Euthanasia, Physician-Assisted Suicide, and the Pursuit of Death with Dignity

By Fr Joseph Woodill

For a number of years I have worn two hats. At a nearby college, I am Dr. Woodill and teach a very popular course on death and dying. Elsewhere, I am Fr. Joseph. As the priest of an older parish, I have buried more people than seems right. I have also attended to their dying. These days many of the young and old—the Orthodox and the not so orthodox—seem to me to hold the same perspective on death and dying. Many insist that one ought to be able to die when and how one wills, and that doctors who assist such dying are only helping us. This is, I teach, a dramatic turn from what was once the usual attitude toward dying.

There is no better history of views about death than The Hour of Our Death by Philippe Aries (Oxford Univ. Press, 1981). In tracing 1,000 years of changing attitudes toward death and dying, Aries finds ours to be an age unlike any other. While past generations sought for a good death by living well, putting affairs in order, and living in the knowledge of the inevitability of death, our age is characterized by denial. We have no “art of dying,” so typical of other times. We have, instead, sought to grasp the measure of death by denying it any place, any meaning, and by rendering it a problem to be solved.

The Medicalization of Death

The medicalization of death resulted in death becoming a medical problem to be solved, or if it could not be solved, to be controlled by our technology, by mercy killing. An excellent presentation of this transformation is Daniel Callahan’s The Troubled Dream of Life: Living With Mortality (Simon and Schuster, 1993). As Callahan explains it, we have, unsuccessfully, tried to measure death by a vision of life that demands control and autonomy. We have sought to kill death by making it a medical problem to overcome, by calling lawyers to write documents that will control it, and by evolving funeral practices that allow us to disassociate ourselves from dying.

If the history of our changing grasp of death is old, the story of the contemporary problem is no more than about twenty years old. It seems to me that our views began to evolve at about the time (1976) that a New Jersey Court ruled on the case of Karen Ann Quinlan. The court ruled—rightly, it seems to me—that she could be removed from the respirator because we ought not to use medical technology to make dying even harder. Medicine is good, but medicine should not contribute to a death without human dignity.

After the court ruled in the Quinlan case that we need not take extraordinary measures to keep those dying alive, the same New Jersey Court ruled in 1985 (in the case of Claire Conroy) that nutrition and hydration (artificially administered food and water) should be treated like any other sort of technology and, so, may also be removed when a patient is dying. The U.S. Supreme Court upheld a Missouri Court ruling (in the case of Nancy Cruzan) that hydration and nutrition could be removed, but only if there was a clear indication that it was the patient’s will. In the light of the ruling on the Cruzan case, Congress passed (Dec. 1, 1990) the Patient Self-Determination Act which required institutions receiving government funding to advise patients that they had the right to indicate in advance how they wanted to be treated.

Living Wills

We know advanced directives as “living wills.” This is a document that attempts to specify what you would want to be done for/to you concerning life-sustaining treatments. It is often combined with a ‘durable power of attorney” that designates a proxy, someone to speak for you. While the living will attempts to insure that medicine will not distort our dying, it has failed to keep its promise. For many reasons, advanced directives fail to insure a death with dignity. Not surprisingly, the document has yet to be written that can insure against the omnipresent ambiguities of life. It will require more than a document to die well.

Even if we could, however, we wouldn’t want to live in a world without modern medicine. Medicine is a blessing and honorable work. I think that the question is, What sort of people do we want to become? and What sort of medicine do we want to practice? We have great faith in technology, but should we expect medicine to underwrite our demands to be in complete control? Since death has proven difficult to control technologically, it follows almost necessarily for some, that they would try to control death by deterring when they will die! Euthanasia seems an almost inevitable consequence of their strategy of avoidance.

Physician-Assisted Suicide and Euthanasia

Living wills and the refusal of life-support technology generally have legal—and religious—sanction. Physician-assisted suicide (where the doctor supplies the cause of death) and voluntary euthanasia (where the physician performs the act resulting in death), however, have recently been scrutinized.

Two cases came before the US Supreme Court in June 1997. A Washington State law had prohibited doctors from granting patients’ requests for assisted suicide. That state law was declared unconstitutional by the Ninth Circuit Court on the grounds that it violated the guarantee of personal liberty in the Fourteenth Amendment to the Constitution. A New York State law, declared unconstitutional by the Second Circuit Court of Appeals, distinguished between what physicians “passively” allow (letting die) and what they might “actively” cause, i.e. supplying an overdose for a requested suicide.

The Supreme Court, in a unanimous decision, ruled in the summer of 1997 that the Constitution does not guarantee a right to commit suicide with the help of a physician. While the decision allowed states to ban assisted suicide, the same decision also left the states the power to legalize the practice. Justice Sandra Day O’Connor left open the possibility that the Court might yet find a right to suicide for some individuals.

The justices did stress—correctly, and as I see it, importantly—that there is an interest in protecting against potential abuses. They also saw danger in undermining the trust we have that a physician will not harm us by blurring the line between healing and harming. Neither side of the debate thinks that the Court has solved the problem. The battle has just begun.

Kevorkian

There is no figure more emblematic of euthanasia than the Michigan pathologist—he is NOT a family doctor with patients—Jack Kevorkian. While many have seen him on the evening news, few bother to read his claims. Prescription Medicine: The Goodness of Planned Death by Kevorkian (Prometheus Books, 1991) is, strangely, dedicated to the enlightened doctors of Hellenistic Alexandria and medieval Armenia. In one of my “favorite” chapters, Chapter 17, Kevorkian declares that a positive result of euthanasia would “allow doctors for the first time to carry out on living human beings otherwise impossible trials of new and untested drugs, devices, or operations” (p. 240). What, he says, prevents the broadening of the spectrum of medicine to include the wonder of “obitiatry” (his word), that is, of experimenting on the dying? Only “the inflexible and harshly punitive Judeo-Christian dogma that espoused the absolute and inviolable ‘sanctity of human life’” (p. 240). Still there is hope, he writes. We may yet overcome “vestiges of those taboos (that) have endured to our ‘enlightened’ time” (p. 240). Even my students, predisposed as they are to applauding euthanasia, cannot believe that Kevorkian wrote this.

I recommend the Armenian Orthodox theologian, Vigen Guroian, as an antidote to Kevorkian. Read the short (about 100 pages), but potent, Life’s Living Toward Dying (Erdmans, 1996). Guroian unpacks a central Orthodox Christian virtue, “the remembrance of death,” to critique Kevorkian and the Thanatos Syndrome—the right to put to death with dignity. Guroian is profitably read along with Callahan (noted above). Callahan tries to recover a vision of medicine from the perspective of the reality of death, while Guroian shows how the Christian life requires the virtue or skill of “living toward dying” (p. 35).

Orthodox Christian Ethics

“Orthodox Christian ethics,” writes Orthodox theologian Fr. Stanley Harakas, “rejects euthanasia; it considers it a special case of murder if done without the knowledge and consent of the patient, and suicide if it is requested by the patient” (p. 129 in Living the Faith, Light and Life Publ. Co., 1993). While the position of Orthodox Christianity is clear and unambiguous, I want to suggest another way of engaging these concerns. Both Callahan and Guroian, each in his own way, are engaged in a classical approach to ethics. Both are Virtue Ethicists. Such ethicists ask questions like: What are we trying to become? What are the practices and virtues (skills) that will move us toward our goal? In what sort of world do humans flourish and grow?

Similar questions might be asked of those favoring euthanasia and assisted suicide. For example, what sort of people would create a culture, a world, where our mortality can be ignored? Surely, not people who will die! What sort of medicine would be favored by a people who refuse to face their mortality? Perhaps a medicine that kills! Doesn’t a doctor who assists in the death of his patients do to medicine what a confessor who gossips does to ministry?

I want to suggest that we Orthodox learn to ask questions of virtue like those asked by the Church Fathers. I recommend John Climacus’ The Ladder of Divine Ascent (Paulist Press, 1985). This book is, after the Bible, the most popular and most translated work in Orthodoxy. In The Ladder, St. John of Sinai tells us that the Christian life is like climbing a ladder from where we are (far from being witnesses of God’s ways) to where we ought to strive to be (loving with God’s own love). The goal of life is not autonomy, control, or escape. The goal of life is God; the God who loves by giving Himself, His life to us and for us. Virtues are needed in order to climb this ladder.

Cultivating a “Remembrance of Death”

We ought, for example, to live in a way that cultivates the virtue or skill of “remembrance of death” (Step 6 on the ladder). We must become skilled at remembering that we are not life, or the source of life, and that anything not of God is our death.

We are also encouraged to break free of gluttony. Gluttony is not only - or even primarily - about food. It is when we have learned the habit of making everything a “feast” for ourselves. People growing toward the Lord gain just the opposite virtue. God makes Himself to be a feast for others, as we ought to.

What sort of medicine would people climbing a ladder to our God want to develop? We would surely want medicine to be a craft that comforts, heals, and relieves pain. We would, however, reject a craft developed to make of life a masquerade, pretending that we are able to avoid all suffering. We would not want a medicine that prompts us to neglect living the sort of life that would allow us to face death with peace.

While documents such as living wills seem to me to be a sincere plea that medicine not be used to make my dying harder than the living, we still would not want a world that tells us to trust in a document to insure what only a life well lived can grant. I want to be able to die in such a way that the pain does not preclude my asking for forgiveness. I want to be, God willing, conscious and with my wife, children, and friends. I want my life and death to have been in some way a blessing, so that others are able to relate to my funeral. We should not only want to have, but help to create a medicine that is part of our climbing the ladder toward God’s ways, thus toward being fully human.

Establishing an Orthodox Christian School

By Nichola T. Krause

A network of Orthodox Christian parochial schools has been successfully established in northeast Ohio as a multi-city, cross-jurisdictional ministry. A brief history of Orthodox Christian Schools of Northeast Ohio, Inc., is related, along with “voice of experience” advice for other Orthodox Christian communities seeking to begin a day-school education ministry.

“A Mission to Educate

Orthodox Christian Schools of Northeast Ohio, Inc., opened the doors of its first elementary-school campus, St. Nicholas Orthodox School, in August 2000. For the 2002-2003 academic year, OCS-NEO will administer three campuses: Akron, Canton, and Cleveland, and begin marketing its Faith-based classical curriculum materials for use by other Orthodox Christian parochial schools and homeschools.

St. Nicholas Orthodox School

St. Nicholas Orthodox School started as a ministry of St. Nicholas Orthodox Church. The 85-year-old parish is located in Mogadore/Suffield, Ohio, and is under the authority of the Right Reverend JOB, Bishop of Chicago and the Midwest/Orthodox Church in America (OCA).

The greater Akron community is home to over a dozen Orthodox Christian parishes of various jurisdictions, and these parishes often work together on service, mission, and adult education projects. In short, the community is vibrant and firmly based. The need for a parochial elementary school was identified in pan-Orthodox committees and by several parish councils: there were nearly 300 school-age students in the Akron parishes alone in 1995, according to an interest survey taken by the Akron Orthodox Clergy Association. Historically, however, the Orthodox Church has not offered Faith-based elementary and high school options—common in the Jewish community and Roman Catholic, Lutheran, and Evangelical denominations—to its families. The cooperative greater Akron area seemed to be a promising environment for both the development of a model and establishment of an Orthodox Christian parochial school.

Exploration into the feasibility of opening a parochial elementary school at St. Nicholas Orthodox Church, Mogadore, was started in early 1994, during the development of a parish mission statement and the revision of the parish’s Long Range Plan. The final forms of those documents were published in January 1997, and called for increased efforts in both community outreach and youth education, including the establishment of a Faith-based elementary school offering a high-quality academic program within five years.

When representatives of the St. Nicholas Orthodox Church Long Range Planning Committee’s school sub-committee first approached the Right Reverend JOB, Bishop of Chicago and the Midwest (OCA), for his blessing to actively pursue the development of a parish-based parochial school, His Grace was completely supportive (August 1999). During a pastoral visit in April 2000, His Grace outlined his specific goals for the project at the diocesan level:

St. Nicholas Orthodox School should:

  1. Provide a high-quality academic education to both Orthodox and non-Orthodox students in the Akron-Canton area, using the Classical model, modified to an Orthodox Christian worldview, which is Faith- and Salvation-history based.
  2. Galvanize the cooperative efforts of the OCA parishes in the Cleveland Deanery, and the numerous non-OCA Orthodox parishes in the Akron-Canton area.
  3. Pprovide a model and serve as a resource for other groups, throughout Orthodox America and in the OCA Diocese of the Midwest in particular, to establish their own Orthodox Christian parochial schools.
  4. Drawing on parish resources with significant experience in publications, produce curricula and professional-grade classroom materials on a continuing basis to support Orthodox Christian classical education.”

The overall mission of St. Nicholas Orthodox School was outlined for the parish assembly in January 2000, and now serves as the mission for Orthodox Christian Schools of Northeast Ohio, Inc., and all its campuses:

OCS-NEO Mission Statement

The mission of OCS-NEO, as an extension and fulfillment of the primary parental responsibility for the education of their children, is to provide an education that…

  1. Guides the spiritual and social development of the students by their participation in the Orthodox Christian community and liturgical cycle;
  2. Reinforces Orthodox Christian character;
  3. Is academically strong.

A school committee, consisting of the parish priest, deacon, and six interested parents (two of whom were university-trained teachers), began meeting bimonthly in August 1999 with the approval of the diocesan bishop. After representatives from this group attended two Charter School Start-Up workshops sponsored by the Ohio Department of Education in Columbus, the committee decided the project was quite feasible, considering the facilities available at the parish complex already and the pool of potential students and skilled volunteers available in the Akron-Canton area. The committee approached the parish assembly at the end of January 2000 for permission to officially begin the project, which was granted, and set a “Year 1” goal of five students and one paid teacher. That committee agreed to become the core of the first School Board.

Development of a Faith- and Salvation history-based, integrated curriculum stressing language and analytical-tool development according to the Classical model; recruitment of instructors and students; and fundraising efforts began immediately. Two teachers were hired in late spring: a university-trained kindergarten teacher with a decade of classroom experience, and an upper-grade instructor with a M.Div. degree and extensive mixed-classroom teaching experience. Both instructors understood the new “Orthodox Christian classical education” model immediately, and contributed immeasurably to its development and success.

St. Nicholas Orthodox School opened its doors with 10 students: 4 kindergarteners and 6 in grades 1-5. A fifth kindergartener enrolled four weeks into the school year, and settled right in to the school’s routine. The student body represented four Akron-Canton area parishes—the host, St. Nicholas; Annunciation Greek Orthodox Church; Holy Assumption Orthodox Church (OCA); and St. Haralambos Greek Orthodox Church—and one non-parish-affiliated student.

The school immediately started the process of being recognized and chartered by the Ohio Department of Education Office of School Options as a Non-public Charter Elementary School. Following successful completion of five steps (adoption and advertisement of a racial non-discrimination policy; review of all school safety inspection records, administrative and disciplinary policies, and curriculum; numerous on-site visits of the school facilities and classroom observation; solicitation of complaints regarding admission policies; and completion of an annual report of enrollment statistics), the school’s charter was awarded 31 January 2001.

The school’s first year was incredible: The Iowa Test of Basic Skills (ITBS), administered in mid-May 2001, showed that our students were excelling academically with the “new” curriculum, placing in the top 10% of students nationwide. More importantly, students were growing in the Faith: “They became an extended family, prayed together daily, learned to chant most of the Third and Ninth Hours by heart, and turn to God in time of crisis,” according to Archpriest Stephen Kopestonsky, principal and spiritual advisor.

Word of mouth and a steady stream of school newsletters were all it took: for its second academic year (2001-2002), St. Nicholas Orthodox School served 24 students, who again prayed and grew in Faith together. Community service projects were added to daily prayer, Faith lessons, and the academic routine. ITBS scores confirmed improvement in the developing Orthodox classical curriculum and student academic performance, too: our students scored in the top 8% nationwide.

Enrollment at St. Nicholas Orthodox School for the 2002-2003 academic year has topped 40 students as of this writing, requiring a change in both venue and name. The school will re-locate (and re-charter, as required by the state of Ohio) as St. Nicholas Orthodox School of Akron.

Branch Campuses

Priests, Orthodox Christian educators, and parents from the greater-Cleveland and Canton areas took notice of St. Nicholas Orthodox School during its first year, and began calling and observing classes. Soon, members of St. Nicholas’ school board were meeting with local school committees in both geographic areas, and repeating the steps of interest survey, assessment, and facility availability with them. The response was phenomenal.

The St. Nicholas Orthodox School board returned to the Right Reverend JOB, and outlined the need: other parishes wanted to start schools, just as he’d hoped. His Grace gave a blessing for Orthodox Christian Schools of Northeast Ohio to be established under his omophorion; St. Nicholas Orthodox School would become the “Akron Campus” of the school network, and additional campuses would be established as quickly as possible to serve interested families.

OCS-NEO was legally incorporated, and secured its own 501(c)3 designation (as a non-profit/tax exempt organization). Negotiations with host parishes and fundraising efforts for the new campuses started in earnest. Five additional instructors were recruited and hired in March 2002, and began training with the Orthodox Christian classical curriculum under guidance of the St. Nicholas Orthodox School faculty.

In 2002-2003, Christ the Teacher Orthodox School will open in the greater-Cleveland area, and the Orthodox Christian Academy at St. Haralambos Greek Orthodox Church will open in Canton. OCS-NEO has started working with interested people in the Youngstown/Warren area toward establishing an Orthodox Christian school on the eastern side of Ohio.

Advice: The Voice of Experience

If an Orthodox Christian school is truly “right” for your parish or pan-Orthodox community, you will know: your efforts will truly be guided by and provided for by the Holy Spirit. If you are reading this article, then chances are that you are part of a group of interested parents and/or educators that has already gathered to discuss the idea of establishing a school. Where do you start?

1. Approach the local Orthodox clergy association, if there is one, and ask for their permission to distribute an interest survey to parents in their parishes regarding the establishment of a school in the area. If there is no association, approach each priest individually to present the idea and ask permission to contact his parishioners. Emphasize that this is a first step only, “testing the waters.” Do not proceed without a blessing.

2. Survey prospective parents. Mail a survey to all the families on the church school rosters and to those with younger children, for all the parishes you have permission to contact. (This is also the time to collect names and addresses from parish secretaries, and begin a mailing-list database.)

3. Analyze the results realistically. The actual number of first-year students will be lower than the “yes” checkmarks on a survey, for a variety of reasons. Many interested parents will “wait and see” if the school is successful/effective before making the decision to enroll their children. Indicating interest on a survey is not the same as driving your children 45 miles each way every day for school, either, and can be a huge factor.

4. Approach your bishop(s) with the survey findings, ask permission to proceed, and ask for a written blessing/authorization. You will need an ecclesiastical endorsement to do anything more than talk. Without it you have absolutely no credibility in the Church, or in the outside world, to raise funds, secure facilities, begin to assemble curriculum and identify instructors, recruit, etc.

5. Document the school’s mission, in the form of a mission statement. This will likely be suggested to you by your bishop(s), when he/they give a blessing to the project. (The OCS-NEO mission was drafted in corporate-mission style in the abstract long before the bishop was approached, but given real meaning only with his guidance.)

6. Start praying for His guidance for all involved in establishing the school, as a group and privately, and keep at it.

7. Assemble a team of professionals to act as the establishing board. This group may consist of some of the initial interested parents and educators, but must be expanded and fine-tuned as quickly as possible to include the people with the necessary training and talent to get the job done. This is a working board - a group of people who will spend at least a year immersed in the project. This board is hard to assemble since it is volunteer, but absolutely necessary.

You will need to include, either as board members or deeply-involved advisors:

a. an experienced, organized project manager, to chair or coordinate the whole school project. (The ministry will be a “full-time” commitment for this person, without a doubt.)

b. an experienced educator or school administrator, to coordinate the selection/development of curriculum with other experienced educators and subject specialists, guide the selection of paid instructors, and spearhead efforts to charter/accredit the school.

c. an influential businessman with great people skills, to credibly encourage support of the school at any and all Orthodox community events, and introduce fundraising committee members to potential donors.

d. an events organizer, to coordinate fundraising events, including sponsorship dinners, pancake breakfasts, and parish-wide sales (e.g., candy, spring flowers, hams at Pascha, etc.).

e. an accountant or professional bookkeeper, to set up accounts and manage the finances for the project in an organized way. This includes helping to establish a realistic budget and purchase order system; overseeing the recording of donations, grants, and tuition payments; completing payroll for teachers; paying facilities rent and utilities, insurance premiums, and professional dues/fees; and paying vendors for office supplies, marketing, and curriculum and classroom materials.

f. a lawyer, to draft and/or review contracts and letters of agreement with instructors, host facilities, etc., and to guide the processes of incorporation and securing non-profit status.

g. an insurance specialist, to organize liability coverage for the school, Directors’ and Officers’ coverage for the board, and life/health coverage for all paid staff. This is an operational necessity for a school and can be a major budget expense; insurance must be handled carefully, by a professional.

h. a facilities expert, to deal with the Emergency Protection Agency, county health department, local building inspectors, and state department of education regarding the physical requirements for the school facilities. (OCS-NEO was guided through this maze by a parishioner who dealt with the facilities inspections every day in his profession, and could easily read and digest the various codes. He even coordinated required follow-up work, like upgrading the emergency lighting system in the classroom areas and fencing in the outside air-conditioning unit.)

i. a spiritual advisor, to keep the entire group focused on the ministry in a God-like way, and keep the emphasis ultimately on nurturing children toward Salvation.

j. a computer-savvy secretary, to route and file the mountains of paperwork required for every single step of the establishment, especially chartering.

k. a publicist or other person skilled in both writing and graphics/layout, to spread the word about the school, in support of recruitment and fundraising efforts.

l. a lead fundraiser/grant-writer, to make face-to-face requests for financial support of large private donors, and pen applications and explanatory text to request foundation monies. (These “ask” skills may be learned from specialized mentoring organizations like Stewardship Advocates, or local non-profit organizations’ workshops in fundraising.)

All of the people on the establishing board must be willing to commit their time and talents, and the commitment is considerable. Try to find one person per position to avoid an overwhelming workload and “volunteer burnout”.

These people must also lead the way as financial contributors: the start-up funds and the initial operating funds, quite frankly, come from the selfless giving of the board. They also “provide a benchmark” for other donors, e.g., if the board did not believe in the success of the project, they would not be significant donors themselves.

A Cloud of Witnesses

From the very second the idea of establishing a school is first discussed, “the school” will become the topic of conversation at every parish council meeting, coffee hour, pan-Orthodox event, and baklava/peroghi workshop. You ? as individuals and a group ? will be watched constantly for reassurance that the school will succeed, or clues that it will fail miserably. Here are some lessons we’ve learned at OCS-NEO over the past three years/schools:

1. Communicate. Make this the primary responsibility for one “in-the-know” person, to make sure that all area priests, parish councils, and parishes (e.g., through their Sunday bulletins) are kept up-to-date on all progress in establishing the school. The “public” will know the effort is real if they see regular, honest progress reports. Any major steps should be announced and explained by your group, with sufficient detail to avoid misunderstandings and prevent rumors.

Use a variety of communications methods (bulletin inserts, mailings, pulpit announcements, radio interviews, posters, information sessions, etc.), and keep repeating: the Orthodox community is large, and it’s very hard to get the word out to everyone.

2. Expect opposition. You will receive verbal criticism and “obstructive action”, from varied and unexpected sources. Do not let this dissuade you from establishing the ministry; just know that it will happen, try to understand why, and deal with it immediately and professionally.

Some of the sources of criticism we have encountered include:

a. those who oppose the establishment of any non-public schools, in the interest of maintaining a “melting pot” model of leveling education for all American students;

b. Those who oppose the use of non-standard curriculum (e.g., anything that differs from the “separate subjects” model, or with a religious/non-secular emphasis);

c. Those who oppose the use of instructors who do not hold university degrees in education, despite their teaching experience, depth of subject knowledge, workshop training in classroom management and educational theory, or natural ability;

d. Those who doubt the ability of the individuals on the establishing board to establish a professional, effective school;

e. Those who doubt that the parish or local Orthodox community can sustain a school ministry in the long term, either financially or in student numbers;

f. Those who fear that the school ministry will harm the host parish in its own fundraising (e.g., those who give to the school will decrease their donations to the parish), or adversely effect the parish facilities (e.g., making them unavailable for other uses, causing excessive janitorial responsibility or physical damage, etc.);

g. Those who don’t see the need for a parochial school, because they have no school-age children or grandchildren of their own; and

h. Those who believe that if they are not personally involved, or do not endorse the project for any reason, the project will fail.

Meet each opposition with prayer and the clear message that an Orthodox Christian school is a ministry offered as an option to interested parents, who want the God-and-Faith-centered lifestyle they are modeling and living at home to be reinforced in their children’s academic environment. And cover your backside: establish policies and procedures that ingrain professionalism in the school from the very beginning.

3. Maintain Administrative Professionalism. As soon as you have a blessing to begin a school ministry, document, document, document! Take careful minutes of each and every meeting, and file them. Establish policies immediately for school board operations (including bylaws and organizational structure); office operations (including admissions, parent notification protocols, etc.); faculty relations (including weekly staff meetings, orientation and review, payroll delivery, etc.); and student life (including attendance, dress code, discipline, etc.). Draft job descriptions for each board and administrative position, as well as for each teaching position, and abide by them.

This is a difficult task for a start-up school, because one person may wear many hats, or even share hats ? it’s easy to muddy the waters between board responsibilities, principal’s responsibilities, faculty duties, and the ever-present fundraising, especially if the work is getting done by “word of mouth”. If necessary, refer to people by position rather than name: “For admissions information, you should contact the school secretary, Ann, at the office on Friday. She can provide you with a complete packet.” or “Our chairman and one of our classroom teachers, would be pleased to present the school to your parish council.” (rather than “Jane and Fr. Jonathan”).

4. Maintain Spiritual Professionalism. The identity and integrity of the school relies on its ecclesiastical sponsor, the orthopraxis modeled by those core people involved in the school ministry project ? board members, principal, teachers, volunteers, and students; and on the spiritual emphasis of the curriculum:

a. Get a blessing. As stated before, an Orthodox Christian parochial school has absolutely no credibility in the Church without an ecclesiastical sponsor, and thus a place in the hierarchy. Potential donors in the community, foundations who offer educational grant monies, the IRS, and the state Department of Education all look for this official endorsement as well, as an external indication that the project is supported by an established, responsible party.

b. Board & staff qualifications. All board members, paid instructors, and volunteers should come highly recommended by their spiritual fathers/confessors as vibrant Orthodox Christians, actively involved in

c. Growing in faith. These people serve as role models for the students, and are ambassadors for the project. Both potential supporters and critics will notice those people involved in the project who do not attend Church services or are “sloppy” with their faith and behavior toward others.

d. Prayer, Church community, and Christian service. The focus of the school’s existence must be the theosis (journey to Salvation) of its students, before academics, extra-curriculars, or recess! Begin and end the day with prayer (i.e., Third and Ninth Hours); put lessons in the Faith, Holy Scripture and Tradition first in the daily schedule; and include faith-building service projects in the school’s activities: serving at soup kitchens, hospital visits (with musical programs, etc.), regularly writing to parish shut-ins, etc.

5. Maintain Academic Professionalism. The secular world will judge the success of your school solely by the credentials of your instructors and the academic performance of the students. Many Orthodox Christian parents will use “test scores” as the deciding factor in determining whether or not to enroll their children: if they won’t “learn” at least as much as they would in their local public school, the additional spiritual benefits aren’t important.

a. Hire only highly-qualified staff, whether they are university-trained teachers or not. Teachers in an Orthodox Christian school must have theological training (some type of “live” coursework, supervised and administered by clergy), and thorough knowledge of history in addition to subject knowledge and classroom experience. Remember, too, that classroom management techniques can be taught; natural rapport can’t. (At OCS-NEO, all instructor candidates that are considered, based on application, essay, recommendations, and transcripts, are required to teach a lesson of their choice at multiple grade levels to students in the school, with an evaluating committee observing.)

b. Adopt the view that all academic skills are potential tools for God’s work and understanding His commandments to mankind, and present them accordingly. Language arts, mathematics, natural science, music, art, and even physical education take on a far greater importance to students when they are presented in the context of Christian service and stewardship. This view also provides a framework for further integration of all subjects.

c. Use high-quality curriculum and classroom materials. Choose from reputable, proven educational publishers under the guidance of an experienced educator/curriculum committee, and beware of generic “Christian” curricula and materials. These materials, especially at higher

d. Grade levels, are absolutely non-Orthodox in their presentation of God, Church, and man’s salvation.

e. Make sure that the school’s academic program meets and exceeds objective standards from a recognized and respected educational oversight body. In Ohio, the granting of “charter” status by the Department of Education both requires and guarantees certain levels of instruction time per subject and in total, subject coverage and materials, etc. Accreditation with an outside agency (like the North Central Association or Association of Christian Schools) is another route to an objective “seal of approval” on an academic program. Plan from the beginning to do one or both: chartering with your state and/or accreditation with a regional agency.

f. Use standardized tests to assess students’ academic performance, including both nationally-known and respected tests like ITBS and your own state’s proficiency tests. Testing allows you to fine-tune subject coverage and emphasis within your curriculum, and provides one more objective testament to the strength of your school’s academic program. They add credibility: if you test, you are concerned with quality academics and continuous improvement of your program. (Tests are expensive, however, and must be planned for well in advance of administering; make sure tests are on the schedule and in the budget from day one.)

A complete “step-by-step” checklist for planting new schools has been developed and is used by OCS-NEO. It is available upon request to interested local groups.

The OCS-NEO administration and faculty are also pleased to talk to and work with interested local groups toward the establishment of Orthodox Christian schools, whether they re-create the school model of its own network as far as policy and curriculum, or start “from scratch”.

Additional information on the Orthodox Christian classical curriculum model, OCS-NEO curriculum materials, our schools’ policies and procedures, and campus activities is available on the OCS-NEO web site: http://www.ocs-neo.org.

For more information on OCS-NEO curriculum and curriculum materials, contact:

OCS-NEO Publishing
755 S. Cleveland Ave.
Mogadore, OH 44260

For more information on establishing a school, contact:

Orthodox Christian Schools of Northeast Ohio, Inc.
755 S. Cleveland Ave.
Mogadore, OH 44260
ATTN: Development Committee

Additional, up-to-date contact information is available on www.ocs-neo.org.

Submitted 20 May 2002 on behalf of the OCS-NEO governing board—Jane Beese, president; Priest Timothy Sawchak, vice president; James Chuma, treasurer; and Melissa Trace, secretary.
Nichola Toda Krause is a parishioner of St. Nicholas Orthodox Church, Mogadore, OH, and was on the original long-range planning committee that framed the Akron area parochial school project. Today, she manages the OCS-NEO Publishing division, producing curriculum, classroom materials, and other resource materials for Orthodox schools. Niki and her husband, Bill, have two children: Katie (now a third grader at St. Nicholas Orthodox School) and Mitchell John (almost 2).

Parents Evening Out

By Lee Ann Pisarchuk

Our church community, like so many others, includes a number of families who have moved from various areas and find themselves lacking nearby relatives or a reliable babysitter. The church becomes their family.

“Parents Evening Out” was designed to help this particular group of people. It is a service provided by our youth to parishioners in the community that have children who are in need of babysitting.

This program is a positive experience for all involved: Parents get an evening out, teens and children get to fellowship together, and the program may be used to raise money to support a desired cause.

How It Works

Determine the number of teens that are available on a given night to baby-sit. A sign up sheet for parents is placed in the fellowship hall and an announcement is placed in the bulletin. Sign up is required and limited, based on the number of teens that are participating. The sign up sheet includes a waiting list in case of cancellations, and a contact person to call if a parent needs to cancel.

The number of teens required is based on the ages of the children that have been signed up. If there are several children under the age of two, more teens are required. Based on the experience of our community, the largest group of children that are signed up is between the ages of 7 and 9. Generally, one teen for every five children in this age group is adequate. Parental “overseers” are also needed, and the number is based on the ages of the children listed. Three parents are sufficient for a group of twenty-five children from 7-9 years of age. We stress that it is the teens that “baby-sit” and care for the children, so that it remains a ministry of the teens and not something that the adults do.

Parents bring their children (ages 1 month to 12 years) to the parish with any items with which the children want to play, including games, cards, toys and videos. Some children bring pajamas. The teens volunteering spend the time with them playing games, reading, providing snacks or tending the needs of the babies. Many activities occur simultaneously according to age groups, and include everything from Twister, board games, movies, arts and crafts, to quiet story time.

Parents of the younger children that require diaper bags are asked to have written instructions for bottle feeding or other particular needs. Sleeping babies are placed on blankets in the rear of the church that has adjoining doors to the Fellowship Hall where all the action takes place. This allows for supervision of the sleeping babies, but not entire separation.

Children may brown bag their dinner, but the church provides a light snack and drink. We have asked for donations of these items.

Parents complete an emergency contact form and are asked to keep their cell phones on or leave a phone number where they can be reached. Time is limited to four hours. Parents rotate supervising the teens. This is a service to the parents free of charge, though donations are accepted in a donation box placed at the door.

The Bonus

This program has been so successful in the kindling of fellowship among the youth, that we’ve had young people sign themselves up to be baby-sat without the knowledge of their parents. It can also fulfill the need of service hours for the teens.

We have had the greatest success on Friday evenings, giving parents an opportunity to have an evening out alone, but also have done this on other days. Other “themed days” include “Valentines Evening,” “Summer Break Away,” and “Christmas Shopping without the Kids.”

Our parish has also used this time to engage in outreach projects such as gifts at Christmas. During the Advent period we have assembled “shoe box gifts” for poor and underprivileged children. We have also provided the children an opportunity to make a Christmas gift for their parents and send it home wrapped.

Lee Ann Pisarchuk is active in St. Justin the Martyr Church, Jacksonville, FL where her husband, Fr. Theodore, is pastor. Lee Ann is especially involved with the youth in the Sunday School, at youth camps and retreats. She is a part-time pediatric nurse and the mother of two boys.

Teaching Self-Esteem

By Albert S. Rossi, Ph.D.

The eyes are the windows of the soul. I used to tell my Beth, when she was five, that I could look into her beautiful blue eyes and see all the way to eternity. She smiled softly. Perhaps she merely understood that her daddy thought she had beautiful blue eyes, but a seed was planted. Today the seed grows as Beth (now nineteen) and I reflect fondly on those moments and talk more about the eyes as windows into eternityâ??a poetic but valid idea.

Children receive much of their self-image, and consequently their self-esteem, from their parents. We parents have the same awesome power God gave Adam and Eve in naming the kingdom entrusted to them. We choose the names our children will be most known by during their lifetimes.

More important, we also give names to the different parts of our children’s self-image, names that can last a lifetime. We parents define some of our children’s core personality. The children adopt these definitions, these little inner characters, to fit particular situations. If I tell my child she is a grateful child, then she will name herself “grateful.” After a few years my child will have a self-image consisting of many parts, many different inner characteristics. These may be, for example, beautiful, lazy, grateful, sneaky, spoiled, messy, sweet, and moodyâ??all for the same child.

A loving parent will take care never to abuse this power. For example, a parent should never call a child a liar. Even if true, the basic message is that the parent expects this child to be a liar and to lie. The predictable result is more and more lies from their child. Instead, when a child lies, the parent should name the lie, correct the child firmly and emphatically, forgive the child, and then put aside the whole incident. No lectures needed.

While parents have great influence on their children, life is more complex than this. Genetics plays a powerful role in influencing children, as do siblings, TV, extended family, and peers. However, the sheer power of parents over self-image is difficult to overestimate.

My eighth-grade son, Timothy, wants me to name his basketball skill. This gets tricky with an adolescent. As we ride home after every game, his response is often the same. He will say (and think honestly because of his adolescent self-doubt), “Dad, I played lousy tonight.” In the past I took this literally and tried to discreetly point out his flaws on the court. I could tell this upset him. I had confused my role as father of a struggling adolescent with a role that wasn’t mineâ??being his basketball coach.

My son wants me at every game as his proud father, as his ally, as his supporter. I learned this lesson slowly. He wants me to appreciate and to name his effort, his teamwork, his growth, and his achievement honestly. At home I have plenty to criticize and correct. At his games he want me to observe him uncritically. I’ve discovered that there is always something positive and truthful to say, even on the bleakest of nights.

Sometimes I say a variation of the theme: “Son, the ball wasn’t dropping for you tonight, but I could see you were trying hard.” He receives his self-esteem, even as an adolescent, in some part from my naming his behavior.

I should have learned this lesson a long time ago. As a Little League coach for five years, I would cringe when a father criticized his son for his baseball play. I knew the boy was trying hard to hit, catch, or throw the ball accurately. The critical remarks of the father made the body more tense and less likely to play graceful baseball. I’ve had boys cry like babies over bad plays they had made because they felt like a disappointment to themselves and others, particularly to parents and peers.

An important difference between successful and unsuccessful parents is that successful parents keep destructive names and destructive comments to themselves. Successful parents resist the temptation to shoot from the hip. Successful parents do discipline regularly, firmly, and emphatically. They don’t allow misbehavior, but they also don’t erode the child’s self-esteem with negative, stinging names. Successful parents are strong enough to discipline squarely and then find the good, true, and beautiful in their children.

Most of all, successful parents let their children know they are exceedingly desired and desirable.

We parents learn slowly. We need to be persistent, vigilant, and very gentle with ourselves and our children. Our lives are classrooms for learning about God’s persistence, vigilance, and gentleness with us.

Originally published in LIGUORIAN, August 1994, reprinted with permission from LIGUORIAN, One Liguori Drive, Liguori, MO 63057.

Dr. Albert Rossi is a retired psychology professor and teaches pastoral theology at St. Vladimir’s Orthodox Theological Seminary in Crestwood, NY.

Resources in Preparation for Dying, Death, & Burial

By Prepared by St. Elizabeth Committee, St. Nicholas Orthodox Church, Portland, Oregon. Reviewed by Fr. John Shimchick.

Several years ago while at St. Tikhon’s Monastery, I became separated from the friend with whom I had traveled. Eventually he returned and announced that he now owned “property” in Pennsylvania. In other words, he had purchased a burial plot at the cemetery located on the monastery grounds. Some people are very careful and intent on planning for death, on putting “their house in order.” There are those who, not trusting the capabilities or motivations of their children, make everything clear—even to the point of having their headstone in place, only the final date needing to be inserted. All the details are in order. Others see discussions about death and the last things as being something too morbid. Sometimes people just don’t get around to it in time. I heard recently that more than 80 percent of the victims killed during the 9/11 attacks had not prepared wills.

As an aid to members within their own and neighboring Orthodox communities, the St. Elizabeth Committee of St. Nicholas Church in Portland, Oregon has prepared a “Resource Packet” of materials to create an awareness of “what medical, pastoral, and funeral resources are available.” In his introduction, Fr. George Gray, the parish’s pastor, states that the packet, consisting of a prayer book, resource guide, and emergency record guide, incorporated materials and suggestions from “the tradition, Liturgy and worship of the Church,” and “enlisted the expertise of clergy, doctors, nurses, lawyers, healthcare professionals, hospice workers, funeral directors, and cemetery staff.” As such, it really brings together, for the first time, probably all of the aspects that can guide an Orthodox Christian in confronting the reality of sickness, dying, and death.

The volume of RESOURCES includes the following topics:

  • Dealing with Death—Alive in Christ
  • Burial Practices of the Byzantines
  • The Priest’s Participation
  • Care and Preparation of the Body
  • Funeral Guidelines of the Orthodox Church in America
  • Why We Pray for the Dead
  • The Descent Into Hell
  • Practical Considerations: Communications—Starting to Talk About End-of-Life Concerns and Wishes
  • Discussing Your Own End-of-Life Wishes
  • Advance Directives (Oregon/Washington)
  • Healthcare Options for Those with Life-Threatening or Terminal Conditions
  • The Time of Physical Dying
  • Resources
  • Modified Checklist for Emergency Record Guide

Materials originally intended for local use

It is important to note that these materials were originally “intended for use at St. Nicholas Church in Portland and reflect the medical, legal, and pastoral situation in Oregon and Washington.” Therefore they represent the information and experiences of ancient, national, regional, and local sources and practices. Some of the information will be generally useful; other parts, perhaps representative of a different experience. In particular, the local or common liturgical practice might be a bit different from those described in the section entitled “At the time of death” (p. 7) and “Care and preparation of the body” (p. 10), and those that describe the funeral services (pp 8-9).

First, many people might not be familiar or even comfortable with the option of not embalming the deceased body or of washing and preparing the body themselves. The editorial remark that “the procedure that takes place in the ‘prep room’ of temporary American mortuaries is one that, quite simply put, is an offense to the temple of the Holy Spirit that our bodies are considered to be” (p. 10) perhaps should be explained more fully—maybe in a different form and way. Most parishes, at least in the eastern part of the United States, probably celebrate some version of what is called the “common practice.”

It should be noted that funerals served during Bright Week do not have simply a “slightly different order of services” (p. 8) or the “addition” of Paschal hymnography (p. 7). The normal funeral service is nearly completely transformed into a Paschal service (all of the hymns of Pascha are sung), with the addition of just a few memorial litanies and hymns. It is the undiluted experience of Paschal joy, the essence of what it means to pass from death to life.

Finally, I am not sure whether the main course at the “Mercy or Memorial” really needs to be limited to fish, regardless of the Gospel story of the risen Christ on the Shore of Lake Tiberias (John 21), assuming the funeral is not taking place during a fasting period.

The RESOURCES include discussions of timely matters such as Cremation, Suicide, Autopsy and Organ Donation, and many other end-of-life concerns that should be discussed by families before the confusion and trauma of sickness and death overwhelm them. The CHECKLIST FOR EMERGENCY RECORD GUIDE at the end of the RESOURCES provides an organized way of noting issues (whom to call, etc.) related to “Preplanning, At the Time of Death, & Afterwards.” The collection of PRAYERS include those for illness, when sickness increases, for one who is terminally ill, in preparation for death, at and after the parting of the soul, for the departed, and assorted prayers and hymns from various services.

Fr. Gray began his introduction to the RESOURCES with the words of Metropolitan Anthony Bloom that “death is the touchstone of our attitude toward life. People who are afraid of death are afraid of life.” These materials help us to prepare for death practically and spiritually over time, in ways that lead not to morbid fear, but to the recovery in our lives of “immediacy and depth.”

We should be grateful to Fr. George and his community for the organization of these materials and for the gift of love, comfort, and support they represent.

These RESOURCES are available and can be freely downloaded as PDF files from the Department of Christian Service and Humanitarian Aid’s page on the website of the Orthodox Church in America or from the list below.

Items can be saved as PDF files by selecting the “save” icon (the picture of a disk at the left end of the screen, below the word “Address.”)

Archpriest John Shimchick is pastor of Holy Cross Church, Medford, NJ, and editor of its diocesan publication, Jacob’s Well.

Church and the Child with Invisible Disabilities

By Wendy Cwiklinski with Addendum by Michele Karabin

[Updated, Department of Christian Service, 2015]

The Invisibly Challenged Child

The name “invisible child” is both a descriptor of and a dedication to our children, who are invisible in the sense that their disabilities, though often severe, are hidden from view. Brain disorders, though biologically based, often are not obvious physically, so the invisible child looks like any other child. In addition, children with these disorders usually have normal intelligence. In fact, many are gifted, sometimes to a high degree, and because of this they are able to develop coping skills that further hide their differences, the result being that they may either not be identified or their struggles will be misunderstood. Because it typically takes such a long time for children to be diagnosed and receive appropriate treatment, they are particularly susceptible to falling through the cracks, dropping out of school, becoming suicidal, or entering the juvenile justice system.
http://www.invisiblechild.org/About.htm

Unlike a child with cerebral palsy or Down syndrome, children with these physical challenges are not always visible. More and more children, for one reason or another, are being diagnosed with brain disorders such as ADHD, autism, depression, or bipolar disorder. These disorders are “visible” through the symptoms, usually manifested in the child’s behavior. It is easy to stand by and think (or say), “If only that parent would get better control of their kid”; “All that child needs is a good spanking”; or “What a bratty kid!”

“These Diagnoses Are Not Real”

Some popular psychologists with newspaper columns and talk shows just might agree with the above heading. Denial is still widespread in our society when it comes to the invisible child. But, for these families, the diagnoses are very real. These disorders are genetic and are recognized within the medical community by commitment to treatment and research. Parents don’t want their kids to have a brain disorder, any more than they want their kids to have any other disease. Unfortunately, the symptoms of these disorders often manifest themselves in what appears to be willful behavior. Rather than helping families of children with these disorders, often we exclude them from our communities by being judgmental. These families need to have spiritual support to face the sometimes overwhelming challenges that these disorders bring to their households.

“What Is It Like for These Families at Home?”

Children with mood disorders can sometimes be difficult to calm down and can rage for hours. They can be physically aggressive, as well as verbally abusive. It’s not a question of parenting. Think of a brain disorder as you would think of a stomach virus. Even the best parent can’t prevent the ill child from vomiting—and sometimes these acting-out behaviors seem like a kind of psychic “vomiting.”

Parents are usually busy shuttling the child from one appointment to another. School can be an issue, especially if the child is not stable enough to stay in regular classroom. Neighbors tend to become less than “neighborly,” and may even shun the family as “social lepers.”

“How Can I Help?”

Maintain an attitude of love, compassion, and acceptance for the family.

The stigma of having a child diagnosed with one of these disorders can be so hard to live with that some parents do not disclose their child’s diagnosis, even to close friends. If they do disclose this to you, honor their trust by keeping it to yourself—unless you have their permission to share.

Offer to help in some way, even if you are turned down. Just the act of offering shows that you are supportive.

Help with the kids. If the family has more than one child, then be a mentor or “big brother/big sister” to the affected child’s siblings. When one child in the family is ill, the norm for family dynamics is to focus more on the child who is ill. Extra attention is usually helpful for the other siblings. Take the kids for a while so the parents can go out for a cup of coffee alone.

Help out in church. Approach the parent during a quiet time (fellowship hour, perhaps?) and offer to have the child or a sibling stay with you during church.

If the child is hospitalized, offer the family the same support you would offer if, for instance, the child was hospitalized with a heart problem.

Make a meal for the family. Often the parents are exhausted from dealing with the day- to-day issues that come with having a child with a mood disorder. Something as small as a meal can be a welcome contribution.

Involve the child with other children at church as much as possible. If behavior is an issue, the child needs to be with other children and learn appropriate behavior. If the child is in Church School, the teachers should be made aware of ways to include the child in as many activities as possible without highlighting any disabilities.

Focus on the child’s positive behaviors. Sometimes the most important thing to realize is that they are in church. Just getting them there can be quite an accomplishment. Realize that children can learn even when they are not perfectly still.

Matushka Wendy Cwiklinski is the parent of five children—four of whom have been diagnosed with mood disorders and/or autism. She works with local and online communities that support parents of children with brain disorders, primarily in the U.S. and Canada. She has a Diploma of Religious Education from St. Vladimir’s Orthodox Seminary, Crestwood, NY, and an M.A. in Religious Education at Fordham University:  Embracing All God’s Children:  Orthodox Theology Concerning Disability and Its Implications for Ministry with Special Needs Youth in the Orthodox Church.  The full paper can be found online: fordham.academia.edu/WendyCwiklinski

Want to Learn More?

Here are some informative websites:

http://www.healthline.com/health/bipolar-disorder

Healthline provides a very comprehensive overview of bipolar disorder as a critical starting point for individuals and/or their loved ones.

http://specialchildren.about.com/od/inthecommunity/a/worship.htm

Article: “Church and the Child with special Needs: Worshipping with a Special Needs Child”

http://www.christianitytoday.com/cpt/2000/006/7.70.html

Article: “Special Needs: How One Church Reached Out to These Struggling Families”

(Both are excellent articles with practical suggestions for parents and for churches—Ed.)

http://www.bpkids.org

Child and Adolescent Bipolar Foundation

http://www.chadd.org

Children and Adults with Attention Deficit Hyperactivity Disorder

http://www.udel.edu/bkirby/asperger/

OASIS—Online Asperger syndrome Information and Support (High Functioning Autism)

http://www.autism-society.org

National Autism Society

http://www.ldanatl.org

Learning Disabilities Association of America

http://www.invisiblechild.org/About.htm

The Invisible Child Organization

http://www.nami.org

National Alliance for the Mentally Ill

Additional Observations and Resources for Parents of Children with Hidden Disabilities

by Michele Karabin

Families living with children who have hidden disabilities could greatly benefit by utilizing state disability resources, special education, and community nonprofit organizations. It is very important for these children to understand their own disability and that they are not like other children. Unfortunately these “invisible children” and their parents are often in denial. Many such children act like they don’t care about school, rather than let other people know they are having difficulty learning. This denial leaves them susceptible to repetitive failures… in work, in school, and in developing relationships.

Job coaches, employment counselors, and school counselors who specialize in hidden disabilities can help them succeed by offering on-the-job and in-school accommodations (e.g. longer time for tests; auditory testing, etc.). Many students reject these valuable resources for fear of being stigmatized and looked at differently by their peers. Many of the youth I’ve counseled remembered rejecting such services in high school. They returned on their own afterward, seeking those same services after repetitive failures due to their hidden disability.

It is important for parents of youth with hidden disabilities, or those who suspect their child of having this kind of disability, to contact the Special Education Department in the child’s school, and then make sure that the child is tested. Being “labeled” will open doors for the child to get the special assistance that he or she needs. Once these children reach high school, there are many transitional services offered that prepare students for post-secondary education (if appropriate) and/or vocational services. The following is the Fairfax County, Virginia, Public School’s statement addressing this issue:

Fairfax County Public Schools uphold the principles of the Individuals with Disabilities Education Act (IDEA) as they support the rights of students with disabilities to have decisions regarding their individual instructional program made through the collaboration of parents who know their child best and professional educators who have knowledge of instructional practices and experience in guiding students with disabilities to become productive citizens.

In my experience, many people are not clear on exactly what “hidden disability” means. The following is a list of what the term may encompass:

Autism

Developmental delay

Emotional disability

Deaf and hard of hearing

Mild mental developmental disability

Other health impairments e.g. osteogenesis imperfecta, otherwise known as fragile bone disease, carpal tunnel syndrome

Speech/language impairment

Brain injury

Visual impairment

Reading this list, which is not exhaustive, the reader can see that it covers a wide range of individuals who require special assistance from community resources.

SkillSource Centers

Northern Virginia has abundant resources for individuals with disabilities. A recent addition to these services are SkillSource Centers. These centers work on a one-stop service model that brings together state services such as the Department of Rehabilitative Services, education, nonprofit efforts, social services and grant programs. This one-stop service is a fine example of community partnerships. Instead of each community service working independently of others, they are interconnected. This makes them more efficient, enabling them to recognize and discuss what works, but most importantly, to correct what does not. Their website is: www.myskillsource.org/home/index.asp.

There are also many nonprofit agencies that focus on specific hidden disabilities. To find information on services within your state, contact your Department of Rehabilitative Services. They would be able to link you to services similar to those I have described above. The website for Virginia is: www.vadrs.org. Another link to every state’s resources is: www.nichcy.org (National Dissemination Center for Children with Disabilities)

Michele L. Karabin is a member of St. Luke Orthodox Church, McLean, VA, and currently is an Employment and Transition Representative with Fairfax County Public Schools in Virginia. She formerly was a State Rehabilitation Counselor, Fairfax County Transition representative and manager of a nonprofit initiative titled “YouthSource,” a grant specifically funded to assist youth with hidden disabilities in finding employment. Michele also developed a Leadership Academy that matched individuals having hidden disabilities with non-disabled youth to plan and implement an academy that focuses on job development and work readiness.

October: Pregnancy and Infant Loss Awareness Month

By Matushka Dennise Kraus

“Thy departure from this earthly life is a cause of grief and sorrow for your parents and all who love you, O little child; but in truth you have been saved by the Lord from sufferings and snares of many kinds.  O Savior and Master of our life: comfort the faithful parents of this departed child with the knowledge that to innocent children, who have done no deeds worthy of tears, are granted the righteousness, peace and joy of Thy kingdom” [Canon Ode 9, The Service of Burial of an Infant].

Each year, approximately one million pregnancies in the United States end in miscarriage, stillbirth or the death of a newborn child.  But this is not just a statistic.  This is a life and a death issue.

It is my belief that both the Gospel and the Orthodox Church hold that life begins at conception — that is, the fertilization of the ovum by the sperm.  God knows the name and age of each person from his or her mother’s womb, as we pray during the Liturgy of Saint Basil.  We must therefore recognize that pregnancy loss — miscarriage, ectopic pregnancy or stillbirth — all result in the death of a human being, a baby, a “Child of God.”  Parents who were anticipating life are now confronted with death.  These deaths result in millions of parents and families grieving.

Grieving Alone

Archpriest John Breck, writing about the mother who has miscarried, states that “her pain needs to be acknowledged, accepted, and palliated through words and gestures of understanding, sympathy and love, offered by her family and the parish community.”  In reality, most parents who experience the loss of a child during pregnancy, suffer alone.  This is especially true in the instance of early pregnancy loss (i.e. miscarriages and ectopic pregnancies) where there is no “body” to be seen and often the mother shows no outward signs of pregnancy.  Many people are unaware of the grief that pregnancy loss causes.  Sometimes the grieving parents, themselves, reinforce the idea that they are not grieving, by pretending they do not experience hurt, as they try to “get on with their lives” and to “try again.”

It is important to note that not only is a parent’s grief over a pregnancy loss real and normal, it is also Christian.  Too many times it is assumed that grief is not Christian—that the bereaved should accept the reality of the loss as being “God’s Will.”  However, we know that when Jesus learned of the death of his friend Lazarus, “Jesus wept” [John 11:35].  Especially in early losses (most miscarriages occur before the twelfth week of pregnancy) people often use the clichés, “It’s God’s will,” “God wanted the baby in heaven for Himself,” “God knows best; the baby would have probably been deformed.”  The only thing these sayings do is indicate to the parents that they should not mourn, that if they “are Christian” they will accept God’s Will and not “complain.”

National Observance of Pregnancy and Infant Loss Awareness

When in 1988 President Ronald Reagan proclaimed October as Pregnancy and Infant Loss Awareness Month throughout the United States, he noted that the day “offers us the opportunity to increase our understanding of the great tragedy involved in the deaths of unborn and newborn babies.  It also enables us to consider how, as individuals and communities, we can meet the needs of bereaved parents and family members to work to prevent causes of these problems.”  Subsequently, the resolution to declare October 15 Pregnancy and Infant Loss Remembrance Daypassed the United States House of Representatives on September 28, 2006.  In honor of Pregnancy and Infant Loss Remembrance Day, it is suggested by many bereavement groups that grieving parents light a candle at 7:00 p.m. in their respective time zones to create a wave of light around the world in memory of babies lost to pregnancy and infant loss.

At Holy Trinity Church, East Meadow, NY, we have been holding a Service of Prayer [Molieben] each year on October 15 beginning at 7:00 pm.  A copy of the service can be found on the parish’s prayer ministry web site.  Following the service, it is good to have fellowship and refreshments of some sort. It would also be a good idea to have pamphlets on grieving available.  Pamphlets and resources can be found on the internet, but especially from the National Share Office.

Guidelines for Helping a Friend or Family Member to Grieve

Not everyone grieves in the same way.  It is important to create a loving and understanding atmosphere to help those affected.  Always work in cooperation with your pastor.  In 2002, I wrote an article for our Diocesan Journal, Jacob’s Well, titled “Comforting Those Who Have Lost a Baby During Pregnancy or Shortly Thereafter.”  I am including the guidelines from that article for people who may not know what to say or how to help a friend or family member who is grieving.

  • The first—and likely the most important—thing you can do is realize that a baby has died and this death is just as “real” as the death of an older child. The parents’ grief and healing process will be painful and take time—lots of time.  They may not be recovered or done “thinking about their baby” after a month or even a year.  Realize that the parents are sad because they miss their baby, and that he or she can never be replaced by anyone else, including future children or children they may already have.
  • Let the parents know that they, their family and the baby are in your prayers. Call or send a sympathy card. You don’t have to write a lot inside; a simple “You and your baby are in my thoughts and prayers” is enough.
  • What the parents need most now is a good listener and a shoulder, not a lecture or advice. Listen when they talk about the death of their baby. Don’t be afraid, and try not to be uncomfortable when talking about the loss. Talk about the baby by name, if they have named the child. Ask what the baby looked like, if the parents saw the baby. Most parents need and want to talk about their baby, their hopes and dreams for their lost child.
  • It is okay to admit that you don’t know how they feel. A good thing to say is, “I can’t imagine how you feel. I just wanted you to know that I am here for you and that I am very sorry.”
  • Give a hug. This is a sign of love and concern. Even if this is all you do, it’s a nonverbal way of saying “I’m sorry” or that “I’m praying for you.”
  • Offer to baby-sit their other children. Often there are follow-up doctor’s visits and the parents need a chance to be together as a couple as well.
  • Offer to bring meals; often mothers have no energy to do even basic things.
  • Offer to go food shopping, help clean the house, do laundry—anything that lightens the burden of daily chores that need to be done. This is especially helpful if the mother is still waiting to miscarry the baby. That process may take days and is physically and emotionally draining.
  • Be careful not to forget the father of the baby. Men’s feelings are very often overlooked because they seem to cope more easily. The truth is that they are quite often just as devastated as their partner.
  • Try to remember the anniversary of the death and due date with a card, call, or visit. Anniversaries can trigger grief reactions as strong as when the loss first happened. Months down the road a simple “How have you been doing since you lost your baby?” can give much comfort.
  • Give special attention to the baby’s brothers and sisters. They too are hurt and confused and in need of attention which their parents may not be able to give at this time.
  • If the children want to talk about the death, don’t be afraid to engage them in conversation. Children have a natural relationship to death and they are open and direct with adults with whom they feel comfortable. When children are allowed to share their dreams and thoughts openly, they are not usually impacted by death in a negative way.
  • If you are pregnant, it may be hard for the bereaved parents (especially the mother) to see or even talk to you. You will need to be very understanding and extra patient with them. They still love you and are happy for you, but it is just such a huge reminder of what they have lost. Your bereaved friends may even feel a little jealous of you (especially after your baby comes), and then get angry with themselves for feeling that way.
  • Remember that any subsequent pregnancies can be a roller-coaster ride of joy, fear and bittersweet memories.
  • Remember also that mourning puts a tremendous strain on relationships between family and friends.

Your help, comfort, and sensitive support can be very influential in how the parents cope with the death of their baby and how they recover. You are important; they need you now more than ever.

After giving birth to two beautiful children, my husband and I experienced the deaths of two babies during pregnancy. Our second baby died while we were attending Saint Vladimir’s Seminary. The prayers and support that we received from the community aided in our healing. The Molieben that my husband serves on October 15 holds special meaning for us. We hope that such prayers will help others to heal as well.

“Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, Who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God” [2 Corinthians 1:3-4].

Definitions

Grief—The thought and feeling experienced within oneself upon the death of someone loved. It is the internal meaning given to the experience of bereavement.

Mourning—The taking of the internal experience of grief and expressing it outside oneself.

Miscarriage—Death of an infant during the first 20 weeks of gestation. Usually a miscarriage occurs in the first 12 weeks. In most states the hospital is responsible for the remains of the baby. However, some states are introducing legislation that would allow parents to request the body for burial.

Ectopic Pregnancy—When the baby (fertilized egg) implants itself outside of the uterus. Medication or surgery is necessary to remove the conceptus (baby), prevent rupture of the fallopian tube, and to safeguard the mother’s life. A ruptured ectopic pregnancy is a potentially life-threatening event for the mother.

Stillbirth—The death of an infant in the last 20 weeks of gestation, but prior to birth. In most states it is the responsibility of the parents to bury the baby.

Neonatal Death—The death of an infant during the first 28 days after birth.

Perinatal Loss—The death of an infant during pregnancy, childbirth, or during the first 28 days after birth.

Helpful Websites

Helpful Resource

Bibliography
The Great Book of Needs, Expanded and Supplemented, Volume III. “The Order for the Burial of an Infant”. St. Tikhon’s Seminary Press. South Canaan, PA. 1999.
Borg, Susan and Lasker, Judith. When Pregnancy Fails: Families Coping with Miscarriage, Stillbirth and Infant Death. 1981. Revised 1989.
Breck, John. The Sacred Gift of Life. Orthodox Christianity and Bioethics. St. Vladimir’s Press. Crestwood, NY. 1998.
Elliott, Martha. An Orthodox Christian Response to the Death of a Child. SVS MA Thesis May, 1998 p9.
Klunger-Bell, Kim. Unspeakable Losses. Understanding the Experience of Pregnancy Loss, Miscarriage and Abortion. New York, London: WW Norton and Company, 1998.
Kohn, Ingrid and Perry-Lynn Moffitt. A Silent Sorrow: Pregnancy Loss: Guidance and Support for You and Your Family. New York: Routledge, 2000.
James, John and Frank Cherry, The Grief Recovery Handbook.
Limbo, Rana K. and Sara Rich Wheeler. When A Baby Dies: A Handbook for Healing and Helping. Bereavement Services. LaCrosse, Wisconsin. Revised Printing 1998.
Lothrop, Hannah. Help, Comfort and Hope After Losing Your Baby in Pregnancy or in the First Year. Fisher Books, 1992.
Moe, Thomas. Pastoral Care in Pregnancy Loss: A Ministry Long Needed. The Haworth Pastoral Press. New York. 1997.
Olson, Heidi B. When the Bough Breaks—Working with Families Who have Experienced The Death of an Infant (A Guide For Healthcare and Other Professionals).
Panuthos, Claudia and Catherine Romeo. Ended Beginnings. Massachusetts: Bergin & Garvey Publishers, Inc., 1984.
Shimchick, John. Sharing The Loss Of The Wished For Child. Parish Ministry Resources. Orthodox Church in America. New York. p. 5
Vogel, Gary E. A Caregiver’s Handbook to Perinatal Loss. deRuyter-Nelson Publications, Inc. St. Paul, Minnesota. 1996
Walker, Gordon T. Dealing with Grief. Second Edition. Conciliar Press, 1988.
Worden, William. Grief Counseling and Grief Therapy. A Handbook for the Mental Health Practitioner. Second Edition. New York: Springer Publishing Company, 1991.
Matushka Dennise Kraus is the wife of Priest Martin Kraus, Rector of Holy Trinity Church, East Meadow, NY and the mother of five children.

Family as Garden

unspecified.jpeg

By Albert S. Rossi, PhD

Our God-given family is our great source of joy and satisfaction. Our God-given family is our source of great frustration and anguish. In this sense, our family is our garden, giving delicious fruit and nutrition as well as intense labor and cultivation.

Christ and His cross are the axis of family life. What, as a Christian, can I expect from my life in my family? We can expect death and resurrection, crosses and crowns. In both our family of origin and current family—that can include close friends, especially where blood-related relatives are scattered afar - we can expect deep joy mixed with intense suffering. This may come from a husband, wife, son, daughter, mother, father, uncle mother or sister-in-law, friend. One thing is sure, some family member is likely to break our hearts, over and over. We need only to look at the life of Abraham, Isaac, Jacob, David and Jesus. Jesus’ brothers were among His strongest detractors (John 7:3-5). We turn our suffering into joy by accepting, embracing and working with reality, forgiving each other seventy times seven, which means without number. Our family members are weak sinning human beings just like us. We all live in the fallen state. Our vocation is to live within the sometimes fractured, sometimes united family lifestyle, love all our family members through it all, and try to sustain the gift of the Holy Spirit, the gift of joy.

Our family life, like our garden, requires continual care. Within our family our first care must be care of ourselves. If we don’t care for ourselves we will have nothing left over for others.

Adam, while living with his family in the garden, was given the awesome task of tending the entire garden of Eden. “The Lord took the man and put him in the garden of Eden to till and keep it” (Gen 2:15). One interpretation of this command is that Adam was to care for himself, his body, soul and spirit before all else. Adam was to tend to his heart as his garden. So, too, for us.

We find this message in many places. When traveling on an airplane the flight crew gives instructions for a possible emergency. The crew describes how oxygen masks will drop from the ceiling. An adult with an infant is instructed to put the mask on her/his face first, and then cover the infant’s face with a mask. At first this seems counterintuitive. Any loving adult would give her/his life to save the infant. However, that’s the point. The loving adult must give up instinctive impulses to do something apparently heroic. The adult must care for her/himself first. If not, both the adult and the infant might perish.

Care for Self

We are called to care for our total self first, physical, emotional/social, intellectual and spiritual. Interestingly, this point is sometimes lost in Orthodoxy, all in the name of love.

We care for our physical self through adequate sleep, nutritious food, exercise, abstention from tobacco and moderation with alcohol. We care for our intellectual self through stimulating reading, inspiring music and other forms of intellectual engagement.

We care for our emotional/social self by cultivating trustworthy friendships, disclosing our deepest thoughts and behaviors in and out of confession, by being more aware of and owning our feelings. We care for our spiritual self through intimacy with Jesus Christ. Like any visible relationship, intimacy with the Lord includes private time with Him in quiet meditation daily, pondering His Word in the bible daily, and trying to please Him by doing His will for us. We try to keep His commandments of love as best we can and go to His holy Church services.

We cultivate the garden of our selves through loving attention to our very soil, our heart.

We try to live in and out of our heart. St. Theophan says, “The essence of the Christian life consists in establishing oneself with the mind in the heart before God in the Lord Jesus Christ, by the grace of the Holy Spirit.”[1] And he goes on to say that he means the physical heart first.

The outer limits of the human person are extremely wide; each of us knows very little about his true and deep self. “Within the heart are unfathomable depths,” affirm the Homilies of St. Macarius. “It is but a small vessel and yet dragons and lions are there, and there poisonous creatures and all the treasures of wickedness; rough, uneven paths are there, and gaping chasms. There likewise is God, there are the angels, there life and the Kingdom, there light and the Apostles, the heavenly cities and the treasures of grace; all things are there.”[2]

Theology gives us a tool to achieve personal peace that we can then bring to the family. “Peace of heart is both the aim of spiritual warfare and the most powerful means to achieve victory in it. So, when passionate turmoil steals into the heart, do not jump to attack the passion in an effort to overcome it, but descend speedily into your heart and strive to restore quiet there.”[3] We go into our heart and stay until we are calm. Simple, yet hard to do.

Asceticism in the Family

Our God is a God of surprises. In family life we expect the unexpected. So, our asceticism—self-denial—is primarily a control of thoughts and expectations. We reclaim our inner selves and provide for others.

In the family we learn to outgrow our parents’ sins, their imprinting onto us. We are created in God’s image, not our parents’ image. Becoming a new person in Christ is an extreme asceticism because we tend to fall into habits of familiarity, those we learned in childhood that include the sinful inclinations of family members.

In the garden of our family we learn from our mistakes. Our family members often help us become aware of our misdeeds and mistakes.

Asceticism in the family means to see beyond the obvious and be able to perceive God’s hand in family life, to perceive the miracles of God as they occur to us and to our relatives. Sanctity consists in making the ordinary extraordinary, perceiving the family routine as a God-given harmony to give Him glory and to provide for our salvation.

Asceticism in the family pivots on prayers. Suppose we accept that family life is difficult. Then what do we do? Jesus gave us the answer in Luke 18, “He told them a parable, to the effect that they ought always to pray and not lose heart.”

Care for Family Members

We cultivate the garden of our family by all the common-sense initiatives we can muster. Love is the only rational family act. We forgive every member of our family, everything, without delay. We know that each family member is our real self, Christ in disguise.

Many of us do not live in a squeaky clean, intact and rather healed family. For a host of different reasons, many of us, perhaps most, live in broken or divided or needy families. That’s life in America today. But, the call of the gospel for family living is the same for all. We never tolerate abuse, but beyond that, we are called to love our God-given family members in divorce and estranged situations, nonetheless. The least we can do is pray for all our family members daily. And, we try to deal the best we can with what we have been dealt in our family, by love and service.

We cultivate the garden of our family through the ego-crushing attention to every spoken and unspoken need of family members. We wash their feet, metaphorically, in the thousands of opportunities that life provides, as Christ’s presence in the person of our family members.

Truth be told, we love our family members or we die. It’s that simple and basic, yet profoundly difficult at times.

When we intentionally tend the garden of our family, inevitably one family member emerges as someone for whom we can do a small act of love. We might take steps right now to make that happen, as plain as a letter or phone call, yet pregnant with consequences.

We cultivate the garden of our family by reaching out to the most marginal member of our family, from our point of view. That might be the person who lives closest to our skin. Again, this might take the form of a casual drop-by visit, a special note of appreciation, a thoughtful smile.

Can I Make a Difference?

Life is like a target, with the black circle in the center as the bull’s eye. Our relationship with Christ, with ourselves, and our family is the black center of the target. The little loving gestures to our family members might be the evidence of whether we are shooting the arrow into the little black circle, or whether the arrow is sailing over the top of the entire target.

Only by living within a family, as Jesus did, can we go through to the other side. Ultimately this means living with the new family, the new Israel, the Church. Only by living within my God-given family can I know that I can make a huge difference in the lives of these few people God has entrusted to me as family members.

Lord have mercy upon us and upon our family.

Discussion Questions

1. What is one difficult but obvious act I can do for one family member to cultivate our relationship? Sometimes this is for an in-law or a not-obvious member.

2. Give one example from your family, illustrating how family life is the life of a garden.

3. What is one example of living-in-one’s-head and living-in-one’s-heart in the family?

4. God could have easily cultivated the Garden of Eden. Why do you think He gave the opportunity and responsibility to Adam? What are the implications for us?

1 Chariton, Igumen of Valamo, Compiler, The Art of Prayer, (London: Faber & Faber, 1977), 165.

2 Ibid., 25.

3 Nicodemus of the Holy Mountain, ed. and revised by Theophan the Recluse, Unseen Warfare, (Crestwood, NY: St. Vladimir’s Seminary Press, 1995), 257.

Dr. Albert Rossi is a retired psychology professor and teaches Pastoral Theology at St. Vladimir’s Orthodox Seminary, Crestwood, NY.

Medical Bioethics: An Orthodox Christian Perspective for Orthodox Christians

By Protodeacon Basil Andruchow

Introduction

The understanding and discussion of contemporary medical bioethical issues is, for Orthodox Christians, predicated on the tenets of the Orthodox Church. These tenets help us to frame the right questions for consideration from the very beginning. The first of these questions asks why humankind exists on earth. The following statements reflect the teachings of the Orthodox Church in response:

 

 

 

 

 

  • God created the world and all that is within it.
  • God created mankind, both male and female, in his image and likeness. Mankind is considered sacred and is eternally precious in God’s sight.
  • We are called by God/Jesus Christ to live our lives in a continuing state of becoming like God.
  • We strive to be in union with God while on this Earth with the expectation, hope and belief that we will be with Him in life everlasting.

Within this context, the concepts, topics, and issues of contemporary medical bioethics must be carefully considered. What follows is a framework for understanding the Orthodox Christian perspective as it relates to medical practices and individual decision-making.

In 1992, the Holy Synod of Bishops of the Orthodox Church in America issued its affirmations “On Marriage, Sexuality and the Sanctity of Life”, which can be obtained from the OCA web site, www.oca.org. Where applicable, a particular relevant affirmation may be included in a particular topic section.

This synopsis of some of the more important medical bioethical issues facing us today as Orthodox Christians is not intended to be a complete presentation of all the issues and topics nor should it be considered an official document. Rather, it is intended to spark thought and discussion with regard to medical bioethical considerations and decision-making.

BEGINNING OF LIFE

Conception

“God wills that men and women marry, becoming husbands and wives. He commands them to increase and multiply in the procreation of children, being joined into “one flesh” by His divine grace and love. He wills that human beings live within families (Genesis 1:27; 2:21-24; Orthodox Marriage Service).”
1992 OCA Synod of Bishops’ Affirmations, “On Marriage, Family, Sexuality and the Sanctity of Life”—The Mystery of Marriage

The Orthodox Church teaches that ‘full personhood’ is present at the time of conception, when the male sperm and the female ovum nucleus merge to form the single, 46 chromosome, totipotential cell called the zygote. The zygote is a biologically unique and complete individual. Following mitosis, or cell division, the developing embryo moves down the fallopian tubes of the woman. The fully developed embryo then attaches to the uterine wall, continues fetal development and is subsequently born into the world. The understanding of and belief in the ‘full personhood’ of the zygote, and thereby the embryo, dictates our Church’s position with regard to abortion and certain aspects of stem cell research.

Conception Control

“Married couples may express their love in sexual union without always intending the conception of a child, but only those means of controlling conception within marriage are acceptable which do not harm a fetus already conceived.”
1992 OCA Synod of Bishops’ Affirmations, “On Marriage, Family, Sexuality and the Sanctity of Life”—The Procreation of Children

The Orthodox Church does not support the general use of contraceptives for conception control. The understanding of our Church’s position with regard to contraceptives is based on the fact that a husband and wife form the basic foundation of the family unit. Sexuality within a Christian marriage is a blessing; the couple in love is expected to bring forth children who are the fruits of the union of “one flesh.” A couple must be willing to accept the possibility of pregnancy from this act of love.

On the other hand, our Church understands that there may be some very compelling reasons for the use of birth control measures. An example is the case of a woman whose health and well-being would be severely jeopardized if she had a child. Matters of this type have a very large pastoral component to them and should be discussed with the couple’s parish priest.

In-Vitro Fertilization

“Married couples may use medical means to enhance conception of their common children, but the use of semen or ova other than that of the married couple who both take responsibility for their offspring is forbidden.”
1992 OCA Synod of Bishops’ Affirmations, “On Marriage, Family, Sexuality and the Sanctity of Life”—The Procreation of Children

An infertile couple may agonize over the fact that they are childless. In the past, this was a fait-accompli. With the rapid development of medical fertility science in the latter part of the 20th century and continuing to this day, techniques have become available to assist childless couples in their efforts to bear children, particularly through the method of in-vitro fertilization. Essentially this method involves the fertilization of the wife’s ovum/egg with the husband’s sperm in an environmentally controlled Petri dish. The resulting embryos are allowed to develop to the stage just before uterine implantation. Three to five of the most viable embryos are selected and placed in the wife’s uterus with the hope of implantation and subsequent birth of a child.

While our Church recognizes the potential benefits that may be derived by a childless couple using the services of a Fertility Clinic, it should be noted that this type of service is expensive and may not always succeed. Again, this is a pastoral issue and the couple should discuss this with their parish priest.

There are, however, other aspects of the in-vitro fertilization process, which may or do run counter to our church’s teaching.

  • First of all, it divorces procreation from the conjugal act and should not be considered to be a normative practice. Yet, in-vitro fertilization could become standard practice due to certain selective benefits mentioned below. The application of this technology in some quarters has also allowed the use of surrogate mothers, in some cases to relieve the wife of the burden of child bearing. The practice of using or being a surrogate mother is expressly forbidden by our Church. As a corollary to the above, it should also be stated that our Church expressly forbids a female or male Orthodox Christian to sell their eggs or sperm, respectively.
  • Second, the process of choosing the most viable embryos, however well-intentioned, might be viewed as a type of eugenics, or selective breeding. Given the trajectory of genetic research, it is not inconceivable that the time may come when parents can ‘pick and choose’ the characteristics of their child, thereby engineering so-called ‘designer babies’. This is a very slippery slope.
  • Third, the unused excess embryos are cryogenically frozen and stored for future use. However, over time these embryos may be in jeopardy of destruction. Since our Church teaches that each embryo is a ‘full person’, if any of these embryos are willfully destroyed, that act is tantamount to the destruction of a person.
  • Fourth, embryos stored in birth control clinics have become a source material for stem cell research. Embryos are destroyed to retrieve the stem cells. (Stem Cell research is further discussed below.)

Abortion

“Abortion is an act of murder for which those involved, voluntarily and involuntarily, will answer to God”
1992 OCA Synod of Bishops’ Affirmations, “On Marriage, Family, Sexuality and the Sanctity of Life”—Abortion

Our Church teaches that the willful and deliberate act of aborting/discarding/destroying an embryo or fetus for the purpose of birth control is expressly forbidden. This is why our church is against using the so-called ‘morning after’ pill. The ‘morning after’ pill is a pharmaceutical compound designed and sold to prevent an embryo from attaching to the uterus.

The humanistic arguments for allowing abortions under certain circumstances, such as in the case of rape and incest, seem at least on the surface to be somewhat compelling and compassionate. Yet our church rejects these arguments. Why? Because no matter what the circumstances of conception, God is always present in the creation of a new person and that new person has just as much right to life as a person conceived in a more ‘acceptable’ manner. Again, if this embryo or fetus is deliberately and willfully destroyed, that act is tantamount to the destruction of a person.

Stem Cell Research:

Stem cells are cells in our body that are used to make and replenish other cells such as kidney cells, liver cells, brain cells, etc. These are referred to as Adult Stem Cells. When stem cells are obtained from embryos, they are called Embryonic Stem cellsand have pluripotential properties. This means that Embryonic Stem Cells have the capability to become any type of body cell. A tremendous amount of research is being performed with both kinds of stem cells because of their vast potential for treating damaged or diseased cell tissue.

Despite the potential benefit that may come from this type of research, our Church does not support the use of embryonic stem cells for this purpose. The rationale is that the ‘harvesting’ of embryonic stem cells requires the destruction of the embryo. Human embryos are considered by our Church to be full persons. Destroying the embryo destroys the person.

While there have been recent advances in biomedical research involving the generation of stem cells without the destruction of an embryo, this research is in its very early stages of development. It will be many years before any viable therapies become available. Meanwhile, the biomedical research community still supports the experimental use of embryonic stem cells in order to more fully understand the biology and chemistry behind specific cell regeneration.

END OF LIFE

Debilitating Diseases, Permanent Incapacitation and Terminal Conditions

“All efforts to heal physical and spiritual sickness, to alleviate physical and spiritual suffering, and to prevent physical and spiritual death are to be supported and defended.”
1992 OCA Synod of Bishops’ Affirmations, “On Marriage, Family, Sexuality and the Sanctity of Life”—Sickness, Suffering and Death

Our human body is vulnerable to injury, disease, and the aging process. We may become temporarily incapacitated, permanently incapacitated, or face a terminal injury/disease. Our lives can be compromised, disrupted and changed. Dealing with these situations can bring hardships, confusion, anger, and depression, affecting the person who becomes ill, their family and loved ones. Yet our Church tells us that God is with us even in times of distress, if we reach out to Him and His grace.

Some individuals and families handle these types of circumstances better than others. Despite the challenges and difficulties that are brought to bear, these situations also create unique opportunities for family, loved ones, and those afflicted, to exercise love, compassion and understanding.

While medical advances have expanded our choice of available treatment options over the past 50 years, there are limitations. There are circumstances beyond the power of medical science to heal; or which render us incapable of choosing or exercising our options, such as in a comatose state. Consequently, it is important that we prepare ourselves for the possibility of this type of situation.

Any prolonged illness or injury will always have both physical/biochemical and spiritual dimensions. The spiritual component manifests with urgency when a person faces permanent disability or terminal illness and must come to terms with his/her mortality. While much has been written about dying and death, there are no customized guidelines. Each of us will face our impending death in our own way. However, some things can be said about this ‘final’ time of our life on earth, if we are willing to face the fact that as our biological existence comes to an end, we can prepare for our transition out of this world and into the hands of God.

A myriad of concerns may confront us when we face our mortality and impending death. Instruction and guidance for the decisions to be made at this time are included below.

Living Wills

A living will, when carefully assembled and executed, addresses one’s personal, emotional and spiritual needs, as well as one’s medical wishes. A living will, when signed and notarized, becomes a legal document recognized by most states of this country. Essentially, a living will designates one’s Primary Health Care Agent and Alternates along with their specified authorities; describes the terms of Life Support; states the kind of pain/condition management a person wants to have; and details what the person wants their family to know concerning their illness and/or death. Further, in order that a Living Will be respected, it usually is necessary to appoint a person who has “durable power of attorney for health care purposes. An excellent document entitled “Five Wishes,” details the process of assembling a living will, and is available from Aging with Dignity [1-888-594-7437].

A living will benefits the person who has a debilitating or terminal illness and also relieves the person’s family from having to make difficult decisions without knowing the person’s wishes. The creation of a living will can be viewed as a charitable and loving act because it fosters an environment of death with dignity and consideration for others.

Hospice and Palliative Care

Hospice Care, as opposed to Nursing Home care, is for persons who have entered the end-stage of a disease. Hospice care is typically associated with end-stage cancer but in actuality provides care for many other end-stage diseases, including heart and liver disease, Parkinson’s disease, and many others.

The care provided by a Hospice Center is not curative in nature but palliative. Palliative care is the active treatment of uncomfortable symptoms, such as, pain, distress and nausea. A proactive and integrated approach to care giving, Hospice Care encompasses the patient and their family. While Hospice care is not curative, it is caring and supportive.

It should be the goal of both the family and the designated care givers to insure, as best as they can, that the final days of a terminally ill person are spent reasonably free of anxiety, tranquil and aware to the extent possible. Integral to maintaining this type of condition is the administration of pain medication. Given the wide range and sophistication of pain medication available today, there is no reason for a person to suffer from debilitating pain.

Artificial Life Support

“Extreme caution is to be exercised in decisions involving medical treatment, especially in the face of death. Extreme care is always in order to find the “royal path” between providing all necessary healing measures and merely prolonging the biological functioning of organs when human life is no longer possible, or even present.”
1992 OCA Synod of Bishops’ Affirmations, “On Marriage, Family, Sexuality and the Sanctity of Life”—Sickness, Suffering and Death

The development of Artificial Life Support (ALS) also made tremendous advances during the latter part of the 20th century. These technologies, when properly and appropriately used, provide temporary body functions enabling a person’s body to heal itself and return to normalcy. Many are sustained by ALS assistance while they are waiting for a suitable transplantable organ (see Organ Donation, below). ALS is generally not regarded or proscribed as a permanent situation or solution. Two of the more common ALS methodologies, which in recent times have become somewhat controversial in life/death decisions, are Respiratory Assistance (Ventilator) and Tubal Nourishment and Hydration.

ALS methodologies, when chronically used on a terminally ill and dying patient only serve to delay and prolong the dying process. The decision to remove all life support and to let a loved one pass into God’s hands, while very difficult and emotional, is necessary in order to allow the person to make his/her transition from this world to the next. Arriving at this decision need not be, nor should it be undertaken, alone. The decision to remove ALS should take place after consultation with the person’s physicians and in counsel with one’s parish priest. Most importantly, this decision should take place in communion with God through prayer, asking for His guidance and help during this most trying and grief-filled time.

Deep Coma, PVS (Persistent Vegetative State) and Brain Death

A person in a deep coma or Persistent Vegetative State (PVS) presents a number of issues that concern our Church. The first consideration is whether the person is technically alive or dead. The answer to that question determines what ALS technologies should be used or not used.

Our Church continuously acknowledges Life and its attendant Sacredness. Where there is a clear chance of recovery, all medically available technologies should be used to support the life of the ill or injured person. On the other hand, if the person is terminally ill or gravely injured from which recovery is not expected, then to use ALS technologies to simply prolong the dying process, is basically immoral. It is important as Orthodox Christians to always keep in mind that “Death has lost its sting.” As sad and grievous as the death of a loved one can be, we as Orthodox Christians also know that while biological life may end, our Life Eternal with God continues.

In deep coma and PVS situations, the criterion for life is brain activity within the cerebral cortex. It is activity in that region of the brain that defines the human condition. It is the place where decisions are made, organization takes place and speculative activities such as creative arts and philosophizing occur. In the absence of any activity in this region, the attending physician(s) will declare the person as ‘brain dead.” Our Church recognizes and agrees with this conclusion. There is no rationale for the continued use of ALS systems to maintain a biological entity when no life force is present. Furthermore, the continued use of ALS may also make it difficult for the soul to leave the body.

The Dying Process

“Those who suffer, and those related to the suffering, are to be helped to find God in their affliction, and so to acquire the divine grace and power to transform their pain into a means of purification from evil, illumination from darkness and eternal salvation in the age to come.”
1992 OCA Synod of Bishops’ Affirmations, “On Marriage, Family, Sexuality and the Sanctity of Life”—Sickness, Suffering and Death

Generally speaking, there are two different but interrelated dynamics involved in the dying process: the physical shutting down of the body and the activities taking place on the spiritual-emotional-mental plane. No two people, if they are conscious and aware, manage the spiritual-emotional-mental activities in the same way.

As the body begins to shut down, there is a corresponding change in a person’s metabolic and circulatory processes. This will result in certain natural signs and symptoms, such as, congestion with gurgling sounds, restlessness, incontinence, and increasing coolness in the hands, feet and legs, to mention a few. Further, most people, when they are told that they are dying, deal with it in stages. Elizabeth Kubler Ross describes five stages in her book, Death and Dying: Denial, Anger, Bargaining, Depression, and Acceptance.

Denial:“I feel fine; this can’t be happening.”

Anger:“Why me? It’s not fair!” “NO! NO! How can you accept this?”

Bargaining:“Just let me live to see my children graduate; I’ll do anything, can’t you stretch it out? A few more years.”

Depression:“I’m so sad, why bother with anything? I’m going to die . . . what’s the point?”

Acceptance:“It’s going to be OK; I can’t fight it, I may as well prepare for it.”

On the spiritual-emotional-mental plane, the person is preparing to detach not only from this world of ‘things’ but also from important relationships. As a consequence, many a person has recognized certain unresolved issues and/or unfinished business. Usually, this type of situation makes it difficult for the person to let go. Many times, restlessness is indicative of this type of situation. The Hospice team can help a family identify the issue and in turn may be able to help the dying patient come to final resolution.

In the final stage and time before death occurs, the greatest gift that we can give to the patient is Love and the greatest gift that the dying patient can give to their family is Love. It is worthwhile to remember that hearing remains all the way to the end. Speak to your loved one in a soft tone of voice, identify yourself, gently hold the person’s hands and say whatever you need to say to help the person to let go. And, by all means shed tears without hiding them from your loved one. Tears express our love and help us to let go.

Quality of Life, Euthanasia and Medically Assisted Suicide

“Scientific research and experimentation are to be undertaken with extreme caution in order not to bring greater evils and sufferings to humankind in place of intended blessings.”
1992 OCA Synod of Bishops’ Affirmations, “On Marriage, Family, Sexuality and the Sanctity of Life”—Sickness, Suffering and Death

The term euthanasia originally was used and understood to mean a “good death.” However, in current times it has come to mean ‘to put an end to a person’s life by a specific act.’ The Orthodox Church cannot and does not support such actions whether it is executed by the patient (suicide) or by any other party (individual or physician assisted suicide), even if the rationale is based on the ‘relief of suffering.’

There is the issue of removing life support systems from a terminally ill patient, which some have described as a form of passive euthanasia. While a terminally ill patient is generally described as someone who has been diagnosed as having only 6 months or less to live, the physical state and palliative care, including ALS, will vary greatly during that time period from the so-called beginning to the end. However, rather than a time window, it is better to view this situation from the standpoint of the dying process, wherein the body has initiated irreversible biological processes that will lead to imminent death. Under these circumstances, our Church is not against the removal of Artificial Life Support when it is agreed that the continuation will not lead to any demonstrable benefit and it is consistent with the patient’s desires.

Preparation for the Funeral

Strictly speaking, funeral preparation is not a medical bioethics issue, but it is a related issue. It is an event arranged with thought and cares by the family and is part of the letting-go process. However, since this is emotionally difficult, arrangements are usually delayed until after the inevitable has occurred and the person has died. For those who are inclined to prepare for their funeral ahead of time and in concert with their family, there is a wealth of information available on the internet. A very good and detailed funeral planning document can be found on the web site: www.funeralplan.com.

Cremation

The Orthodox tradition of burying its dead is the normative practice of our Church. However, there has been a resurgent interest in cremation in recent decades. While there are no canonical or dogmatic traditions prohibiting cremation, the common practice of cremation, at least in the Roman Empire under the influence of Christians, was abolished in the 5th century. In general, the Orthodox Church has considered cremations in lieu of burial a dishonoring of the dead. This is in accordance and consistent with Christ’s death, burial and subsequent resurrection. Consequently, an Orthodox Christian lives in anticipation of Christ’s second coming and the resurrection of our bodies. However, it is important to realize that our resurrected body is not considered to be a ‘physical’ body but to be our ‘spiritual’ body. Thus, it follows that the lack of a physical body, such as in the case of total destruction in a fire or explosion, in no way affects a person’s salvation.

The most pertinent reasons for our Church’s practice of burying its dead rests not only on the fact of Christ’s death, burial and resurrection but also on our Church’s teaching that there is a continuity between the ‘living’ and the ‘dead’. The physical body demands respect because it is considered to have housed the ‘temple’ of God and as such, it too is worthy of remembrance. This is clearly demonstrated by the bodies of the Saints whereby they have exhibited clear signs of sanctification and holiness after their death. Further, it is our Orthodox Church’s practice and tradition to have memorial services at the cemetery over the body in remembrance of our departed loved ones.

There are situations wherein certain countries (Japan) and certain states (Louisiana) require cremation by law. In such cases the law is to be obeyed. However, the ashes should be placed in an urn and buried in a cemetery. In all other cases, the Orthodox practice of burial should be followed.

Organ Donation

There are two opposing theological viewpoints within the Orthodox Church regarding the donation of one’s body organs upon death.

First there is the view which maintains that since we are all created in the image of God, the harvesting of organs should be considered a form of mutilation and be thereby prohibited by the Church.

The other perspective is that there is no greater gift that a dying person can give than to donate a vital organ(s) so that someone’s life may be improved and/or prolonged. In fact, it might even be said that we are morally obligated to provide these organs, which we will no longer need, as a gift of unconditional brotherly or sisterly love for our neighbor.

Some express the fear that the bodies of humans will be viewed as simply a source of ‘spare parts’. This is hardly the situation, at least in this country, whereby Hospital and Medical Centers go to great lengths to insure informed consent; that is to say, a person’s organs upon death are not be taken without the expressed written consent of the patient. If an Orthodox Christian has died without leaving written consent to remove his/her organs, they should not be removed.

Summary

“Human beings are to be reminded by every means that they are not isolated individuals but are members one of another who will give account to God and to their fellow creatures for their every thought, word and deed; and that their eternal destiny depends on what they have done with their lives on earth.”
1992 OCA Synod of Bishops’ Affirmations, “On Marriage, Family, Sexuality and the Sanctity of Life”—Sickness, Suffering and Death

This synopsis of some of the more important medical bioethical issues facing us today as Orthodox Christians is not intended to be a complete presentation of all the issues and topics nor should it be considered an official document. Rather, it is intended to spark thought and discussion with regard to medical bioethical considerations and decision-making. For a more exhaustive treatment of these topics and issues, the reader is referred to and encouraged to read the following books by Fr. John Breck:

  • John Breck, Stages on Life’s Way: Orthodox Thinking on Bioethics, St. Vladimir’s Seminary Press, Crestwood, NY (2006)
  • John Breck, The Sacred Gift of Life: Orthodox Christianity and Bioethics, St. Vladimir’s Seminary Press, Crestwood, NY (1999)

The behavioral and moral dilemmas that we face and will face as medical and scientific technologies rapidly emerge in the 21st century are complex and demand deep consideration. Much of what is and will be available to physicians as the result of medical research represents great benefits to humankind. The tremendous advances in cardiac care, such as therapeutic protocols for heart attacks and innovative surgical techniques used to correct heart artery/valve problems, are only one of the many areas of medical advancement/achievement that have improved the quality and length of human life. On the other hand, the medical frontier becomes a slippery slope when medical research and practices are found to be in stark opposition to the core tenets of the Orthodox Church and its teachings.

This document was prepared by Protodeacon Andruchow for parish presentation and discussion at St. Nicholas Church, Salem, MA. Reprinted by the OCA Department of Christian Service and Humanitarian Aid with permission.

Protodeacon Basil Andruchow is retired and attends St. Nicholas OCA Parish in Salem, MA. With a doctorate in Environmental Chemistry, he held the position of Quality Assurance Manager for the Massachusetts Water Resource Authority. He is a member of the OCA Medical Ethics Commission.

Zoe for Life!

By Kathy Kovalak

(ZOE is the Greek word for Life)

In 1977, a group of Orthodox women in Ohio began meeting to see how we could make a life-saving difference in today’s society. A survey was sent to the women in the area aged eighteen and over. Responses indicated three major areas of concern: the need for an Orthodox Christian adoption agency, help for women in crisis pregnancies, and assistance for battered women and children.

The group began meeting with professionals in the area, with the thought of starting an Orthodox adoption agency. We found that this would not be difficult to achieve, but there were few babies to be put up for adoption; they were being aborted. Contacting Care Net, a national organization advising those who want to establish crisis pregnancy centers, we were told that experience had taught them that Orthodox Christians have a higher abortion rate than the U.S. norm. According to Care Net, “Orthodox Christians”, we were told, “have two strikes against them—a concentrated ethnic group and a tightly knit religious group. For reasons of pride and shame, these factors invariably are linked to high abortion rates.” This was confirmed after talking with our parish priests who told us that many Orthodox women abort their children, but their priests become aware of the event only through confession. Thus our group, ZOE for Life came into being.

ZOE for Life is a non-profit, Christ-centered organization with three major goals:

  1. to help pregnant women in distress who need confidential, emotional, and spiritual support to encourage them to choose life for their unborn child;
  2. to assist Orthodox Christians seeking to adopt; and
  3. to provide an Orthodox Christian education on living the Christian life, and other life affirming resources.

How ZOE for Life Operates

ZOE for Life Is a Pan-Orthodox national organization, based in Cleveland, Ohio. Led by Paula Kappos, president, we have a board of directors of five Orthodox women; Executive Director, Kathy Kovalak, and volunteers helping us here and throughout the country. While we limit adoption assistance to the Orthodox community, we help any woman with a crisis pregnancy. We have a toll-free help-line number, manned by Paula Kappos who was trained to assist women in crisis. Information about us can be found on our website, www.zoeforlifeonline.org.

So few women in an unplanned pregnancy are well versed on the various services and support groups available to them. The overwhelming concern is “What am I going to do now?” Many wrestle with abortion, some with adoption, and some with suicide. It is disturbing that most of the Orthodox Christian women who are in trouble do not turn to their church for guidance, and there are so few support groups to turn to within the Orthodox community. These women need emotional support, confidential access to professional agencies, and access to potential adoptive Orthodox families to encourage them to carry their infants to term.

ZOE serves as a conduit, guiding women to a wider range of support organizations, providing them with a more attractive set of options and hopefully a more promising outlook on their situation. For example, there is financial assistance, housing assistance, medical assistance, adoptive services, and other services available. It is ZOE’s goal to connect these women with the needed services. We pray they will make the best choices for their own future and for the future of the child God has entrusted to them.

ZOE HOUSE

God took us in an additional turn with the opening of ZOE House, which was not part of our original plan. We thought we could use a place where Moms could come to talk and get counseling. It would also give us a centralized office. We didn’t know if this would be possible financially, but we thought we would try. A small home, owned by St. Vladimir’s Ukrainian Orthodox Church, was made available to us to rent.

What evolved was a place where Moms in need can come to obtain baby items free of charge. This was made possible by very generous donations of new and used baby items from the surrounding Orthodox community. The house is open 4 days a week, 3-4 hours each day. It is manned by five volunteers. Women make appointments to come in, having been told about us from various child and family agencies in the Cleveland area. This has become a wonderful Orthodox outreach ministry in the community.

Are we having an impact? Since starting, we’ve had hundreds of calls for help on our helpline. We’ve helped with several adoptions including one recently in 2010 in which the birth mother was originally planning to abort. Priests have called seeking support for parishioners in crisis, women who had already made appointments for an abortion. We’ve given out baby items to over one hundred women in need.

We are ordinary Orthodox Christians. Together, with God’s help, we can change the world. If we don’t speak for the unborn, who will? If each of us could help just one person avoid the lifelong torment and guilt of an abortion, if we could save even one life, if we can help create even one family, wouldn’t that be a blessing for all of us?

There are at least two victims in every abortion: the baby and the mother who felt she had no other option. Women who have had abortions so often say, “If only I had someone to stand by me”. The missing “someone” is you and me.

If you would like to help, if you know someone who needs our help, or for more information please call, 440-893-9990, Helpline, 877-436-LIFE, ZOE House, 440-888-9990, or visit www.zoeforlifeonline.org.

Kathy Kovalak is a retired RN who has always worked in Obstetrics and Pediatrics. She is a certified Childbirth Educator, and has been volunteering at Womankind, a crisis pregnancy center in Cleveland. At Archangel Michael Orthodox Church, Broadview Heights, OH, Kathy is a Church School teacher and also serves in leadership roles on its various Outreach committees. She and her husband, Bob, are the parents of three, and the grandparents of seven, all of whom are actively involved in the church.