"Ultrasonic Antenatal Screening: the Orthodox Theological Viewpoint" 24/2/2006 Address to the 1st Panhellenic Conference on Ultrasound in Obstetrics and Gynaecology My dear ones, Mister Chairman of the Hellenic Society of Ultrasound in Obstetrics and Gynaecology, In your letter of invitation, which gave me the opportunity to attend this paramount scientific conference tonight, in order to address words emanating from the experience of the Church on bioethical matters, you tellingly stated, and I quote: “If the rapidly developing application of ultrasound in Medicine has decisively and sweepingly affected the progress of almost all medical specialisations over the last 30 years, as regards Obstetrics and Gynaecology, in particular, it has been undoubtedly both the cause of formidable developments that have allowed immediate solutions to serious everyday diagnostic and therapeutic problems and the opportunity for the blooming of new medical sub-specialisations such as Embryology, Antenatal Screening and Assisted Reproduction. All these developments certainly entail broader legal, bioethical, theological and social problematics and wavering”. Thank you for facilitating my thought, since, as representative of the scientific community, you acknowledge, in the process of prenatal screening, the existence of “theological and social problematics and wavering” that should be taken seriously into consideration by those subject to the screening in question. These are the mother, as the one who bears the embryo, the father, as the one who contributes to the work of creation, the doctor, who is responsible for monitoring mother and embryo, and the medical profession per se, which is called to put its endurance and its limits to the test. At the heart of this whole process, the embryo, which, though apparently so weak and unable to express its will, has tremendous rights that all agents surrounding it must recognise and respect. The purpose of ultrasonic antenatal screening is the assessment of the embryo’s state inside its mother’s womb and the appropriate medical operation that may be required. If I may quote from a recent pronouncement of our Holy Synod, “our Church expresses Her admiration for the achievement, welcomes the acquisition of new knowledge, is charitably relieved by the anticipation of a revolution in diagnostic, preventive and therapeutic Medicine, glorifies the all-wise God for the gift and wishes and prays that the deeper knowledge of our biological and genetic identity will facilitate the progress to spiritual self-knowledge and the knowledge of God. However, she understands that the revolution in Genetics comprises not only great promises but also risks due to the fact that our ignorance is greater than our knowledge, prudence rarer than irrational desire and values weaker than interests. »For these reasons She draws the attention of us all to the necessity of protecting the human gene from interests of any kind, financial exploitation, eugenic manipulation, arrogant domination. It is not the genome that gives value to man, but man who gives value to his genome”(1). I shall not tire you further by enumerating the scientific and broader advantages of prenatal screening nor shall I dwell on areas of medical interest, which will certainly be presented and debated extensively by experts on these matters in the course of the Conference. However, please allow me briefly to note the view of our Orthodox Church on the issue, also referring to the great work accomplished by the Committee of the Church of Greece on Bioethics. This generally acclaimed work is carried out with consistency, responsibility and on the basis of a combination of scientific knowledge and ecclesiastic experience. In this manner, the Committee is able to pronounce itself on relevant modern and, if I may say, burning issues. The Orthodox Church always upheld respect for the uniqueness of God the Creator and for the inestimable value of the human person as an absolute axiological and ethical criterion in any cultural reality. The human person is evaluated within the framework of the Trinitarian conception of its meaning, namely with reference to the Holy Trinity. An autonomous man, emancipated from God, has no value. He takes on value from the moment he is an image of God and the distinction between “nature and person” allows the reference of man to God, while excluding any attempt at his being raised to the position of an absolute being. Any decision of man must be made within the framework of his participation in ecclesiastic life, with reference to God’s commands and in relation to the Creator of life. The exhortation of the Church “let us commend ourselves and one another and our entire lives to Christ our God” aims precisely at showing that our dependence on God is an affirmation of our entity. This is why “any attempt at existing independently of this absolute criterion was seen as a deviation from the principles of the Orthodox tradition and experience, because it leads directly or indirectly to disconnection from the Word of creation. The threat of an incursion of genetic technology against man and his volitional functions ultimately emanates from the broader sociopolitical, ideological-economic and spiritual tendencies towards the devaluation of the sanctity and the value of the human person, which, in turn, resulted from the new value system as this latter was formed in the 19th and 20th centuries”(2). In this respect, raising the human person to the status of an absolute evaluative criterion of the fruits of modern civilisation and genetic technology sets the framework within which Eugenics must also move as well as the limits of the “right” of man to undertake all genetic matters indiscriminately. On the basis of the above principle, it is imperative that the goal of the research and applications connected with prenatal screening be not set by nor confined merely to utilitarian considerations but that they serve solely therapeutic or scientific aspirations. Consequently, it is necessary clearly to set the limits of the interventions allowed. Here the questions raised are enormous and crucial, in view of the colossal implications of potential applications: is killing the embryo permissible, when doing otherwise may lead to the birth of an invalid child? In the former case, who will make the decision on the interruption of pregnancy? In the latter case, what is the significance of a birth of an invalid child? If this is the will of God, who has the right to resist Him? “We fear lest an invalid child is born. Nonetheless, it is still born invalid, charged with the implications of the tragic heritage of death. The main invalidity is death, not sickness. That is why what is worthwhile and constitutes capital gift is immortality in man” (Metropolitan Nikolaos of Mesogaia and Lavreotiki, “Spiritual and ethical limits of modern medical technology”). “The non-recognition of the sanctity of life leads to unpleasant situations. Then egoism and the reason of the powerful prevail, then the mind is enslaved by passions and science and technology may end up a plague for mankind. Without love of God and respect for the sanctity of life inhumanity often dominates. Nowadays, thanks to the means available to science and technology the eugenic perception of life and society has started gaining ground. The view of Francis Crick, 1962 Nobel laureate in Medicine, is telling: «No new-born infant should be recognized as human before passing certain tests regarding its genetic qualities. […] If it fails in these tests, it loses the right to life». Sadly, we return to the era of the Caeadas chasm of ancient Sparta… In other terms, according to the view of the distinguished scientist, none of the youths today taking part in the Paralympic Games, though disabled from birth, should now be in life. Nowadays, thank God, this view seems to be far from officially established. Nevertheless, both prenatal screening becomes standard practice and new facts about the course of the life of society emerge, while the general tendency takes us there too. Things become more complex, if, for instance, the genetic test shows that the embryo may evolve into someone with a hereditary cumber of a disease, about which, however, it is unknown whether and when it will manifest itself. »One may ask: is it bad for parents to know that the baby which will be born will suffer from the Down syndrome or from Mediterranean anaemia? The reasonable answer would be “no”. But then society itself should have experienced life in such a way as to allow parents the possibility to choose, of their own free will, the ordeal and the cross instead of deliverance. Society should have taught —and here I do not except the responsibility of the Church— that it is the Cross that gives meaning to life and not the effort to shake off anything that distresses us or is cumbersome in a carefree life”(3). “The Church, which sees the weak man with infinite sympathy, which carries Her message through the narrows of pain —love, patience, humility cannot be conceived free of pain— and which surpasses human measures through the filter of physical weakness and deficiency and acknowledges the greatness of man solely through imperfection and injustice; the Church, which meets man where society forgets him, how can this Church accept the sacrifice of man on the altar of a legitimised eugenic injustice?”(4) Otherwise, we should assume that the embryo has no rights and that it is prey to the choices of the “intelligent and powerful” agents involved in the matter. Yet it is precisely by virtue of the fact that the embryo is a human and a person in the process of development, a life dependent on and produced by the will of third parties, unable to sustain or to defend itself on its own, that its rights certainly arise as well. “The first [of these rights] is the right to human identity. The embryo has the ethically inalienable right to manifest this identity itself and to develop its personality. Instead of deciding what and which it is, we must give it the possibility to manifest this to us itself; to prove itself as human and to unfold its physical and mental traits that differentiate it from all other men. It is this right that science and society must protect. »The second right is the right to life. The natural course of the embryo is that of every man. We must recognise and protect and care for its right to live. The embryo must reach its own state of autonomous life under the best possible conditions. But then the aim of its existence must also be life and life only, never experimentation (see experimental embryos) or surplus (surplus embryos) or waiting in conditions of refrigeration (frozen embryos). The fact that for thousands of embryos the warm motherly place of development has been replaced by the cold environment of a freezer and the possibility of life has been replaced by the prospect of experimentation and death constitutes a debasement of the value of man and a violation of the right to life. »The third right is the right to eternity. The embryo has the prospect of immortality; it is destined, from the moment of its conception, to pass on to eternal life. This shows God’s right to repeat His image in man”(5). The problem needs spiritual treatment. The interruption of pregnancy is an interruption of life. In this case, the interruption of life is decided incompetently on the basis of utilitarian criteria. The Christian ethical perception of life and death differs from the so-called “social ethics”. Spiritual ethics speaks of sacrifice, endurance, cross, Golgotha, pain, privation, ascesis, resurrection, vindication, struggle, theosis. What becomes of all that, in view of the decision to interrupt the pregnancy because the infant that is coming is problematic? Finally, who can convince us that God’s will is not a blessing for us? “Any difficulties the couple may come across during the pregnancy are treated with faith in God’s Providence, with prayer and by conversation with an experienced spiritual father. There are parents who avoid proceeding to antenatal screening, because this may cause many ethical and spiritual dilemmas that they cannot handle, unless there is a particular reason, which the Christian medical scientist will indicate”(6). In principle, the possibility of pre-symptomatic diagnosis is something positive, since it will warn the individual person about his or her predisposition to a certain disease, so that he or she may avoid being exposed to dangers contributing to the manifestation of this disease. “The Church stands before this achievement in awe and admiration. I do not mean its intelligence but its practical applicability. The need for quality of life and the desire for better health are so human and so natural. This is why anything that may relieve the pain and check the disease is seen by the Church in a particularly charitable spirit as a gift of God and a victory of man over the great enemy that is the fall, the domination of disease and weakness ”(7). However, this early diagnosis may also be detrimental to the individual from a psychological point of view, particularly when the disease he or she is predisposed to is not curable. In this case, should man’s right to know retreat before his opposite right not to know? Nonetheless, the matter is not as simple. Genetic diagnosis also affects the relatives of the individual, who may have an interest to know. Consequently, the right of one not to know may be in conflict with the right of relatives or third parties to know, such as the right of a spouse to be informed of the state of health of his or her spouse in the cases of the conclusion of marriage or of a marriage already concluded or in view of procreation. Whose right will prevail? And who will decide whether medical confidentiality should be broken? The difficulty is obvious and has led many geneticists to refuse to use the antenatal diagnostic method, even though it may be available. Similar dilemmas come up in the relationships between employer and employee, insured and insurer. “In the clash between social sensibilities and companies, we now have the general feeling that no committee manages to check the impetus of the economic power. Commercialisation and patenting of products lead to those of genetic qualities and particularities and of course to the economic outlook on everything. Modern developments gradually lead to the commercialization of achievements to such a degree that even the genetic secrets of each one of us are monitored. Accordingly, in a few years’ time, each one of us will bear a number of traits, the patent for each one of which will be claimed by a company. In this manner a shift is effected from the person to the impersonal, from each individual man to the company”(8). It is true that the misuse of the new methods of genetics generally attracts the attention of theologians, sociologists and theoreticians of Ethics. However, before the use or the uses of scientific research, there is the nature of genetic knowledge, which does not seem to preoccupy scientists as much as it should. The problem may appear to be a philosophical one and as such without practical implications, yet it is important that an answer be given to the question what could or should be the nature of this knowledge. In other terms, the problem is reduced to its origin or to its foundations, namely whether this knowledge may eventually determine the spiritual dimension of man, degrading it from the level of divine origin to a mechanistic perception. In reality, it is all about the fundamental question, whether, in the ultimate analysis, man can be “manufactured” on his own initiatives. “Man to order” is no longer a matter of science fiction. As things indicate, we may one day arrive at the point of creating “super-humans”. Yet, if this is the aim of Eugenics, then it is a wholesale substitution of nature, an unholy and sacrilegious domination over it. Could this be good or bad? From what has been mentioned above, one may easily draw the conclusion that very serious, mainly ethical problems arise from the uncontrollable diffusion of the methods of Eugenics and it is incumbent mainly upon scientists themselves to keep this science within the ethically acceptable boundaries. To this purpose, all those involved must help. And the part of the Church can and must be decisive. In other terms, the Orthodox Church must indicate those boundaries within which eugenic practices must be kept. Otherwise, mankind will lament on the ruins of human beings that will be accumulated by man’s unrestrained egocentric tactics that turn him from an image of God into a narcissistic self-image, for a while, until he realises his fall. [Transl. into English by Dr Nikolaos C. Petropoulos] Notes 1. Press Bulletin of the Holy Synod, June 28, 2000. 2. Metropolitan Damaskenos, formerly of Switzerland, “Episkepsis”, 10.4.1987. 3. Archbishop’s Address to the Annual General Congress of the Hellenic Obstetric and Gynaecological Society, 18.12.2004. 4. Metropolitan Nikolaos of Mesogaia and Lavreotiki, “Free from the genome”, p. 101. 5. Holy Synod of the Church of Greece, “The Orthodox view on assisted reproduction”. 6. Metropolitan Ierotheos of Nafpaktos and Saint Vlassios, “Bioethics and Bio-Theology”. 7. Metropolitan Nikolaos of Mesogaia and Lavreotiki, “Free from the genome”. 8. Ibidem.