The Latter-day Saints Tradition
Religious Beliefs and Healthcare Decisions Edited by Deborah Abbott
he Church of Jesus Christ of Latter-day Saints was Tfounded in 1830 by a young man named Joseph Smith Jr., who received a series of revelations throughout his lifetime. The first came in 1820, when two heavenly beings, later identified as Jesus and God the Father, appeared to Smith; one of them told him that all of the many religious sects were wrong and forbade him to join any of them. In 1827, an angel Contents gave him plates of gold engraved with holy scriptures The Individual and the 5 now known as the Book of Mormon. According to the Patient-Caregiver Relationship tradition, Smith was ordained by John the Baptist on May 15, 1829, and some time later by the Apostolic Family, Sexuality, and Procreation 6 disciples Peter, James, and John; his ordination Genetics 12 marked the divinely authorized restoration of the Organ and Tissue Transplantation 12 Apostolic Church, which was founded by Jesus Christ and had died with the first generation of apostles.1 Mental Health 13 Joseph Smith’s leadership by revelation caused tur- Death and Dying 14 moil within the Latter-day Saints church; members Special Concerns 18 claiming revelations of their own caused a number of schisms in the early days of the church. Today, two major churches from this tradition survive. The largest, with 5.2 million members in the United States as of December 2000, is the Church of Jesus Christ of Latter-day Saints, or LDS church, headquartered in Salt Lake City, Utah. The LDS church, commonly known as the Mormon church, is one of the fastest growing reli- gions, showing dramatic growth in a combination of “membership, market share, visibility, and/or impor- tance over the next few decades.”2 The other major Part of the “Religious Traditions and church, with about 250,000 members as of October Healthcare Decisions” handbook series published by the Park Ridge Center Deborah Abbott, M.P.H., formerly with the Park Ridge for the Study of Health, Faith, and Ethics Center, is currently with Georgia State University.
THE PARK RIDGE CENTER 2001, is the Community of Christ, formerly the God, and they see the two as necessarily com- Reorganized Church of Jesus Christ of Latter Day plementary. As a result, Latter-day Saints are Saints (RLDS) church, headquartered in more open to scientific and medical advances Independence, Missouri.3 than many others in religious traditions that The term “Mormon” is often used to refer to have a deeply scriptural foundation.6 Latter-day members of the Church of Jesus Christ of Latter- Saints “are encouraged to take full advantage of day Saints. Although “Mormon” is not an offensive modern medicine and technology in the preven- term, most members prefer to be called “Latter-day tion and cure of sickness.”7 Officially, the LDS Saints.” In referring to the Community of Christ church holds that “members should not use (referenced here as “Community”) or its members, medical or health practices that are ethically or one should not use the term “Mormon.” Members legally questionable. Local leaders should advise of the Community of Christ refer to themselves as members who have health problems to consult “Saints” or simply “members.” competent professional practitioners who are li- Both churches seek to distinguish themselves censed in the countries where they practice. from the other. The Church of Jesus Christ of Bishops may not use fast offerings [charity] Latter-day Saints claims to be unique in that even funds to pay for unproven medical care without today its prophetic leadership continues to re- First Presidency [high council] approval in each ceive and codify divine revelation.4 Meanwhile, case.”8 Part of this emphasis is perhaps a re- the Community of Christ under its former name sponse to what seems to be an ongoing LDS published the following statement: proclivity to seek out herbal and naturopathic cures. This tendency is a vestige of official nine- While the RLDS church and the LDS (or Mormon) teenth-century urgings that “those with insuffi- church have some common features, such as a cient faith to be healed should eschew orthodox common historical beginning, there is no connec- treatments in favor of herbal remedies.”9 tion between the groups. In fact, the paths taken by Not only does the LDS tradition respect med- the two have been so divergent since separation in ical science and technology, it also upholds a 1844 as to make the similarity in name at the pres- profound respect for the moral integrity of per- ent time inharmonious with religious faith and sons within the healing professions. This is illus- practice . . . The RLDS and LDS are often incor- trated most clearly by the fact that medical rectly seen as closely related in their theology and professionals, rather than ecclesiastical officials, practice by the uninformed observer. Often this as- are often cited as the primary consultants in sumption leads to the “lumping together” of these cases of medical-moral perplexity.10 groups which is entirely inappropriate. The RLDS Latter-day Saints have a reputation for foster- church has far more in common theologically with ing a tightly knit community that manifests itself mainline Protestant churches than it does with the clearly when its members are sick or otherwise LDS church. Every attempt should be made by per- in need. Those who have significant illnesses are sons involved with both groups to clearly distin- often surrounded by a well-organized charitable guish between the two. This understanding will lead effort to provide practical, professional, and spir- to much more effective ministry to both groups.5 itual support.11 With regard to suffering, “Latter-day Saints do not believe that pain is intrinsically good. In their FUNDAMENTAL BELIEFS teaching there is little of asceticism, mortification, CONCERNING HEALTH CARE or negative spirituality. But when suffering is un- avoidable in the fulfillment of life’s missions, LDS: Latter-day Saints believe that both scien- one’s challenge is to draw upon all the resources tific and religious truths have their source in of one’s soul and endure faithfully and well. If
2 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS benefit comes from pain, it is not because there is crisis, care of the dying and deceased, etc., the anything inherently cleansing in pain itself.”12 church does not pretend to give simple answers to complex and perplexing questions. Further, because Community: This church’s world headquarters there are no clear rules of conduct in every case issued a short document titled “Helpful which are dictated to persons faced by these situa- Information for Health Care Professionals in tions, the availability and intervention of a large Meeting the Spiritual Needs of Patients Who Are array of support/clarification services and personnel Members of the Reorganized Church of Jesus will likely be welcomed and appreciated.13 Christ of Latter Day Saints (RLDS Church),” which contains the following statement: With regard to individual medical practices, the Community of Christ published the following The basic beliefs of the RLDS church pertaining statement: “The moral evaluation of other spe- to health and healing are simply stated: cific procedures, including new techniques made possible through scientific advancement, will be We believe in God as the source of love and life mediated as necessary through the Standing and truth, High Council of the church, as the chief inter- In Jesus Christ as the personal revelation of God, preters of faith and doctrine in matters related to In the Holy Spirit as God’s presence with and in us, biomedical ethics.”14 In the human soul as body and spirit, In the ultimate health of salvation as perfect wholeness through divine grace, INSTITUTIONAL AUTHORITY AND And in human freedom and agency with responsi- INDIVIDUAL CONSCIENCE bility and accountability as divine gifts. LDS: The role of authority in the LDS church is IMPLICATIONS: The church believes that hu- somewhat paradoxical. On the one hand, obedi- mankind is endowed with freedom to choose to ence to church authority is strongly emphasized serve God or to reject God. Because free moral in official church rhetoric15 and in the commu- choice is an important church doctrine, the church nities of Latter-day Saints. On the other hand, resists the imposition of any ecclesiastical restric- the church actually has very few authoritative tion or proscription which limits a person’s exercise doctrines and rarely takes official or formal posi- of this freedom. Preferably, medical decisions hav- tions on social matters.16 The guidance offered ing moral implications will be made by the individ- to members of the LDS church on specific med- ual and/or family in consultation with a physician, a ical ethical issues arises from the “central tenets qualified minister or priesthood member, profes- of the faith: the centrality of marriage and chil- sional counselor, etc. These decisions should always dren; the overriding importance of maintaining be made in light of a full range of moral, legal, reli- family harmony and stability, and protecting the gious, and cultural influences within which the per- health and well-being of mother, children, and sons live. The RLDS member faced with difficult ‘tabernacles [children]-to-be;’ the preservation and complex issues and decisions related to health of free agency and personal accountability; and will look to his/her faith as a resource and milieu the total unacceptability of decisions based on in which such issues and decisions can be clarified. ‘selfish’ rationales.”17 The individual’s faith will provide support in Historically, the LDS church has been very his/her exercise of the freedom to choose, and the slow to make statements concerning medical church will provide caring ministry in all circum- ethical issues. Traditionally, the development of a stances. Whether these issues are related to sexual- position comes in several stages. First, the three- ity and procreation, passages of human life, health member First Presidency, the highest council of
THE PARK RIDGE CENTER 3 the church, responds privately to specific cases; should seek guidance from God and consult with much later it may make an official public state- their doctors, families, and ecclesiastical officials. ment on the issue; and then, if a different general societal consensus emerges, it may modify the offi- Community: This church has been described as cial statement so that it conforms with public “a theocratic democracy—a government of God trends. Courtney Campbell, a prominent analyst of directed divinely under the law of ‘common con- LDS medical ethical thought, believes “the LDS sent’ of the people.”22 Of all the churches with tradition will likely confront the emerging health LDS heritage, it has been the one most open to policy issues of contemporary bioethics with eccle- the ideas of mainline Protestantism. In fact, this siastical silence and an affirmation of personal and church often emphasizes its similarity to and con- professional responsibility.”18 nection with the major U.S. Protestant churches. For practical purposes, the LDS church has The church gives very broad guidance to its published periodically throughout this century a members, rarely making categorical statements. General Handbook of Instructions that serves as There is, however, a body within the church the official manual of church policy and practices. structure known as the Standing High Council The book includes information on such topics as that gives consideration to moral and ethical is- church administration, performance of ordinances sues, including certain bioethical questions. The and rituals, and enforcement of church discipline; council consists of twelve high priests, appointed it also enumerates church positions on a variety by the First Presidency, who meet once a month of medical and moral issues. It is available only to to study issues and develop statements of policy; ecclesiastical leaders and is designed to guide the First Presidency sets the agenda based on its them in leading members for whom they have re- understanding of what important issues face the sponsibility.19 However, the General Handbook church. The council’s policy statements are pub- does not and cannot address every situation, lished internally in a policies and procedures much less provide an “answer.” The teachings are manual and are sometimes distributed to the full- typically very brief, address specific practices, and time ministerial staff for guidance in counseling frequently carry no explicit scriptural references individual church members. The church encour- or explanatory justification. In addition to con- ages individual members to rely on their own sulting official church positions, “individual conscience and has published the following state- members of the LDS Church are understood to ment about human agency: be capable of receiving divine direction or revela- tion for their personal ‘stewardships’—the practi- It is . . . a fundamental tenet of the church that cal problems encountered in daily life, in humankind is endowed with freedom of choice to relations with family members, or with other per- serve God or reject God, that persons cannot be sons.”20 Among the twenty-four health-related saved in the Kingdom of God except by the grace topics addressed in the General Handbook, nine of the Lord Jesus Christ, whose atonement gives include a clause indicating that the ultimate deci- persons the possibility of coming once more into sion-making authority rests with the parties in- God’s presence . . . Because free moral choice is volved; this is part of a trend toward, and in some an important doctrine, based on the principle of ways a reversion to, the attitude that God, rather God-given human agency, the church resists the than the church, should judge the morality of imposition of any restrictions or policies limiting a such decisions.21 In the absence of a clear ecclesi- person’s exercise of agency. However, there are astical directive, difficult medical questions implied parameters of social expectations that are should be addressed from the standpoint of per- developed within the church community that have sonal moral agency and the prevailing profes- their origins in Scriptural revelation, tradition, and sional ethics of medicine. Persons involved practice.23
4 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS Where an official ecclesiastical position has priesthood member, professional counselor, etc. not been taken, the church holds that “medical These decisions should always be made in light decisions having moral implications [should] be of a full range of moral, legal, religious, and cul- made by the individual and/or family in consul- tural influences within which the persons live.”24 tation with a physician, a qualified minister or
THE INDIVIDUAL AND THE PATIENT-CAREGIVER RELATIONSHIP
oth the LDS church and the Community of Interestingly, the current General Handbook BChrist emphasize individual moral agency does not include references to experimental proce- within the context of the religious community and dures, despite the prominent role played by the belief system; they do not use the secular term Latter-day Saints in early clinical trials of the artifi- “autonomy” in their discourse because it implies cial heart. This omission may be explained by the self-determination independent of God. The LDS fact that oversight by institutional review boards of church, in many of its medical ethics statements, research using human subjects has been almost places confidence specifically in the ability of universally implemented in the United States. medical care providers to resolve morally trouble- some medical situations, and the Community of Community: The church recognizes and sup- Christ, while silent on many specific medical pro- ports the common-law right to self-determina- cedures, also trusts in the ability of those involved tion that has led to the doctrine of informed to arrive at an appropriate decision. In resolving consent to medical treatments.26 difficult situations, both churches place a strong emphasis on collective decision making rather Truth-telling and confidentiality than individual choice. Both would agree that it is LDS: “The LDS church always encourages hon- the patient who must make the final decisions re- esty and truthfulness in all settings and situa- garding his or her care but that the process of de- tions.”27 The church has no official position on cision making should include family members, truth-telling and confidentiality in medical set- professional caregivers, friends, and in some in- tings. (See “Institutional authority and individual stances ecclesiastical leaders. conscience,” above.)
Community: No position. (See “Institutional au- CLINICAL ISSUES thority and individual conscience,” above.)
Self-determination and informed consent Proxy decision making and advance directives LDS: In the mid-1970s, the LDS church issued LDS: The LDS church, in a section of the the following statement: “The Church recog- General Handbook entitled “Prolonging Life,” nizes the need for carefully conducted and con- supports the ability of family members to make trolled experimentation to substantiate the decisions regarding continuation of treatment efficacy of medicines and procedures. We be- when “dying becomes inevitable” for a member lieve, however, that the free agency of the indi- of the church. Such decisions should be made vidual must be protected by informed consent after consulting with appropriate medical person- and that a qualified group of peers should re- nel and seeking divine guidance through prayer view all research to ascertain that it is needed, and fasting. The General Handbook does not ad- is appropriately designed and not harmful to dress legal issues in this context and does not dis- the person involved.”25 cuss advance directives or living wills.28 Utah, the
THE PARK RIDGE CENTER 5 state with the highest percentage of Latter-day sions. Lacking such evidence, the surrogate has a Saints, does have a standard living-will statute.29 responsibility to follow guidance principles which Under circumstances involving end-of-life de- have received strong legal consensus in recent cisions, ecclesiastical direction stipulates that years. One is the “substituted-judgment” standard, “no unreasonable means” are required to pro- in which the patient’s surrogate attempts to make long life. However, no substantive criteria for the decision that the individual, if competent, determining “unreasonable means” are given. would choose. Another is the “best interest” stan- This means that patients, their families, and dard—acting to best promote the good of the indi- physicians may interpret and apply this standard vidual in terms of the relative balance of benefits differently in various situations.30 and burdens . . .
Community: The Standing High Council has Personal stewardship encompasses the responsibil- stated: ity of individuals to think ahead to the kind of care they may wish to receive at the end of their lives or When family members must become surrogate de- after they become incapable of deciding for them- cision-makers, they will function best if they are selves. It greatly reduces the uncertainty and diffi- qualified to represent the patient’s desires and have culty of treatment decisions if, sufficiently early in some evidence regarding the nonautonomous pa- life’s journey, planning has begun for an advance tient’s previously held views. Such evidence can directive, a living will, or a durable power of attor- take the form of a living will, an advance directive, ney for health care. We place great value on the in- or a durable power of attorney for health care. This formed and reflective decision-making process in can be most helpful to family members and med- this life. It is wise to use this process to deal with ical professionals as they make the actual deci- the natural conclusion of life—our own death.31
FAMILY, SEXUALITY, AND PROCREATION
DS: The LDS church and its membership church. Polygamy was part of LDS practice only L are often noted for their very conservative during the middle and late nineteenth century, and traditional views on family (including gen- and it provoked great hostility toward the Latter- der role attitudes and behavior), sexuality, and day Saints. Church president Wilford Woodruff procreation. A prominent teaching of the church abolished the practice in 1890. Some small holds that adults are encouraged to marry and splinter groups still practice plural marriage, but provide temporal bodies, called “tabernacles,” the larger church vigorously dissociates itself for the spirit children of God so that these chil- from this practice. dren may enter a loving family, grow, and be The First Presidency issued a letter on tested on earth.32 “Standards of Morality and Fidelity” to all mem- One unique doctrine of the LDS church is that bers of the LDS church on November 14, 1991, couples whose marriages are “sealed” in a temple that said, in part: and who remain faithful will continue their mar- riage and continue to procreate in the afterlife. In We call upon members to renew their commitment addition, earthly children of parents whose mar- to live the Lord’s standard of moral conduct. riage has been sealed may be sealed to their par- Parents should teach their children the sacred na- ents, thus immortalizing the family bonds. ture of procreative powers and instill in them a Many people wrongly associate polygamy, or desire to be chaste in thought and deed. A correct plural marriage, with the modern-day LDS understanding of the divinely appointed roles of
6 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS men and women will fortify all against sinful prac- to a 1975 survey. And although 1986 survey data tices. Our only real safety, physically and spiritu- indicated that the LDS birthrate was lower than ally, lies in keeping the Lord’s commandments. ever, at around twenty births per thousand, LDS families continue to have an average of one more The Lord’s law of moral conduct is abstinence child than the average American family, as they outside of lawful marriage and fidelity within mar- have throughout this century.38 The consistently riage. Sexual relations are proper only between higher-than-average birthrate indicates that LDS husband and wife appropriately expressed within couples tend to use artificial birth control more the bonds of marriage. Any other sexual contact, as a means of spacing than of limiting their fami- including fornication, adultery, and homosexual lies. Apparently in LDS culture, family size is de- and lesbian behavior, is sinful. Those who persist termined more by the encouragement to have in such practices or who influence others to do so children than by the discouragement from using are subject to Church discipline.33 artificial birth control.39
Community: Unlike the LDS church, this Community: The church holds that “counseling church has never accepted the idea that mar- on contraception as part of the stewardship of riage covenants continue after death.34 The life, is appropriate in whatever context it might church holds no unique positions on issues of arise.”40 family, sexuality, and procreation. However, one of the few causes for dismissal from the church Sterilization is adultery.35 LDS: Sterilization as a means of birth control is viewed very differently by the LDS church than are temporary methods of birth control—it is CLINICAL ISSUES “seriously deplored.” The statement on steriliza- tion (including vasectomy) that appears in the Contraception 1989 General Handbook is consistent with past LDS: Prior to 1989, the official position of the ecclesiastical teaching:41 LDS church was to oppose artificial contracep- tion; however, actual practice often deviated Surgical sterilization should only be considered from this teaching. The statement on birth con- (1) where medical conditions seriously jeopardize trol in the 1989 General Handbook represents a life or health, or (2) where birth defects or serious softening of previous policy against the use of trauma have rendered a person mentally incompe- artificial birth control and implicitly accepts that tent and not responsible for his or her actions. a couple may, after prayerful consideration, Such conditions must be determined by compe- space their children as may be best for their tent medical judgment and in accordance with law. family: “Husbands must be considerate of their Even then, the person or persons responsible for wives, who have a great responsibility not only this decision should consult with each other and for bearing children but also for caring for them with their bishop . . . and receive divine confirma- through childhood . . . Married couples should tion through prayer.42 seek inspiration from the Lord in meeting their marital challenges and rearing their children ac- Community: “The church supports the perform- cording to the teachings of the gospel.”36 ance of medical procedures designed to accom- In practice, the proportion of Latter-day Saints plish sterilization if, in the opinion of the who use modern birth control methods at some physician, and others qualified to judge, such a point in their lives is the same as that of the na- procedure is in the best interest of the patient, tional population,37 around 96 percent, according the family, and/or society.”43
THE PARK RIDGE CENTER 7 New reproductive technologies use of either AIH or AID are no different from LDS: Given the LDS emphasis on reproduction children conceived through intercourse.47 in the context of marriage and the church’s gen- Absolutely no artificial insemination should be eral acceptance of medical technology, one might performed outside the context of a marriage. The reasonably assume that the church would wel- 1985 General Handbook states, “The church dis- come advances that allow otherwise infertile LDS approves of artificial insemination of single sisters. couples to bear children. As a general matter, the Single sisters who deliberately refuse to follow the church does accept such technologies for married counsel of their priesthood leaders in this regard couples, as long as the genetic link to both par- will be subject to disciplinary action.”48 Further- ents is assured.44 When gametes from third parties more, a child cannot be sealed to only one parent, are introduced, however, the church discourages so the resulting child would remain unsealed.49 this use of technology. Community: The policy of the Standing High Community: This church’s position is similar. Council, formulated in 1966, is this: The church supports the use of reproductive technologies in which the resulting child will be On this subject the scriptures are silent. It is our opin- genetically linked to both parents. While other ion that when competent medical opinion has indi- arrangements are not considered “immoral,” the cated that natural procreation is not possible, artificial church advises caution, given the unpredictable insemination may be used . . . so long as the donor is social complications. the husband. We are inclined to say that A.I. by donor other than the husband, provided it is done with the Artificial insemination husband’s consent, is not immoral; still, because of LDS: The 1989 General Handbook states that the unresolved legal, sociological and psychological artificial insemination by donor (AID) “is dis- implications A.I. or IVF [in vitro fertilization] by other couraged” because it “may seriously disrupt than the husband is not recommended by the church. family harmony . . . However, this is a personal matter that ultimately must be left to the hus- Gamete intrauterine fallopian transfer (GIFT) band and wife, with the responsibility for the de- LDS: No official LDS position on GIFT exists. cision resting solely upon them . . . [Similarly,] Given the LDS positions on AIH and AID, how- donation of sperm is discouraged.”45 The text ever, GIFT would likely be acceptable if a does not directly address artificial insemination woman’s own egg was implanted in her fallopian by husband (AIH), but because it is distin- tube along with the sperm of her husband. Other guished from AID and is not explicitly discour- GIFT arrangements would probably be discour- aged, one may assume that it is acceptable. aged but left to the discretion of the couple. A unique consideration regarding salvation arises because of the Latter-day Saints’ practice of Community: No official church position on GIFT sealing for eternity the family bonds between hus- exists. Given this church’s positions on AIH and band and wife and between children and parents. AID, however, GIFT would likely be acceptable if The 1989 General Handbook states, “A child con- a woman’s own egg was implanted in her fallop- ceived by artificial insemination and born after the ian tube along with the sperm of her husband. parents are sealed in the temple is born in the As long as both husband and wife consent, the covenant. A child conceived by artificial insemina- church would not view other GIFT arrangements tion before the parents are sealed may be sealed as immoral but would not recommend them. to them after they are sealed.”46 This means that, with respect to their eternal salvation as members In vitro fertilization (IVF) of their families, children conceived through the LDS: Consistent with the LDS stances on AIH
8 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS and AID, the LDS policy on IVF, first articulated Community: No official position exists on surro- in 1989, states: “In vitro fertilization using gate motherhood. However, given its positions semen other than that of the husband or an egg on AIH and AID, the church would not recom- other than that of the wife is strongly discour- mend surrogate arrangements because of the aged. However, this is a personal matter that ulti- potential legal, sociological, and psychological mately must be left to the judgment of the complications. Arrangements in which the child husband and wife. A child conceived through in is genetically related to only one member of the vitro fertilization after parents are sealed in the couple would be less desirable than those in temple is born in the covenant. Such a child which the child is the offspring of both parents. born before parents are sealed in the temple may be sealed to them after they are sealed.”50 The fact that the term “strongly” appears with refer- ABORTION AND THE STATUS OF ence to IVF but not artificial insemination sug- THE FETUS gests that IVF may be more morally problematic. The statement does not elaborate the specific ob- LDS: The following statement was published in jections, but these may include the fact that IVF the newspaper Deseret News on January 19, often involves freezing and eventually destroying 1991, under the heading “LDS Position on unneeded embryos as well as selectively aborting Abortion,” and the text was incorporated into fetuses in cases of multiple pregnancy. The issue the October 1991 revision of the Supplement to of when a fetus receives its soul (and therefore the General Handbook of Instructions: when it becomes a “person”) is nonetheless still unsettled in the LDS tradition; because of this, In view of the widespread public interest in the personal discretion may be appropriate on this issue of abortion, we reaffirm that The Church of point.51 (See section on abortion below.) Jesus Christ of Latter-day Saints has consistently opposed elective abortion. More than a century ago, Community: See the church’s position on artifi- the First Presidency of the Church warned against cial insemination above. this evil. We have repeatedly counseled people everywhere to turn from the devastating practice of Surrogate motherhood abortion for personal or social convenience. LDS: The LDS statement on surrogate mother- hood is very simple, straightforward, and sur- The Church recognizes that there may be rare cases prisingly mild. “Surrogate motherhood is in which abortion may be justified—cases involving discouraged. It might cause spiritual, emotional, pregnancy by incest or rape; when the life or health and other difficulties.”52 Voluntary and commer- of the woman is adjudged by competent medical cial surrogacy are not distinguished. authority to be in serious jeopardy; or when the Surrogate arrangements involving artificial in- fetus is known by competent medical authority to semination may entail specific difficulties for have severe defects that will not allow the baby to Latter-day Saints, particularly for married surro- survive beyond birth. But these are not automatic gates. If the surrogate mother is single, the artifi- reasons for abortion. Even in those cases, the cou- cial insemination itself will not be approved. If the ple should consider an abortion only after consult- surrogate mother is married and has been sealed ing with each other, and their bishop, and receiving to her husband, she, rather than the “adoptive” divine confirmation through prayer. mother, will be sealed for eternity to the child in- volved; under current LDS policy, no provision The practice of elective abortion is fundamentally exists for breaking this bond so that the child may contrary to the Lord’s injunction, “Thou shalt not be sealed to his or her adoptive parents.53 steal; neither commit adultery, nor kill, nor do
THE PARK RIDGE CENTER 9 anything like unto it” (Doctrine and Covenants abortion bill that would have prohibited abortion 59:6). We urge all to preserve the sanctity of human except under the three conditions outlined in life and thereby realize the happiness promised to LDS policy. This bill did pass the Utah state legis- those who keep the commandments of the Lord. lature but was later judged to be unconstitution- al.57 The law would have dramatically reduced the The Church of Jesus Christ of Latter-day Saints as number of abortions performed annually in Utah, an institution has not favored or opposed specific currently about 5,000. The Utah abortion rates legislative proposals or public demonstrations con- (number of abortions per the number of women cerning abortion. of childbearing years) and ratios (number of abortions divided by the number of live births) Inasmuch as this issue is likely to arise in all are half or less than half the national average, states in the United States of America and in many though the same rates and ratios as calculated other nations of the world in which the Church is during the first eight weeks of pregnancy have established, it is impractical for the Church to take been higher than the national average.58 a position on specific legislative proposals on this Interestingly, the LDS church does not equate important subject. abortion with murder. Unlike other churches, the LDS church has never formally addressed However, we continue to encourage our members the issue of when life begins and therefore does as citizens to let their voices be heard in appropri- not argue against abortion on the grounds that it ate and legal ways that will evidence their belief in destroys a human life. When LDS leaders have the sacredness of life.54 discussed the “ensoulment” of the fetus, they have often set it at the time of “quickening” With regard to circumstances in which abortion (movement detectable by the mother), but oth- may be justified because of a risk to the mother’s ers have assumed ensoulment to occur at birth. health (second paragraph), “no differentiation is These discussions represent doctrinal specula- made in formal policy as to whether ‘health’ tion, not official church positions. should be given a narrow (physiological) or broad The fact that abortion is not equivalent to mur- (psychological and physiological) interpretation, der is illustrated by the difference in ecclesiastical though the context of earlier policy statements, as sanctions associated with each. “Disciplinary ac- well as the ongoing procedural stipulation that in- tion, including excommunication, may be applied dications of life or health as reasons for abortion to any Latter-day Saint who encourages, performs, must be confirmed by medical professionals, may or submits to an abortion; the scope of the sanc- tilt the balance towards a more objective, physio- tion thus applies to family members and physi- logical understanding of ‘health.’ Here again, how- cians as well as to pregnant women. At the same ever, the silence of the text on this point leaves time, those disciplined may undergo a period and open the possibility of practical flexibility.”55 process of repentance and receive forgiveness Even in the “rare cases in which abortion may from ecclesiastical authorities, a practice that pre- be justified,” it is not necessarily appropriate. supposes a distinction between abortion and the Couples considering abortion under these circum- taking of innocent human life.”59 According to stances are expected to consult both each other LDS scripture, murderers “shall not have forgive- and the local ecclesiastical authority, and after they ness in this world, nor in the world to come.”60 have made the decision to abort, they are expected to “receiv[e] divine confirmation through prayer.”56 Community: In contrast the following excerpt is The statement quoted above, a reaffirmation of from the “Statement on Abortion” (January 24, LDS policy, was published in the midst of a 1974, reaffirmed in 1980) by the Standing High heated debate in Utah surrounding a proposed Council that “support[s] the legality of abortion
10 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS and the right of a woman to make her own deci- weaken marriage or promote immorality. We feel sion in the matter. It also emphasize[s] the the emphasis should be placed on the teaching of moral importance of the decision and the need values and moral guidelines which accent the posi- to live in ways which would minimize the need tive worth of chastity before marriage, fidelity for such decisions.” within marriage, and a reverence for life as Christian principles. If a termination of the preg- 6. We affirm the inadequacy of simplistic answers nancy is chosen, those who share the burden of that regard all abortions as murder or, on the making the choice must assume responsibility for other hand, regard abortion only as a medical pro- this act of agency.62 cedure without moral significance.
7. We affirm the right of the woman to make her PRENATAL DIAGNOSIS AND TREATMENT own decision regarding the continuation or termi- nation of problem pregnancies. Preferably this de- LDS: The LDS church has no official position cision should be made in cooperation with her on prenatal diagnosis and treatment as such, companion and in consultation with a physician, but, given the fact that abortion may be justified qualified minister, or professional counselor. This in cases where severe deformity is detected in decision should be made in light of the full range utero, it is safe to assume that prenatal diagnosis of moral, medical, legal, and cultural influences under some circumstances is acceptable. Such within which the person lives. cases might include a family history of genetic disease or other negative medical indications. In 8. We affirm the need for skilled counselors to be cases in which no risk is apparent, amniocente- accessible to the membership of the church to as- sis may not be appropriate. sist persons in their struggle with issues centering in human sexuality, responsible parenthood, and Community: No position. (See “Institutional au- wholeness of family life. There is a need for thority and individual conscience,” above.) church leaders to be cognizant of counseling re- sources within the community to which our mem- bers may be referred.61 CARE OF SEVERELY HANDICAPPED NEWBORNS In this statement the Council also asserts: LDS: LDS ecclesiastical policy has not directly Church leaders recognize that there may be rare addressed the issue of selective treatment of im- occasions which might make it necessary, because paired newborns. Because of the LDS emphasis of the conditions of the conception or the preg- on the transformational (rather than the termi- nancy, to terminate a particular pregnancy. Yet for nal) nature of death and the belief in ultimate purposes of teaching children and young people justice for the handicapped, one might expect what we consider to be moral principles and the LDS policy to lean toward a presumption in law of the church, these teachings must include favor of nontreatment, assuming prayerful con- placing a high value on the preservation of life and sideration and appropriate medical understand- proscribe the use of abortion as a means of merely ing on the part of those involved in decision terminating an unwanted pregnancy or as an alter- making. In practice, however, most LDS families native method of contraception. Just as surely as choose to prolong life in such cases.63 the church must stand for the sanctity of marriage and forbid adultery and fornication, so must it also Community: No position. (See “Institutional au- stand against any practice which would seem to thority and individual conscience,” above.)
THE PARK RIDGE CENTER 11 GENETICS
oth the LDS church and the Community of never has specifically condemned the termination BChrist accept the pursuit of knowledge re- of pregnancies involving seriously defective fe- garding human genetics, provided that such tuses.”64 One 1983 estimate indicated that, in knowledge is not used in what they consider im- practice, two-thirds of Utah pregnancies with ge- moral ways. Neither church has made explicit netic abnormalities were terminated (versus about where it would draw the line between moral and 80 percent nationally).65 A couple facing a deci- immoral, however, and the Community of Christ sion to terminate any pregnancy, however, should church is likely to be more liberal in its al- seek consultation with a local church leader and lowances than the LDS church. prayerful consideration. (See section on abortion.)
Community: The church affirms “the right of CLINICAL ISSUES the woman to make her own decision regarding the continuation or termination of problem Genetic screening and counseling pregnancies.” (See section on abortion.) Neither church has taken a position on this issue. (See “Institutional authority and individ- Gene therapy ual conscience,” above.) LDS: Bioethicist Courtney Campbell knows of no policies that have ever been developed con- Sex selection cerning issues in genetic engineering.66 Lester LDS: The LDS church opposes all genetic test- Bush, a Latter-day Saint who has written exten- ing for sex selection. sively on medical ethics issues in the LDS church, has said, “to the extent that [the use of Community: The church opposes sex selection if genetic engineering] is limited to the treatment abortion is involved but may permit it if the se- of disease, I really cannot conceive of a pre- lection is done prior to implantation in cases of dictable rationale for Mormon objections to this assisted reproduction. amazing new tool.”67
Selective abortion Community: No position. (See “Institutional au- LDS: “Interestingly enough, the First Presidency thority and individual conscience,” above.)
ORGAN AND TISSUE TRANSPLANTATION
DS: The LDS church is distinctive in its em- drugs, and other potentially harmful substances. L phasis on the importance of the body for (See “Special Concerns” below.) salvation; the body is seen “as an essential part of the soul.”68 Latter-day Saints believe that sal- Community: The church holds that at the resur- vation and eternal life with Jesus Christ require rection, people will be given spiritual bodies, that one experience bodily life on earth. The the characteristics of which are not now known. body is considered a “temple” or “tabernacle” Saints recognize that earthly bodies perish but of God and is to be treated as such; Latter-day that part of each person lives on after death. Saints are explicit in their prohibitions against “The persisting ‘being’ of a person, described as the use of tobacco, alcohol, coffee, tea, illegal ‘the spirit,’ does not reside in the grave. This
12 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS belief is emphasized in a scripture, unique to Community: The church holds no specific posi- Saints, that states, ‘the spirits of all men, as soon tion but would probably view the decision to do- as they are departed from this mortal body . . . nate organs as an individual decision or, in cases are taken home to that God who gave them life’ in which the individual’s desires are not known, (Alma 19:44, Book of Mormon).”69 a family decision.
(b) Procurement from anencephalic newborns CLINICAL ISSUES and human fetuses
Recipient issues LDS: The LDS church has taken no official po- LDS: The 1989 General Handbook states, “The sition on the procurement of organs and tissues decision to receive a donated organ should be from anencephalic newborns and human fe- made with competent medical counsel and con- tuses. Because earthly embodiment is necessary firmation through prayer.”70 for salvation in LDS theology, procurement from living human fetuses (which do not yet have Community: The church holds no specific posi- earthly bodies) would not be acceptable because tion but would view the decision to receive do- it would interfere with their eternal progression. nated organs or tissues as, ultimately, an Children with severe deformities that make individual decision. them unaccountable for their actions or cause neonatal death, such as anencephaly, are Donor issues thought to be specially chosen by God and need (a) Procurement from cadaveric and living donors only have a body in order to be saved. Because of this, procurement from such children may be LDS: The 1989 General Handbook states: acceptable, provided the action does not hasten “Whether an individual chooses to will his own death. In all cases, medical, ecclesiastical, and bodily organs or authorizes the transplant of or- familial consultation and prayer should inform gans from a deceased family member is a decision the decision to procure tissues or organs. for the individual or the deceased member’s fam- ily.”71 Latter-day Saints are entirely free to donate Community: No position. (See “Institutional au- organs under appropriate medical protocols and to thority and individual conscience,” above.) serve as living donors for family members.72
MENTAL HEALTH
DS: During the nineteenth century, Latter- Community: No unique position on mental L day Saints often attributed extreme forms of health. mental illness to possession by demons and evil spirits.73 With the turn of the century came an increasing emphasis on scientific medicine CLINICAL ISSUES within the church and a corresponding evolution in LDS attitudes toward mental health. Today, Involuntary commitment while a trace of their former attitudes remains, Neither church has taken a position on this issue. Latter-day Saints hold typical beliefs about the (See “Institutional authority and individual con- causes and treatments of mental illness.74 science,” above.)
THE PARK RIDGE CENTER 13 Psychotherapy and behavior modification put LDS gospel values and inspiration through the LDS: The 1985 General Handbook section on Holy Ghost above professional dicta). Second, they counseling states: should bring their clients to repentance (thus im- plying, in many cases, an ultimate goal of sending Church members who have problems or questions those who have sinned to their bishop where guilt that trouble them should make a diligent effort, in- and repentance can be worked through). And, cluding earnest prayer, to find solutions and answers third, they should help their clients acquire tradi- themselves. If they need help, they are to consult tional values. Implicit in the foregoing counsel, of freely with their bishops and receive from them the course, is an emphasis on sin, guilt, repentance, and counsel they need. If members call, visit, or write to righteous living as key factors in mental health, and Church headquarters about intimate personal mat- thereby, the treatment of mental illness.76 ters, they deprive themselves of a great blessing. Community: No position. (See “Institutional au- The Church makes a bishop, who is a spiritual ad- thority and individual conscience,” above.) viser and temporal counselor, accessible to every member. He should know his members well and Psychopharmacology should understand the circumstances that cause LDS: “Psychoactive medications seem never to their problems. These local leaders are, by their have been particularly controversial within the ordination or setting apart, entitled to a heavenly church . . . Given . . . the assumption that an in- endowment of the discernment and inspiration dividual is in the hands of a professional quali- necessary to advise those who seek help.75 fied to prescribe medications, there have been no expressed leadership objections to the judi- In addition to this formal statement on the role cious use of tranquilizers, antidepressants, an- of priesthood members in pastoral care, a num- tipsychotics, or related drugs.”77 ber of themes have been expressed both offi- cially and unofficially with regard to the roles Community: No position. (See “Institutional au- and duties of psychotherapists. These have been thority and individual conscience,” above.) summarized thus: Electroshock and stimulation First, psychotherapists are advised that to be suc- Neither church has taken a position concerning cessful in their field, they themselves must live by electroshock and stimulation. (See “Institutional and be actively involved in the Mormon gospel (and authority and individual conscience,” above.)
DEATH AND DYING
DS: According to LDS theology, at the time of with perfect and incorruptible bodies. Because of L death, the spirit of a person separates from these beliefs about the afterlife, the end of life on his or her body and returns to God, the giver of earth may be seen more as a transition, often to life. The spirits of the righteous rest in paradise better things, than as a final loss. Still, death is while the spirits of the wicked face the wrath of not taken lightly, and grief is quite natural among God. Personal identity is eternal, and the virtuous Latter-day Saints in the face of such a loss.78 reunite with friends and family. At the time of the resurrection, the spirits of all persons, regardless Community: Saints believe that when a person of their righteousness, will be eternally reunited dies, his or her spirit goes “home” to God and
14 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS that, at the resurrection, all persons will receive 2. The Stewardship of Human Beings. Since a spiritual body. (See the introduction to “Organ human beings are created in God’s image, their and Tissue Transplantation” above.) relationships always presuppose a radical sense of both dependence and equality. There is no funda- mental moral discontinuity between the dying per- CLINICAL ISSUES son in the bed and the caregiver at the bedside; what they hold in common is more significant Determining death than the fact of illness that separates them . . . Neither the LDS church79 nor the Community has addressed the issues of defining death and 3. Moral Agency . . . The principle of free agency determining when death has occurred. in the LDS tradition requires respect for the self- determined decisions and choices of others . . . At Pain control and palliative care the same time, a responsible choice will be the Neither church has taken a position on pain outcome of a collaborative procedure, in which control or palliative care. (See “Institutional au- patients, family members, and medical caregivers, thority and individual conscience,” above.) but not necessarily ecclesiastical authorities, are important participants. Forgoing life-sustaining treatment LDS: The 1989 General Handbook states: These theological principles form the context for positions in the LDS tradition on the termination When severe illness strikes, Church members of treatment that (a) establish a general presump- should exercise faith in the Lord and seek compe- tion in favor of utilizing available medical technol- tent medical assistance. However, when dying be- ogy to sustain life, (b) permit forgoing medical comes inevitable, it should be looked upon as a interventions in some instances to allow a patient blessing and a purposeful part of an eternal exis- to die, and (c) prohibit assisted suicide and active tence. Members should not feel obligated to extend euthanasia in all situations.82 mortal life by means that are unreasonable. These judgments are best made by family members after Community: The church supports the right of all receiving wise and competent medical advice and persons to refuse life-sustaining treatment based seeking divine guidance through fasting and prayer.80 on the principle of self-determination.83 It also:
This statement represents an opening to the supports the patient’s right to execute a living will possibility of withdrawing life-sustaining medical indicating that no resuscitation be attempted in the care; previous statements required that church case of specified circumstances. It further supports members ask medical care providers “to assist in the concept that the family, in the absence of such reversing conditions that threaten life.”81 indication by the patient and in case the patient is Courtney Campbell has enumerated three unable to indicate his or her wish for whatever themes in LDS theology that shape thinking on reason, has the right to request no resuscitation if the issue of whether or when to withhold or in their judgment the condition is hopeless, pro- withdraw medical treatment: vided such indicated order is legal in the state in which the hospital is licensed.84 1. The Sovereignty of God. A theological presump- tion in favor of life is established by the dominion In cases in which family members must act as of the Deity over life and death. Life is a funda- surrogate decision makers, the church recog- mental, though not absolute, good; death is neither nizes that: to be sought nor seen as an ultimate enemy . . .
THE PARK RIDGE CENTER 15 there will be disagreements among conscientious tary active euthanasia from unrequested active persons. Mindful of this, we counsel those involved euthanasia. Thus it focuses not on motivation but to remember that the decision to allow a person to rather on the deed itself. No ecclesiastical sanc- die is not the moral equivalent of causing the person tions are discussed, however, indicating that eu- to die, and may be an expression of trust in the care thanasia may not be the moral equivalent of of a loving God. All parties to these difficult deci- “shedding of innocent blood,” an unpardonable sions can find in them opportunities for understand- sin90 that denies one the blessings of exaltation.91 ing, acceptance and forgiveness rather than blame Most recently, the LDS church has opposed a or guilt. Confronting the mystery of death can lead ballot measure in Oregon allowing physician-as- to a fuller appreciation of our faith in eternal life.85 sisted suicide on the basis that it “is contrary to the Lord’s direction in this dispensation when He declared: ‘Thou shalt love [thy] neighbor as Suicide, assisted suicide, and active euthanasia thyself. Thou shalt not . . . kill, nor do anything LDS: For much of its history, the LDS church like unto it’ (Doctrine and Covenants 59:6).”92 viewed suicide as murder of the self and, on the grounds that it constituted “shedding of inno- Community: The church clearly distinguishes cent blood,” strongly condemned it. Like mur- between passive and active euthanasia, allowing der, suicide was viewed as a sin that would the former under certain circumstances and prevent the person from receiving eternal bless- condemning the latter: ings and rewards after death. Now, a more mer- ciful stance is adopted toward those who commit The act of putting to death painlessly a person suicide: determination of responsibility and guilt suffering from an incurable disease has tradition- is thought to rest in God’s hands. The 1989 ally been called euthanasia. It entails causing General Handbook represents the change in pol- death to occur. The Standing High Council, along icy86 and states, “A person who takes his own with the preponderance of religious, medical and life may not be responsible for his acts. Only legal opinion, opposes acts of what is now com- God can judge such a matter. A person who has monly referred to as “active euthanasia.” This op- considered suicide seriously or has attempted position extends to situations in which the patient suicide should be counseled by his bishop and requests death at the hands of family members, may be encouraged to seek professional help.”87 medical personnel, or others. If a member in good standing of the LDS church commits suicide, normal procedures are Allowing death to occur, on the other hand, may followed for the funeral and for the disposal of involve the withholding or withdrawing of life-sus- the body.88 taining medical treatment in circumstances where In contrast to its positions on suicide and death is the natural outcome. We recognize that most other bioethical matters (which have be- there are circumstances where it is more appropri- come gradually more liberal), LDS opposition to ate to allow individuals to die than to artificially euthanasia has become increasingly rigid. The keep their bodies alive. Allowing death to occur is 1989 General Handbook states, “A person who permissible when death is the inevitable and natu- participates in euthanasia—deliberately putting ral outcome and the measures required to post- to death a person suffering from incurable con- pone it would rob the patient of the ability to ditions or diseases—violates the commandments relate meaningfully to others or to experience sat- of God.”89 isfaction with the quality of his or her existence. The statement makes no moral distinction be- Such measures include artificially assisted nutri- tween those who have merciful intentions and tion and hydration.93 those who do not, nor does it distinguish volun-
16 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS Autopsy and postmortem care nal well-being of the deceased.”97 Neither do LDS: “The Church of Jesus Christ of Latter-day members believe that a person’s body is essen- Saints holds that an autopsy may be performed tially himself; a person’s spirit continues with if the family of the deceased gives consent and if God while the mortal body decays. However, the the autopsy complies with the law of the com- church recognizes the needs of the living friends munity.”94 and family of the deceased:
Community: No position. (See “Institutional au- Our deepest feelings prompt us to provide some thority and individual conscience,” above.) kind of visible symbol to express the love we have experienced and the bonds of unity we have Last rites, burial, and mourning customs forged when death separates us. In most instances, LDS: Modern LDS funerals are, for the most as those who remain, we will value some signifi- part, fairly simple and “expressive of hope, life cant location where the lasting value of our rela- and resurrection.”95 tionships can be symbolized. This may take the form of burial of the body, with some form of The Church of Jesus Christ of Latter-day Saints monument. Alternatively, survivors may arrange counsels its members to bury their dead in the for the cremation of the body and the provision of earth to return dust to dust, unless the law of the some kind of living plant, plaque or other sym- country requires cremation. However, the decision bolic expression.98 whether to bury or cremate the body is left to the family of the deceased, taking into account any Stillbirths laws governing the matter. Burial of the body usu- LDS: The LDS church has acknowledged the ally follows a funeral or graveside service. The potential ambiguities associated with stillbirths: body of a deceased member of the Church who has received the temple endowment should be Although temple ordinances are not performed for dressed in temple clothing. Relief society sisters stillborn children, no loss of eternal blessings or dress deceased women, and priesthood brethren family unity is implied. The family may record the [dress] the men. When it is not possible to clothe name of a stillborn child on the family group the body, temple clothing may be laid over it. record followed by the word stillborn in parenthe- ses. Memorial or graveside services may or may A member of the bishopric typically presides at not be held as determined by the parents.99 the burial, where a simple, earnest prayer is of- fered to dedicate the grave, with blessings prom- Community: The church does not have a formal, ised as the Spirit dictates. This prayer may include written position on stillbirths. a dedication of the grave as a sacred resting place until the resurrection if the person giving the [Church members] practice a believers baptism. prayer holds the Melchizedek priesthood and has This leads . . . members to understand that the been asked to give such a dedication. The grave death of a young child, although tragic and site often becomes a sacred spot for the family of painful, does not raise concerns about . . . salva- the deceased to visit and care for.96 tion. Funeral or memorial services are often con- ducted for children who are stillborn, and these Community: According to the Priesthood typically take their form from the needs and de- Manual, the church does “not believe that the sires of the family.100 form of the service has any bearing on the eter-
THE PARK RIDGE CENTER 17 SPECIAL CONCERNS
Diet and drugs Community: The church has no requirements LDS: All members of the LDS church in good for undergarments or other special clothing. standing are to adhere to an 1833 revelation to Joseph Smith called the Word of Wisdom. This Pastoral care in medical settings “commandment” proscribes the use of wine, LDS: The LDS church sponsors home and visit- strong drinks, tobacco, and hot drinks, and ing teachers for the welfare of every family and commends the use of “wholesome herbs,” flesh member of the church. Thus each member has (to be used sparingly), grain, and fruit for the a home teacher with responsibilities for pastoral health and well-being of the Saints.101 Similarly, care in medical settings. The home teachers members “should not use any substance that make regular hospital visits and, when re- contains illegal drugs or other harmful or habit- quested by a patient or his or her family, may forming ingredients.”102 offer special prayers for the welfare of the pa- Latter-day Saints recognize that spiritual tient, perform the priesthood blessing of anoint- health as well as physical health is at stake ing the sick, or administer the sacrament of the whenever substance abuse is occurring. Abuse Lord’s Supper. Female LDS patients may receive and addiction often limit personal agency, and, additional pastoral care from visiting teachers. because the proper use of personal agency is so Hospital rules and pastoral staff should make vital to salvation in LDS theology, Latter-day provision for the ministrations of home or visit- Saints should strive to avoid substance abuse of ing teachers for LDS patients. all kinds.103 Community: The church has offered the follow- Community: While the Word of Wisdom (see ing guidance to pastoral staff who may serve above) is part of the scripture of the church, it is members: not interpreted in a strictly prescriptive way. Rather, the Word of Wisdom “counsels persons Insofar as the religious care of patients is con- to see that their personal behavior does not de- cerned, patients are free to request the services of tract from their physical well-being. It suggests their own pastor or receive the denominational min- that we should eat wisely and rest adequately. It istry provided through the hospital chaplain staff. suggests that the abusive use of substances such These services include short-term pastoral counsel- as alcohol and tobacco may impair our health to ing, administering the sacraments, and prayers of the point where we are less able to serve God petition and intercession. The church has no spe- ... We are advised to avoid experimentation cific times at which administering the sacraments of with or addiction to harmful substances and to baptism, holy communion, or anointing and laying adhere to strict moral principles.”104 on hands for the sick is required. Provision for these ministerial services should be made, however, and Undergarments no hospital rules or policies should interfere with LDS: Latter-day Saints who have been “en- their being performed with grace and dignity.106 dowed” in a temple ceremony (have committed themselves to God and the LDS church) are ex- pected to wear a temple undergarment as a re- RELIGIOUS OBSERVANCES minder of their covenants and as a protector of modesty. Hospitalized Latter-day Saints may Baptism choose not to wear their garment if a gown is LDS: “Baptism by immersion for the remission of more appropriate.105 sins” is a central article of faith in LDS teaching.
18 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS However, LDS children are not baptized until and says in substance: “In the name of Jesus they reach the “year of accountability,” defined as Christ and by authority of the Holy Melchizedek eight years old. Before that age, they are pre- Priesthood, I lay my hands upon your head and sumed not to have the knowledge and accounta- anoint you with this consecrated oil, which has bility necessary to sin against God. Those who die been dedicated for the blessing of the sick.” before the age of accountability will receive all Additional words may be said in harmony with, the rewards of those who lived long enough to be and under the guidance of, the Spirit. baptized. Therefore, neonatal baptisms are un- necessary and, in fact, inappropriate.107 The men- Following this anointing, two or more priesthood tally retarded (those with mental ages less than bearers lay their hands upon the head of the sick eight years) are also considered incapable of sin person, and one being spokesman calls the person because of their lack of knowledge and therefore by name and says in substance, “In the name of need not be baptized.108 Jesus Christ and by the authority of the holy Melchizedek Priesthood, we seal and confirm Community: As in the LDS church, baptismal upon you this anointing with which you have been candidates must be at least eight years old, and anointed to the end that . . .” He then voices a parents must give consent if the candidate is a prayer of supplication and of blessing as the Spirit child. Baptism by complete immersion is the directs. The ordinance concludes in the name of only recognized mode, and it is valid only when Jesus Christ. If two priesthood bearers are not the candidate and officiating minister are both available for the ceremony, one may perform both in the water.109 Baptism is never observed in the parts of the blessing.112 hospital setting.110 “The resulting relief, healing, and fulfillment Blessing of the sick are not to be boasted about or heralded, but LDS: There is no rite in the LDS church com- rather [are] to ‘be spoken with care, and by con- parable to “last rites.” However, nonsacramental straint of the Spirit’ ([Doctrine and Covenants] blessings of the sick are regularly performed111 63:64; 84:73; 105:24)”113 and are often seen as and are based on the biblical injunction “If any “joint victories” for faith and medicine.114 one of you is ill, he should send for the elders of the church, and they must anoint him with oil Community: “Sacraments relating to the care of in the name of the Lord and pray over him. The the sick include Administration (anointing with prayer of faith will save the sick man and the oil, laying on of hands, and prayer of faith for Lord will raise him up again. . .” (James divine blessing); and the Lord’s Supper (using 5:14–15). While the purpose of blessing the sick specified prayers and bread and grape juice).”115 is to summon divine assistance in the healing of Administration is usually implemented by two or an afflicted person, the manifestations of “divine more elders, but in emergencies it may be per- assistance” are many. Healing may occur as a re- formed by only one.116 sult of direct action by God or may be mediated While hospitalized members of this church by the actions of physicians or other medical may “seek to participate in the sacraments of caregivers. the church, [the sacraments] are not required for salvation and thus they are not seen to have Blessings of the sick are generally given by two emergent efficacy. Of course, provisions should Melchizedek Priesthood bearers. There are not be made for church sacraments as they may be prescribed prayers for this kind of blessing, but requested. They are seen as an important means one of the priesthood bearers anoints the head of of bringing comfort, strength, and healing to the sick person with a little consecrated olive oil persons through faith and divine grace.”117
THE PARK RIDGE CENTER 19 Fasting this priesthood, which permits them to serve in LDS: “Church members fast together generally various capacities in the church. on the first Sunday of each month, in prepara- tion for fast and testimony meeting. They usually Community: The spiritual head of this church is abstain from food and drink for two consecutive the prophet-president who, together with two meals, attend Church services, and donate a fast counselors, constitutes the First Presidency, the offering [equivalent to the cost of the two for- chief administrative quorum of the church. A gone meals] for the care of the needy. Addition- council of Twelve Apostles makes up the chief ally, an individual, family, or congregation may missionary quorum of the church; the individual fast for a specific cause such as one who is sick apostles also function as administrators in their or otherwise afflicted.”118 fields. There are three chief financial officers of the church, the presiding bishop and two coun- Community: There is no requirement for any selors. These eighteen general officers make up specific sacrament. Fasting the breakfast meal the Joint Council, an administrative and policy- once a month on Communion Sunday is sug- making council. gested with an equivalent donation of money to A World Conference made up of delegates the church’s oblation (world hunger) fund. from the thirty-eight countries where the church is active meets biennially. This conference ap- Holy days proves annual budgets, sustains the general offi- LDS: Sunday is the Sabbath Day in the LDS cers, and approves, by common consent, church. Members are expected to rest from their legislation affecting the belief and practices of daily labors as well as serve and worship the the church as a whole. Lord on that day.119 “Ministry needs are met in each congregation by a staff of lay ministers called priesthood mem- Community: Sunday is the Sabbath Day in this bers. The priesthood includes both men and church. women.”120 The Priesthood Manual reminds its readers that “most denominations have but one ordained minister in a congregation. Our priest- POLITY, SCRIPTURE, AND DOCTRINE hood members should be very sensitive to this fact when visiting in a hospital and not assume Polity ministerial privileges or prerogatives when cir- LDS: The First Presidency, comprised of the cumstances do not justify it. Furthermore we president of the church and two counselors, pre- should be sensitive to the sheer numbers of our sides over the LDS church. The Council of the priesthood members who may visit a sick per- Twelve Apostles acts under the direction of the son.” Healthcare providers should be aware that First Presidency. Unanimous decisions by the priesthood members generally “follow the princi- First Presidency and the Quorum of Twelve ple of going two by two when visiting the sick.”121 Apostles constitute the official policy of the church. Scripture and doctrine The church has two orders of priesthood, both LDS: LDS scriptures include the Bible (King of which are nonprofessional. The lesser of the James Version), Book of Mormon, Pearl of Great two is the Aaronic priesthood, which is comprised Price, and Doctrine and Covenants. The Articles of worthy young men aged twelve to eighteen of Faith, written shortly before Joseph Smith’s who receive priesthood offices within this order. death and currently used by most Latter-day The greater order is the Melchizedek priesthood. Saints, affirm a belief in three separate divine Generally, men aged nineteen and older receive entities, the Father, Son, and Holy Spirit. The
20 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS articles deny original sin, affirm the value of This statement affirms among other things a gen- Christ’s atonement, and allow for individuals to erally trinitarian Godhead; it acknowledges that experience salvation through faith and obedi- human sin is a rebellion against God which re- ence. Saints recognize the primacy of two intro- sults from free agency; and it affirms the efficacy ductory principles, faith and repentance, and of Christ’s atonement for our salvation and his two ordinances, baptism by immersion and the role as the instrument of reconciliation between laying on of hands for the gift of the Holy Ghost. God and humanity. This church recognizes eight sacraments and ordinances: baptism, confirma- Community: Church scriptures include the Bible, tion, communion of the Lord’s Supper, ordina- Book of Mormon, and Doctrine and Covenants. tion, administering to the sick, marriage, blessing There is no formal creed, but a Statement of of babies, and blessing of youth and adults by an Beliefs is published in Exploring the Faith.122 evangelist-patriarch.
NOTES
1. Melton 1993: 131–34. to aid in the preparation of this document. All quota- tions from the General Handbook that are reprinted 2.Preston Hunter, "Adherents.com FAQ," Adherents.com here were taken from published secondary sources. web site. Last updated September 13, 2001. Accessed November 12, 2001.
THE PARK RIDGE CENTER 21 43. “Statement of Policies.” 78. EM, 364–65. 44. Bush 1985: 57. 79. Campbell 1991: 38. 45. General Handbook 1989, 11-4, as quoted in Campbell 80. General Handbook 1989, 11-6, as quoted in EM, 1991: 25–26. 1160. 46. General Handbook 1989, 11-4, as quoted in EM, 70. 81. Campbell 1991: 33. 47. Campbell 1991: 26. 82. Ibid., 31-32. 48. General Handbook 1985, 11-4, as quoted in Bush 83. “Preparation for Life-Prolonging Decisions.” 1993: 171. 84. “Statement of Policies.” 49. Bush 1993: 171. 85. “Preparation for Life-Prolonging Decisions.” 50. General Handbook 1989, 11-4, as quoted in Bush 86. Campbell 1991: 34. 1993: 172. 87. General Handbook 1989, 11-5, as quoted in EM, 51. Bush 1993: 172. 1422. 52. General Handbook 1989, 11-5, as quoted in Campbell 88. EM, 1422. 1991: 27. 89. General Handbook 1989, 11-5, as quoted in EM, 53. Bush 1993: 172–73. 1096. 54. Deseret News, January 19, 1991. The statement on abor- 90. Campbell 1991: 35. tion was issued January 11, 1991, by Bruce L. Olsen, Managing Director of Public Communication/Special 91. Doctrine and Covenants 132: 19–27. Affairs, CLDS, Salt Lake City, Utah. 92. Oregon Public Affairs Council 1994. 55. Campbell 1991: 29. 93. “Preparation for Life-Prolonging Decisions.” 56. Ibid., 30. 94. EM, 89. 57. Campbell 1993: 52. 95. Bush 1993: 30. 58. Bush 1993: 165. 96. EM, 239. 59. Campbell 1991: 28–29. 97. RLDS Priesthood Manual, 191. 60. Doctrine and Covenants 42: 18, as quoted in EM, 970. 98. “Beliefs Related to the Human Body.” 61. Melton 1989: 187. 99. General Handbook 1989, 11-6, as quoted in EM, 62. Ibid., 188. 1097. 63. Campbell 1993: 54, 57. 100.A. Bruce Lindgren, world church secretary for the Community of Christ, e-mail to the Center's editorial 64. Bush 1985: 54. staff, October 19, 2001. 65. Bush 1993: 166. 101. Bush 1993: 48–49. 66. Campbell 1991: 39. 102.General Handbook 1989, 11-6, as quoted in EM, 67. Bush 1985: 63. 1097. 68. EM, 344. 103.EM, 429. 69. Cited in “Beliefs Related to the Human Body.” 104.“Who Are the Saints?” 1985: 29–30. 70. General Handbook 1989, 11-6, as quoted in EM, 105.Bush 1993: 17. 1097. 106.“Statement of Policies.” 71. Ibid., 1051. 107. Cowan 1984: 53, 64–65. 72. Campbell 1991: 38. 108.Cowan 1984: 65. 73. Bush 1993: 109. 109.Priesthood Manual, 224. 74. Ibid., 121. 110 . “Helpful Information,” 3. 75. General Handbook 1985, 11-2, as quoted in Bush 111. 1993: 129. Bush 1993: 37. 112 . 76. Bush 1993: 129. EM, 1308. 113 . 77. Ibid., 136. Ibid., 1309.
22 THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS 114 . Bush 1993: 104. 119 . Cowan 1984: 96–97. 115 . “Helpful Information,” 3. 120.“Helpful Information,” 2. 116 . Priesthood Manual, 237. 121. Priesthood Manual, 184, 190. 117. “Helpful Information,” 3. 122.Exploring the Faith, 2nd ed.; Independence, Mo.: Herald Publishing House, 1989. 118 . EM, 500–501.
BIBLIOGRAPHY
“Beliefs Related to the Human Body.” See First Presidency “Helpful Information.” See Reorganized Church of Jesus (1982). Christ of Latter Day Saints. N.d. Bush, Lester E., Jr. 1985. “Ethical Issues in Reproductive Melton, J. Gordon. 1989. The Churches Speak on: Abortion. Medicine: A Mormon Perspective.” Dialogue 18, no. 2: Detroit, Mich.: Gale Research. 40–66. ———-. 1993. Encyclopedia of American Religions. 4th ed. ———. 1993. Health and Medicine among the Latter-day Detroit, Mich.: Gale Research. Saints: Science, Sense, and Scripture. New York: Oregon Public Affairs Council, 1994. "Church Position on Crossroad. Ballot Measure 16 (Physician-Assisted Death) and ———, ed. 1979. “Mormon Medical Ethical Guidelines.” Ballot Measure 19 (Anti-pornography)," Portland, Ore. Dialogue 12, no. 3: 97–106. “Preparation for Life-Prolonging Decisions.” See Standing Campbell, Courtney S. 1991. “Sounds of Silence: The High Council. Latter-day Saints and Medical Ethics.” In Bioethics Priesthood Manual. See Reorganized Church of Jesus Yearbook 1, ed. Baruch Brody et al., 23–40. Boston: Christ of Latter Day Saints. 1985. Kluwer Academic Publishers. Reorganized Church of Jesus Christ of Latter Day Saints. ———. 1993. “Embodiment and Ethics: A Latter-day Saint 1985. The Priesthood Manual. Independence, Mo.: Perspective.” In Bioethics Yearbook 3, ed. B. Andrew Herald Publishing House. Lustig et al., 43–67. Boston: Kluwer Academic Publishers. ———. N.d. “Helpful Information for Health Care Professionals in Meeting the Spiritual Needs of Cowan, Richard O. 1984. The Doctrine and Covenants: Our Patients Who Are Members of the Reorganized Modern Scripture. Salt Lake City, Utah: Bookcraft. Church of Jesus Christ of Latter Day Saints (RLDS Crapo, Richley H. 1987. “Grass-Roots Deviance from Church).” Official Doctrine: A Study of Latter-day Saint ———. N.d. “A Statement of Policies Relating to the Care of (Mormon) Folk-Beliefs.” Journal for the Scientific RLDS Church Members in Medical Care Facilities.” Study of Religion 26, no. 4: 465–85. Standing High Council [of the Reorganized Church of Encyclopedia of Mormonism. 1992. Ed. Daniel H. Ludlow. Jesus Christ of Latter Day Saints]. January 1992. 5 vols. New York: Macmillan. “Preparation for Life-Prolonging Decisions.” First Presidency of the Reorganized Church of Jesus Christ “Statement of Policies.” See Reorganized Church of Jesus of Latter Day Saints. October 1982. “Beliefs Related Christ of Latter Day Saints. N.d. to the Human Body, Burial, Cremation, etc.” “Who Are the Saints?” 1985. Independence, Mo.: Herald First Presidency, 1991. “Letter of Standards of Morality and Publishing House. Condensed from An Introduction to Fidelity,” (November 14, 1991), Salt Lake City Utah: the Saints Church, by Peter A. Judd and A. Bruce The Church of Jesus Christ of Latter-day Saints. Lindgren (Independence, Mo.: Herald Publishing Heaton, Tim B. 1986. “How Does Religion Influence House, 1976). Fertility? The Case of Mormons.” Journal for the World Conference Bulletin. [Proceedings of the biennial Scientific Study of Religion 25, no. 2: 248–58. World Conference of the Reorganized Church of Jesus ———. 1987. “Four Characteristics of the Mormon Family: Christ of Latter Day Saints.] April 1994. Contemporary Research on Chastity, Conjugality, Children, and Chauvinism.” Dialogue 20, no. 2: 101–14.
THE PARK RIDGE CENTER 23 Introduction to the series
eligious beliefs provide meaning for people gious views on clinical issues. Rather, they R confronting illness and seeking health, partic- should be used to supplement information com- ularly during times of crisis. Increasingly, health- ing directly from patients and families, and used care workers face the challenge of providing as a primary source only when such firsthand appropriate care and services to people of different information is not available. religious backgrounds. Unfortunately, many We hope that these booklets will help practi- healthcare workers are unfamiliar with the reli- tioners see that religious backgrounds and gious beliefs and moral positions of traditions beliefs play a part in the way patients deal with other than their own. This booklet is one of a pain, illness, and the decisions that arise in the series that aims to provide accessible and practical course of treatment. Greater understanding of information about the values and beliefs of differ- religious traditions on the part of care providers, ent religious traditions. It should assist nurses, we believe, will increase the quality of care physicians, chaplains, social workers, and adminis- received by the patient. trators in their decision making and caregiving. It can also serve as a reference for believers who desire to learn more about their own traditions. Each booklet gives an introduction to the his- tory of the tradition, including its perspectives on health and illness. Each also covers the tradi- tion’s positions on a variety of clinical issues, with attention to the points at which moral dilemmas often arise in the clinical setting. Final- ly, each booklet offers information on special concerns relevant to the particular tradition. The authors have tried to be succinct, objec- tive, and informative. Wherever possible, we have included the tradition’s positions as reflected in official statements by a governing or other formal body, or by reference to positions formulated by authorities within the tradition. Bear in mind that within any religious tradition, there may be more than one denomination or sect that holds views in opposition to mainstream positions, or groups that maintain different emphases. THE PARK RIDGE CENTER FOR THE STUDY OF HEALTH, FAITH, AND ETHICS The authors also recognize that the beliefs and 211 E. Ontario ● Suite 800 ● Chicago, Illinois 60611-3215 values of individuals within a tradition may vary www.parkridgecenter.org from the so-called official positions of their tradi- tion. In fact, some traditions leave moral deci- The Park Ridge Center explores and en- sions about clinical issues to individual hances the interaction of health, faith, and conscience. We would therefore caution the read- ethics through research, education, and er against generalizing too readily. consultation to improve the lives of individuals and communities. The guidelines in these booklets should not substitute for discussion of patients’ own reli- © 2002 The Park Ridge Center. All rights reserved.
THE LATTER-DAY SAINTS TRADITION: RELIGIOUS BELIEFS AND HEALTHCARE DECISIONS