A Christian Foundation for Bioethics: Prayer as Epistemology

Return to Intersections Home

Introduction: A Pastoral Challenge Taken from Modern Medicine

How ought a pastor respond if approached by a couple who are considering induction of a premature delivery of their child who will die immediately after birth even if brought to full term? The pastor is also informed that there is a significant chance the child will die in utero if the parents choose to attempt a full-term birth.

Secular bioethics would typically address such a case in terms of the autonomous choice of the parents, especially the mother. The circumstances may be unfortunate, but they do not present a challenging secular moral issue. For Christians, however, concerns for personal autonomy are at best one-sided and incomplete. To provide proper guidance, the pastor would need to consider how best to minister to the entire family, including the unborn child, given the spiritual realities of the case. For example, careful induction designed to reduce the chance of a stillbirth might increase the likelihood of being able to baptize the child and of the parents to love and bond with the child before death. However, induction would also intervene into the natural course of the pregnancy and, thereby, potentially play a role in bringing about the child’s earlier death. Should such an intervention be treated as an abortion and, therefore, as a violation of the commandment given in Exodus 20 and Deuteronomy 5 not to commit murder?[1]

This is an important question.

Properly to address such bioethical concerns and to guide the couple’s medical choices, we must take a step back and recognize that one should first turn to a right knowledge of God and be in appropriate relationship with Him. Thus, my analysis of how to approach the case is anchored in the rich history of Church Tradition, Orthodox theology, and prayer, and how such a foundation requires us to reorient all of medicine so that we treat both body and soul.

I. Prayer as Epistemology

Christianity should not be thought of as a set of philosophical principles, one interpretation among others of a series of historical (even Biblical) texts, a set of values, a political vision, or a conceptual theological conversation. Christianity is primarily a rightly worshipping community. Knowing God and His will is different than intellectual acumen, historical knowledge, or theological reflection. A properly oriented life of prayer and asceticism is essential for coming to know God and His commands. It requires a life of rightly directed piety—prayer, fasting, and asceticism.

This is why Orthodox Christian epistemology is primarily liturgical; it is based in right worship and right belief. The lex orandi (law of prayer) has a privileged place in the life of the Church and grounds the lex credendi (law of belief) in an encounter with God. There is no independent morality that can be properly understood outside of right worship and right belief. The right, good, and virtuous can only be adequately appreciated in terms of our relationship with God Who draws us to Him on His own terms.

Here, Orthodox Christian reflection often turns to the ancient Church Fathers and Saints for insight because it should not be our own preferences or moral judgments that guide us but rather careful application of God’s word as it has been consistently interpreted by its most trusted teachers. They are not read as independent authorities but as exemplar knowers of how to come to know God and to live in obedience to His will. To understand their teachings, however, requires stepping into their Christian worldview, including presuppositions regarding the reality of God, canons of moral and epistemological probity, and practice of worship. The testimony of the Church Fathers and Saints is embedded in an in-depth practice of knowing God through Christian worship and life.

Orthodox epistemology is unlike philosophy and rather different than what is often found in Roman Catholic or Protestant theology; rather than attempting to know God through rational analysis, one seeks completely to repent of all one’s sins and in so doing become holy and thus to be with God. It is a process of knowing, of curing the soul, of opening oneself to God through liturgy and prayer, fasting, almsgiving, and other Christian ascetic practices.

Even approaching the Bible for insight requires special care. As Elder Aimilianos reminds us: 

When one undertakes to examine Scripture in an idle, intellectual way, he creates hatred and quarrelling. Why? Because the intellectual approach to Scripture does not help us to turn and reflect on our sins, but instead makes us focus on problems, and intellectual faculties are aroused to no real purpose. “Knowledge” by itself does not add anything. On the contrary, it encourages the cultivation of the individual and his private sense of things; it fosters the self-sufficiency of his personal opinions, which he then seeks to justify and impose on others. . . . Filled as I am with my own opinion about things, I am not able to receive anything from God.[2]

Holy scripture is to be approached with simplicity so as “to allow God to tell us what He wants to tell us. . . . Read it because you want to acquire its true context, that is, the Holy Spirit.” [3]

Interpreting the Bible as an academic exercise as if it were no more than a set of historical texts can easily lead one astray. Instead, study of scripture should “bring peace to your heart, communion with God, love of neighbors, and the consciousness of your own sinfulness: the recognition of how unworthy and ill-prepared you are to stand before God.”[4]

As Father Michael Pomazansky put it: “Christian faith is a mystical revelation in the human soul. It is broader, more powerful, closer to reality than thought. It is more complex than separate feelings. It contains within itself the feelings of love, fear, veneration, reverence, and humanity.”[5] Knowledge of God is not so much intellectual but existential. One does not seek to know abstract facts about God, but personally to know Him, to acquire a will in union with His, and to reshape one’s life to draw oneself closer to Him.

II. Using Such a Foundation to Orient Modern Medicine

Applied to healthcare, this approach calls us to recognize that medical interventions cannot be sufficiently evaluated if one only regards bodily functions, pain, suffering, and other human interests in this physical life; a transcendent focus is also essential. “For what will it profit a man, if he gains the whole world, and loses his soul” (Mark 8:36). The Church has always taught that medicine is permissible, and its use generally encouraged, provided that it does not involve sinful actions or otherwise impede one’s relationship with God.

St. Basil (AD 329–379), for example, reminds Christians that medicine is a gift from God: 

Each of the arts is God’s gift to us, remedying the deficiencies of nature . . . And, when we were commanded to return to the earth whence we had been taken and were united with the pain-ridden flesh doomed to destruction because of sin and, for the same reason, also subject to disease, the medical art was given to us to relieve the sick, in some degree at least.[6]

St. Basil notes approvingly that “with mandrake doctors give us sleep; with opium they lull violent pain.”[7] At the same time, he issued a stern warning regarding putting too much faith in medical practice: “To place the hope of one’s health in the hands of the doctor is the act of an irrational animal.”[8] Medicine supports important human goods, but neither health nor the pursuit of any other earthly goods should replace faith in and obedience to God.

As St. Maximos (AD 580–662) reminds us, often the distortion of human goods, rather than the goods themselves, leads to sinful practices. “It is not food that is evil but gluttony, not the begetting of children but unchastity, not material things but avarice, not esteem but self-esteem. This being so, it is only the misuse of things that is evil.”[9] Such considerations also explain why St. Basil requires that we think carefully about how medical care is utilized, restricting “whatever requires an undue amount of thought or trouble or involves a large expenditure of effort and causes our whole life to revolve, as it were, around solicitude for the flesh.”[10] Working to save life at all costs—or obsessive engagement with other forms of medical care, such as plastic surgery in search of the “perfect look”—risks turning the desires of this life and the ministrations of medicine into idols. Medicine should not become an all-encompassing endeavor. Careful spiritual discernment is essential.

Still, Christianity has long-settled reflections regarding the sinfulness of many practices. Consider, for example, very briefly, abortion, physician-assisted suicide, euthanasia, and castration.

Abortion has been routinely condemned from the earliest times as a violation of the commandment against murder.[11] Opposition to euthanasia and assisted suicide is similarly grounded in a recognition that such acts constitute murder and self-murder. Fully to appreciate the implications of such acts one must recognize the spiritual harm of killing on the physicians who perform abortions, euthanize patients, or who aid and abet individuals in killing themselves. One must also appreciate the full spiritual impact of these choices on the patients themselves.

However, while we are commanded not to kill, we are not always obliged to save. Humans are finite beings; aggressive curative care may not necessarily be appropriate. There will indeed come a time when it is appropriate to give up the pleasures of this life, refuse additional medical care, and turn wholly to God. Determining precisely when this point in one’s life has come requires good spiritual preparation and appropriate pastoral counseling. However, recasting the intentional killing (or assisted self-killing) of patients as “medical care” involves a significant shift in the moral foundations of medical practice. We are to accept killing as among the usual menu of treatments that physicians offer patients and that patients request from their physicians. It requires us to think of the medical profession without the traditional Christian constraints against intentionally bringing about the deaths of patients.

Abortion, assisted suicide, and euthanasia are not neutral actions. Each of us will stand before the dread judgment seat of Christ (2 Cor 9–11). It might be better for us to be judged without having committed homicide.

With regard to castration, Genesis 1:27 is central for understanding Orthodox Christianity: “So, God made man; in the image of God He made him; male and female He made them”; which is reaffirmed in the gospel of Mark: “But, from the beginning of creation, God ‘made them male and female’” (Mark 10:6). The Church Fathers recognized that being created in the image of God (the imago Dei) described a foundational relationship between God and man, with significant implications for properly appreciating basic human goods, which in turn have repercussions for medical decision-making. For example, castration that results from rejection of one’s creation as male (or the analogous surgical alterations to accommodate rejection of one’s creation as female) is mutilation that inappropriately rejects the fundamental sexual nature of God’s creation. Castration was forbidden in the very first canon of the first council at Nicaea (AD 325) except in very rare cases of medical necessity to save the life or health of the patient.[12]

In short, all of medicine, must be appreciated first and foremost in terms of our relationship with God. We must take care to treat body and soul. Used properly to treat disease and infirmity, medical care may even help teach us the patience to love others, to forgive sins, and to trust in God. Wrongly directed, however, medicine can distort our relationships with others and with God. Like all human goods, medicine must be placed within the demands of the Christian life and understood in terms of the struggle toward salvation.

III. Conclusion: Applying the Framework—A Suggested Resolution in Christ

Returning to the case of medical induction of a premature delivery, as my thesis noted, a more complete bioethical analysis requires rightly turning to God and coming to know Him. Having sketched out foundational elements of Orthodox Christian epistemology and how it frames medical care in terms of the demands of a Christian life, my hope is that at least this much is clear: first, the parents ought carefully to seek a discerning spiritual guide, such as a trusted pastor, Christian community, spiritual father, or holy elder; second, such guidance should be provided in terms of what decisions best orient parents and child toward God. Some choices may provide the possibility of God’s blessings even if less than medically optimal. There may be situations where a traditionally Christian perinatal hospice would be appropriate, for example.

My own evaluation of this specific case is that we need not think of the induction by itself as an abortion under such circumstances, provided that the child’s development is far enough along and special care is taken that one may achieve the medically supported goals of a live birth and Orthodox baptism of the child.[13] The parents would likely need significant Christian counseling following the child’s death. Regardless of the virtue of our intentions, we will often require spiritual therapy to heal and return humbly back to God.

My advice in this case is not neutral. It is a judgment set within Orthodox Christian tradition as outlined above. I can imagine other, rather different, advice being given from a pastor whose formation was within a different Christian religion. To emphasize, however, the goal is not to act in terms of any specific person’s autonomous choice or personal preferences, but carefully to apply God’s commands, especially as they have been consistently interpreted throughout Christianity. After all the aim of any real love for someone is to share with that person the joy of salvation in Christ and to provide orientation towards Him.

Consequently, appropriate spiritual orientation is essential. Where you stand and the direction you face matters. Here, Orthodox Christianity affords the opportunity to immerse oneself in ancient forms of prayer and liturgical services that no longer have close analogies in much of Western Christianity. The typical Sunday service begins with Hours and Vespers the evening before, returning for Matins (Orthros) in the morning and then Divine Liturgy. In love and in the joy of the resurrected Christ, I recommend them to you.[14]


[1] All biblical citations and quotes are from St. Athanasius Academy of Orthodox Theology, The Orthodox Study Bible (Thomas Nelson, 2008). Old Testament text: © 2008 by St. Athanasius Academy Septuagint; New Testament text: New King James Version © 1982 by Thomas Nelson a division of HarperCollins Christian Publishing, Inc.

[2] Aimilianos of Simonopetra, Psalms and the Life of Faith (Athens: Indiktos, 2011), foreword.

[3] Aimilianos of Simonopetra Psalms and the Life of Faith, foreword.

[4] Aimilianos of Simonopetra, Psalms and the Life of Faith, foreword.

[5] Father Michael Pomazansky, Orthodox Dogmatic Theology, trans. and ed. Hieromonk Seraphim Rose (Platina: St. Herman of Alaska Brotherhood, 1994), 48.

[6] St. Basil, “Ascetical Works: The Long Rules,” in The Fathers of the Church, vol. 9, ed. R. J. Deferrari et al., trans. Sister M. M. Wagner (Washington, DC: The Catholic University of America Press, 1962), 330–31.

[7] St. Basil, “The Hexaemeron,” in Nicene and Post-Nicene Fathers, Second Series, vol. 8, ed. Philip Schaff and Henry Wace (Peabody, MA: Hendrickson, 1994), 78.

[8] St. Basil, “The Long Rules,” 331.

[9] St. Maximos, “Four Hundred Texts on Love” in The Philokalia, vol. 2, comp. St. Nikodimos and St. Makarios, trans. G. E. H. Palmer, Phillip Sherrard, and Kallistos Ware (London: Faber and Faber, 1983), 83.

[10] St. Basil, “The Long Rules,” 331.

[11] Orthodox Christianity has recognized abortion as a prohibited form of homicide from the first century. See, for example, the Didache, which dates from the first century AD: “Do not murder a child by abortion, nor kill it at birth.” J. N. Sparks, ed., “The Didache,” in The Apostolic Fathers, trans. R. Kraft (Minneapolis, MN: Light and Life Publishing Company, 1978), 309.

Similarly, the Epistle of Barnabus, dated to the first or second century AD summarizes the position of the Church: “Do not murder a child by abortion, nor, again, destroy that which is born.” J. N. Sparks, ed. “Epistle of Barnabas,” in The Apostolic Fathers, 298.

The Church’s later reflections on abortion include the summary in Canon 91 of the Quinisext Council (AD 691) that states: “Those who give drugs for procuring abortion, and those who receive poisons to kill the fetus, are subjected to the penalty of murder.” Philip Schaff and Henry Wace, eds., “The Canons of the Council in Trullo (often called the Quinisext Council),” in Nicene and Post-Nicene Fathers, Second Series, vol. 14 (Peabody, MA: Hendrickson Publishers, 1995), 404.

[12] “If anyone has been operated upon by surgeons for a disease, or has been excised by barbarians, let him remain in the clergy. But if anyone has excised himself when well, he must be dismissed even if he is examined after being in the clergy. And henceforth no such person must be promoted to holy orders. But as is self-evident, though such is the case as regards those who affect the matter and dare to excise themselves, if any persons have been eunuchized by barbarians or their lords, but are otherwise found to be worthy, the Canon admits such persons to the clergy.” Sts. Nicodemus and Agapius, “Canons of the Ecumenical Synods: 1st Ecumenical Synod,” in The Rudder of the Orthodox Catholic Church: The Compilation of the Holy Canons (Chicago: Orthodox Christian Educational Society, 1957), 163.

This judgment was reaffirmed at the First and Second Regional Synod, canon 8: “For precisely as the first Canon of the Council held in Nicaea does not punish those who have been operated upon for a disease, for having the disease, so neither do we condemn priests who order diseased men to be castrated, nor do we blame laymen either, when they perform the operation with their own hands. For we consider this to be a treatment of the disease, but not a malicious design against the creature or an insult to creation.” Sts. Nicodemus and Agapius, “Canons of the Regional Synods: The 1st and 2nd Regional Synods,” in The Rudder of the Orthodox Catholic Church, 465.

[13] As H. T. Engelhardt, Jr. (1941–2018) notes: “If the child will die in any event and one is acting to provide baptism, then one will not have an intimate causal involvement in bringing about death, if one delivers the fetus at a gestational stage when a child could otherwise (without the defects) have survived with special care, had that been appropriate.” The Foundations of Christian Bioethics (Lisse: Swetz & Zeitlinger, 2000), 280.

[14] Distantly ancestral versions of some aspects of this analysis have appeared in the journal Christian Bioethics (Oxford University Press).