A moral theologian has reminded Catholic doctors to uphold the ethical values of their profession and refrain from doing things harmful to human life, particularly to unborn children. “The most important principle is to maintain… More
POPE FOR WORLD DAY OF THE SICK 2016
MESSAGE OF HIS HOLINESS POPE FRANCIS
FOR THE 24th WORLD DAY OF THE SICK (Feb 11th 2016)
Entrusting Oneself to the Merciful Jesus like Mary:
“Do whatever he tells you” (Jn 2:5)
Dear Brothers and Sisters,
The twenty-fourth World Day of the Sick offers me an opportunity to draw particularly close to you, dear friends who are ill, and to those who care for you.
This year, since the Day of the Sick will be solemnly celebrated in the Holy Land, I wish to propose a meditation on the Gospel account of the wedding feast of Cana (Jn 2: 1-11), where Jesus performed his first miracle through the intervention of his Mother. The theme chosen – Entrusting Oneself to the Merciful Jesus like Mary: “Do whatever he tells you” (Jn 2:5) is quite fitting in light of the Extraordinary Jubilee of Mercy. The main Eucharistic celebration of the Day will take place on 11 February 2016, the liturgical memorial of Our Lady of Lourdes, in Nazareth itself, where “the Word became flesh and made his dwelling among us” (Jn 1:14). In Nazareth, Jesus began his salvific mission, applying to himself the words of the Prophet Isaiah, as we are told by the Evangelist Luke: “The Spirit of the Lord is upon me, because he has anointed me to bring glad tidings to the poor. He has sent me to proclaim liberty to captives and recovery of sight to the blind, to let the oppressed go free, and to proclaim a year acceptable to the Lord” (Lk4:18-19).
Illness, above all grave illness, always places human existence in crisis and brings with it questions that dig deep. Our first response may at times be one of rebellion: Why has this happened to me? We can feel desperate, thinking that all is lost, that things no longer have meaning…
In these situations, faith in God is on the one hand tested, yet at the same time can reveal all of its positive resources. Not because faith makes illness, pain, or the questions which they raise, disappear, but because it offers a key by which we can discover the deepest meaning of what we are experiencing; a key that helps us to see how illness can be the way to draw nearer to Jesus who walks at our side, weighed down by the Cross. And this key is given to us by Mary, our Mother, who has known this way at first hand.
At the wedding feast of Cana, Mary is the thoughtful woman who sees a serious problem for the spouses: the wine, the symbol of the joy of the feast, has run out. Mary recognizes the difficulty, in some way makes it her own, and acts swiftly and discreetly. She does not simply look on, much less spend time in finding fault, but rather, she turns to Jesus and presents him with the concrete problem: “They have no wine” (Jn 2:3). And when Jesus tells her that it is not yet the time for him to reveal himself (cf. v. 4), she says to the servants: “Do whatever he tells you” (v. 5). Jesus then performs the miracle, turning water into wine, a wine that immediately appears to be the best of the whole celebration. What teaching can we draw from this mystery of the wedding feast of Cana for the World Day of the Sick?
The wedding feast of Cana is an image of the Church: at the centre there is Jesus who in his mercy performs a sign; around him are the disciples, the first fruits of the new community; and beside Jesus and the disciples is Mary, the provident and prayerful Mother. Mary partakes of the joy of ordinary people and helps it to increase; she intercedes with her Son on behalf of the spouses and all the invited guests. Nor does Jesus refuse the request of his Mother. How much hope there is in that event for all of us! We have a Mother with benevolent and watchful eyes, like her Son; a heart that is maternal and full of mercy, like him; hands that want to help, like the hands of Jesus who broke bread for those who were hungry, touched the sick and healed them. All this fills us with trust and opens our hearts to the grace and mercy of Christ. Mary’s intercession makes us experience the consolation for which the apostle Paul blesses God: “Blessed be the God and Father of our Lord Jesus Christ, the Father of compassion and God of all encouragement, who encourages us in our affliction, so that we may be able to encourage those who are in any affliction with the encouragement with which we ourselves are encouraged by God. For as Christ’s sufferings overflow to us, so through Christ does our encouragement also overflow” (2 Cor 1:3-5). Mary is the “comforted” Mother who comforts her children.
At Cana the distinctive features of Jesus and his mission are clearly seen: he comes to the help of those in difficulty and need. Indeed, in the course of his messianic ministry he would heal many people of illnesses, infirmities and evil spirits, give sight to the blind, make the lame walk, restore health and dignity to lepers, raise the dead, and proclaim the good news to the poor (cf. Lk 7:21-22). Mary’s request at the wedding feast, suggested by the Holy Spirit to her maternal heart, clearly shows not only Jesus’ messianic power but also his mercy.
In Mary’s concern we see reflected the tenderness of God. This same tenderness is present in the lives of all those persons who attend the sick and understand their needs, even the most imperceptible ones, because they look upon them with eyes full of love. How many times has a mother at the bedside of her sick child, or a child caring for an elderly parent, or a grandchild concerned for a grandparent, placed his or her prayer in the hands of Our Lady! For our loved ones who suffer because of illness we ask first for their health. Jesus himself showed the presence of the Kingdom of God specifically through his healings: “Go and tell John what you hear and see: the blind regain their sight, the lame walk, lepers are cleansed, the deaf hear, the dead are raised, and the poor have the good news proclaimed to them” (Mt 11:4-5). But love animated by faith makes us ask for them something greater than physical health: we ask for peace, a serenity in life that comes from the heart and is God’s gift, the fruit of the Holy Spirit, a gift which the Father never denies to those who ask him for it with trust.
In the scene of Cana, in addition to Jesus and his Mother, there are the “servants”, whom she tells: “Do whatever he tells you” (Jn2:5). Naturally, the miracle takes place as the work of Christ; however, he wants to employ human assistance in performing this miracle. He could have made the wine appear directly in the jars. But he wants to rely upon human cooperation, and so he asks the servants to fill them with water. How wonderful and pleasing to God it is to be servants of others! This more than anything else makes us like Jesus, who “did not come to be served but to serve” (Mk 10:45). These unnamed people in the Gospel teach us a great deal. Not only do they obey, but they obey generously: they fill the jars to the brim (cf. Jn 2:7). They trust the Mother and carry out immediately and well what they are asked to do, without complaining, without second thoughts.
On this World Day of the Sick let us ask Jesus in his mercy, through the intercession of Mary, his Mother and ours, to grant to all of us this same readiness to be serve those in need, and, in particular, our infirm brothers and sisters. At times this service can be tiring and burdensome, yet we are certain that the Lord will surely turn our human efforts into something divine. We too can be hands, arms and hearts which help God to perform his miracles, so often hidden. We too, whether healthy or sick, can offer up our toil and sufferings like the water which filled the jars at the wedding feast of Cana and was turned into the finest wine. By quietly helping those who suffer, as in illness itself, we take our daily cross upon our shoulders and follow the Master (cf. Lk 9:23). Even though the experience of suffering will always remain a mystery, Jesus helps us to reveal its meaning.
If we can learn to obey the words of Mary, who says: “Do whatever he tells you”, Jesus will always change the water of our lives into precious wine. Thus this World Day of the Sick, solemnly celebrated in the Holy Land, will help fulfil the hope which I expressed in the Bull of Indiction of the Extraordinary Jubilee of Mercy: ‘I trust that this Jubilee year celebrating the mercy of God will foster an encounter with [Judaism and Islam] and with other noble religious traditions; may it open us to even more fervent dialogue so that we might know and understand one another better; may it eliminate every form of closed-mindedness and disrespect, and drive out every form of violence and discrimination’ (Misericordiae Vultus, 23). Every hospital and nursing home can be a visible sign and setting in which to promote the culture of encounter and peace, where the experience of illness and suffering, along with professional and fraternal assistance, helps to overcome every limitation and division.
For this we are set an example by the two Religious Sisters who were canonized last May: Saint Marie-Alphonsine Danil Ghattas and Saint Mary of Jesus Crucified Baouardy, both daughters of the Holy Land. The first was a witness to meekness and unity, who bore clear witness to the importance of being responsible for one another other, living in service to one another. The second, a humble and illiterate woman, was docile to the Holy Spirit and became an instrument of encounter with the Muslim world.
To all those who assist the sick and the suffering I express my confident hope that they will draw inspiration from Mary, the Mother of Mercy. “May the sweetness of her countenance watch over us in this Holy Year, so that all of us may rediscover the joy of God’s tenderness” (ibid., 24), allow it to dwell in our hearts and express it in our actions! Let us entrust to the Virgin Mary our trials and tribulations, together with our joys and consolations. Let us beg her to turn her eyes of mercy towards us, especially in times of pain, and make us worthy of beholding, today and always, the merciful face of her Son Jesus!
With this prayer for all of you, I send my Apostolic Blessing.
From the Vatican, 15 September 2015
Memorial of Our Lady of Sorrows
Easter Message from the President
My dear brothers and sisters in Christ,
Soon we will be celebrating Easter, commemorating our risen Lord’s victory over death. We also reflect upon Jesus’ ultimate sacrifice by death on the cross. Jesus surrendered His life, died in the most horrific way,in obedience to His Father’s will to redeem our sins. Jesus’ passion is the greatest testimony of God’s love to us. As Easter is approaching, it is only appropriate for us to examine our conscience, introspect upon our experiences in our life as doctors. How much love have we given to our suffering patients? We recall when Jesus told us about the Final Judgment, where he would assess us on what we did to the least of us (Matthew 25:31-46). He would ask us, “Did you feed me when I was hungry? Did you give me drink when I was thirsty? Did you welcome me when I came as a stranger? Did you cloth me when I was naked? Did you care for me when I was ill? Did you visit me when I was imprisoned?”
Many people call themselves Catholics, and a number of these also become doctors. However, how many of us can truly call ourselves Catholic doctors? How many of us truly live our faith in our life as doctors, serving our patients with tender loving care, helping those who are suffering and marginalized, following Jesus’ teaching which strongly defended and cared for the poor? As Catholic doctors, we must NOT be tempted by materialistic gain. The focus of our service should always be at the interest of the patient we care for. This is what Jesus told us to do, to love and serve one another, just as He loved us (John 13:34).
Also, we have to constantly remind ourselves that no matter how expert we think we are, our knowledge is still limited. Let us not be complacent and arrogant with our medical capabilities. We must acknowledge that at times we encounter cases which cannot be resolved with our current level of knowledge, no matter how hard we try to find the answers. There are times where we simply feel powerless. As followers of Christ, we should always leave our words and actions in the hands of God. At the time of need, we are encouraged to ask God for help (Matthew 7:7), for all things are possible for God (Mark 10:27). We have to have faith in Him, for if we have faith the size of a mustard seed, you will be able to move the mountain (Matthew 17:20). Speaking from my own experiences, I encourage you to always pray to God in every service we provide to others in need. Through the intercession of St. Luke and Raphael the Archangel, patron saints of the doctors, and Mary, Health of the Sick, we give thanks to the Lord for our knowledge and skills to treat the sick and injured, and we ask God to guide and support us in every action we do, particularly in difficult times.
Like Jesus, some of our brothers and sisters have also made the ultimate sacrifice in their duty as doctors. I would like to also take this opportunity to reflect upon their stories, learn from their experiences, and ask you to remember them in your prayers. Among others, we remember especially the work of a Salesian priest and medical doctor Fr. John Lee Tae-Seok, who dedicated himself at the service to the lepers in Sudan until his death from cancer at the tender age of 47. We also remember the story of Dr.EleonoraCantamessa, a 44-year-old good Samaritan who was tragically killed in Bergamo, Italy, while giving first aid to a man who was wounded in the fighting between gangs of immigrants. Seeing an injured person lying on the road, Dr.Cantamessa’s immediate reaction was to stop her vehicle and attend to him. She was also killed by rival gang members who wanted him dead. These two heroes did not stop their work even after realising the severity of the situation they were facing, and knowing that their actions might cost them their lives. It was their life calling to save others, and they truly put the interest of their patients above their own safety. I trulyyearn that these two people inspire your life as Catholic doctors. Ihope you are encouraged to give your all in your service to God, caring of the sick and injured, and help your patients improve their quality of life. My prayers are with you in every step you take. Happy Easter! May God bless all of us and lead us in our practises.
Ignatius Harjadi Widjaja MD DEd
President of AFCMA
Christmas Message from the President
My dear brothers and sisters in Christ,
As we prepare our hearts to celebrate God’s incarnation to the world to redeem our sins, and as we approach the end of the year, let us take this opportunity to reflect and introspect upon our services as medical doctors. Our calling as healthcare providers is noble. In Evangelium Vitae, an encyclical letter regarding the value and inviolability of human life, Pope Saint John Paul II highlighted that our work is a very valuable service to life. He went on to mention that the work of healthcare persons “expresses a profoundly human and Christian commitment, undertaken and carried out not only as a technical activity but also as one of dedication to and love of neighbour” (EV 89). He continued by saying that “(our) profession calls for them to be guardians and servants of human life” (EV 89).
Realising the privileges we have and the importance of our services, it is an absolute requirement for us to always respect the human dignity and its sanctity in making our decisions for our patients. Human dignity is highly regarded in the eyes of our Catholic faith. Humans are God’s most advanced creation. We recall that “God made man in his own image, made him in the image of God (Genesis 1:27).”
Indeed, this point is further emphasised “Catholic health care ministry is rooted in a commitment to promote and defend human dignity; this is the foundation of its concern to respect the sacredness of every human life from the moment of conception until death. The first right of the human person, the right to life, entails a right to the means for the proper development of life, such as adequate health care”.
In providing healthcare services, the respect of human dignity means we view all our patients as equals regardless of their racial and socio-economic backgrounds. “The inherent dignity of the human person must be respected and protected regardless of the nature of the person’s health problem or social status. The respect for human dignity extends to all persons who are served by Catholic health care” (E.R 23). The greatest challenge in this regard is to prevent ourselves from being servants to money and power. We have to constantly remember that all lives are equal in the eyes of God and thus we must not discriminate in treating our patients.
Furthermore, “A person in need of health care and the professional health care provider who accepts that person as a patient enter into a relationship that requires, among other things, mutual respect, trust, honesty, and appropriate confidentiality”. In my opinion, these four aspects can be fulfilled if we base our works on the acts of love, more specifically God’s love. As I have previously mentioned, God himself has given us a privilege in our ability to save people’s lives. Therefore, as a form of our thanksgiving to God, we should use our talents to spread His love to others, to the patients we treat.
How do we show God’s love in practice? The absolute requirement is sincerity. Being a medical doctor is not just a profession, it is a life calling. We have to carry out our duties with honest intentions to improve people’s lives. Our patients entrust their lives into our hands, so it is our moral obligation to honour this by putting all our efforts and provide the best service to treat them. I strongly believe that one of our most joyous moments as doctors is when we see our patients leave in pure happiness after being cured from their illness.
Relating this to Christmas, let us take this opportunity to give hope to our patients through our services, with the same spirit as God’s arrival on earth which gave hope to many who were longing for a saviour. We should all remember that whatever we do to the least of our brothers and sisters, we do it for God (cf. Matthew 25:40).
I sincerely wish you all a very Merry Christmas and a Happy New year 2015. God bless every step of our lives and may He guide and protect us in our service to Him and to our patients in need.
Ignatius Harjadi W. MD
President of AFCMA
Easter Message from the President
My dear brothers and sisters in Christ,
On behalf of the Exco of AFCMA, I wish you all a very happy Easter. It is the culmination of our journey as Catholics. It is the commemoration of Jesus’s death and resurrection, signifying the completion of his mission on earth, to redeem our sins. It is also a reminder for us to continue spreading the Good News to the people around us, through our words and actions.
As medical practitioners, we too should practice Catholicism in our lives. It is important to appreciate that these two aspects are inseparable: we are both medical doctors and Catholics. It is simply impossible for us to think that we can neglect our Catholic values while doing our medical practices and only follow Catholic teachings while we are not on duty. When tested by the Pharisees, Jesus said that we ought to “give back to Caesar what is Caesar’s, and to God what is God’s” (Mark 12:17). It is entirely possible that the two can go hand-in-hand. We can carry out our duties as medical practitioners while at the same time following Jesus’ teachings in all our words and actions.
Firstly, it is important for us to utilise our God-given intelligence in taking care of our patients. When assessing them, we have to take all aspects into consideration. Our analysis on our patients should not only on their physical and physiological state, but also their psychological state, social status (including their religion), and financial situations. Each of our patients is an entire entity comprising of all these aspects and should be treated accordingly.
In each of our actions and the decisions we make, we have to put the patient’s needs as the primary focus. Patients should be viewed as subjects who we should treat in the highest regards. Never are they objects we can simply use to our advantage. They are much more than just our sources of income. We should remember our oaths, that we have an obligation to save lives and improve the lives of people.
In our line of jobs, we are constantly faced with ethical and moral questions. These are the times where we have to exercise our conscience. It is our duties as Catholics to answer these tough questions according to our faith in Christ. At times, our final decisions could attract controversies, some of which may even result in persecutions against us. However, it is imperative to remind ourselves that we should live our faith unconditionally, and that it is in these difficult situations that our faith is tested.
We have learned from our experiences during Lent that we have to introspect, inspect our conscience. As medical practitioners, we are also encouraged to continuously looking back at our experiences, at our actions for the day, and take lessons from them, to improve and renew ourselves, both as persons and as professional catholic doctors. Now that we have come to the end of the Lenten period, we should use the momentum to continue our practice to introspect and reflect upon our lives.
Jesus died on the cross to redeem our sins, regardless of who we are. We have to use the same analogy in carrying our duties as medical practitioners. We must not let our personal preferences towards certain people get in the way of our primary duties to help others desperate for our assistance. Our first priority is to save lives.
To conclude my message, I would like to once again emphasize that being a medical practitioner is God’s gift to us, and we have to always view it as a privilege. Therefore, it is our moral and spiritual obligations to utilise God’s gift to help others while spreading the word of God in our daily lives. I kindly offer my most sincere prayers, may the Holy Spirit guide us in all our thoughts and actions.
Yours in Christ,
Ignatius Harjadi Widjaja.
President of AFCMA
Christmas message from the President
Dear sisters and brothers in Christ,
Christmas is the time for happiness, the time of joy, the time to celebrate. Traditionally, this is the time where we reunite with the people close to our hearts. And as it happens one week before the changing of the year, it also serves as a good time to reflect on our life journey throughout the passing year.
While these days a lot of these celebrations have been secularised, as Catholics, it is important for us to constantly remember that the essence of the day is to commemorate the nativity of Jesus. It marked the beginning of His mission on earth to redeem our sins. God the Father sent His only Son to the world to die on the cross to restore the broken relationship between us mortals and our Creator because of our original sins. Realising how powerful His mission was, we should feel amazed that God chose to start His journey in such humility, being born in a stable and put in a manger. The circumstances on which Jesus was born would probably be much worse than all of us when we were born.
On the other hand, we also recall that earlier this year, the Princes of the Church elected Jorge Mario Bergoglio SJ to succeed Pope Benedict XVI who announced his retirement from the Papacy due to poor health. As we could see from his words and actions, Pope Francis puts emphasis on his vision to make the Church poor and for the poor. Pope Francis has repeatedly urged his followers to put more attention on the disadvantages and the helpless.
As Catholic doctors, serving the poor should also be one of the central themes of our duties. The Hippocratic Oath stated that we must treat the sick, free of all intentional injustice. We also recall Jesus’ words that whatever we do the least of his brethren, we do it to Him (Matthew 25:40). Therefore, it should be the nature of our services to serve the needy. Additionally, we have to fully grasp that patients are never objects, and neither are they media to achieve our personal glory and prosperity. They are our fellow human beings who we should treat with dignity.The centre of our services should always be the patients, not ourselves.
Since He was born, Jesus has taught us, by example, the spirit of humility in serving God. Throughout His life, Jesus had always been obedient to His Father. Not once did he stray from his mission to proclaim God’s love to the world. We too, as His followers, should always remember that we are both children of the earth and children of God. Therefore, in our words and actions, it is always vital to constantly remind ourselves of our Christian values. We must always remember to be humble in our services to others, and we must always focus in helping others improving their quality of life.
As Pope Francis once said in 2003, each day we all face the choice to be Good Samaritans or to be indifferent travellers passing by. Which pathway do we wish to take? Christmas is a commemoration of God’s love to us sinners. It is our call as Christian doctors to pass on His grace to our fellow brothers and sisters who rely on us to save their lives and relieve their illness.May the peace of Christmas fill our hearts and strengthen us in carrying out our duties. Merry Christmas to all of us, and may God bless all of us.
Dr.Ignatius HarjadiWidjaja
President of AFCMA
Advanced Directives & Related Bio-ethical Issues in Asia
Introduction
This article will try to discuss issues related to Advance directives with particular reference to the situation in Asia. In terms of numbers the Chinese, Muslims and Indians form the majority of the population in Asia. The religion of most Chinese including the Japanese and Korean is Buddhism. On the other hand the Muslims led by the Indonesians practice Islam while the Indians practice Hinduism. All religions teach us to do good and “Thou Shalt Not Kill”. Most countries in Asia except for the Philippines have less than 10% Catholics. In Malaysia which has a population of more than 28 million the percentage of Catholics is only 4%. Advance Directives are relatively unknown in Asia.
What is an Advanced Directive?
An Advanced Directive is defined as a document with written instructions made by a person before he/she reaches the terminal phase of a terminal illness or a persistent vegetative state and incapable of asking decision about medical treatment when the question of administering the treatment arises. It is preferably a duly notarised document executed by a person of legal age and of sound mind upon consultation with a physician and family members. It directs healthcare providers to administer terminal care when the person executing such directive reaches the terminal phase of his terminal illness. Before I delve further into Advance directives it is important also to mention death/brain death, euthanasia, dysthanasia, orthothanasia, ordinary and extraordinary care and DNR or Do Not Resuscitate as they are all interrelated with Advance Directives.
Death/Brain Death
From the medical point of view Death can be diagnosed and certified when the heart stops and spontaneous breathing stops (conventional definition) or when the brain including the brain stem stops functioning (Brain Death definition). With the advance in Resuscitation and setting up of Intensive Care Wards some patients whose hearts had stopped or failed and whose breathing was stopping or had ceased were successfully resuscitated. A small percentage of the successfully restarted heart beating ‘survivors’ could not be taken off life supports. This group was actually ‘dead’ (by the old definition) because if there were no artificial supports (breathing machines, etc.) or if they were taken off these supports, the heart and breathing would stop. Medical advance (efficient Resuscitation and Intensive Care Units) created this problem of supporting the ‘dead’ and not as many erroneously refer to as supporting ‘life’. The concept of Brain death evolved and intensive care spread and became universally established from the 1960’s. It is now accepted that a patient in the intensive care ward requiring artificial supports (breathing machines, supportive drugs, etc.) to maintain heart/breathing functions can be diagnosed as ‘dead’ if assessment and testing of the total brain function (including Brain Stem function) shows absence of such functions that is Brain Death. The concept of Brain death has to be accepted in hospitals that run Intensive Care Units/Wards. If one does not accept Brain death as a medical entity the situation can arise whereby the ICU beds are occupied by ‘dead’ people (cadavers) on artificial supports. This is a constant dilemma faced by doctors who run ICU wards if the concept of Brain death is not understood and accepted. To diagnose brain death two specialists run through bed side tests/testing the brain stem function independently and repeat the test after a specific interval before the final conclusion is made. In countries where Organ Transplantation Programmes have been started brain death must be accepted as otherwise the only Organs for successful transplantation will only be available from living donors.
Euthanasia
By Euthanasia is meant any action or ommision which of itself and by intention causes death with the purpose of eliminating all suffering. The pity aroused by the pain and suffering of of terminally ill patients, abnormal babies, the mentally ill, the elderly and those suffering from incurable disease does not justify any form of Euthanasia either active or Passive. It is not a question of helping a sick person but the intentional killing of a person. Healthcare Personnel should always remain faithful to the task of giving service to the service of life and assisting it to the end. Human life is sacred–all men must recognize that fact (HUMANAE VITAE).
Dysthanasia is meant as the undue prolongation of life by futile therapy which ends in an undignified death. It is an abusive use of extraordinary or inappropriate technological means to prolong life and is usually costly and is done for fear of a malpractice suit.
Ordinary and Extraordinary Care ANH or Artificial Nutrition and Hydration is regarded as ordinary care and cannot be legitimately withheld even if death is imminent. In 2004 Pope John Paul 2nd during an International Congress on the Vegetative State stated that ” ‘The administration of water and food even when provided by artificial means always represents a natural means of preserving life, not a medical act. Its use furthermore should be considered in principle ordinary and proportionate and as such morally obligatory insofar as and until it is seen to have obtained its proper finality, which in the present case consist in providing nourishment to the patient and alleviation of his suffering.
DNR or a Do Not resuscitate Order is usually executed when death is imminent. Life sustaining treatment is withdrawn from a patient in a terminal condition or in a permanently unconscious state when a medical practitioner signs a do-not-resuscitate order on the request of the patient or his representative if the patient lacks capacity to do so. The life sustaining treatment typically withdrawn is cardiopulmonary resuscitation (CPR). A DNR is morally permissible only if one can judge that CPR is excessively burdensome for the patient taking into account his or her situation and physical and moral resources or that CPR imposes excessive financial burden on the family and community.
POLST or Physician Orders for Life Sustaining Treatment is causing alarm in Catholic Healthcare circles. POLST orders include a DNR order (do not resuscitate) and an AND Order (Allow Natural Death) which is to withhold assisted nutrition and hydration and another Order to withhold antibiotics. The POLST ensures that the patient’s wishes are followed.A patient can choose any one of the three following measures:
a/ First Choice–‘Comfort Measures only’ which means providing care to relieve pain and suffering
b/Second Choice—‘Limited Additional Interventions’ which includes comfort care but may also include IV fluids and antibiotics.
c/Third Choice–‘Full Treatment’ which includes comfort care, IV fluids, antibiotics, CPR, the type of breathing support, artificially administered nutrition and all other intensive medical care measures including transfer to a hospital.
On the surface POLST appears to be a sincere effort to encourage individuals to plan and address their end of life care needs. However POLST has a detrimental effect on Catholic Moral teaching. It makes patient autonomy an enforceable right and gives all patients whether terminally ill or not total control of their end-of-life issues.It attacks the sacred value of human life by allowing individuals to hasten their own deaths on the basis of their personal intentions . exerted independently of Catholic healthcare ethical values.
History of Advance Directives
Advance Directives began to be developed in the US in the late 1960’s.In 1976 Barry Keene introduced the Bill in California and the latter became the first US state to legally sanction Living Wills. In 1992 all the 50 US States had passed legislation to legalize some form of Advance Directive.
Advance Directives generally fall into 3 categories: Living Will. Power of Attorney and Health Care Proxy.
Living Will
This is a written document that specifies what type of medical treatment are desired should the individual become incapacitated.A Living Will can be general or specific. the most common statement in a Living Will is to the effect that:- If I suffer from an incurable irreversible illness, disease or condition and my attending physician determines that my condition is terminal, I direct that life sustaining measures that only serve to prolong my life be withheld or discontinued. More specific Living Wills may include information regarding an individual’s desire for such service as analgesia (pain relief), antibiotics, hydration, feeding, CPR (cardiopulmonary resuscitation) and the use of life support equipment including ventilation.
Health Care Proxy
This is a legal document in which an individual delegates another person to make health care decisions if he or she is incapable of making his/her wishes known.The health care proxy in essence has the same rights to request or refuse treatment that the individual would have if capable of making and communicating decisions.
Power of Attorney
Through this type of Advance Directive an individual executes legal documents which provide the power of attorney to others in the case of an incapacitating medical condition. The Durable Power of Attorney allows an individual to make bank transactions, sick social security checks, apply for disability or simply sign cheques to pay the utility bill while an individual is medically incapacitated.
Advance Directives in Asia
While the Western Countries like the US has legalized some form of Advance Directives, the latter is relatively unknown in Asia. Up to date only Singapore has passed its Advance Medical Directive Act (Chapter 4A) on July 1997. This is an Act to provide for and give legal effect to Advance Directives to medical practitioners against artificial prolongation of the dying process and for matters connected therewith. The Act permits only natural death and not euthanasia or abbetment of suicide. The Advance Directive does not affect palliative care. Any Person who makes a Directive shall register his Directive with the registrar of Advance Medical Directives. Also any person who has made a Directive may in the presence of a witness revoke the Directive in writing, orally or in any other way in which the patient can communicate. The Medical Practitioner responsible for the treatment of the person who has been certified terminally ill shall obtain the opinion of 2 other medical specialists as to whether they agree to with the determination that the patient is terminally ill. Terminal illness means an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery where a/death would within a reasonable medical judgement be imminent regardless of the application of life sustaining treatment and b/the application of extraordinary life sustaining treatment would only serve to postpone the moment of death of the patient. A few other countries in Asia are presently trying to promote Advance Directives in their country. In Hong Kong in 2006 the Law Reform Commission released their final report on ‘Substitute Decision making and Advance Directives in relation to Medical treatment’ and recommended the promotion of Advance Directives but not Legislation.Chinese family members often play a very influential role in relation to end-of-life decisions. The Chinese often view overt reference to death as taboo and would like to talk about death. A Wong et al study showed that 6%of those not engaging in Advance Directives did so because of family objections. In Japan terminally ill patients also rely on Family Members and Physicians for making end-of-life decisions (Kinoshita 2007). These cultural differences are common in Asian countries and may result in patient’s medical directive preferences be override. Current Korean Medical Law does not include categories for end -of-life care but the Law concerning emergency medical care states that “Physicians are not allowed to discontinue emergency care without appropriate reasons.
Therefore if ill patients are transferred to ICU they must be kept on ventilators until death, brain death or a judicial decision from a court of law (YS LEE 2009). In The Philippines in July 2004 an Act was presented to their House of Representatives to be passed. This Act was introduced by Rodriguez D. Davidas Declaring the Rights and Obligations of Patients and Establishing a grievance mechanism for Violation thereof and for other purposes. This Act shall be known as the Magna Carta of Patient’s Rights and Obligations. Advance Directive is included in this Act—Any Person of legal age and of sound mind may make an Advance directive for physicians to administer terminal care when he suffers from the terminal phase of a terminal illness.
Conclusion
Advance directives and the interrelated bio-ethical issues like Euthanasia and Brain Death have been described. Whilst Advance Directives are commonly used in the Western countries like US and are legalized, in Asia only Singapore has legalized it. Due to our cultural differences Advance Directives may not be popular in Asian countries as the Family Bond is very strong amongst Asian Families. Finally Advance Directives attacks the sacred value of human life by allowing individuals to control their own end-of-life issues independent of Catholic Healthcare Ethical Values.
Prepared by Dr. Freddie Loh Immediate Past President of AFCMA and Asian Representative to FIAMC.
POPE AND MEDICAL DOCTOR
POPE AND MEDICAL DOCTOR Church for the Poor : What Pope Francis teaches us Catholic Doctors
The Argentinian Jesuit Jorge Mario Bergoglio was just elected Pope a few weeks ago, just before Easter, taking the regnal name Francis. Nevertheless, through his nature and character, he has established his own style of Papacy, much to the admiration of a lot of us.
As Catholic doctors, there is a lot we can learn from Pope Francis, and we should actually look up to him as a role model in serving the people. Inspired by St. Francis of Assisi, he is a figure who is humble and very concerned about the poor and disadvantaged. When we identify ourselves as Catholic doctors, we are not mere doctors who happen to believe in the Catholic faith, but we are medical professionals who incorporate Catholic teachings into our daily activities. Do we base our actions on the honest intention to improve the general well-being of people or is making money our sole reason of carrying out our duties? Have we shown humility as doctors and provide the most sincere care to our patients, or do we just consider them as objects? In treating our patients, do we consider all of them equal? Or do we turn a blind eye on our patients who are struggling financially?
It is important to acknowledge the reality that a lot of the world’s 7 billion people are living under the poverty line. In line with this, we have to also appreciate that a lot of these impoverished people have trouble accessing the appropriate healthcare they deserve, particularly in the developing countries in Asia, Africa, South America, and Eastern Europe. In my opinion, the first point we have fully grasp is that we could become who we are now as medical professionals not only because of our talents and efforts, but also because of God’s will. Through His grace and with His blessings, we develop our talents and skills to become experts in our respective medical fields, such as cardiology, surgery, gynaecology, and so on.
Using this expertise to serve the patients with sincerity and humility, especially those who are financially disadvantaged, is our noble way to thank God for the privileges He has given us. We have to remember Jesus’ message to us when He talked about the kingdom of heaven and the last judgment (Matthew 25:31-46). There He emphasised that whatever we do to the least of his brethren, we do it to Him. It is through these lowly and poor people that we could see the face of Jesus. Furthermore, as we recall, from the parable of the good Samaritan, the two greatest commandments Jesus gave us are to love God unconditionally and to love others as ourselves (Luke 10:25-37, Deuteronomy 6:5, Leviticus 19:18).
Combining this with our oath, is it important to always realise that it should be our nature to serve people without discrimination. Pope Francis has called us all, including us medical professionals, to care for and serve the poor. It is one of the, if not the, central theme of his Papacy. He has said that he wants the Church to be the Church for the poor. There are a number of inspirational people we can view as examples to serve the lowly. Saint Damien of Molokai SS.CC., despite not being a medical professional himself, devoted his life to care for the physical, spiritual, and emotional needs of those in the leper colony in Hawaii.
We then also have Blessed Mother Teresa of Calcutta, who showed great devotion to care for the disadvantaged people from the slums of India. More recently, we have Fr. John Lee Tae-Soek SDB, a Korean medical doctor who dedicated his life to the services of the poor people with leprosy in war-ravaged Southern Sudan. Pope Francis also reminded us to put more emphasis on human life and dignity on top of other material matters. The pro-life movements should focus their actions not only to prevent abortion, but also to save people’s lives and prevent euthanasia. On the other hand, in the recent times, we have witnessed the advances of medical technology which are able to provide the best treatment for various diseases and illnesses.
Unfortunately, a lot of these technologies are only accessible to very few people who have significant financial advantage to afford them. If we flash back to a quarter of century ago, when these technologies were not invented, doctors were still able to utilise purely their talents and skills to accurately diagnose and provide the appropriate and acceptable treatment for the same diseases and illnesses. A lot of doctors in the recent times rely heavily on these very expensive technologies, although they might not provide significant advantage over the conventional techniques employed decades ago. Even worse, these doctors are often pressured by the medical institution (e.g. the hospital) to utilise these cutting-edge technologies, albeit unnecessary, to pay off the debt for purchasing the equipment. The point to highlight here is to warn us Catholic doctors not to fall into the traps of commercialisation of our services. Again, it is imperative to constantly remind ourselves that we should put more focus of our duties on the patients and not the institutions we work for.
I recall my own personal experience a couple of years ago when a young boy from a Muslim family diagnosed with tetanus and required immediate hospital treatment was unable to do so because of his parents’ financial difficulties. When I learned about his background story, I decided to donate some money for his treatment. The boy was eventually cured, and a week later his mum came to thank me. One sentence which touched my heart was, “You must be a Christian, as you have been very kind.”
May this thought empower us Catholic doctors to serve with our sincere heart, providing the healthcare to all patients regardless of their background, especially their financial situations. Remember, with His love, God has given us talents and privileges. Thus, it is only appropriate to share the love to others, especially to those who earnestly need our help; those who are poor and disadvantaged. Caring for the least of His brethren is our way to glorify His name. Let us pray so that God bless us in all our duties to serve Him and others.
Ignatius H. Widjaja, President of AFCMA (Asian Federation of Catholic Medical Associations)
