A Prayer for the Midwife: A Late Byzantine Ritual as Liturgical Model for Responding to Moral Distress in Medicine
Julie Gunby, Saint Louis University, Northside Hospital Gwinnett

Providing medical care requires practitioners to deal in matters of life and death and entails intimate involvement with suffering and evil. Even when no medical errors occur, physicians and nurses perform painful procedures, inflict unintentional injury and harm, and are actors in the events leading up to the death of their patients. Whereas Western moral theory centers on matters of guilt and personal culpability, the moral residue attendant to the practice of medicine is best described, following Clement of Alexandria, as spiritual harm or “entanglement with evil” rather than culpable commission or omission. It is the purpose of this essay to offer a theological analysis of two prayers for midwives that were introduced into Orthodox service books (euchologia) in Greece and Russia in late Byzantium. The goal of this account is to demonstrate ways that these prayers for midwives from the late 15th century point to Christian liturgical and pastoral resources that are relevant to alleviating the moral distress associated with the practice of medicine today. The paper proceeds in four parts: I first situate the prayers historically and theologically in the Christian tradition. I then offer a critical reading of the prayers from the standpoint of theological ethics and midwifery practice. Finally, I conclude by suggesting ways that the themes which arise in this analysis can be used to address some of the more vexing and underrecognized elements of moral distress associated with the practice of medicine, particularly those aspects of medical care involving non-culpable agent-regret and lament.