Showing posts with label end of life care. Show all posts
Showing posts with label end of life care. Show all posts

Saturday, February 13, 2010

The Flame of Divine Love: The Last Judgment

In Western society, many people tend to think of God and theology in legalistic terms. We may encounter those who think that God is an angry Judge waiting to punish them for breaking His laws. Contemporary movies and television programs have contributed the erroneous popular vision of God, judgment, Heaven, and hell. American misconceptions regarding hell likely find root, directly or indirectly, in the picture presented in Dante Alighieri’s Divine Comedy and religious ideas generally present in Roman Catholicism and Protestantism. Within the Orthodox Way, however, theological understanding is primarily rooted in the Inexhaustible Love of God.  By teaching the true Orthodox vision of the Kingdom of Heaven and hell, inasmuch as we can comprehend it, within a culture that tends to compartmentalize knowledge and disconnect theological ideas from every-day life, we can help people to acquire an understanding that fits harmoniously within the whole Orthodox theological worldview, embodied in the comprehensive spiritual life of the Church.

Before the beginning of Great Lent, a period of preparation for Holy Pascha (Easter), we commemorate the Last Judgment when we all will stand before God:

When the thrones are placed, and the books are opened, and God sitteth for judgment, O what a fearful sight, as the angels stand in fright, and thy river of fire floweth by! What then shall we do, we men who have come under condemnation by reason, of the multitude of our sins? And as we hear him call the blessed of his Father to his kingdom, and send the sinners to punishment, who will bear that terrible verdict? Wherefore, O Savior and Lover of mankind, alone King of the ages, hasten to me before the end with repentance, and have mercy upon me. (1)

Before we commemorate the Last Judgment, we are prepared by the Sunday of the Tax Collector and the Pharisee, reminding us that the person accepted by God is not the outwardly religious Pharisee, who is filled with pride and judges others as worse sinners than himself, but the humble soul who, feeling the depth of his own spiritual sickness, sincerely and prayfully turns his heart to God in repentance.  We are also prepared by the Sunday of the Prodigal Son, which teaches us that no matter how far we drift from God and squander the good things we have received, if we repent (turning away from what is unnatural toward God), our Loving Father is ready to run toward us, warmly embrace us, and receive us back with joy.

God is Unconditional Love and God is a Consuming Fire.  God is Love and is Fire.  Love and Fire are One.  There is no contradiction here. God's Uncreated Love is Uncreated Fire.  In the prayers of the Church, we ask God not to consume us because of our sins, but to consume our sickness, our deadness, "the thorns of our transgressions," and to purify and illumine our souls.  For those who seek healing, the Uncreated Fire is purifying and transformative.  The Fire consumes all that is unhealthy and barren.  The Fire of God's Love does not cause pain for the purified and illumined, but is the moist breeze of Paradise and refreshing River of Life that brings everlasting joy and peace.

Those who are full of selfishness and pride will not experience God's Love as Paradise.  The unloving will be consumed by Pure Love.  St. Isaac the Syrian explained that

those who are suffering in hell, are suffering in being scourged by love.... It is totally false to think that the sinners in hell are deprived of God's love. Love is a child of the knowledge of truth, and is unquestionably given commonly to all. But love's power acts in two ways: it torments sinners, while at the same time it delights those who have lived in accord with it. (2)

St. Gregory the Theologian wrote from the same perspective, “O Trinity, Whom I have been granted to worship and proclaim, Who will some day be known to all, to some through illumination and to others through punishment!” (3) Likewise, St. Basil the Great said,

I believe that the fire prepared for the punishment of the devil and his angels is divided by the voice of the Lord.  Thus, since there are two capacities in fire, one of burning and the other of illuminating, the fierce and scourging property of the fire may await those who deserve to burn, while illuminating and radiant warmth may be reserved for the enjoyment of those who are rejoicing. (4)

Those whose hearts have been purified, their souls healed, and are filled with divine love become flames united with the Uncreated Flame of Unquenchable Love.  Our goal in this life is summarized in the words of an ancient spiritual father, Abba Joseph, who said, "If you will, you can become all flame."

As the unloving, proud, and impure will be tortured by the presence of Divine Love, they will also be abused by their own souls, a result of their refusal to accept the healing offered to them by their compassionate Creator and Physician. In his “Letter to Publius,” St. Ephrem the Syrian noted that “the gehenna [hell] of the wicked consists in what they see, and it is their very separation that burns them, and their mind acts as the flame.” (5) He explained that “the hidden judge which is seated in the discerning mind has spoken, and has become for them the righteous judge, who beats them without mercy with torments of contrition” and “saliently accuses and quietly pronounces sentence upon them.” (6) The “inner intelligence has been made the judge and the law, for it is the embodiment of the shadow of the law, and it is the shadow of the Lord of the Law.” (7)

The Last Judgment is a reality for each of us, but we are reminded of this reality within the Church as we are also reminded of the Way of the eternal kingdom of God: humility, repentance, love, and prayer. God has planted the Church for the our healing so that we may be united with Him and become radiant torches of Divine Love, Peace, and Joy. For those seeking the healing of their souls and union with God, the images of the Last Judgment assist us in finding humility and focusing on the condition of our own souls with rather than judging others.  Pride is a great enemy that keeps us from seeing ourselves as we really are with sobriety.  We live in a culture wherein we are constantly being tempted to act and think in ways unnatural to our human nature and that are contrary to the path of good health.

The fear of hell can serve to bring us to repentance.  The highest reason for pursuing salvation is love for God, not fear of punishment, but because of our spiritual delusion and the sickness in our souls, fear of separation from God in hell can serve as motivation to overcome our laziness and pursue the Way of spiritual healing that God has given us.  Always being mindful of God's love, we should remember the words of St. Silouan the Athonite, "Keep your mind in hell and despair not."

Since the Last Judgment is a reality, we should not downplay the necessity of repentance as an essential aspect of the healing process in this life.  When someone is facing physical sickness and death, they may be more receptive to hearing about repentance than at other times. Within an Orthodox context, we can help patients facing physical sickness and death achieve deep healing in their souls so that they may experience the Kingdom of Heaven (even in this life) and be resurrected in their physical bodies, not to judgment and spiritual death, but eternal life and joy in body and soul.

While some may not give much thought to the Last Judgment until they face their own mortality, others may possess a rational fear of hell, but without knowledge of God's love.  They may see God as a Judge, but not as a loving Father.  (Perhaps their concept of God has been twisted by exposure to heretical doctrine and/or unhealthy human relationships.)  In such cases, we must help these individuals learn about God's unconditional love for mankind (philanthropia), the Orthodox Way as the path of healing, and our goal of becoming purified, illumined, and united through the unquenchable flames of Divine Love.


(1)  Glory at "Lord, I have cried," Vespers, Sunday of the Last Judgment

(2)   Alexander Kalomiros, The River of Fire, presented at the 1980 Orthodox Conference, sponsored by St. Nectarios American Orthodox Church, Seattle, WA (Seattle: St. Nectarios Press, 1980), quoting St. Isaac the Syrian, Homily 48. The text of The River of Fire is available at http://www.stnectariospress.com. See also Lazar, 8-9.

(3) Metropolitan Hierotheos of Nafpaktos, Life After Death, trans. by Esther Williams (Levadia, Greece: Birth of the Theotokos Monastery, 1996), 259, quoting St. Gregory the Theologian, Or. 23.13, On peace 3, PG 35, 1165B.

(4) Archbishop Lazar Puhalo, On the Nature of Heaven and Hell According to the Holy Fathers (Dewdbey, Canada: Synaxis Press, 1995), 9, quoting St. Basil the Great, “Homily on Psalms,” 28.6; See also Met. Hierotheos, 257.

(5) Ibid., 7-8, quoting St. Ephrem the Syrian, “Letter to
Publios,” para. 21-23. 

(6) Ibid., 8

(7) Ibid.

Wednesday, January 13, 2010

"Care at the End of Life"

"Care at the End of Life: What Orthodox Christianity Has to Teach"
by His Grace Bishop THOMAS

I. Making Decisions at the End of Life in a Post-Traditional Culture: Finding One’s Way to God

Orthodox Christianity offers orientation in the cosmos. More precisely, it leads us away from our passions and purifies our hearts so that we can be illumined by the uncreated energies of God and come into union with Him. (1) Contemporary man finds himself bereft of such orientation. Both his life and his death tend to be trivialized, reduced to what can make sense without any recognition, much less experience, of transcendent mean­ing, purpose, and obligation. As a consequence, much reflection on end-of-life decision-making gives priority, if not exclusive attention, to com­fort care, death with dignity, and the preservation of personal autonomy until death. All of this is done without ever asking the foundational ques­tion, What was life really all about? much less the foundational spiritual question of how I should and can repent from a life that was poorly lived so as finally to turn in repentance to God. Properly directed care at the end of life is care that focuses on repentance. To talk about end-of-life decision-making and not to place centrally the urgent is­sue of repentance is to miss the target completely. Care at the end of life should offer a final opportu­nity to the dying person to find orientation. That is, end-of-life care must bring the dying person to repentance through a recognition of how the holy, indeed, God, defines the meaning of the right, the good, and the virtuous. Good end-of-life care can­not be the product of a secular or philosophical bioethics. It must be the proclamation of a liv­ing theology. Orthodox Christianity teaches how to become oriented in life and to achieve a good death. What is important to be said cannot be stated adequately in secular terms.

II. Against the Grain of Secular Culture: Re­membering That One’s Religion Is Not a Per­sonal Matter

We live in a world that increasingly accepts pas­sive euthanasia in the sense of withdrawing or withholding treatment with the intention to bring about an earlier death. More and more, this world accepts not only active euthanasia (for example, the use of analgesics to hasten death), but also physician-assisted suicide and blatant voluntary active euthanasia. All of this is exactly what a bad death is about: it is focused on the willful con­trol of the end of one’s own life, rather than on humility and repentance. Orthodox Christianity brings a quite different message. Orthodox Chris­tianity teaches repentance, conversion, and the importance of turning to God. It surely does have concerns with the good, with justice, and with protecting life. But these concerns are set within concerns for the holy. Orthodox Christianity is not against making the world better; indeed, it knows that in the end the world will be made better after Christ comes in judgment (Revelation 21). In the meantime, the Orthodox Church must remind the world that the first Orthodox Christian convert to enter heaven was the thief on the cross, who did no good thing save to repent and convert (Luke 23:39–43). The thief had no opportunity after his conversion to accomplish anything worthwhile. Literally at the end, however, he turned to holi­ness, which holiness is personal: the triune God. Orthodox Christians, too, realize that truth is not propositional, but personal. Because of his con­version, the thief on the cross had a good death. Orthodox Christianity has to teach first and fore­most that we should turn to that Truth and, in so turning, we will come to know holiness. This fact of the matter, that truth exists and is personal, should orient our lives and our deaths, and should direct all end-of-life decision-making. It should help us to see the death of the thief as the icon of a good death.

The personal character of the truth is one of the central distinguishing marks of Orthodox Christian theology. To begin with, those who are theologians in the strict sense are not those who merely know about God, but those who know God: they are holy Fathers. At least half of the great Orthodox theologians of the twentieth cen­tury were not academicians; many never attended a university. Yet they had noetically experienced God. They had come to know God. (2) This is why the Orthodox Church rarely, and only for rhetori­cal purposes, gives proofs for the existence of God. Otherwise, such endeavors would be some­thing like a wife developing five proofs for the existence of her husband with whom she lives. Offering such proofs would be a hint that she is alienated from her husband, that she no longer experiences his presence. Because we experience God, we do not believe in his existence as one might believe in a philosophical proposition. His presence is realized in our lives and in our deaths. For this reason, instruction in how to die well is not derived from manuals and treatises, but from accounts of the lives and the deaths of saints. We look to the models of proven successful dying. This point of attention always directs us beyond the good towards the holy.

Because it is central to understand the good, the right, and the virtuous only with reference to God, Orthodox Christianity refuses to accept the dilemma that Plato (428–348 B.C.) develops in his dialogue, Euthyphro. In response to the question as to whether the good is good because God approves of it, or whether God approves of it because it is good, Orthodox Christianity real­izes that the good, including the good of a good death, can never be understood adequately apart from God. It is something like not being able to understand the orbits of the planets without ref­erence to the sun. Orthodox Christianity refuses to reduce theology or moral issues to natural-law reflections or discursive philosophical analyses and arguments. It focuses instead on the kind of person we should be for eternity. It does this in the face of a Truth that it is absolute and endur­ing: the Persons of the Trinity.

In contrast, spiritual character-building in our contemporary culture is frequently regarded as a do-it-yourself task, like the assembly of a meal in a cafeteria. The result is that one examines vari­ous moral and religious positions as if they were dishes from which one could sample and choose on one’s own, composing in an aesthetic and will­ful fashion one’s own life and one’s own death. Orthodox Christianity, in contrast, reminds per­sons that they must rightly orient their life-and­death choices through ascetically directing their lives to the meaning of the universe, Who is God. Orthodox Christianity is thus not simply pro-life, but pro-life directed to God, which direction in our lives and deaths is only achieved through ascetic struggle. One can only have a rightly-ordered ethic of life through turning rightly to God. The good cannot be understood apart from the holy. A philosophical analysis and refl ection will never be enough. (3) Orthodox Christianity, as a consequence, does not offer an ethic of life, but a way of rightly and theologically living one’s life. There can be no adequate understanding of rightly directed decision-making at the end of life, absent an adequate theological orientation.

Although life in general, and dying in partic­ular, are ascetic struggles, one should note that Orthodox Christianity recognizes the importance of pain control and comfort care. In particular, Orthodox Christianity has from the beginning ap­preciated that pain and distress can bring the dy­ing to temptation and despair, thus leading them away from a wholehearted pursuit of salvation. St. Basil the Great (329–379) therefore notes with approval that “with mandrake doctors give us sleep; with opium they lull violent pain.” (4) In­deed, twice in each Liturgy, the Church prays for “a Christian ending to our life, painless, blame­less, peaceful, and a good defense before the fear­ful judgment seat of Christ.” (5) This prayer empha­sizes the goodness of a death that is painless and peaceful. In so doing, however, it does not lose sight of the great offering to God made by the death of martyrs. In all these cases, a blameless death is like the death of the thief, repentant and marked by confession of Christ. As a result, there is nothing more frightening than the prospect of dying peacefully in one’s sleep without warning, without a final opportunity for prayer and repen­tance. In summary, with regard to decision-making at the end of life, there must be a focus on God, and this can require withholding and withdrawing treatment when such would distract from turn­ing wholeheartedly to God. The focus remains on wholeheartedly aiming at repentance.

III. Seeing the Big Picture

Life lived fully within the horizon of the finite and the immanent has a trivial character in contrast to a life lived in recognition of God. So, too, does end-of-life decision-making remain radically mis­directed and incomplete, no matter how much it might be embedded within a concern for death with dignity or directed by an ethic of life. Set within the horizon of the finite and the immanent, reflections on one’s death and decision-making at the end of life highlight creature comforts for a creature who thinks of himself as about to go out of existence. One is blind to the earnestness of taking advantage of final opportunities rightly to orient one’s life towards the future beyond death, that is, to God. Orthodox Christianity has the task of pointing out this big picture: the significance of death and the nature of the truth. As to the latter, Orthodoxy reminds the world of Who this Truth is. Only oriented to the Triune God can one in the end understand the meaning of life, the signifi ­cance of death, and the goal to which one should direct one’s decisions at the end of life.


ENDNOTES

1 The final stage beyond illumination (theoria or union with God) is what is achieved by true theologians. “The mysti­cal and perfecting stage is that of the perfected ones, who in fact become the theologians of the Church” (Hierotheos, Bishop of Nafpaktos, Orthodox Spirituality, trans. Effie Mavromichali, [Levadia, Greece: Birth of the Theotokos Monastery, 1994], p. 50).

2 “The theologians of the Church are only those people who have arrived at a state of theoria, which consists in illumi­nation and theosis. Illumination is an unceasing state, ac­tive day and night, even during sleep. Theosis is the state in which someone beholds the glory of God, and it lasts as long as God sees fit” (John S. Romanides, Patristic Theology, trans. Hieromonk Alexis [Trader], [Goldendale, Washing­ton: Uncut Mountain Press, 2008], p. 50).

3 Orthodox Christianity has an attitude towards philosophical reflection like that of St. Paul’s: “Where is the wise? Where is the scribe? Where is the dis­puter of this age? Did not God make foolish the wisdom of this world? For since, in the wisdom of God, the world knew not God through its wisdom, it pleased God through the foolishness of the preaching to save those who believe. For indeed, Jews ask for a sign, and Greeks seek wisdom, but we proclaim Christ Who hath been crucified; to the Jews, on the one hand, a stumbling block, and to Greeks, on the other hand, foolishness” (1 Cor 1:20–23). This Pauline in­sight is often reinforced by the Fathers. One might consider the rather critical things St. John Chrysostom has to say regarding secular Greek philosophy. See, for example, his first Homily on the Gospel of Saint Matthew and his second Homily on the Gospel of Saint John.

4 St. Basil the Great, “The Hexaemeron,” Homily 5, §4, in Nicene and Post-Nicene Fathers, Second Series, eds. Phil­ip Schaff and Henry Wace (Peabody, Massachusetts: Hen­drickson Publishers, 1994), vol. 8, p. 78.

5 The Liturgikon (Englewood, New Jersey: Antakya Press, 1989), pp. 281, 299.


(The article is by His Grace Bishop THOMAS, Diocese of Charleston, Oakland, and the Mid-Atlantic, Antiochian Orthodox Christian Archdiocese of North America. Used by permission.)