The thief who died on the cross with Jesus Christ had "a good death," a leading Christian medical ethicist said Saturday in Riverside.

The man, identified as Dismas, admitted his guilt and defended Christ's innocence. He was rewarded with the promise of being with the Savior in paradise.

In their final, dying hours, the faithful cannot plan on such luck, Dr. Tristam Engelhardt Jr. told a Christian medical ethics conference Saturday.

"When I'm very vulnerable, very sick, very confused, are you (the doctor) going to clearly give me direction on where I should go?" he asked the physicians in the audience.

Physicians may not be able to give such help if their patients do not leave an advanced directive, also called a living will, spelling out what treatment is acceptable. And that document must be available not only to the doctor, but to the family and priest, he said.

Engelhardt spoke at a conference on Christian medical ethics sponsored by St. Andrew Orthodox Church in Riverside. About 100 people, including doctors, nurses and attorneys, attended at the Mission Inn. A member of the Antiochian Orthodox Church, he is a professor of medicine at Baylor College of Medicine and a professor of philosophy at Rice University. He is editor of the Journal of Medicine and Philosophy.

Orthodox Christian prayer asks for a painless death, Engelhardt said, but that moral wish should not be warped into active euthanasia, when drugs are used to hasten death.

Reading the Bible and praying around the bedside as loved ones died "made sense for 2,000 years, but now has become suspect. Death can be as sanitized and unobtrusive as possible."

Society wants "not as much death with dignity but as much pleasure up to the end," he said. But the best examples of "good death" were Christ on the cross and the martyrs, who died in humility and submission to God, he said. A good death does not necessarily mean one without pain or uncertainty, but a death that fulfills the patient's moral beliefs.

Engelhardt said he is worried as much about physicians as their patients. Christian doctors opposed to abortion, for instance, in some states must tell expectant women about prenatal testing that could lead to abortion or risk losing their licenses.

However, he said the motive for performing a test or choosing a treatment course determines its morality. Prenatal testing could lead to successful treatment of spina bifida. Or he said a parent may choose to forgo chemotherapy and decide to spend the money to put his children through college.

The medical community, pressured by cost containment, influenced by society's disdain for moral absolutes and taught to prolong life, may push for treatment that violates basic Christian principles, Engelhardt said.

"If the procedure is not being done to help the child, tell the physician to go away," he said. And if there is little hope of a cure, he said it is acceptable to turn down potential treatment and "let God's will be done."

The secular world understands waiting to update a will or until a pension plan vests. It may not understand that Orthodox Christians want to be ready to be judged, he said.

Responding to audience questions, Engelhardt said the Orthodox Church opposes cremation, not only because it believes in incarnation but because believers have received Christ into their bodies through communion.

Organ donation from parent to child is encouraged, but Engelhardt said he is struggling with the "puzzle" of brain death, which determines whether harvesting organs is acceptable. Sybel Alger can be reached by e-mail at salger@pe.com or by phone at (909) 654-0564.

Published 8/15/1999