Entries with tag bioethics .

HIV/AIDS Research: An Orthodox Christian Response

As we prepare to receive the Sacrament of Holy Unction on Holy Wednesday evening, two articles in recent editions of The New York Times addressing breakthroughs in HIV/AIDS research came to mind precisely because the Sacrament of Holy Unction is understood as the Sacrament of Healing.

On March 4th and March 5th the newspaper reported that scientists have made significant progress in their search for a vaccine and a cure for HIV. With regard to a vaccine, researchers reported the results of an experiment wherein monkeys were injected with long-lasting AIDS drugs. The monkeys that received the injections were protected against infection for weeks. Monkeys that received monthly injections of antiretroviral drugs were completely (100%) free of infection after exposure to the virus. Researchers believe that a single shot every three months could work just as well as a monthly injection. A very small controlled human trial is expected to start later this year in the United States, South Africa, Malawi and Brazil.

Since 2010, it has been known that healthy people taking a small daily dose of antiretroviral drugs, a procedure known as pre-exposure prophylaxis (PreP), can achieve 90% protection against infection. Unfortunately, protection against the virus decreased almost completely once patients missed even a single dosage. If researchers are able to achieve a significant degree of prevention via a monthly (or even quarterly) injection it might be possible to maintain pre-exposure prophylaxis while reducing factors that may lead participants to miss or refuse daily oral drugs (stigma, fear, and basic human forgetfulness). Click here for the full story.

The next day, March 5th, “The Times” reported that a second infant born with H.I.V. was apparently cured of the virus through aggressive drug treatment. The child—a girl born in Long Beach, CA—was treated with an antiretroviral cocktail consisting of AZT, 3TC and nevirapine. A similar case was reported last year; an infected child born in Mississippi was also aggressively treated with antiretroviral drugs and is now 3 years old and still virus-free. A clinical trial in which 50 infected infants will be treated is set to begin within three months. Click here for the full story.

In just a few decades, HIV/AIDS research has yielded incredible results. Whereas in the past people diagnosed with HIV/AIDS would not live for long, today, people diagnosed with HIV/AIDS are often treated as patients with a chronic (albeit fatal) illness. Since being diagnosed with HIV in 1991, Earvin “Magic” Johnson, Jr. speaks of “living with AIDS” rather than “dying of AIDS.”

When AIDS was first discovered we knew very little about the disease. Many, for instance, believed that this was a disease that only affected individuals of a particular gender, race or sexual orientation. Moreover, physicians were unaware that unborn children could contract the virus from infected mothers during pregnancy, labor, delivery or breastfeeding. Such misconceptions led to countless infections and deaths.

Our lack of understanding of HIV/AIDS also led many faith-based communities to reconsider their internal practices. This was especially an issue for most Christians with regard to the distribution of the Holy Eucharist. In the Orthodox Church, where Communion is received using a common spoon, some feared that the disease could be transmitted by partaking in the Common Cup. We can only imagine how this might have caused many to fear receiving Holy Communion. Among other suggestions, some supported the introduction of disposable cups and spoons as a way to ease people's fears and to decrease the chance of infection.

Fortunately, such measures were never introduced nor were they necessary. They were not necessary, on the one hand, because the disease is not transmitted through the sharing of food and liquids, and on the other hand, and most importantly, no one can contract a disease through the Holy Body and Blood of Jesus Christ.

There is no telling what the future holds. We hope and pray that God will inspire the work of researchers so that we may eradicate HIV/AIDS one day. However, until such time, it is important to remember that individuals with the disease continue being images of God. They are not “sick people,” they are not “sinful,” or “abominations." They are our brothers and sisters, worthy of the same love and mercy that we expect from our Lord. There is no room for judgment or condemnation, otherwise what we risk losing is not just our physical health but also our souls.

Until a cure or vaccine is discovered and becomes widely available, it is important that we consider the efficacy of various efforts to prevent the spread of HIV/AIDS, especially in those regions where the disease has reached epidemic levels. The sociocultural realities on the ground as well as proven effectiveness of various efforts will often help determine which preventative measures should be utilized. Among the many efforts used include sex-education, increasing accessibility to testing, needle exchange programs, and the distribution condoms. There are both advocates and critics of these and other efforts, and perhaps we can address these further in a later post. But, what we can say now is that it is absolutely essential for us, as Orthodox Christians, to insist that our Orthodox Christian principles be given serious consideration in our homes but also in the public square. When used alone, we know that there is no single measure of defense that is perfect. Therefore, it behooves us to embrace those efforts proven to lower the morbidity and mortality rates of HIV/AIDS while also embracing our timeless Orthodox Christian values.

Of course, the Church’s teachings about human sexuality has a place in the discussion around HIV/AIDS. However, the principles of faith, hope and love, as well as the Church's enduring message of forgiveness, mercy, repentance and reconcilliation are even more invaluable in the effort to confront HIV/AIDS.

It is truly a blessing for us to receive the Sacrament of Holy Unction, the Sacrament of Healing. By healing, however, we need to recall that what is meant goes far beyond overcoming physical maladies, but more importantly, overcoming sin and death.

Archimandrite Nathanael Symeonides is the Director of the Department of Inter-Orthodox, Ecumenical and Interfaith Relations of the Greek Orthodox Archdiocese of America.

Human Enhancement and Technology

Herbal remedies for human disease predate history and large amounts of herbal remedies were found at excavation sites of the ancient civilizations such as Sumeria, China and Egypt. The Old Testament documents refer to caraway, mandrake and other plants used for health purposes.  Humanity has striven to prevent or cure diseases throughout history to reduce human suffering and extend life.  These technologies, while apparently primitive now, lead to modern uses of plants for healing and therapy. In many cases, e.g. taxol from the Yew tree for the treatment of cancer, or penicillin from the Penicillium fungus for treatment of infections, modern technology only refined what the nature offered. Unfortunately, some of the new technologies present a possible temptation for “refining” human beings as well. This threat, while potentially greater now than ever before, has precedents in human history when medical knowledge was used to alter people and make them “better” than the norm (for example, making men able to sing in the higher register through castration).

Human enhancement is generally defined as any attempt to temporarily or permanently overcome the current limitations of the human body through either natural or artificial approaches.  The range of applications considered to be human enhancement varies with different sources.  In general, as technology has progressed, therapies have also advanced, and with time, the line between corrective treatments and “enhancement” became blurred.  The development of plastic surgery to patch up skin after an injury or fix a physical defect has lead to the use of surgery to make aesthetic and age-removing alterations to the body.  The development of steroids to treat painful and debilitating conditions has also lead to a series of drugs that can be used by sports stars for enhancing muscle mass to improve speed, strength, and agility.  Appropriate applications of aesthetic and performance enhancements are regulated to some extent by the medical profession as a whole, by sports agencies, and others, however, the potential for financial gain often severely complicates these issues. 

Even more extreme applications for enhancement technologies are genetic selection approaches that accompany in vitro fertilization (IVF). Genetic monitoring for chromosomal aberrations is a necessary step in IVF, however, this type of screening also allows for selection of known genetic traits.   Pre-implantation genetic screening of children conceived by in vitro fertilization is now offered in a variety of clinics in the world, providing screening of embryos for different features (gender, hair color, eye color, others).  This approach can eventually also open the door forthe introduction of new traits into or elimination of other traits from children—for example, introduction of extra genes for growth hormone to create a taller child (which has been done in trout to make for better fishing) or elimination of genes that contribute to obesity or cancer to reduce the risks of these problems in offspring.  While this type of genetic manipulation of offspring is not permitted in most nations right now, the fact that the technology is possible and that selection approaches are already in place for embryos created by in vitro fertilization may point to the possible applications of these technologies for human enhancement in the future.

Some technologies that are being developed to help those who are afflicted with a particular illness can have applications that extend well beyond their intended target diseases.  For example, a drug that was developed in mice to help improve stimulus response times in Alzheimer’s patients was discussed by the military as a drug that could also improve response times in soldiers who are performing rapid firing of firearms.  Tools used to help paralyzed patients move a computer curser with a thought could also be used by the military to permit a bomb to be detonated with a thought as well.  While these technologies will no doubt help those in need, researchers who developed them probably never considered potential military applications.  Even though some of these applications may even be appropriate for the military (that is not clear from what little is known at this point in time), some discussion about applications is really essential before they are tried on healthy individuals or in a mass scale situation. 

The development of new technologies is likely to continue at rapid rate, and the movement from the development of a technology to its application is often equally swift.  In most situations, technology is not regulated at the level of its initial development but rather at the stage of application of a particular technology to a given problem or challenge.  While this is perhaps reasonable since most technologies come equally with benefits and limitations, the net result is that technologies most often become available to the general public with little ethical reflection on whether the application is appropriate or reasonable.  Often the distinctions between what is ethically appropriate and what is not are nuanced in the methods that are being used, the goals that are being sought, and even the intentions of the individuals seeking to use the technology. 

There are perhaps three keys that should be considered when attempting to examine technology issues as they relate to human enhancement.  First, we must always realize that gifts of knowledge (and technology is one of these) is a gift of God, and in this light, we must with all humility realize that an appropriate goal of technology is not to exalt human achievements or to prove human mastery over death, disease and aging, but rather to seek to eliminate suffering and pain in a God-centered manner.  Secondly, humanity must use discernment in the use of these gifts of technology.  This discernment must come from something deeper than simple study of a problem, or ethical discourse on the issues—it must come from a spiritual awareness of the world, human nature, and self.  Discernment needs to weigh its answers on a fine scale.  Finally, the third key is to strive to acquire the mind of the saints, of those holy ones living in different times who responded to the problems of their day with holiness, discernment and enlightenment.  While we cannot transport their exact decisions and ideas to our age, we can strive to reach a deeper level of understanding and let their lives and approaches from their times be an example to us in our time. 

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