify water (1 Tim 5:23)

· to be clean (Deut. 23:12–14, Lev. 15);

· to ensure adequate sleep and rest (Exod 20:8-11, Eccl 5:11, Mark 6:31);

· refrain from excessive alcohol consumption (Prov 20:1, Prov 23:29-35, Eph 5:18)

· strive to find reasons for joy in the world (Prov. 17:22);

· give up trying to completely control your life (Phil 4:6)

It is worth acknowledging that the significant emphasis on spiritual health found in Scripture and Tradition has at times obscured the value of physical health, which is also discussed at length. Moreover, the very distinction between spiritual and physical health within Scripture is rather arbitrary. It is no coincidence that, speaking of the healing of the man lying by the sheep’s pool, the Savior affirms that He “healed the whole man” (John 7:23). Care for the health of the body should not be set against care for the salvation of the soul, but should be a harmonious part of the overall path to salvation. Emphasizing the importance of combining physical and spiritual healing, St. Basil the Great wrote: “Just as one should not avoid the art of medicine altogether, so it is unwise to place all one’s hope in it. But just as we make use of the arts of agriculture— —while asking the Lord for the fruits… so, in calling a doctor to us… we do not turn away from our hope in God.”

On this path, there should be neither neglect nor excessive attention to the body. The Lord did not seek to recreate paradisiacal conditions for human life on earth, because His Kingdom is not of this world; nevertheless, we are called, to the best of our ability, to care for our bodies as temples of the Holy Spirit and to glorify God through them (1 Cor 6:19–20).

  • The Christian attitude towards the body
  • Health and Illness in Scripture
  • The Christian Approach to Treating Illness
  • Transplantology
  • Suffering and the Problem of Theodicy
  • Sources of Suffering in the World: The Patristic Approach
  • Reflecting on Personal Suffering
  • The Sacrament of Anointing of the Sick in the Context of the Moral Perception of Suffering
  • Perception of death
  • The Issue of Euthanasia and Its Christian Assessment

Nowadays, it has become customary to emphasize the diversity of people and their life perspectives. Yet, despite all their differences, people are united by their mortality. Many languages have expressions that say death is the path of all the earth. The question of conquering death was already raised in the Epic of Gilgamesh—the oldest literary text. It has surrounded humanity throughout history, though its proximity may vary. For example, in the past, infant mortality was widespread. The lack of antibiotics and modern diagnostic and resuscitation methods made diseases fatal that are successfully treatable today. It is worth noting that most people, excluding those who died in accidents, passed away at home, surrounded by their loved ones. Death was familiar to people from childhood; they saw it and perceived it as the inevitable end of life, which one had to approach in the right state: having put one’s moral life in order, having made peace with God, one’s neighbors, and oneself. These days, death also surrounds us, but it happens in a completely different way. News feeds are filled with it; we see it in movies and books, yet we have practically stopped encountering it in real life and find ourselves unable to have a serious conversation about it. People may speak of death in general, but against the backdrop of modern medical advances, actual death is perceived as a glaring injustice and tragedy. Such feelings can be all the more intense from within an atheistic worldview, in which earthly life is viewed as the only one.

In the Holy Scriptures of the Old Testament, death is perceived as the natural outcome of the life of fallen humanity. Already in the Garden of Eden, God says to Adam: “You are dust, and to dust you shall return” (Gen. 3:19). In this context, we may recall Job, who says: “Man, born of a woman, is of few days… he passes away like a shadow and does not remain” (Job 14:1–2) and calls the grave his father, and the worm his mother and sister (Job 17:13, 14). In a similar vein, Solomon says: “The fate of the sons of men and the fate of animals is the same: as one dies, so do the others… Everything comes from dust, and everything returns to dust” (Eccl. 3:19–20). At times, reflections on death are not so much ready-made answers as they are questions: “In death there is no remembrance of You; in the grave, who will praise You?” (Ps. 6:6). However, even the Old Testament perspective is not without hope. For example, David says: “We will die and be like water poured out on the ground, which cannot be gathered up; but God does not desire to destroy the soul and considers how not to cast away even the outcast” (2 Sam. 14:14). Later, in the Wisdom literature, a sense almost like that of the New Testament emerges: “The souls of the righteous are in the hand of God, and no torment shall touch them. In the eyes of the foolish they seemed to have died, and their going was counted as destruction, and their departure from us as annihilation; but they abide in peace… their hope is full of immortality” (Wis 3:1–4).

In the New Testament, the attitude toward death is more optimistic. Undoubtedly, it continues to be perceived as a tragic reality. For example, sympathizing with Martha and Mary over the death of their brother Lazarus, the Savior wept. (John 11:35), and in an eschatological perspective, death is called the last enemy (1 Cor. 15:26). At the same time, within the context of a fallen world, it is what shortens and ends the life of a passionate human being. Thus, the Apostle Paul says: “For to me, to live is Christ, and to die is gain… I have a desire to depart and be with Christ” (Phil 1:21–23). The death of those who believe in God is not without hope: “From now on, blessed are the dead who die in the Lord” (Rev 14:13). This blessedness is especially profound for Christians in the prospect of the bodily resurrection. It is no coincidence that the Apostle Paul comforts the disciples in their possible grief over the dead: “For if we believe that Jesus died and rose again, so too will God bring with Him those who have fallen asleep in Jesus” (1 Thess 4:14).

The practice of a reflective attitude toward death, well known to Christians since ancient times, was in a sense rediscovered in the 20th century. In 1969, Elisabeth Kübler-Ross’s world-renowned book «On Death and Dying» was published. In this work, she outlined the now-famous stages a person goes through in the terminal stage of an illness, when processes are diagnosed that will inevitably lead to death within six months. Systematizing the results of her work with the dying, she spoke of five main states or stages: denial, anger, bargaining, depression, and acceptance. According to the author, the order of the stages may vary; a person may linger in one stage for a long time, skip some, or repeat them over time. Modern researchers often speak of a greater number of stages, including, for example, shock, longing, or hope. Her son, Ken Ross, says that “The Five Stages are intended as a general framework—they are not some kind of recipe or ladder for overcoming grief. If people wanted to use other theories or models, she didn’t mind. She just wanted to start a conversation”[1].

Initially, denial arises as a defensive reaction in a person who refuses to acknowledge the possibility of their own mortality. They are convinced that a mistake has been made, seek second opinions from other specialists, and begin to avoid discussions on the subject, trying to convince themselves and others that they feel fine. In the second stage, upon realizing the reality of the terminal stage, a person loses all their traditional points of reference. Seeing themselves as a decent person, they feel a sense of injustice and anger. Their anger may be directed at healthy people who continue to enjoy life, at doctors who are powerless to help, or at God, who is allowing them to die. However, at some point, the “bargaining” stage sets in, and hope arises in the person’s mind that they might strike a deal with fate. It is precisely at this stage that the person usually goes to church, promising God to mend their ways and start over. At this moment, repentance and a change of life can indeed occur; however, it is not uncommon for a person, alongside visiting the church, to turn to esotericists, shamans, and folk healers. They often need a quick result, for the illness waits for no one. In the pastoral conversation that usually takes place at this stage, it is important to provide the person with an answer to the question: “Will the Church solve his problem?” The correct answer must begin with the fact that the Church does not exist to solve a person’s everyday problems, but to lead him to salvation. On this path, it may turn to God with a request for the sick person’s healing, but it approaches everything that happens with trust. At the same time, by embracing a Christian worldview, the sick person themselves becomes able to view their illness from a different perspective. In this sense, the Church does not solve problems, but rather removes them, allowing one to see in them opportunities for spiritual and moral growth. In turn, the stage of depression begins when a person realizes not only the reality but also the inevitability of what is happening to them. In this stage, E. Kübler-Ross distinguishes two parts. The first—reactive depression—is filled with fears of losing one’s health, social role, and financial status. The person experiences fear of impending pain and suffering, fear of burdening relatives with their infirmities, and fear of the coming separation. The second—preparatory or anticipatory depression—involves the person feeling sorrow for the familiar world they will have to leave behind. Finally, the last stage—acceptance—occurs when a person experiences genuine humility in the face of the processes taking place within them. __

Recognizing that dying, in both a spiritual and a physical sense, can be very different, the Church prays to God: “May the end of our Christian life be painless, unashamed, and peaceful.” Given that liturgical prayer expresses the faith and hope of the Church, this testimony proves to be very important. Sometimes, when speaking of the Christian perception of dying, it is emphasized that a person must suffer for all their sins and almost refuse painkillers. And yet, in light of the prayer cited above, it can be unequivocally stated that the Church sees nothing wrong with a Christian’s death being painless, with the person dying with dignity, not abandoned or disgraced by those around them, with their spirit at peace, and with the ability to die reconciled with God and their neighbors. This is precisely the goal of palliative care, which focuses on patients who can no longer be cured but who can be helped to live out the remainder of their lives as pain-free, dignified, and peaceful as possible.

However, whereas in the past a person’s death did not depend on those around them, the current level of development in biomedical technology allows for the prolongation of bodily life even after brain death has been declared. The question of disconnecting a dying person from life-sustaining machines has become a genuine bioethical problem, for which various solutions are proposed. The difference is determined by the attitude of those discussing the issue toward the relationship between the sanctity of life and quality of life. Currently, according to Prot. John Brek, we can speak of three approaches to the problem[2]. The first can be called vitalism, which assumes that life is sacred in any case and that it is necessary to fight for it regardless of quality of life. This approach is often characteristic of non-believers, since, as they believe, there is no life beyond this one, and therefore one must fight to the end for the life one has. The second approach assumes that quality of life is far more important than its sanctity, so euthanasia must be permitted and people who are suffering should be allowed to leave this life without unnecessary suffering. Finally, the third approach considers it morally acceptable to withhold treatment from terminally ill patients, allowing them to die naturally.

There are only two truly unique processes in a person’s life: birth and death. The first always occurs unconsciously for us, but as the second approaches, people are often fully conscious. Leaving aside cases of murder or suicide, it can be said that people often do not choose the circumstances of their death. They accept it as a fact against which they are completely powerless. However, as Frederika de Graaf accurately observed, “when a person cannot be active but can only be, they still have a task… They have a responsibility for their attitude toward the inevitable end—that is, toward what they cannot change. There is a choice: to be a victim or to choose the path of inner freedom”[3]. Research[4] suggests that even as they are dying, people can feel gratitude for the happy moments that filled their lives. With the right attitude toward what is happening, they experience a sense of having completed a meaningful task, of having fulfilled their purpose. A dying person is no longer capable of long-term relationships, but this does not mean they are incapable of relationships at all. Being limited in time and strength, they are capable of dialogue, during which the simplest words take on special depth and value.

[1] https://www.bbc.com/news/stories-53267505

[2] Breck, J., prot. The Sacred Gift of Life. pp. 285–287

[3] Graaf F. de. There Will Be No Separation. How to Survive the Death and Suffering of Loved Ones / Frederika de Graaf; foreword by Bratus B. S. — Moscow: Nikaia, 2016. — P. 44

[4] Tang ST, Lin KC, Chen JS, Chang WC, Hsieh CH, Chou WC. Threatened with death but growing: changes in and determinants of posttraumatic growth over the dying process for Taiwanese terminally ill cancer patients. Psychooncology. 2015 Feb;24(2):147–54. doi: 10.1002/pon.3616. Epub 2014 Jul 5. PMID: 25044970.

If we reflect on our attitude toward pain, our first reaction will always be rejection. However, even a brief reflection on its meaning allows us to recognize pain as a necessary part of our physical existence—that which stops us in the face of danger. This is true not only of physical pain but also of all other unpleasant sensations—spiritual, psychological, or moral—that arise in us as a reaction to wrongdoing. While acknowledging the protective function of pain in general, it is not easy for a person to accept, let alone make sense of, their own suffering. At the same time, the experience of a wide variety of people, both believers and non-believers, suggests that suffering may have not only causes by which it can be explained, but also meanings that can make it morally and spiritually fruitful.

In foretelling persecution to his disciples, the Savior did not urge them to avoid suffering by any means necessary, but called them blessed. Faithfulness to the Teacher during persecution and the closeness to God that exists because of this faithfulness prove to be far more important than momentary comfort. In the same way, suffering caused by illness or external circumstances can be reinterpreted. Upon being baptized, a person becomes capable of perceiving pain as Job did, and even more deeply than he did, because Job lived before the Law, whereas Christ’s disciples had already seen the path that all that is good in the world must inevitably take, albeit to varying degrees (2 Tim 3:12). At the same time, it is evident that not all suffering leads to repentance and a reevaluation of life. It can vary in intensity and duration. These factors, along with upbringing, temperament, and environment, prove decisive in the process of choosing a strategy for perceiving and enduring suffering. If they are minor and short-lived, such as minor injuries or the common cold, a person endures them as an annoying misunderstanding from which it is pointless to draw conclusions. However, if the suffering is excessive, the person simply lacks the strength for a spiritual understanding of what is happening. Conscience helps a person distinguish such suffering from misunderstandings arising from changes in the weather or lifestyle, prompting them to consider whether there are moral roots to the problems that have arisen.

As is well known, suffering often causes a person to feel bewildered and ask, “Why?”, a question that may be linked to rebellion against God. At the same time, saints from various eras have advised people to reflect on the spiritual causes that may be behind what is happening. These may include not only sins but also a lack of virtues. Moreover, even if a person sees no such causes, following Job’s example, they should trust in God and, recalling Christ’s call, share with Him the burden of standing against the world, which lies in evil. In this context, it is especially important to turn to Isaiah’s teaching about the Servant of the Lord, Who: “was wounded for our transgressions, He was bruised for our iniquities; the chastisement for our peace was upon Him, and by His stripes we are healed” (Isaiah 53:5).

As a result of humbly accepting God’s will, a person endures suffering with the patience of which the Savior Himself speaks: “By your patience you will save your souls” (Luke 21:19). Often, patience as a quality of a believer provokes censure and anger, because it is perceived as an unwillingness to change anything or to fight against problems and injustice. However, the meaning of patience is entirely different. The word ὑπομονή means not only patience, but also steadfastness and constancy. In the context of consciously bearing sorrows, the meaning associated with constancy is important, because it is a constancy of trust and hope. Recognizing the deep connection between patience and hope, the Apostle Paul writes to the Romans: “Everything that was written in the past was written to teach us, so that through patience and the comfort found in the Scriptures we might have hope” (Rom 15:4). And while rebellion leads to a breakdown in communion, trust and hope, on the contrary, lead to a deepening of the relationship, which is expressed in prayer. At the same time, a Christian who has the right attitude toward illness prays not so much for it to pass, though of course this is entirely permissible and natural, but in boldness may pray with the words of Christ, saying to God: “My Father! If it is possible, let this cup pass from Me; nevertheless, not as I will, but as You will” (Matt. 26:39).

At the same time, suffering can be very serious and even potentially fatal. Often it is a bitter medicine for sin, which God allows a person to endure. It is worth emphasizing that God does not desire for a person to suffer and does not cause illness, but respects human freedom, which seeks its own paths. Furthermore, one cannot assert that there is a direct correlation between human well-being and one’s spiritual state. Illness and suffering may be sent to a person not only as a consequence of something, but also as a prelude and preparation. For example, illness may serve as a prevention against a grave sin. In such a situation, in addition to seeking medical care, a person traditionally wishes to participate in the sacrament of the Anointing of the Sick, turning to God with repentance and a request for healing.

God created the world good, but “through one man sin entered the world, and through sin, death” (Romans 5:12), as well as every painful condition of mortality and passion. It is not uncommon for believers to view every illness as a punishment sent by God. However, in the context of the patristic tradition (?), such a perception is incorrect. For example, according to St. Maximus the Confessor: “four things alter the bodily constitution…: angels, demons, the weather, and lifestyle”[1]. Considering that angels are God’s messengers, one might say that the primary source of suffering in the world is God.

  1. There is no doubt that when Christian authors refer to God as the source of suffering, they mean suffering in a therapeutic sense. Thus, St. Basil writes: “God eradicates evil; evil does not come from God. And a doctor eradicates disease, not inflicts it upon the body”[2]. The example of the doctor is important because Christians have used it since ancient times. Moreover, the scale of calamities is commensurate with the scale of the disease, so “God cures the vices of the whole people through the punishments of the whole people”[3] In addition to the image of a doctor, one could also use the image of a teacher, since the punishments that God allows to occur always serve as a lesson; they either correct a mistake, prevent something from being done, or prepare a person for a trial. For example, St. Anastasius of Sinai writes: “As for the temptation from God, which befalls a person for his own good, it does not cut off the soul from good hope”[4].

  2. By calling the evil one the source of bodily changes—and thus of suffering—they imply that, by tempting a person, he leads them to sin and suffering. And suffering, of course, not so much physical as spiritual. Thus, in the same question-and-answer, St. Anastasius says that “temptations, coming from the devil by God’s permission, fill the soul with despair, anger, and hopelessness”[5].

  3. When they call the cosmos the source of suffering, they do not mean that it acts independently and in parallel with God. Of course, the Lord is the Almighty, but His will itself can be either benevolence or permission. In the first case, He Himself is the source of the action; in the second, He allows man to act. At the same time, we must take into account that God has established laws in the world that we must follow. Reflecting on the nature of punishments and temptations, St. Anastasius says: “We are often exposed to dangers, temptations, and infirmities, the cause of which is neither God nor the devil, but our own inability to reason correctly and our inattention, as happens to those who, seeing the weather change toward winter, nevertheless take their ship out of the harbor…”[6]. This means that processes that appear to be spiritual may have entirely explainable material causes. Emotions can be triggered by hormonal changes. Naturally, all of this may have spiritual sources as well, but it is completely unacceptable to reduce everything to them. One such process is aging. Formally, this happens to a person, but it is a fact of the cosmos, in which everything ages and dies.

  4. Finally, the cause of suffering may be a person’s own lifestyle. According to St. Maximus, the point is that “lifestyle” influences “the quality and quantity of food and drink, their excess or deficiency”[7]. These words perfectly illustrate a truly Christian attitude toward the laws by which the created world exists. It is precisely the recognition of the significance of the laws of the created world that helps to explain quite rationally many health problems, which are entirely natural in nature and to which everyday religious consciousness sometimes attributes spiritual causes.

Naturally, all laws in the world have God’s will as their spiritual foundation, which manifests in the world both as direct intervention and as permission. It is precisely within the framework of permission that the last three sources of suffering are realized. Given that the causes of suffering are manifold and often hidden from our understanding, we have no right to pass judgment on our neighbor or condemn them on our own. At the same time, a believer not only has the right—but must pray for the suffering person and strive to help. Of course, sometimes the cause is so obvious that a Christian can suggest what might be the cause, but even in this case, he cannot claim his knowledge as the only correct one. For example, when a person witnesses the moral suffering of a sinner, it is easy to point to the sin that is the cause of it. However, in order to point out a person’s mistakes, one must have spiritual experience and a loving heart so that one’s words bring benefit and do not reduce everything to mere condemnation.

[1] Maximus the Confessor, St. Selected Works. Moscow, 2004. p. 167

[2] St. Basil the Great. Op. cit. p. 648.

[3] St. Basil the Great. Op. cit. p. 648.

[4] Anastasius of Sinai, Venerable. Pp. 270–271.

[5] Ibid., p. 271.

[6] Ibid., p. 270.

[7] Maximus the Confessor, Venerable. Selected Works. Moscow, 2004. p. 167

Reflecting on the problem of suffering, C.S. Lewis noted that the heightened sense of the injustice of suffering coincided, in a remarkable way, with the invention of anesthesia. Humans have suffered throughout history since the Fall, yet never have they problematized suffering so intensely, nor contrasted it so sharply with their faith in God, as in the 20th century. Paradoxically, during this time, on the one hand, the creation of international organizations to limit military action was proposed, while on the other, the bloodiest wars in human history were waged. The perception of suffering has changed in such a way that the very existence of illness and death has come to be seen as an obstacle on people’s path to God. It is no coincidence that Georg Büchner called the problem of suffering the refuge of atheists[1]. As if echoing him, Prot. Sergiy Zheludkov wrote: “Someone said that merely being present while a child is suffering from meningitis is enough to rob a person of their faith in God”[2]. A. Laato and J.K. de Mor address this same issue in the introduction to the collection of articles “Theodicy in the World of the Bible”: “For modern man, the inexplicability of suffering in the context of religion was the main reason why he completely renounced it…”[3]. The main problem has become the conflation in modern language of the concepts of “evil” and “suffering,” which were previously, in the patristic era, perceived as cause and effect, sometimes connected only indirectly.

In the history of philosophy, theodicy refers to the justification of God in the face of the evil that exists in the world. The word itself derives from two Greek roots: θεός (theos) – God, and δίκη (dike) – justice. Although this problem was raised as early as in ancient Egypt, Babylon, and classical philosophy, the modern term was introduced by G.W. Leibniz in the 18th century. The classical formulation of the problem of theodicy can be stated as follows: God is omnipotent, omniscient, and all-good. Based on the presence of these perfections in God, one asks: “How is it possible to speak of the existence of a morally perfect, omnipotent, and omniscient being given the obvious existence of evil in the world? The problem lies in the fact that if God is good and desires good, He must desire the destruction of evil, yet we see that evil continues to exist. From this formulation of the question, the conclusion is drawn that God is either not good or not omnipotent—for, knowing about evil, He does not destroy it. It is important to remember that the problem of theodicy does not arise in every society. For example, in pagan societies, where gods were depicted as bloodthirsty and demanding human sacrifices, it was impossible to even raise the question of why they allowed suffering in the world; therefore, the question of justifying God was not as pressing.

__

The Good God and the Existence of Evil According to Scripture __

When discussing theodicy in Scripture, it is important to remember that the world created by God was originally deemed by Him to be “very good” (Gen. 1:31), which in turn implies that evil is “unnecessary” and “unplanned” in the world. At the same time, there are several passages in the Old Testament that, upon reading, may give the impression that God is involved in evil. Traditionally, two passages from the prophetic books are cited, as well as the Book of Job.

For example, in the Book of Isaiah, God says: “I form the light and create darkness, I make peace and bring calamity; I, the Lord, do all these things” (45:7). Most exegetes, along with Chrysostom, assert that the author “refers to… calamities as evil here.”[4] In addition to exegetical reflections, it is necessary to consider the historical context in which these words were written. According to A. Laato’s hypothesis, this text may have been directed against Persian dualism[5], the danger of whose influence was very great. It was important for the prophet to emphasize not that God creates evil, but that everything—both good and evil—originates from Him, and that there is no other god or spirit who could create anything apart from His will. Perhaps the words of the prophet Amos are connected to this as well; their Synodal translation is softened, while the Slavonic version accurately conveys the Greek: “There is no evil (in the Synodal version, ‘calamities’ in the LXX κακία) in the city that the Lord has not created.” (Amos 3:6). St. Basil writes: “Understand that Scripture means by this the calamities sent upon sinners for the correction of their transgressions”[6] .

However, most often, when the problem of evil in Holy Scripture is discussed, the Book of Job comes to mind. The story of Job is well known enough that there is no need to retell it. On the one hand, it belongs to a genre of texts found in the Near East that consist of the lamentations of a righteous person who has fallen into misfortune. On the other hand, its radical difference from pagan texts lies in the moral purity of Job, who did not compromise his righteousness. The arguments of Job’s friends are quite traditional; similar ones can be found in abundance in both the Old and New Testaments. Their logic is simple and can be described using the following syllogism:

  1. God punishes sinners through suffering.

  2. Job suffers, which means he is clearly being punished.

  3. Job is a sinner.

However, the paradox is that such logic is completely rejected by God Himself. After speaking with Job, God says to Eliphaz the Temanite: “My anger is kindled against you and your two friends, because you have not spoken of Me as truly as My servant Job has!” (Job 42:7). These words of God destroy all reasoning, because Job, who throughout the book was indignant and did not understand the reason for his sufferings, spoke of God better than they did. As F.N. Kozyrev very rightly observes, “it is impossible to correctly understand Job’s blasphemous outbursts without taking into account the important fact that they are addressed primarily not to God, but to his friends”[7]. Upon closer examination of Job’s rebellion, we understand that he was not fighting against God, but, knowing his own righteousness, was fighting against the image of God that his friends were trying to impose on him—against the one who could punish the “righteous of heart.” However, the fact that Job did not accept false explanations does not mean that he did not accept the sufferings themselves. To an even greater extent, he wanted an explanation for them. One might think that within the framework of the Old Testament relationship between God and the world, there are indeed no answers to Job’s questions. The story of Job anticipates the theodicy that God Himself brings about in the world. In this story, Job “won a true victory over Satan, defeating him through his faithfulness to God—a faithfulness that borders on defiance of God”[8].

At the end of the book, God speaks to Job about His creations: Behemoth (who was “made to rule over his brothers” (Job 40:14)) and Leviathan (“…he is king over all that is proud!” (Job 41:26)). However, despite the fact that He created them—they embody the forces of evil, which only He can overcome. God speaks mysterious words to Job about His battle with them: “There is no one bold enough to challenge him [Leviathan] to battle; who then will dare to stand before Me? Who will go before Me and bind My reward?” (Job 41:2–3). From these words, it is clear that in the battle against evil, no one stands before God; He is the first to wage this struggle. It is precisely in the experience of this encounter that Job comes to know who his Advocate is, the One to whom he had been crying out. (Job 17:3), but this revelation comes not through positive affirmations, but through the experience of questions. That is precisely why he says: “I had heard of You by the hearing of the ear; now my eyes have seen You. Therefore, I despise myself and repent in dust and ashes.” (Job 42:5-6). In Job’s situation, God could not be justified by the circumstances known to all; Job sensed this, yet he trusted the Creator. A number of authors suggest that Job was given a revelation of the Savior’s coming sufferings. However, in the context of the Old Testament, the answer to the question of how a righteous person can suffer if he is faithful to an almighty and good God was clearly apophatic.

The New Testament begins with a declaration of fundamental changes in the relationship between God and humanity. In the Sermon on the Mount, we find the words of Jesus Christ, “Blessed are those who mourn, for they will be comforted,” as evidence that with His coming into the world, questions about evil would take on a new meaning. It can be said with certainty that the problem of justifying God in the face of a suffering world is preeminently a Christian problem. In the Gospel, we see that Christ does not tolerate evil; He raises every dead person He sees or is told about. When asked about the man born blind, He denies that his suffering is a punishment for the sufferer himself or his loved ones. He states the reason: “That the glory of God may be revealed” (John 9:3), so that His mercy might be revealed in him.

When the tower at Siloam fell and crushed eighteen people, the Savior says: “Or do you think that those eighteen people on whom the tower of Siloam fell and killed them were more guilty than all who live in Jerusalem?” (Luke 13:4). It would seem that no one is capable of answering such a question, for to do so one must know the judgments of God. But that is precisely why God Himself answers: “No, I tell you, but unless you repent, you will all likewise perish” (Luke 13:5). Does He answer the question about the cause of suffering? Yes, He answers by remaining silent, by refusing to give an explanation. In a certain sense, He puts an end to primitive and simplistic arguments, such as those offered to Job by his friends, and speaks only of the fact that people must repent.

Although every suffering has an obvious cause, a person can never say why exactly now things happened this way and not another. This means that despite the apparent clarity of the causes, one must understand that suffering always remains a mystery, and only God knows its true causes.

[1]Büchner, G. Danton’s Death // Plays… Prose. Letters. – Moscow, 1972. – p. 120.

[2] Zheludkov, S. Prot. Why Am I Orthodox? URL: http://www.hot.ee/krasavin/zel21.html (accessed: 12/15/2012)

[3] Theodicy in the World of the Bible / edited by Antti Laato and Johannes C. De Moor. Brill, 2003, p. vii

[4] St. John Chrysostom. Discourses on the Devil 1. // Works: in 12 vols. / Archbishop of Constantinople, St. – St. Petersburg, 1896. – Vol. 2. Book 1. – pp. 278–279.

[5]Theodicy in the World of the Bible / edited by Antti Laato and Johannes C. De Moor. Brill 2003. – p. xxvi (The authors note that they were influenced by two commentaries: C. Westermann, Isaiah 40–66: A Commentary (OTL), London 1969; K. Elliger, Jesaja II (BKAT, 11), Neukirchen-Vluyn 1978.)

[6] St. Basil the Great, Works: in 2 vols. / St. Basil the Great ,Archbishop of Caesarea in Cappadocia. – Moscow: Sibirskaya Blagozvonnitsa, 2008. – Vol. 1. – p. 648.

[7] Kozyrev, F. N. The Temptation and Victory of Saint Job, the Duel of Jacob / F. N. Kozyrev. – Moscow: Dom Nadezhdy, 2005. – p. 97.

[8] Kozyrev, F. N. Ibid., p. 180.

Nevertheless, the people of the Old Testament are not without hope. Moreover, this hope is revealed to them not only through their descendants, in whom their lives continue, but also in the hope of the coming Messiah, who “took upon himself our infirmities and bore our diseases” (Isaiah 53:5). Death will be destroyed, and “the Lord God will wipe away the tears from all faces” (Isaiah 25:8). In this regard, it is necessary to pay attention to the concept of peace (שָלוֹם;šālôm) , which, on the one hand, signifies holistic physical and spiritual well-being, but in an eschatological perspecti , signifies the blessed fullness of life in God, the fulfillment of God’s plan for humanity. Given that the Fall itself is a phenomenon of a spiritual nature, spiritual health is perceived as a higher value than physical health.

· purify water (1 Tim 5:23)

· to be clean (Deut. 23:12–14, Lev. 15);

· give up trying to completely control your life (Phil 4:6)

It is worth acknowledging that the significant emphasis on spiritual health found in Scripture and Tradition has at times obscured the value of physical health, which is also discussed at length. Moreover, the very distinction between spiritual and physical health within Scripture is rather arbitrary. It is no coincidence that, speaking of the healing of the man lying by the sheep’s pool, the Savior affirms that He “healed the whole man” (John 7:23). Care for the health of the body should not be set against care for the salvation of the soul, but should be a harmonious part of the overall path to salvation. Emphasizing the importance of combining physical and spiritual healing, St. Basil the Great wrote: “Just as one should not avoid the art of medicine altogether, so it is unwise to place all one’s hope in it. But just as we make use of the arts of agriculture—while asking the Lord for the fruits… so, in calling a doctor to us… we do not turn away from our hope in God.”

The Christian Approach to Treating Illness

Already in the Old Testament, according to the law, a person afflicted with certain types of skin diseases was required to consult the priests, who were called to assess his condition. They did not engage in treatment, viewing God as the only One who “gives life and causes death, strikes down and heals” (Deut. 32:39). Given the close connection between ancient physicians and pagan cults, Old Testament authors viewed healers with suspicion. Seeking their help was not to replace prayer to God (2 Kings 16:12). At the same time, natural remedies were not rejected. For example, through the prophet Isaiah, God commands that King Hezekiah’s festering foot be “bandaged with figs,” thanks to which he is healed (Isa 38:21). In a later era, Jesus, son of Sirach, exhorts: “Honor the physician for his skill, for the Lord created him, and healing comes from the Most High” (Sir 39:1,2). Along with respect for the physician, he approves of taking the medicines the physician prepares: “The Lord created healing from the earth, and a wise man will not despise them. <…> The one who prepares medicines makes a mixture of them, and his work is never done, and through him there is good on the face of the earth” (Sir. 39:4,8). Building on this tradition, the Church has never forbidden believers from seeking medical help. Among the saints there were many who helped the sick, relying on professional medical skills: the Apostle Luke, the Great Martyr Panteleimon, the non-mercenaries Cosmas and Damian, and St. Luke, Bishop of Crimea. It is well known that St. Basil the Great established the first organized public hospital in Caesarea.

However, while endorsing the practice of medicine, the Christian tradition emphasizes the physician’s responsibility in caring for patients. A believing physician must remember the biblical commandments that underlie all Christian activity. He must not take advantage of patients’ dependence and helplessness by blackmailing them with the threat of withholding treatment. At the same time, a physician has the right to refuse to perform actions that he considers morally unacceptable. The most obvious morally reprehensible actions are those that lead to the death of a human being (abortion, euthanasia, fetal therapy) or violate the boundaries of personal identity (cloning, surrogacy). There are those that are permitted, but with serious restrictions due to the risk of embryo loss (IVF, ICSI, etc.). Some of these procedures have been known since ancient times, while others are associated with modern medical technologies that were previously unknown. One of the fields in which, despite a generally positive assessment, discussions are still ongoing is transplantology.

Against the backdrop of debates about the agency of so-called artificial intelligence and transhumanists’ efforts to transfer consciousness into a digital environment, the question of the meaning of human corporeality arises with renewed force and urgency. The Platonic and Gnostic teachings regarding the body as a prison for the soul were rejected by Christians as far back as antiquity. In advocating for a respectful attitude toward the body, they appealed to: God’s gift of bodily life (Gen 2:7); God’s incarnation in a physical body (John 1:14), His actual death on the cross and resurrection (Luke 24:49); to the indwelling of the Holy Spirit in the disciples, which allowed them to perceive the body as His temple (1 Cor 6:19). Furthermore, it was necessary to defend not only the body itself, which was honored by God, but also natural bodily processes, such as marriage and the eating of food. It is no coincidence that the Apostle Paul warns Timothy about the appearance of those who would take a negative view of marriage and food created by God, calling them hypocrites “whose consciences have been seared” (1 Tim 4:3). Later, in the struggle against quasi-Gnostic distortions that led to excessive disregard for the body’s needs, saints from various eras emphasized the importance of attending to bodily needs.

At the same time, the corporeality we are discussing is a vulnerable and mortal one. This fact can be interpreted in different ways, within the framework of two opposing civilizational approaches: the soteriological and the hedonistic. On the one hand, the meaning of life and its value are truly revealed against the backdrop of illness and death. This means that vulnerability prevents us from becoming spiritually complacent and compels us to strive for spiritual renewal. On the other hand, the themes of suffering and death terrify people to such an extent that deep and serious conversation about illness and death is tabooed and banished from the cultural sphere. Everything associated with suffering and finitude repels a consciousness raised in the pursuit of consumption and comfort. Old age, traditionally perceived as a time to reevaluate life in light of higher, non-transient values, has come to be seen as a battleground for clinging to fading youth. A person of traditional culture, at any age, lived looking forward to the future; he grew up, grew old, and died, accepting these stages and everything associated with them—including illness and infirmity—as a given. It is no coincidence that Moses says: “The length of our days is seventy years… Teach us to number our days, that we may gain a heart of wisdom” (Ps 89:10,12). Modern man goes through these same stages, but because of the syndrome of a life put on hold, he sees practically no value in them. First, he strives for the peak of his effectiveness, for the fullness of life, and then he strives to linger there, worrying about the inevitable loss of this state.

One of the most pressing bioethical issues is the issue of euthanasia[1]. The term itself derives from the Greek εὖ (good) and θάνᾰτος (death). In antiquity, it meant death without pain or suffering, whereas today it is understood as a deliberate act or omission by a physician leading to the death of a patient suffering from an incurable disease, which is why euthanasia is sometimes called “mercy killing.” Thomas More was one of the first to write about euthanasia in the modern sense. He did not use the word itself (Francis Bacon was the first to do so), but in his work Utopia, he wrote that priests and magistrates should persuade the gravely ill to starve themselves to death or take a sleeping potion so as not to suffer and not be a burden to others.

Attitudes toward euthanasia have varied throughout history. Although the Bible does not explicitly prohibit any form of euthanasia, it is clear from the overall context that a person should not assume the role of a judge who decides how long others should live. When discussing active forms of euthanasia, it is worth noting that the reasons for which one person has the right to kill another in the Old Testament are limited to lawful grounds and are connected to mortal sins. In all other cases, the commandment “You shall not murder” (Exodus 20:13) applies. This is so because only God can decide who shall live and who shall die. An example condemning active euthanasia can be seen in the story of Saul: “And the battle against Saul grew fierce, and the archers struck him, and he was severely wounded by the arrows. And Saul said to his armor-bearer, ‘Draw your sword and run me through with it, lest these uncircumcised men come and kill me and mock me. But his armor-bearer would not, for he was very afraid. Then Saul took his own sword and fell upon it (1 Sam. 31:3–4). Although Saul’s motivation does not entirely coincide with that of those dying from illness, he too asks for the end of his life, fearing the suffering to come, yet he does not receive it. Reflecting on the day of death, Solomon writes quite clearly: “No one has power over their own spirit to keep it, and no one has power over the day of death; just as there is no reprieve in war, so wickedness will not save those who dwell in it” (Eccl 8:8)[2]. Given that the killing of animals was permitted, the strict prohibition against killing a human being is linked to the status of the human person, who bears the image of the Creator.

In ancient times, many pagan cultures permitted the killing of the terminally ill. In Ancient Greece, Socrates and the Stoics considered the killing of the gravely ill permissible, while Aristotle, on the contrary, believed that this should not be allowed. Finally, Hippocrates, in his famous oath, strictly prohibited euthanasia. It remains prohibited in most countries today, yet the number of states where it is permitted in one form or another is steadily growing. For the first time in modern history, euthanasia was legalized in the Netherlands in 2002. That same year, it was legalized in Belgium, and later in Luxembourg.

Based on the method of implementation, there are two types of euthanasia: active and passive, which are used in the terminal stages of illness, specifically when processes are detected in the body that will inevitably lead to the person’s death within six months. Active euthanasia, like its variant “assisted suicide,” involves administering drugs to the patient that will lead to a painless and rapid death. Passive euthanasia, in turn, involves the deliberate withdrawal of life-sustaining treatment and life-support measures. In some countries where active euthanasia is prohibited, assisted suicide or passive euthanasia may be permitted. In countries that prohibit euthanasia, there are laws under which all forms of hastening death, whether through action or inaction, are prohibited. For example, in Russia, there is the Federal Law “On the Fundamentals of Health Protection of Citizens in the Russian Federation” dated November 21, 2011, which contains two articles directly addressing issues of euthanasia. First, there is Article 20, “Informed Voluntary Consent (IVC) to Medical Intervention and to Refusal of Medical Intervention”. According to the article, in all cases except emergencies, the patient or their representative must consent to or refuse the provision of care. It is possible to challenge the patient’s decision, but this can only be done through the courts. Second, there is Article 45, which is very clearly titled “Prohibition of Euthanasia.” It states, in particular: “Medical professionals are prohibited from performing euthanasia, that is, hastening a patient’s death at the patient’s request through any actions (or inaction) or means, including the cessation of artificial life-sustaining measures.” In this case, it follows that a doctor who performs active euthanasia, from a legal standpoint, is either committing murder (Article 105 of the Criminal Code of the Russian Federation), or causing death through negligence (Article 109 of the Criminal Code of the Russian Federation), or, in the case of passive euthanasia, failing to provide assistance to the patient without a valid reason (Article 124 of the Criminal Code of the Russian Federation). At the same time, Articles 20 and 45 do not contradict each other, since a doctor, even one who has received an IDS and is not providing assistance to the patient, will seek to save the patient by other means, whereas a doctor performing euthanasia seeks specifically to end the patient’s life.

It is quite evident that the Christian position entails a complete and unequivocal prohibition of all forms of active euthanasia, as they are directly linked to murder or suicide. The Foundations of the Social Concept of the Russian Orthodox Church state that the Church’s rules apply to euthanasia, “according to which intentional suicide, as well as assisting in its commission, are regarded as a grave sin.” A deliberate suicide who “has done this out of human resentment or for some other reason out of cowardice” is not entitled to a Christian burial and liturgical commemoration (Timothy Alex. Canon 14).”

While people often do not wish to draw metaphysical conclusions from brief periods of suffering, when faced with extremely intense and debilitating suffering, they are sometimes simply unable to do so. Suffering may be associated with the terminal stage of an illness or a trauma; it may manifest as comatose states and everything else that causes extremely severe pain, in which a person has practically no strength left for spiritual work. Often, in such circumstances, the body requires technical life support to maintain vital functions. At the same time, the patient’s condition itself can vary: they may be experiencing severe, unbearable suffering, or they may be in a coma and feel no pain at all. Accordingly, the motivation for disconnecting from life- support machines varies, although in any case the very idea is possible only against the backdrop of the understanding that the person’s condition cannot be improved. In examining the Christian view of euthanasia, Father Roman Tarabrin, on the one hand, evaluates various strategies for a doctor’s actions. He asserts that:

· If a healthcare professional initiates a new pathological process that leads to the patient’s death, they are killing the patient through active euthanasia.

· If he refrains from saving the patient’s life by refusing or discontinuing available treatment with the intent to kill (i.e., if he is disheartened by the prospect of the patient surviving on their own), then he has killed (or attempted to kill) the patient through passive euthanasia.

· If he refuses to treat a patient whom he believes is on the verge of death, or discontinues treatment because he considers it medically futile and burdensome for the patient, he is simply removing a medical obstacle to the natural process of dying. (In such cases, he would be delighted if the dying process were to unexpectedly reverse and the patient were to survive)[3] .

At the same time, in his view, the Christian himself “must cease burdensome treatment if it hinders his spiritual development and, ultimately, his meeting with Christ in eternity.”

The Church always upholds the principle of the sanctity of life as a gift from God and believes that He alone has the right to take that life. At the same time, there are situations where suffering proves so intense that it leads not to transformation but to the degradation of the person. In this situation, while categorically rejecting euthanasia, the Church holds that there are circumstances in which it is permissible to disconnect a person from life- sustaining machines so that their life may end naturally. The Foundations of the Social Concept of the Russian Orthodox Church state on this matter: “Delaying the hour of death sometimes only prolongs the patient’s suffering, depriving a person of the right to a dignified, ‘unashamed and peaceful’ passing, which Orthodox Christians ask of the Lord during divine services. When active therapy becomes impossible, it should be replaced by palliative care (pain relief, nursing care, social and psychological support), as well as pastoral care. All of this is aimed at ensuring a truly human conclusion to life, warmed by mercy and love.”

This view is fully consistent with liturgical Tradition, which includes “the Rite for the Departure of the Soul from the Body, when a person has suffered for a long time,” in which the Church prays that “the servant of God may be delivered from his unbearable illnesses and the bitter infirmities that afflict him, and that he may find rest where the spirits of the righteous dwell.”

Such an approach is possible because the very essence of death—and thus our attitude toward it—is radically transformed by Christ’s Resurrection. While remaining a separation of soul and body, death “in Christ” ceases to be a separation of man from God. In previous lectures, it was noted that Christians experience baptism as death with Christ and resurrection in union with Him. From within this understanding of baptism, the Apostle Paul writes: “For to me, to live is Christ, and to die is gain.” In the words of Fr. Alexander Schmemann: “Our death, accepted into Christ’s death, is purified, healed, and freed from death—from death as distortion and separation, from death whose sting is sin—so that it may become an entrance not into death, nor even into some mysterious ‘existence,’ but into union with Christ.”

[1] One of the key works on this topic is the dissertation by Rev. Roman Tarabrin: https://rave.ohiolink.edu/etdc/view?acc_num=osu1689920677060385

[2] Translated from the LXX

[3] Tarabrin, R. “An Orthodox perspective on hastening a patient’s death.” Master’s thesis, Ohio State University, 2023. http://rave.ohiolink.edu/etdc/view?acc_num=osu1689920677060385

People who are unfamiliar with Christianity often get the impression that Christians have a positive attitude toward suffering. In reality, Christians simply know that suffering, when properly understood, can have a beneficial effect on a person. However, this does not mean that suffering itself becomes something positive or normal. Following in the footsteps of the Savior, who healed the sick, James writes: “Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will heal the sick, and the Lord will raise him up; and if he has committed sins, they will be forgiven him” (James 5:14–15).

In a human being, as a complex spiritual and physical being, everything is interconnected. Of course, a person may fall ill for a variety of reasons, but one way or another, these reasons will affect his spiritual and mental health. A person might have fallen away from the Church because of sin, but he might have been deprived of church life because of illness. In both cases, he needed prayerful support and moral guidance in order to be restored. In this context, the meaning of the sacrament of the Anointing of the Sick is in some ways similar to that of the sacrament of Penance, which is why historically they were sometimes regarded as a single sacrament. Thus, if a person becomes spiritually ill, they must repent in order to be restored to full communion with Christ. If, however, they become physically ill and cannot be a full member of the community, the Church prays that they may be restored not only spiritually but also physically, so that they may return to an active Christian life.

A look at the text of the Rite of Anointing shows that spiritual and physical health are most closely connected. At the same time, the first reading we encounter is devoted not so much to repentance or healing, but specifically to patience and fortitude, since, to begin with, a person needs strength to endure sorrows, and this strength is necessary so that he may fruitfully receive all the rest. The service contains a large number of readings, but their meaning revolves, in one way or another, around repentance and the spiritual and physical restoration of the person. Thus, in the prayer read by the third priest, he asks: “Yes, O Lord, send down Your healing power from heaven, touch the body, quench the fever, ease the suffering, and drive away every hidden ailment. Be a healer to Your servant, raise him from his bed of suffering and from his bed of pain, healthy and unharmed, and grant him to be pleasing to Your Church and to fulfill Your will.”

It is often said that forgotten sins are forgiven in this sacrament. The danger of such a statement lies in the fact that the Anointing of the Sick may be perceived as a substitute for the sacrament of repentance. The emphasis should rather be placed on the fact that a person suffering from a serious illness may find it difficult to recall specific sins and, having a repentant attitude, asks God for the forgiveness of them all. If, however, a person has the strength and is of sound mind, they should resort to the sacrament of confession. According to Protopresbyter John Brek, the beneficial nature of suffering for a person can manifest itself in the following way:

· It can awaken in a person an awareness of complete dependence on God’s love and mercy.

· The sick person’s consciousness testifies that he is not the master of the situation. This realization leads to humility.

· Suffering purifies the soul of passions, lusts, pride, and the like, and heightens one’s attention to every moment of life.

· Suffering reminds a person that they are mortal.

· Suffering renews and strengthens the sick person’s connection with the community through shared prayer and support.

· Suffering is a participation in the life and suffering of the Savior.

· Suffering helps a person become more attuned to the suffering of others.

Transplantation (from the Latin transplantare, meaning “to transplant”) is defined as “the replacement of missing or irreversibly damaged tissues or organs with the patient’s own tissues (organs) or with organs taken from another organism.” The goal of transplantation is: “to save the patient’s life, restore the functions of damaged organs or tissues, and improve quality of life in cases of incurable diseases when other treatments are ineffective. Transplantation allows for the replacement of a non-functioning organ (kidney, liver, heart) with a healthy donor organ.” Currently, there are several types of transplantation, depending, first, on the source of the transplant and, second, on its condition. First, this may involve transplantation within the same organism (autotransplantation), a genetically identical organism (isotransplantation), an organism of the same species (allotransplantation), or an organism of a different species (xenotransplantation). Currently, some blood vessels, organs, or parts thereof are transplanted from genetically modified pigs. Second, it may involve a transplant from an embryo, a living donor, or a cadaver. Transplantation from an embryo is unacceptable from a Christian perspective, as the embryo is destroyed in the process. In the case of transplantation from a living donor, the donor’s personal consent is essential, as is a medical determination that no significant harm will be caused to the donor’s health. In the case of postmortem organ removal, the question of the exact moment of the donor’s death is of paramount importance, as is the question of the donor’s free decision regarding donation. In legal practice, there are three main models:

  1. The presumption of non-consent (opt-in) means that organs may be harvested only if there is explicit, documented consent from the donor during their lifetime or from their relatives after their death. (United States, United Kingdom, Canada, Australia). Supporters of this approach emphasize maximum respect for personal autonomy and transparency of the procedure for the family.

  2. The opt-out system means that a person is presumed to consent to postmortem donation by default unless they have refused during their lifetime. (Spain, France, Belgium, Scandinavian countries), the Netherlands, Portugal, the Czech Republic, Poland). This approach increases the number of donors, but there is a risk of violating the will of a person who was unaware of this law.

  3. Hybrid models, which assume consent but limit it under certain conditions.

The issue of organ donation is extremely pressing, as there is a shortage of organs, and many patients die before they can undergo surgery. Currently, in addition to human organs and organs from certain animals, organs are being grown from human stem cells using various methods, and technical devices capable of replacing biological organs are also being developed.

There are no direct or indirect references to transplantation in the Holy Scriptures; however, its proponents point to the call to sacrificial love (John 15:13) and to giving freely what has been received as a gift (Matthew 10:8). The only example of transplantation mentioned in tradition is considered to be the miracle of the Holy Martyrs and non-mercenaries Cosmas and Damian. In response to a prayer, they appeared in a dream to a sick man, and he heard a dialogue: “Where can we get a leg to replace the diseased one?” “Today they will bury a Moor with a healthy leg.” They cut off the leg of the deceased Moor, attached it to the sick man’s leg, and applied a healing ointment. When the patient awoke, his leg was healthy.” Although this is the only such case in all of tradition, supporters of transplantology view it as a clear example approved by the saints.

When evaluating transplantation from a religious perspective, one must rely on Christian conceptions of the body and its connection to the soul. Rejecting reincarnation, the Church affirms that the soul and body are most closely connected. St. Irenaeus of Lyons wrote: “God grants salvation to the whole nature of man, consisting of body and soul in close unity, since the Word took this upon Himself, and adorned with the gifts of the Holy Spirit, of whom our bodies are and are called temples.” The characteristics of the body, its genetics, and its illnesses influence the soul, a person’s self-perception, and identity. However, while emphasizing the connection between body and soul, we understand that the body’s cells are constantly being renewed, and identity is not created by a sense of unity with specific cells and internal organs. The brain is likely an exception, though its transplantation is currently discussed only hypothetically. Thus, the Foundations of the Social Concept of the Russian Orthodox Church state: “Donor organs and tissues are assimilated by the person receiving them (the recipient), becoming part of the sphere of his or her personal unity of soul and body. Therefore, under no circumstances can such a transplant be morally justified if it poses a threat to the recipient’s identity, affecting their uniqueness as a person and as a member of the human race”[1].

We perceive the body and its parts as belonging to us, but this very fact may mean that we can perceive them as a gift from the Creator, which we are able to share with those in need, for “it is more blessed to give than to receive” (Acts 20:35). At the same time, transplantation as an act of giving and a manifestation of sacrificial love presupposes the good and free will of the donor or his relatives in the event of his death, since a gift cannot be forced. In such situations, we may recall the words of the apostle: “Each of you should give what you have decided in your heart to give, not reluctantly or under compulsion; for God loves a cheerful giver” (2 Cor. 9:7). In the case of a living donor, the opinion of doctors is crucial; they assess the consequences of removing an organ or part of an organ for the donor, whose health must not be significantly harmed.

Finally, a number of ethical questions arise when assessing recipients’ perceptions of donated organs. First, a person’s acceptance of another’s organ cannot in any way be regarded as a desecration of their body, since nothing material is inherently unclean (Matt. 15:11). Our bodies are of equal value, and each becomes a temple of the Holy Spirit in accordance with the Christian life. Furthermore, the organs received cannot be called dead, since they are stored in a special manner and, should irreversible changes associated with death begin, they become unsuitable for transplantation. Second, transplantation cannot in any way affect the resurrection of the dead, since within 10 years nearly all cells in the body are replaced (excluding heart cells, eye lenses, and neurons), and there can be no question of the resurrection of all cells that once belonged to us. Moreover, over the course of thousands of years, the cellular matter of which we are composed has already been the cellular matter of other people. God, who created our body from the dust of the earth, will be able to restore it in its entirety, no matter what condition it may be in.

In any case, neither medicine in general nor transplantology in particular can definitively solve the problem of death and suffering, which remain an inescapable part of life in the world after the Fall.

[1] (OSK RPC XII.7)

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