lutheranfinal

The Lutheran Tradition
Religious Beliefs and

Healthcare Decisions
Edited by Deborah Abbott
Revised by Paul Nelson
uring the Middle Ages, most of western Europe

D was united, however tentatively, under the lead-
ership of the Roman Catholic church. In the early
sixteenth century, this union fractured, due in part to
the work of a German monk named Martin Luther.
Luther had striven to guarantee his salvation through
ascetic practices but slowly came to believe that
Contents
salvation can come only through the grace of God,
The Individual and the 4 not through any human effort. This fundamental
Patient-Caregiver Relationship principle of Luther’s thought, “salvation by grace
through faith alone,” diverged from the traditional
Family, Sexuality, and Procreation 6
Roman Catholic belief that both faith and human
Genetics 12 effort are necessary for salvation. The other funda-
Organ and Tissue Transplantation 14 mental principle of Luther’s thought, that the Bible is
the sole rule of faith and the only source of authority
Mental Health 15 for doctrine, contrasts with the Roman Catholic
Medical Experimentation 15 reliance on both the Bible and tradition. Luther
and Research translated the Bible into German and, thanks to the
Death and Dying 16 recent invention of the printing press, it was distrib-
uted widely and became a best-seller. The availability
Special Concerns 19 of a Bible in the language of the common people,
coupled with Luther’s idea of the Bible as the sole
source of authority, marked the beginning of a signifi-
cant shift away from Rome as the final source of reli-
gious authority for many Christians.
Part of the “Religious Traditions and

Deborah Abbott, M.P.H., formerly with the Park Ridge Center, is
Healthcare Decisions” handbook series currently affiliated with Georgia State University.
published by the Park Ridge Center
for the Study of Health, Faith, and Ethics Paul Nelson, Ph.D., is Professor of Religion and Chair of the
Department of Religion at Wittenberg University.
THE PARK RIDGE CENTER

Luther first presented his ideas publicly in traditionally built hospitals and been open to
1517, when he nailed to the church door in scientific developments and cures, but those
Wittenberg his Ninety-five Theses protesting endeavors and attitudes have not retained a
the corruption he saw reflected in both the specifically Lutheran flavor (Marty 1986: 171,
teachings and the practices of the Roman 18–19).
Catholic church. Although Luther was not the Luther himself respected doctors and
first reformer of the church in this era, many promoted close working relationships between
cite the posting of his theses as the beginning them and pastors in caring for the sick. He
of the Protestant Reformation, which ultimately expected doctors to identify and treat medically
resulted in the formation of many non–Roman the natural causes of sickness, but he believed
Catholic, or Protestant, churches in northern that more underlay sickness than a doctor could
and western Europe. In 1530, the German address (Lindberg 1986: 177–78). Luther saw
princes who supported Luther presented to the illness as both a result and a sign of that which
Holy Roman Emperor the Augsburg Confession, separates humans from God (Marty 1986: 48)
an official statement of Lutheran faith; following and understood the meaning of suffering, both
that event, congregations identified with Luther personal and social, as somehow tied to God’s
could formally be called “Lutheran” churches. decision to redeem sinners and the world
Soon thereafter, Lutheranism spread through the death of Christ on the cross
throughout Germany, Sweden, Denmark, (Lindberg 1986: 176–77).
Finland, Iceland, and Norway, and in the mid- The first draft of a proposed ELCA social
seventeenth century, to the American colonies. statement understands “healing in terms of
Today, Lutheranism in the United States is God’s work of creating, redeeming, and
divided among two large and seven relatively sustaining humankind” (ELCA 2001b: 4).
small denominational groups. The largest, the “Providing good quality health care for all is
Evangelical Lutheran Church in America a social obligation and responsibility compelled
(ELCA), has 5.3 million members in more by justice” (ELCA 2001b: 9). The proposed
than 11,000 congregations; approximately statement finds “current forms of health-care
270 hospitals, nursing homes, and other social resource distribution . . . ethically indefensible”
service organizations are affiliated with the and calls for reforms that would assure
ELCA. The Lutheran Church—Missouri Synod “universal access to a comprehensive decent
(LCMS), which is more conservative than the minimum of health care for all persons” (ELCA
ELCA on many theological and moral issues, 2001b: 9-10). The draft does not stipulate
has 2.6 million members in more than 6,000 particular mechanisms for achieving universal
congregations. Collectively, the smaller Lutheran access but encourages ELCA members to partic-
churches have about half a million members in ipate “vigorously and wisely . . . in the public
1,700 congregations (Nelson 1991: 123). discussion on how best to fulfill this obligation”
(ELCA 2001b: 10). These matters are explored
in an ELCA congregational study booklet, Our
FUNDAMENTAL BELIEFS CONCERNING Ministry of Healing: Health and Health Care
HEALTH CARE Today, prepared by the task force that drafted
the proposed social statement (ELCA 2001d).
Lutherans as a group do not hold distinctive The LCMS, generally leery of an emphasis on
views on health care or healing. In many “social ministry” lest it obscure the central focus
respects, including their acceptance of modern on proclaiming the Gospel and administering
medicine, Lutherans blend in with the largely the sacraments, nevertheless directs attention to
secular culture (Marty 1986: 18). They have the church’s “communal Christian care.” Parish
2 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

nurse programs are identified as one of its wrong is uncorrupted” (Schneider 1990: 16);
possible expressions in a study document titled the potential for error within individual
Faith Active in Love: Human Care in the conscience is tempered by the Scripture as
Church’s Life (LCMS 1999: 29). understood in the Lutheran tradition. The
following statement by the American Lutheran
Church, one of the bodies that merged to
I NSTITUTIONALAUTHORITY AND form the ELCA, emphasizes the importance
INDIVIDUAL CONSCIENCE of subjection to God’s law: “One remains subject
to God’s law not only for one’s personal good
Issues of institutional authority and individual but for the good of the entire body of Christ.
conscience are rooted in Lutheran ethics, which A caring community cannot sanction or condone
is inseparable from Lutheran theology. a situation where each member does what
According to Lutheran pastor and writer Edward appears good, right, and self-satisfying simply in
Schneider, “A basic word in the vocabulary of that member’s own eyes. No one can be a law
Lutheran theology is the word ‘and.’ Our solely to self; each lives in relationship with
theology speaks of law and gospel, of the others” (ALC 1980: 10).
believer as saint and sinner. It insists upon Lutheran church bodies in the United States
faith and work. It deals with the kingdom of often issue statements or other documents that
God and the kingdom of the world. The genius reflect internal deliberation on moral and ethical
of this theology is its ability to dialectically issues of importance to church members. These
relate aspects of the faith which often tend to are normally designed to educate and guide
be separated and thereby deprived of their full members in developing their own positions on
meaning” (Schneider 1990: 15). This issues. Within a particular church, various docu-
“both/and” approach shapes the way Lutherans ments may differ in the degree to which they
exercise their conscience in this imperfect world. reflect the “official teaching” of the church.
Lutheran professor of religion Paul Nelson has Sometimes the churches publish works by a
written, “The sober recognition that we are less single author which are intended to provide
than perfect people living in a far from perfect information and encourage reflection but do not
world, along with the conviction that we are, represent an official position of the church. The
nevertheless, forgiven sinners are the two history of mergers within the Lutheran church
benchmarks of a Lutheran moral vision. may also complicate the status of various state-
The former precludes self-righteousness and ments. For example, the ELCA was formed in
underlies the sense that often we can do little 1988 by the merger of the Lutheran Church in
else but choose between greater and lesser evils. America (LCA), the American Lutheran Church
The latter makes choice and action possible (ALC), and a smaller body, the Association of
despite the attendant ambiguities” (Nelson Evangelical Lutheran Churches (AELC). The
1993: 151). A statement by the ELCA empha- ELCA elected to accept and encourage the
sizes this point when it says that Christians must continued use of the “social statements” issued
face complex ethical decisions “in all their by the ALC and LCA while it developed its own
ambiguity, knowing we are responsible ulti- teachings (Nelson 1991: 123), and continues
mately to God, whose grace comforts, forgives, to use these statements as “part of the basis of
and frees us in our dilemmas” (ELCA 1992: 1). ELCA advocacy on health care” (ELCA 2001d:
Lutherans, like other Protestants, emphasize 52). Statements by the ALC and LCA, although
the importance of individual conscience over those churches no longer exist, will therefore
institutional authority, but “Luther makes no be cited here when the ELCA has not made a
claim that one’s natural sense of right and statement on a particular topic or when an ALC
THE PARK RIDGE CENTER 3

or LCA statement adds significantly to the teaching function builds upon and seeks to nurture
substance of an ELCA statement. Social state- the freedom of Christians to decide and act respon-
ments “represent the official policy of the church sibly. Social statements help shape the conscience
and are considered binding on staff members and of Christians by appealing to their faith, moral
others who may speak on behalf of the church” convictions, and reason. The respect they evoke
but are not binding on individual church comes from the truth and wisdom they embody,
members (Nelson 1991: 128). A formal statement which has stood the testing of various forums
by the ELCA explains the standing of social within this church and to which testing they always
statements in this way: continue to be subject. Their effective teaching
significance will be determined by the intrinsic
Because they view issues from the perspective of quality of their contents and by their use in the
the Church’s faith, social statements are clearly church. (ELCA 1989: 6)
rooted in the biblical and confessional witness of
the Evangelical Lutheran Church in America. Within the LCMS, the Commission on
They are subject again and again to the testing of Theology and Church Relations has issued a
whether they are faithful to Scriptures as “the number of reports on medical ethical issues;
authoritative source and norm of [this church’s] while they are not themselves the official posi-
proclamation, faith and life” (ELCA, 2.03) and to tions of the synod, they do reflect the synod’s
its creeds and confessions (ELCA, 2.04, 2.05, positions. Substantive documents that provide
2.06). They themselves are not new creeds or information and guidance for synod members
confessions. [The parenthetical references are to and others who are grappling with the issues
the ELCA’s constitution.] addressed, they are quoted extensively here.
Only synodical conventions have the authority
Church members are called upon to give social to establish official positions of the church
statements serious consideration as they form their (personal communication, David Mahsman,
own judgments. In their use as teaching documents, Director of News and Information, LCMS).
their authority is persuasive, not coercive. Their
THE INDIVIDUAL AND THE PATIENT-CAREGIVER RELATIONSHIP
utherans generally favor open communica- self-determination should always be understood

L tion between caregiver and patient. “The
relationship between patients and providers
within that relationship” (ELCA 2001b: 12).
should be . . . a partnership of trust in pursuit

of a shared goal” (ELCA 2001b: 7). Patients CLINICAL ISSUES
have the final authority to decide among their
medical options, but they also have an obliga- Self-determination and informed consent
tion to evaluate those options within a broad Lutherans, consistent with their general respect
context, considering the effects of their decisions for medicine and informed decision making, are
on other people. According to the first draft likely to favor self-determination and informed
of a proposed ELCA social statement, “our consent. As a proposed ELCA social statement
individual autonomy must . . . be understood puts it, “health care professionals and patients
within the context of our obligation to seek to deliberate together on the facts and values
be obedient to the will of God, because ulti- represented by options for treatments and care,
mately we belong to God and our exercise of with patients making free and informed consent

to whatever services are to be received” (ELCA person’s life—is to erect a barrier that gets in the
2001b: 7). An earlier statement by the LCA is way of the honesty and openness essential to
largely consistent with this view but describes a fellowship and human community.
possible exception: “To treat a patient in viola-
tion of his or her deeply held, carefully consid- None of this, of course, is to suggest that informa-
ered, and clearly expressed preferences is to do tion should indiscriminately be made available to
violence to that person. . . . At the same time, it anyone who wants it. There are many situations,
must be emphasized that pain and other factors including doctor-patient relationships, in which
often distort the decision-making process, keeping faith with others means maintaining strict
resulting in expressions of preference that may confidentiality about certain matters. . . . However,
not represent a person’s true wishes. In such it is an equally serious breach of faith to withhold
cases, it may be appropriate to administer from a patient information needed to make deci-
treatment (by authority of court order, if sions about his or her life or to prepare for death.
necessary) if so doing would sustain the life (Lee 1983: 15)
of the patient” (LCA 1982: 5).
The LCMS recognizes that “Christians A 1992 statement by the ELCA, which draws
who have had different specific experiences upon the LCA statement, states that “truthful-
may at times disagree concerning application ness and faithfulness in our relations with others
of principles to specific cases” but affirms that, are essential to the texture of human life”
within the synod, “agreement exists on the (ELCA 1992: 2). In the same spirit, an early
fundamental guiding principles,” including the statement from the ALC illustrates the negative
commitment to care and not to kill. Within the effects of failing to tell the truth when a person
framework of those guiding principles, the is dying: “[often] the dying person experiences
LCMS honors individual conscience and death as a tragic comedy, supported by a cast of
self-determination. “Christians have numerous actors and actresses playing deceptive roles in a
reasons to seek effective ways to assist their conspiracy of silence” (ALC 1977: 7).
loved ones and their health care team in No official statement by the LCMS was found.
determining their wishes concerning health
care” (LCMS 1993: 21–22). Proxy decision making and advance
directives
Truth-telling and confidentiality Lutheran statements tend to support the use of
“Central to [the provider-patient] relationship advance directives and the ability of people to
is respecting patient confidentiality and privacy make informed decisions about the care of those
of medical information” (ELCA 2001b: 7). with whom they have close relationships.
A companion study guide to the LCA’s 1982 According to the ELCA, “Advance directives are
social statement Death and Dying discussed welcome means to foster responsible decisions
truth-telling and confidentiality in this way: at the end of life” (ELCA 1992: 4). An earlier
statement by the LCA addressed at greater
In any community that respects other people and length the issue of proxy decision making:
is sensitive and responsive to their needs, truthful- “If the situation involves a child under the age
ness and faithfulness are crucial. Lying or other- of majority, who is therefore legally incompetent,
wise resorting to deception is to manipulate others or a person who is mentally impaired and hence
rather than relate to them as persons. It is to view unable to participate fully in the decision-
them as adversaries rather than as friends and making process, a shared decision-making
neighbors. Withholding information from process is preferable. Collective wisdom is likely
someone—particularly information relating to that to result in better decisions, and no one should

be left to bear alone the full burden of deciding. agreeing to the uselessness of further ‘heroic
Participants in this decision-making process may efforts’ and consenting to termination of treat-
include family members, the physician and ments” (LCMS 1993: 22). The synod recognizes
other health care professionals, the pastor, and the complexity of medical decision making and
others close to the person” (LCA 1982: 3). The encourages people to seek God’s guidance:
statement continued, “A particular responsibility “People who know themselves to be redeemed
of each individual is making treatment prefer- by Christ seek to make the right rather than the
ences known, after careful consideration, so as wrong decisions for His sake and for the benefit
to facilitate the decision-making process and of their neighbor. How else should we seek to
relieve the burden on others. Living wills . . . bring God’s love and care to our neighbors?
represent one way of doing this” (LCA 1982: 7). Right or wrong ethical decisions, of course, do
The LCMS concurs in its approval of advance not make us right or wrong with God—we live by
directives and proxy decision making: “It is grace—but people who live by grace ponder
good ethical procedure for the doctor to request God’s guidance and seek principled ways to
and receive a statement signed by the patient, if apply that guidance to the complexities of life in
competent to consent, or by the nearest of kin, a world made difficult by sin” (LCMS 1993: 30).
FAMILY, SEXUALITY, AND PROCREATION
xpressing well the Lutheran view, the LCA Sexuality, when expressed appropriately, is
E has stated that “sex, marriage, and family are
gifts of God in which to rejoice. Their essential
viewed positively in the Lutheran tradition. An
LCA statement affirmed that “human sexuality
goodness cannot be obscured by any crisis of our is a gift of God for the expression of love and
time” (LCA 1970: 1). Contrary to the view that the generation of life. . . . In the expression of
celibacy is preferable to marriage, Luther human sexuality, it is the integrity of our rela-
believed that marriage is a very important tionships which determines the meaning of our
vehicle through which to create a sense of actions. We do not merely have sexual relations;
community (Lindberg 1986: 181); but he did not we demonstrate our true humanity in personal
believe that marriage is a sacrament, because it relationships, the most intimate of which are
does not confer grace (Marty 1986: 130). sexual” (LCA 1970: 1). The ALC stated more
The LCA characterized marriage this way: directly, “We believe that Scripture sets the stan-
“Christian faith affirms marriage as a covenant dard of a lifelong monogamous marriage of one
of fidelity—a dynamic, lifelong commitment of man and one woman. We believe that sexual
one man and one woman in a personal and intercourse reaches its greatest potential only
sexual union. . . . Marriage is not simply a legal within the committed trust relationship of
transaction which can be broken when the marriage” (ALC 1980: 5). The ELCA maintains
conditions under which it was entered no longer the positive Lutheran view of sexuality: “We
exist. It is an unconditional relationship, a total affirm that the goodness of sexual intercourse
commitment based on faithful trust. This union goes beyond its procreative purpose” (ELCA
embodies God’s loving purpose to create and 1991: 4).
enrich life. As the needs of the partners change, Sexual intimacy outside of marriage is
the covenant of fidelity must be renewed by discouraged: “Marriage is the appropriate
God’s grace and continually reaffirmed by context for sexual intercourse. This continues to
husband and wife” (LCA 1970: 1–2). be the position of this church” (ELCA 1991: 4).

The ELCA is nonetheless in the process of affirmed the denomination’s previous positions,
debating its traditional position on homosexu- it recognized that conscientious Christians within
ality and homosexual practices. While no new and outside the LCMS disagree about the moral
official position has been issued, a formal justifiability of various reproductive technologies.
process of study and deliberation is under way. The document’s specific concerns and judgments
With respect to procreation, the ALC are discussed below.
concluded, “Thus, while ‘be fruitful and
multiply’ still expresses the collective human
obligation to reproduce and thereby perpetuate CLINICAL ISSUES
the human species, procreation is not an obliga-
tion of sexual intercourse. Rather, it is a privi- Contraception
lege and gift from God to be used responsibly Contraception is generally acceptable to
[and] appropriately” (ALC 1977: 3). Lutherans. The ELCA has said, “Whenever
The LCMS takes a similar view on marriage, sexual intercourse occurs apart from the intent
sexuality, and procreation: “We honor God and to conceive, the use of contraceptives is the
the neighbor rightly when we . . . regard responsibility of the man and of the woman”
marriage as a divine, lifelong institution, (ELCA 1991: 4). In addition, the ELCA “recog-
ordained by God for the good of man and nize[s] the need for contraceptives to be avail-
woman . . . [and] affirm God’s will that sexual able . . . and for research [on] and development
intercourse be engaged in only between a man of new forms of contraception” (ELCA 1991: 8).
and woman committed to a complete and life- A more expressive statement was issued by the
long sharing of their lives with one another in ALC in 1977: “Effective birth control methods
a marriage covenant not to be broken . . . and facilitate responsible procreation and greatly
affirm that this union of mutual love is the only enhance the ability to exercise stewardship of
proper context for human procreation” (LCMS genetic resources. Enjoyment of sexual inter-
1981b: 40). “The Biblical injunction to ‘be course without fear of unwanted pregnancy is
fruitful and multiply’ is to be understood as appropriate. Men and women are equally
a blessing as well as a command. It is one of responsible for contraception and procreation.
God’s good gifts to His people, for procreation Sexual intercourse is the privilege of mature
is an actual sharing in God’s ongoing creative persons acting responsibly within the context
activity” (LCMS 1981b: 17). In 1992, the LCMS [of] a commitment known in the Christian
reaffirmed its 1973 position “that the synod community as marriage. However, contraceptive
recognize homophile behavior as intrinsically information and assistance should also be
sinful” (LCMS 1992, Res. 3-12A) and, in available to all sexually active persons, regard-
support of that position, cited a 1981 report less of age or marital status” (ALC 1977: 3-4).
stating that “the homosexual is held accountable According to the LCA, “The ethical significance
to God for homosexual thoughts, words, and of the use of any medically approved contracep-
deeds” (LCMS 1981b: 35). tive method within a covenant of marital fidelity
In 1996 the Commission on Theology and depends upon the motivation of the users.
Church Relations of the LCMS published a study A responsible decision for or against having a
document, Christians and Procreative Choices: child will include evaluation of such factors as
How Do God’s Chosen Choose? Organized the health of the potential mother, a reliable
around four case studies involving surrogacy, prognosis concerning the health of a possible
artificial insemination by a donor, in vitro child, the number and spacing of other children,
fertilization, and voluntary childlessness, the the family’s economic circumstances, and the
document sought to model “biblically disciplined rapid growth of population. People have a right
moral reasoning” (LCMS 1996: 5). While it not to have children without being accused of

selfishness or a betrayal of the divine plan; and The LCMS view is similar, but the synod is
every child has a right to be a wanted child” much more explicit about the conditions under
(LCA 1970: 5). which the procedure may be appropriate:
The LCMS accepts the appropriate use of birth “Sterilization may under some circumstances be
control but cautions against its perpetual use: an acceptable form of contraception. . . . There
should be no moral objection to it, especially for
In the absence of Scriptural prohibition, there couples who already have children and who now
need be no objection to contraception within a seek to devote themselves to the rearing of those
marital union which is, as a whole, fruitful. children, for those who have been advised by a
. . . With respect to voluntary childlessness in physician that the birth of another child would be
general, we should say that while there may be hazardous to the health of the mother, or for
special reasons which would persuade a Christian those who for reasons of age, physical disability,
husband and wife to limit the size of their family, or illness are not able to care for additional chil-
they should remember at all times how easy it is dren” (LCMS 1981b: 19–20). The church’s 1996
for them simply to permit their union to turn study document appears to reaffirm this position.
inward and refuse to take up the task of sharing in
God’s creative activity. Certainly Christians will
not give as a reason for childlessness the sorry N EW REPRODUCTIVE TECHNOLOGIES
state of the world and the fear of bringing a child
into such a world. We are not to forget the natural Artificial insemination
promise embedded in the fruitfulness of marriage. Artificial insemination by a husband (AIH) is
To bear and rear children can be done, finally, as not problematic among Lutherans; however,
an act of faith and hope in the God who has artificial insemination by a donor (AID) is cause
promised to supply us with all that we “need to for moral concern within the ELCA and has
support this body and life.” (LCMS 1981b: 19–20) been rejected by the LCMS. The ALC stated,
“Artificial insemination, . . . in which only one of
In a more recent study document, the LCMS a couple (the woman in present circumstances)
admits that “in special circumstances there can provides genetic material and other genetic
be reasons for choosing childlessness.” When material comes from an anonymous donor,
“pregnancy and childbirth . . . pose a threat to becomes a consideration for some married
the health of a woman, or when the probability couples. There are, however, such moral,
of severe genetic disease afflicting a potential emotional, and legal ambiguities that must be
child becomes known,” a Christian couple may taken into account as to render the procedure
conclude that “they will better serve God and suspect for a Christian” (ALC 1980: 6).
their neighbors by choosing not to have chil- According to one critical study, published in a
dren” (LCMS 1996: 32). 1986 joint LCA-ALC pamphlet series,
Procreation Ethics, “AIH presents few legal,
Sterilization social, or ethical problems” (Schneider 1986: 5).
Statements about sterilization by the ELCA and In contrast, “AID is not an ethically acceptable
its predecessors tend to be tentative but not alternative to childlessness in the case of male
negative; for example, “We recognize the need . . . infertility” because of psychological difficulties
for sterilization to be considered” (ELCA 1991: and because the donor “exercises his procre-
8) and “In defining the acceptable limits of ative powers apart from any marital bond or
controlling reproduction, we agree that volun- commitment. . . . By the introduction of donor
tary sterilization may be an appropriate option” semen, AID separates procreation from marriage
(ALC 1980: 6). and thereby violates the marriage covenant”

(Schneider 1986: 11, 12). The author concludes only when the sperm and egg come from
that “a couple who find themselves childless husband and wife and all of the fertilized eggs
because of male infertility are better advised are implanted in the womb of the wife. They
either to come to terms with their childlessness also objected to “experimentation with, destruc-
or to seek children through adoption” tion of, or storage of unneeded or defective
(Schneider 1986: 13). fertilized eggs” and “interruption of an IVF
Likewise, the LCMS Commission on Theology pregnancy for any reason other than to prevent
and Church Relations has implicitly approved the death of the mother” (LCUSA n.d.: 31–32).
AIH but cautioned that it “may be a way of The LCMS Commission on Theology and
avoiding underlying psychological problems Church Relations is “reluctant to locate the
within a marriage rather than treating them” problems that arise [in IVF] simply in the
(LCMS 1981b: 38). It has also rejected AID on medical technique itself and to suggest that
the grounds that “the process of fertilization is Christians could never faithfully use it” (LCMS
removed from the personal context of the one- 1996: 37). Nevertheless, the church is troubled
flesh union of husband and wife in a way that about the potential for abuse. “When embryos
not even their consent can allow” (LCMS 1981b: explicitly created from within a marriage are
39). In a 1996 study, the LCMS finds that AID denied the possibility of nurture in the womb
subjects marital partners to “psychological and that God created to receive them, then the
emotional risks” and puts children “at risk of unique and sacred expression in the embryo of
wondering what significance, if any, is to be the one-flesh union of marriage is subject to
found in the hiddenness of their relationship to distortion and diminution” (LCMS 1996: 39).
their biological father” (LCMS 1996: 22). The
same considerations apply to human egg and Surrogate motherhood
embryo donation. All are to be rejected. In an essay on surrogate motherhood, published
as part of the LCA–ALC pamphlet series, the
Gamete intrauterine fallopian transfer author states that “wholesale condemnation may
(GIFT) not be appropriate, but Christian perceptions of
No Lutheran statements on gamete intrauterine the significance of human procreation and its
fallopian transfer were found; presumably, indi- place within the marital relationship are not
vidual synods’ positions would mirror their posi- compatible with the basic premise of surrogate
tions on AIH or AID, depending on whether or motherhood: that one could deliberately
not the sperm and egg came from the husband conceive and bear a child with no commitment
and wife. either to the child or to its father” (McDowell
1986: 10).
In vitro fertilization (IVF) LCMS representatives to a pan-Lutheran
The Lutheran Council in the USA (LCUSA), committee studying in vitro fertilization objected
formerly a cooperative agency of the LCA, ALC, to the use of surrogate wombs in IVF procedures
and LCMS, issued a study document circa 1983 on the grounds that it “involves the intrusion of
entitled In-Vitro Fertilization. The eleven study a third party into this one-flesh union [i.e.,
participants “unanimously concluded that IVF marriage] and is contrary to the will of God”
does not in and of itself violate the will of God (LCUSA n.d.: 31). In its 1996 deliberations on
as reflected in the Bible, when the wife’s egg procreative issues, the LCMS recognized the
and husband’s sperm are used” (LCUSA n.d.: possibility for disagreement within its commu-
31). Representatives from the LCMS, in nity of faith. Just as prior documents have
disagreement with other members of the allowed for conscientious disagreement, so this
committee, held that IVF is unobjectionable discussion of procreative choices presented

reasoned positions against third-party intrusion struggle involved in the decision. Although abor-
into the marital relationship but left open the tion raises significant moral issues at any stage of
possibility of conscientious dissent. Nevertheless fetal development, the closer the life in the womb
it is clear that the LCMS is worried that surrogacy comes to full term the more serious such issues
“may complicate or interfere with the parent- become. . . . This church opposes ending
child relationship” and “risks turning a child into intrauterine life when a fetus is developed enough
a ‘project’ or ‘product’” (LCMS 1996: 17). to live outside a uterus with the aid of reasonable
and necessary technology. . . . Our biblical and
Abortion and status of the fetus confessional commitments provide the basis for us
Abortion has been an issue of great concern to continue deliberating together on the moral
among American Lutherans, as in many issues related to these decisions. We have the
Protestant churches, during the past few responsibility to make the best possible decisions
decades. Delegates to the 1991 biennial in light of the information available to us and our
Churchwide Assembly of the ELCA approved sense of accountability to God, neighbor, and self.
the following statement that generally discour- In these decisions, we must ultimately rely on the
ages abortion but specifically recognizes possible grace of God. (ELCA 1991: 6–7)
exceptions in cases in which the life of the
mother is threatened, the child was conceived The LCMS has consistently taken a strong
during involuntary sexual intercourse, or the anti-abortion stance. A 1979 resolution on abor-
fetus has extreme abnormalities: tion stated that “the living but unborn are
persons in the sight of God from the time of
Because of the Christian presumption to preserve conception . . . and since abortion takes a
and protect life, this church, in most circum- human life, abortion is not a moral option,
stances, encourages women with unintended preg- except as a tragically unavoidable byproduct of
nancies to continue the pregnancy. . . . This medical procedures necessary to prevent the
church encourages and seeks to support adoption death of another human being, viz., the mother”
as a positive option to abortion. . . . This church (LCMS 1979a: 117). A 1984 statement declared,
recognizes that there can be sound reasons for “Scriptural principles . . . compel us to regard
ending a pregnancy through induced abortion. abortion on demand not only as a sin against
The following provides guidance for those consid- the Fifth Commandment forbidding the destruc-
ering such a decision. . . . An abortion is morally tion of human life, but also as a grievous offense
responsible in those cases in which continuation against the First—that we worship the one true
of a pregnancy presents a clear threat to the phys- God and cling to Him alone. The act of abortion
ical life of the woman. . . . A woman should not be clearly manifests a refusal to honor God as the
morally obligated to carry the resulting pregnancy Creator and to seek Him above all else in time
to term if the pregnancy occurs when both parties of need” (LCMS 1984: 32). In 1992, more than
do not participate willingly in sexual intercourse. 95 percent of the delegates at the triennial
This is especially true in cases of rape and incest. convention of the LCMS (Stanich 1992: 734)
. . . There are circumstances of extreme fetal voted in support of a resolution that restated the
abnormality, which will result in severe suffering church’s 1979 teaching and called for increased
and very early death of an infant. In such cases, activity in support of it (LCMS 1992: 116). The
after competent medical consultations, the synod again reaffirmed its position and renewed
parent(s) may responsibly choose to terminate the its call to action in 1995 (LCMS 1995: 141).
pregnancy. Whether they choose to continue or The 1996 study Christians and Procreative
end such pregnancies, this church supports the Choices affirmed that “the living but unborn are
parent(s) with compassion, recognizing the persons in the sight of God from the time of

conception,” while admitting that contrary argu- used against the wishes of a parent, or when abor-
ments based on such biological facts as the high tion is the only option offered. (ALC 1977: 4)
incidence of spontaneous miscarriage, the
phenomenon of twinning, and the “indetermi- The Ethics of Prenatal Diagnosis, a pamphlet
nate personhood of the embryo in its earliest in the 1986 LCA–ALC series, encourages
stages” deserved careful attention (LCMS 1996: caution and medically informed decision
38). However, subsequent actions by the LCMS making: “Under current conditions amniocen-
in convention are unambiguous. tesis, the most fruitful of the diagnostic tech-
In 1998 the LCMS convention resolved to niques, involves certain serious risks for the
“uphold and underscore Christian concern for fetus. Is the taking of such risks morally
sanctity of life” (Res. 3-13A), “affirm life and warranted by the concern to prevent possible
oppose abortion on demand” and “willful abor- genetic defect or to prepare a family for the
tion” (Res. 3-14), and “denounce partial-birth possible birth of a child with genetic disease?
abortion as a barbaric procedure” (Res. 6-02) . . . Any prudent and morally responsible delib-
(LCMS 1998). eration about whether amniocentesis should be
The 2001 convention established a standing undertaken will involve a careful assessment of
commission on sanctity of life (Res. 6-01) and the technique’s possible benefits in relation to
directed synodical presidents to write to the these potential costs” (Santurri 1986: 6–7).
President of the United States requesting “a No official statement by the LCMS was found.
thorough review and reversal of the Food and
Drug Administration’s decision to permit the use Care of severely handicapped newborns
of the abortifacient drug RU-486” (Res. 6-02A) The LCA is the only constituent body of the
(LCMS 2001). ELCA that has officially addressed the topic of
the care of severely handicapped newborns. In
Prenatal diagnosis and treatment 1982, it held that in the case of “a newborn
The ELCA has not directly addressed the issue of infant with serious birth defects . . . the
prenatal diagnosis and treatment, although its Christian response . . . must be a strong
statement on abortion (above) indicates that in presumption in favor of treatment. Exceptions
some cases, prenatal diagnosis may lead to a might arise in cases of extreme and over-
morally acceptable decision to have an abortion; whelming suffering from which death would be
this suggests that prenatal diagnosis is acceptable a merciful release, or in cases in which the
to the ELCA. The ALC stated that prenatal diag- patient has irretrievably lost consciousness”
nosis was acceptable under some circumstances: (LCA 1982: 4).
A pamphlet titled The Nontreatment of
Evaluation of a pregnancy-in-process by currently Seriously Handicapped Newborns, published as
imperfect and imprecise methods (mainly amnio- part of the 1986 LCA–ALC series, advocates
centesis) is appropriate under some circumstances. equal treatment of all persons regardless of age:
This is the case with families with increased “Our reasons for stopping treatment of handi-
genetic risk or with existing children suffering capped newborns must hold across the lifespan
from metabolic or developmental abnormalities. and must be compatible with reasons for
Amniocentesis will help provide data [with] which treating. No one should be treated actively when
to decide for or against abortion, to assuage treatment no longer does any good. That reason,
parental fears, and to facilitate adequate medical however, does not single out unwanted infants as
treatment. It must, however, be questioned as a nonpersons; it does not regard early human life
routine screening procedure, as a means of as dispensable or replaceable; and it does not
assuring the desired sex of the offspring, when prefer the rights or values of adults to the lives

and needs of these patients” (Tiefel 1986: 11). nowhere does the document indicate that
The LCMS document Christian Care at Life’s newborns are to be treated differently from
End states, “In respect for our relationship with others. In the case of severely handicapped
God and with one another, we are required to newborns, as in the case of all severely compro-
give and to receive ‘ordinary’ care in which the mised individuals, those involved in making
good effects of the treatment are proportionate decisions should “ponder God’s guidance and
to the difficulty and inconvenience involved, seek principled ways to apply that guidance to
care that can be provided without imposing an the complexities of life in a world made difficult
excessive burden on the patient and on others. by sin” (LCMS 1993: 30). See “Death and
We may, and perhaps should, reject ‘extraordi- Dying,” below, for additional discussion of
nary’ care and in such cases ‘let nature take its LCMS principles.
course’” (LCMS 1993: 20–21). The document
recognizes that people of faith may disagree in
their application of these principles, but
GENETICS
he ELCA and its predecessor bodies have of human embryos. The resolution stated that
T generally displayed cautious optimism about
the possibilities created by new knowledge of
the “Synod convention reject[s] without reserva-
tion as contrary to God’s Word any technique or
genetics. “While we may celebrate the potential method of human cloning that results in the
of genetic knowledge, its application presents destruction of human embryos or the creation of
challenges that range from interesting questions human embryos for the purpose of harvesting”
to troubling personal crises and social (Res. 3-15B) (LCMS 1998). The Commission’s
dilemmas” (ELCA 2001a: 5). These matters are study is ongoing at this time.
explored in a book intended for congregational
study, Genetics! Where Do We Stand as
Christians? which, though not a statement of CLINICAL ISSUES
church policy, assists readers in facing these
challenges (ELCA 2001a). The ELCA has also Genetic screening and counseling
published a book on human cloning, which The ELCA has not yet officially addressed the
contains papers presented at a church consulta- topic of genetic screening and counseling. The
tion that brought together persons working in ALC was fairly positive about their possibilities:
genetics, theology, ethics, and law (ELCA “The benefit of expert genetic counseling is
2001c). This book, too, is intended to foster potentially very great. . . . As an endorsement of
individual and congregational deliberation responsible parenthood, the church has an obli-
rather than provide definite answers or set forth gation to foster genetic education of youth and
church policy. young adults, to assist older mothers, families
The 1998 convention of the LCMS requested with a history of genetic defects, and families
its Commission on Theology and Church with abnormal children in obtaining adequate
Relations to prepare a study document on the expert genetic counseling” (ALC 1977: 4).
issues raised by human cloning and directed Similarly, in 1980 the ALC stated, “Should
that special attention be given to issues either partner bear hereditary traits that might
surrounding the production and harvesting impose serious genetic difficulties upon their

child, we encourage them to seek competent For certain diseases detectable in utero [such as
genetic counseling” (ALC 1980: 6). Tay-Sachs disease] the prospective symptoms are
A pamphlet titled Genetic Screening and so harsh that it is meaningful to speak of selective
Counseling, published in the 1986 LCA–ALC abortion not as the abandonment of parental care,
Procreation Ethics series, emphasizes respon- but quite the contrary, as the very manifestation of
sible use of genetic knowledge, which, in the such care. At the same time, there are other
author’s view, may include an obligation not to genetic afflictions [such as Down’s syndrome] in
procreate: “Responsible use of our genetic relation to which an argument for genetic abortion
knowledge in screening and counseling for the is not so easily made—if it can be made at all.
prevention of unnecessary suffering is in accord . . . Finally, there will be borderline cases (neural
with God’s purposes. However, . . . it is also tube afflictions) where there is enormous variation
possible and even likely that sinful human in degree of severity and where the exact degree
beings will misuse the knowledge they gain or in a given case cannot be projected by the appro-
be misguided in their application of that knowl- priate prenatal tests. Given a moral presumption
edge” (Childs 1986: 7). “Christian couples against fetal destruction, perhaps the reasonable
facing the risk of severe genetic disorders in choice under such conditions of uncertainty is to
their children need to consider their obligation forego the abortion option in the hope that a
to forego the freedom to procreate, and not tolerable existence will be achieved. (Santurri
gamble with the odds in order to prevent unnec- 1986: 10; see also ELCA 2001a: 26-32)
essary suffering” (Childs 1986: 9; see also ELCA
2001a: 26-32). The LCMS would strongly disagree with the
As indicated above (under “Contraception”), assertion that abortion could be an acceptable
the LCMS recognizes that Christian couples may way to “care” for any human fetus; instead, it
conscientiously choose not to have children would argue that “since abortion takes a human
when there is a probability of severe genetic life, abortion is not a moral option, except as a
disease (LCMS 1996: 32). See also “Prenatal tragically unavoidable byproduct of medical
diagnosis and treatment,” above. procedures necessary to prevent the death of
another human being, viz., the mother” (LCMS
Sex selection 1979a: 117).
A 1977 statement by the ALC asserted that See also “Prenatal diagnosis and treatment”
prenatal diagnosis must “be questioned . . . and “Abortion and the status of the fetus,” above.
as a means of assuring the desired sex of the
offspring” (ALC 1977: 4). Gene therapy
Because of its strong opposition to abortion In June 1983, the presiding bishop of the LCA,
and its insistence that all eggs fertilized in vitro James R. Crumley, Jr., and 57 other religious
be implanted in the mother’s womb, the LCMS leaders issued a resolution asking Congress to
would almost certainly oppose any efforts to forbid genetic engineering of human germline
select the sex of a particular child when the cells. Crumley told reporters, “There are some
destruction of an embryo would result. aspects of genetic therapy [for human diseases]
that I would not want to rule out. My concern is
Selective abortion that someone would decide what is the most
No official statements specifically addressing correct human being and begin to engineer the
selective abortion were found. The 1986 germline with that goal in mind” (as quoted in
pamphlet The Ethics of Prenatal Diagnosis states Nelson 1991: 127–28).
a presumption against abortion but argues that While sharing Crumley’s concerns, the
in some cases abortion is a permissible way to author of the LCA–ALC pamphlet Genetic
“care” for the severely handicapped: Manipulation expressed much more optimism:

“New tools for dealing with nature may be Although the LCMS has not issued any offi-
means by which God is using us to work at cial statements on gene therapy, the Commission
bringing back the whole created order into line on Theology and Church Relations is currently
with God’s own purpose. The Christian is discussing the issue.
inclined, therefore, to underscore the promise
rather than the peril of new discoveries.
. . . [T]he drive of Christianity toward the future
redemption of all things would seem to suggest
that those who oppose the procedure be asked
to present solid reasons for that opposition”
(Burtness 1986: 10).
ORGAN AND TISSUE TRANSPLANTATION
oth the LCA and the LCMS have issued use of our needed organs at the time of death in
B statements encouraging organ transplanta-
tion under certain circumstances.
order to relieve the suffering of individuals
requiring organ transplants),” and “encourage[d]
family members to become living kidney
donors” (LCMS 1981a: 204).
CLINICAL ISSUES
Procurement from cadaveric and living
Issues concerning recipients donors
No official statements from any Lutheran “The Lutheran Church in America regards the
churches were found concerning recipients of donation of cadaver organs as an appropriate
transplants. means of contributing to the health and well-
being of the human family” (LCA 1984: 2).
Issues concerning donors See “Issues concerning donors,” above, for
Although the ELCA has not yet addressed this the LCMS position on the procurement of
issue, the LCA was very positive about organ organs from cadaveric and living donors.
and tissue donation: “The Lutheran Church in
America recognizes that the donation of renew- Procurement from anencephalic newborns
able tissue (e.g., bone marrow) and live organs and human fetuses
(e.g., a kidney) can be an expression of sacrifi- No official statement from any Lutheran synod
cial love for a neighbor in need [and] encour- was found. The LCMS would almost certainly
ages its members to consider the possibility of object to procurement from anencephalic
organ donation and to communicate their wishes newborns or human fetuses if death were the
to family members, physicians and health care result. It has resolved to “reject without reser-
institutions” (LCA 1984: 2). vation . . . any technique or method of human
Similarly, in 1981 the LCMS adopted a reso- cloning that results in the destruction of human
lution that encouraged churchwide education embryos or the creation of human embryos for
about organ and tissue transplants, including the purpose of harvesting” tissue or organs for
informing members of “the opportunity to sign a transplantation (Res. 3-15b) (LCMS 1998).
Universal Donor Card (which is to authorize the

MENTAL HEALTH
uther believed that mental and physical that often accompanies it” (ELCA 2001b: 6).
L health are interrelated: “With regard to
depression Luther recommended not only
At its 1995 synod convention, the LCMS
adopted a resolution “that the Districts of the
Scripture and prayer, but good company, good Lutheran Church—Missouri Synod identify indi-
food and drink, music, laughter, and if neces- viduals and/or establish a Task Force on Mental
sary, fantasies about the other sex! . . . Thus Illness within each District to address the
Luther related physical and mental health, concerns/needs of persons with serious mental
commenting at one point: ‘Our physical health illness and the concerns/needs of families”
depends in large measure on the thoughts of our (LCMS 1995: 143).
minds’” (Lindberg 1986: 182).
The ALC issued a paper calling on the church
to be more responsive to people with mental CLINICAL ISSUES
illnesses. It emphasized that Christians should
not judge those with mental illnesses or view No official statements from any Lutheran synods
mental illness as God’s punishment but rather were found concerning involuntary commitment,
offer care and support to the mentally ill and psychotherapy and behavior modification, or
their families (ALC n.d.). The first draft of a psychopharmacology.
proposed ELCA social statement maintains that
“[m]ental health services must be fully incorpo- Electroshock and stimulation
rated within health care services. The suffering A statement by the ALC affirmed that electro-
caused by mental illness—to both sufferers and convulsive shock therapy could be useful under
loved ones—is not only debilitating but is inten- certain circumstances (ALC n.d.: 3).
sified by the labeling, isolating, and moral blame
MEDICAL EXPERIMENTATION AND RESEARCH
ccording to the first draft of a proposed research purposes (Res. 3-15B) (LCMS 1998).
A ELCA social statement, “Research and [the]
development of knowledge and new technolo-
Three years later, the convention adopted a
resolution on stem cell research. While “not
gies and practices are an essential part of well- opposed to all stem cell research as a means of
coordinated health care,” and such research is seeking alleviation for disease”—the use of
worthy of “substantial financial investment” umbilical cord and adult stem cells is unobjec-
(ELCA 2001b: 8). tionable—the convention found the destruction
The LCMS Commission on Theology and of human embryos to be “sinful and morally
Church Relations is currently studying medical objectionable” and denounced “the utilitarian
research involving human cloning. However, values that place possible healing of medical
the 1998 LCMS convention rejected the diseases over the life of defenseless human
creation or destruction of human embryos for embryos” (Res. 6-13) (LCMS 2001).

DEATH AND DYING
n the Lutheran tradition, death is not simply a and resurrection of Jesus Christ, God has
I natural event—it is the ultimate result of sin.
One prominent Lutheran thinker has put it this
removed the “sting” of death and continues to
envelop believers even outside of their mortal
way: “In the tradition, death is not merely the existence (Marty 1986: 159). “Even as the
result of natural law. It is a crisis, a decisive person who awakes from a night’s slumber is the
event. I am partly responsible for it. I have taken same one who went to sleep in the first place, so
actions against God—even if I have seemed to be the person who lies down to die is the very one
‘saintly’—and am thus an agent of what is ahead to be awakened to his eternal destiny in the
of me. Somehow what is happening is also my resurrection of all people” (LCMS 1979b: 21).
due. This is a particularly uncomfortable aspect
of the Lutheran view of death, but without it the
therapy and affirmation this version of faith CLINICAL ISSUES
offers is hollow” (Marty 1986: 165).
Not all Lutheran discussions of death empha- Determining death
size this point, however. For example, the ALC’s In 1977 the ALC affirmed that “definitions of
primary statement on death and dying begins death consist of more than biological facts. They
with the sentence: “Death is a natural event in must also consider the personal and the spiritual
the course of human life” (ALC 1977: 7). In a dimensions of life. Since the dimensions of
discussion of the LCA’s 1982 statement, Death biology and personhood are present in every
and Dying, author Daniel Lee observes that instance of life and death, both deserve equal
“being born and dying are part of the dynamic consideration in any serious attempt to render
life processes as God has created them” (Lee definition” (ALC 1977: 7).
1983: 2). But death is not the end of human In a companion study guide to the LCA’s
existence, for “neither life nor death are [sic] 1982 statement Death and Dying, Daniel Lee
absolute. We treasure God’s gift of life; we also discusses the technical definitions of death:
prepare ourselves for a time when we may let go “The whole or total brain definition has the
of our lives, entrusting our future to the cruci- most to recommend it. Unlike the upper or
fied and risen Christ who is ‘Lord of both the higher brain definition it does not reduce the
dead and the living’ (Romans 14:9)” (ELCA concept of death to irreversible loss of
1992: 2). The first draft of a proposed ELCA consciousness. Nor does it violate social sensitiv-
social statement goes even further. “We should ities in the way that the upper or higher brain
not cling to life at all costs, thereby denying the definition does. Unlike the spontaneous heart-
reality of death in our lives and the promise of lung definition it does not run the risk of
salvation and eternal life” (ELCA 2001b: 7). declaring death when consciousness is still
The LCMS’s 1979 Report on Euthanasia possible. And, unlike the more inclusive heart-
reflects well the traditional Lutheran view of lung definition, it does not by implication extend
death: “God created human beings to live and the definition of human life beyond the point
not to die. Death in any form is inimical to what where integrated functioning of the organism as
God originally had in mind for His creation. a whole is possible” (Lee 1983: 51).
. . . Dying, therefore, is not just another point in The LCMS, consistent with the foregoing
the cosmic process or in the experience of statements, has said, “When death, therefore, is
living, as it is sometimes made out to be” described only in terms of the total stoppage of
(LCMS 1979b: 18). For Christians, death does the circulation of blood and the cessation of the
not have the final victory; through the death animal and vital functions, or even as irre-

versible coma, that may not say enough. For Forgoing life-sustaining treatment
behind such a statement is a view of human life The first draft of an ELCA social statement indi-
which identifies it solely with that of the animal cates that “when death is likely or imminent, a
kingdom. This does not do justice to the biblical peaceful death should become the goal of a
revelation. . . . Dying, therefore, is called giving health care system, sought as confidently and
up one’s spirit. . . . The use of the criterion of competently as other goals through adequate
‘brain death’ has contributed to a more palliative care and services such as hospice.
constructive discussion in depth of the subject at Our health care services should not abandon
hand” (LCMS 1979b: 18). those who are dying” (ELCA 2001b: 7). The
ELCA and its predecessor bodies support the
Pain control and palliative care right of persons to forgo life-sustaining treat-
Lutherans generally agree about the importance ment, including nutrition and hydration: “Food
of pain control, despite its possible risks, and and water are part of basic human care.
palliative care. “Physicians and other health Artificially-administered nutrition and hydration
care professionals also have responsibility to move beyond basic care to become medical
relieve suffering. This responsibility includes the treatment. Health care professionals are not
aggressive management of pain, even when it required to use all available medical treatment
may result in an earlier death” (ELCA 1992: 4). in all circumstances. Medical treatment may be
“Every reasonable effort should be made to limited in some instances, and death allowed to
collaborate with patients to alleviate pain” occur. Patients have a right to refuse unduly
(ELCA 2001b: 7). “At the same time, adjust- burdensome treatments which are dispropor-
ments in administering [pain-relieving] drugs tionate to the expected benefits” (ELCA 1992:
should be made so as not to deprive the patient 3). In such cases, the patient should be the
of consciousness prematurely” (LCA 1982: 5). primary decision maker, but all decisions should
“When artificially-administered nutrition and be made in consultation with others who are
hydration are withheld or withdrawn, family, directly involved: “We consider . . . [advance
friends, health care professionals, and pastor directive] legislation [to be] consistent with the
should continue to care for the person. They are principle that ‘respect for that person [who is
to provide relief from suffering, physical capable of participating] mandates that he or
comfort, and assurance of God’s enduring love” she be recognized as the prime decision-maker’
(ELCA 1992: 3). in treatment. The patient is a person in relation-
The LCMS takes a very similar stance: ship, not an isolated individual. Her or his deci-
“Administering pain-killing medications, even at sions should take others into account and be
the risk of shortening life, is permissible, since made in supportive consultation with family
this does not entail the choice of death as either members, close friends, pastor, and health care
a means or an end” (LCMS 1993: 5). Death as a professionals” (ELCA 1992: 1).
“solution” to suffering is never an option in the A 1993 report issued by the LCMS stated that
LCMS; instead, suffering gives Christians the “when the God-given powers of the body to
opportunity to practice their faith through sustain its own life can no longer function and
caring: “In Christ we discover that we need not doctors in their professional judgment conclude
flee from the sufferer whose suffering resists that there is no real hope for recovery even with
alleviation and explanation. Our baptism life-support instruments, a Christian may in
concretely witnesses to Christ’s presence with us good conscience ‘let nature take its course’”
and gives us strength in the presence of (LCMS 1993: 5). Likewise, a 1995 resolution
suffering” (LCMS 1993: 25). opposing legalization of assisted suicide said,

“We respect the individual’s right to refuse treat- is an affront to the Lord, who gives life, and
ment or to forbid life-support systems by a prior opens the door for abuse and future legislation
directive and to be allowed to die” (LCMS 1995: that would deny the freedom of many” (LCMS
141). Disagreement exists within the synod over 1995: 143). The synod also maintains that
whether artificially administered nutrition and “Christians are obligated to make their position
hydration constitute “ordinary” (necessary) or known, by whatever means possible, as a way of
extraordinary care for someone in a persistent helping to shape public opinion on the question
vegetative state. The validity of both positions of euthanasia” (LCMS 1993: 31). In 1998 the
can be demonstrated given the guiding princi- LCMS convention reaffirmed its rejection of
ples articulated by the LCMS. In such an assisted suicide (Res. 6-02A) (LCMS 1998).
instance, individual conscience is respected.
Autopsy and postmortem care
Suicide, assisted suicide, and euthanasia A 1982 statement by the LCA encouraged
Both the ELCA and the LCMS maintain a members to consider authorizing an autopsy or
strong stand against assisted suicide. The ELCA donating a body for scientific purposes (LCA
has stated, “As a church we affirm that deliber- 1982: 7).
ately destroying life created in the image of The LCMS regards the practice of donating
God is contrary to our Christian conscience. one’s body for medical research as “a matter of
. . . We oppose the legalization of physician- individual conscience” (Nelson 1991: 139).
assisted death, which would allow the private
killing of one person by another. Public control Last rites, burial, and mourning customs
and regulation of such actions would be Although cremation has become increasingly
extremely difficult, if not impossible. The poten- acceptable among Lutherans, it is still a
tial for abuse, especially of people who are most minority practice; most Lutherans are buried
vulnerable, would be substantially increased” after death. Burial from a church, rather than
(ELCA 1992: 4). from a funeral home, is the traditional practice
The LCMS, consistent with its strong pro-life of Lutheranism, and one that is once again on
stance, has condemned death as a means to end the ascendancy after a period of decline.
suffering. “To the dismay and fear of many, the Lutheran graveside services reflect widely held
advocates of euthanasia, as well as of assisted Christian beliefs and emphasize both the reality
suicide, have sought to justify the taking of of death and the hope of resurrection (Marty
human life on moral grounds by describing it as 1986: 163–64).
a truly compassionate act aimed at the relief of
human suffering. In light of what the Scriptures Stillbirths
say about the kind of care God wills that we The historical Lutheran teaching and practice
provide to those who suffer and are facing is to baptize only living persons (LCA 1970: 5); if
death, we reject such claims as neither compas- the possibility of life exists in a stillborn, baptism
sionate nor caring. Christians aim always to would be appropriate (Marty 1986: 143).
care, never to kill” (LCMS 1993: 3).
The LCMS holds that euthanasia and assisted
suicide are contrary to God’s law (LCMS 1993: 5)
and that “any attempt to legalize assisted suicide

SPECIAL CONCERNS
ATTITUDES TOWARD DIET AND THE USE the LCA and ALC, includes two services entitled
OF DRUGS “Service of the Word for Healing” and “Laying
on of Hands and Anointing the Sick.” Although
ne author representing the LCA wrote that anointing the sick is not a sacrament in the
O stewardship of the gift of life “includes
eating balanced diets, exercising regularly and
Lutheran church as it is in the Catholic
churches, these services do display a sacra-
otherwise doing those things that contribute to mental quality (Ballard 1987: 20). The use of
good health” (Lee 1983: 12). According to the liturgies for healing is encouraged in the first
first draft of a proposed ELCA social statement, draft of a proposed ELCA social statement
stewardship of our own health includes “taking (ELCA 2001b: 13).
reasonable steps to prevent illness and disease”
and “engaging in healthy behaviors.” The state- Holy days
ment recognizes, however, that “[d]isability, Like many Christians, Lutherans observe litur-
disease, and illness do happen . . . even to those gical festivals and designate certain days in
who are good stewards” (ELCA 2001b: 10). commemoration of saints, martyrs, and other
A 1971 LCMS resolution stated, “We notable Christians. Unlike the Roman Catholic
encourage all people to avoid perverting God’s church, the Lutheran church does not consider
will by resorting to indiscriminate termination of these occasions “holy days,” nor does it recog-
life, either directly through such acts as abortion nize “feasts of obligation.” Each Sunday is the
or euthanasia or indirectly through the improper Lord’s Day.
use of drugs, tobacco, and alcohol” (Resolution
9-07, as quoted in Larue 1985: 63). Polity, scripture, and doctrine
The ELCA is “the most liberal of Lutheran
church bodies in North America. . . . The
R ELIGIOUS OBSERVANCES church is divided into 65 synods, each headed
by a bishop. During the final merger process [in
Baptism and Eucharist 1987], headquarters for the new church were
Baptism and Eucharist are the two sacraments established in Chicago. Administratively, the
in the Lutheran church; most Lutherans are churchwide organization is divided into units
baptized in infancy. with particular program responsibilities,” and
the whole church is headed by a presiding
Blessing of the sick bishop (Melton 1993: 320). The ELCA accepts
Although Lutheranism is a liturgical tradition, the Bible as the inspired word of God, the three
“there is less recourse here than in some other great ecumenical creeds (the Apostle’s, Nicene,
traditions to the notion of a separate supernat- and Athanasian) as declarations of faith, the
ural sphere to which the believer seeks access Unaltered Augsburg Confession as a witness to
through the use of anointing oils, the laying on the gospel, and the other confessional writings
of hands, or special prayers of healing designed of the Book of Concord as valid interpretations
to induce miracles” (Marty 1986: 84). of the faith.
Nevertheless, Lutheran interest in liturgies of The LCMS is relatively conservative. It main-
healing has increased in recent years. The 1982 tains that the Bible is the inerrant Word of God
edition of Occasional Services: A Companion to and it operates with modified congregational
Lutheran Book of Worship, published jointly by polity. “The members’ responsibility for congre-

gational leadership is a distinctive characteristic
of the synod. Power is vested in voters’ assem-
blies, generally comprised of adults of voting
age. Synod decision making is given to the dele-
gates at national and regional conventions,
where the franchise is equally divided between
lay and pastoral representatives” (Bedell 1994:
96). In addition to the Bible, the synod accepts
all the writings in the Book of Concord as “a
true and unadulterated statement and exposition
of the Word of God” (LCMS Constitution II); the
Book of Concord includes the three great
ecumenical creeds, the Augsburg Confession,
Luther’s Small Catechism, his Large Catechism,
and four other sixteenth-century statements
(Nafzger 1994: 7).

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(A paper issued by the ALC’s Standing Committee for Draft of a Social Statement. (A proposed social state-
Church in Society “as a stimulus to thought and ment drafted by the ELCA Task Force on Health and
action within ALC congregations.”) Health Care. It is to be presented to the 2003
Churchwide Assembly.)
______. 1977. Health, Life, and Death: A Christian
Perspective. (A paper issued by the ALC’s Office of ______. 2001c. Human Cloning: Papers from a Church
Research and Analysis following two years of study by Consultation. (Papers presented at a consultation on
its Task Force on Ethical Issues and Human Medicine. human cloning convened by the Division for Church
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______. 2001d. Our Ministry of Healing: Health and
______. 1980. Human Sexuality and Sexual Behavior. (“A Health Care Today. (A study guide prepared by the
statement of comment and counsel addressed to the ELCA Task Force on Health and Health Care in
member congregations of [the ALC] and their conjunction with their drafting of a proposed social
members individually, for their consideration and such statement.)
action as they may deem appropriate.”)
Larue, Gerald A. 1985. Euthanasia and Religion: A Survey
Ballard, Richard G. 1987. “Lutheran Ambivalence toward of the Attitudes of the World’s Religions to the Right-to-
Healing Ministry.” Lutheran Forum 21, no. 4: 17–21. Die. Los Angeles: Hemlock Society.
Bedell, Kenneth B., ed. 1994. Yearbook of American and Lee, Daniel E. 1983. Death and Dying: Ethical Choices in a
Canadian Churches. Nashville: Abingdon. Caring Community. New York: Lutheran Church in
America.
Burtness, James H. 1986. Genetic Manipulation. New York:
Lutheran Church in America. Lindberg, Carter. 1986. “The Lutheran Tradition.” In
Caring and Curing: Health and Medicine in the
Childs, James M. 1986. Genetic Screening and Counseling.
Western Religious Traditions, ed. Ronald L. Numbers
New York: Lutheran Church in America.
and Darrel W. Amundsen, 173–203. New York:
Evangelical Lutheran Church in America. 1989. Social Macmillan.
Statements of the Evangelical Lutheran Church in
Lutheran Church in America. 1970. Sex, Marriage, and
America: Policies and Procedures. (“Approved by the
Family. (Social statement of the Lutheran Church in
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America, adopted by the Fifth Biennial Convention.)
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______. 1982. Death and Dying. (Social statement of the
______. 1991. A Social Statement on Abortion. (A social
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Assembly of the ELCA.) ______. 1984. “Resolution on Organ Donation.” (Adopted
by the Twelfth Biennial Convention.)
______. 1992. A Message on End-of-Life Decisions. (This
message, issued by the Church Council of the ELCA, ______. 1986. Procreation Ethics: A Series of Essays on
“encourages further deliberation” throughout the Issues at the Beginning of Human Life.
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Lutheran Church—Missouri Synod. 1979a. Convention
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______. 2001a. Genetics! Where Do We Stand as Synod.
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______. 1979b. Report on Euthanasia with Guiding
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Theology and Church Relations that “concludes with a
statement of some basic principles which may prove
helpful in reaching spiritual and moral decisions that
bear the stamp of validity in terms of God’s Word.”)

______. 1981a. Convention Proceedings. St. Louis: McDowell, Janet Dickey. 1986. Surrogate Motherhood. New
Lutheran Church—Missouri Synod. York: Lutheran Church in America.
______. 1981b. Human Sexuality: A Theological Melton, J. Gordon. 1993. Encyclopedia of American
Perspective. (A report of the Commission on Theology Religions. Detroit: Gale Research.
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Lutheran Tradition: Being Well. New York: Crossroad.

Introduction to the series
eligious beliefs provide meaning for people The guidelines in these booklets should
R confronting illness and seeking health, partic-
ularly during times of crisis. Increasingly, health-
not substitute for discussion of patients’ own
religious views on clinical issues. Rather, they
care workers face the challenge of providing should be used to supplement information
appropriate care and services to people of different coming directly from patients and families, and
religious backgrounds. Unfortunately, many used as a primary source only when such first-
healthcare workers are unfamiliar with the reli- hand information is not available.
gious beliefs and moral positions of traditions We hope that these booklets will help
other than their own. This booklet is one of a practitioners see that religious backgrounds
series that aims to provide accessible and practical and beliefs play a part in the way patients deal
information about the values and beliefs of differ- with pain, illness, and the decisions that arise in
ent religious traditions. It should assist nurses, the course of treatment. Greater understanding
physicians, chaplains, social workers, and adminis- of religious traditions on the part of care
trators in their decision making and care giving. providers, we believe, will increase the quality
It can also serve as a reference for believers who of care received by the patient.
desire to learn more about their own traditions.
Each booklet gives an introduction to the
history 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.
Finally, each booklet offers information on spe-
cial concerns relevant to the particular tradition.
The editors 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 THE PARK RIDGE CENTER
FOR THE STUDY OF HEALTH, FAITH, AND ETHICS
views in opposition to mainstream positions, or
groups that maintain different emphases. 205 West Touhy Avenue ● Suite 203 ● Park Ridge, Illinois 60068-4202
The editors also recognize that the beliefs and

values of individuals within a tradition may vary The Park Ridge Center explores and
from the so-called official positions of their tradi- enhances the interaction of health, faith,
tion. In fact, some traditions leave moral decisions and ethics through research, education, and
about clinical issues to individual conscience. We consultation to improve the lives of
individuals and communities.
would therefore caution the reader against gener-
alizing too readily. © 2002 The Park Ridge Center. All rights reserved.

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The Lutheran Tradition

Religious Beliefs and

uring the Middle Ages, most of western Europe

Part of the “Religious Traditions and

THE PARK RIDGE CENTER

2 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

THE PARK RIDGE CENTER 3

THE INDIVIDUAL AND THE PATIENT-CAREGIVER RELATIONSHIP

utherans generally favor open communica- self-determination should always be understood

should be . . . a partnership of trust in pursuit

4 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

THE PARK RIDGE CENTER 5

FAMILY, SEXUALITY, AND PROCREATION

6 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

THE PARK RIDGE CENTER 7

8 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

THE PARK RIDGE CENTER 9

10 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

THE PARK RIDGE CENTER 11

12 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

THE PARK RIDGE CENTER 13

ORGAN AND TISSUE TRANSPLANTATION

14 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

MEDICAL EXPERIMENTATION AND RESEARCH

THE PARK RIDGE CENTER 15

16 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

THE PARK RIDGE CENTER 17

18 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

THE PARK RIDGE CENTER 19

20 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

THE PARK RIDGE CENTER 21

22 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

The editors also recognize that the beliefs and

24 THE LUTHERAN TRADITION: RELIGIOUS B ELIEFS AND HEALTHCARE DECISIONS

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