Easter Message from the President

coloring_eggs_in_bali
coloring Easter eggs in Bali

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

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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)

Sanctity of Life

Reproduced here is an article on the Sanctity of Life with reference to Asia posted on the FIAMC website by Dr Freddie Loh, Immediate Past President of AFCMA:

Introduction: This article tries to sum up the various bioethical issues affecting life with particular reference to the situation in Asia. Bioethics is defined as the application of moral principles to the life sciences, to the many problems in relation to human life that has resulted from the rapid advancement in science and technology. Asia consists of more than 12 countries of various sizes and each with different races, cultures and religions eg. the main religion in Malaysia and Indonesia is Muslim, in Philippines is Catholicism, in Japan and China is Buddhism, etc..The Catholic population in these countries with the the exception of the Philippines is very small e.g. the percentage of Catholics in Japan is 0.4%, in Thailand <1%, Indonesia 2’7% and Malaysia 4%.

francis-life-tweet

The issues confronting the Catholic Church in Asia are the same as those in Europe and the advanced countries and can be divided into (A) Beginning of life issues and (B) End of life issues.

Due to limited space only those issues which are common will be discussed in some detail. Our catholic Church teaches us that life begins at conception and is inviolable and should be protected until its natural end (Charter for Health Care Workers). Also Human Life is Sacred–all men must recognise that fact (Humanae Vitae).

A. Beginning of Life Issues:

  1. Abortion: The inviolability of the human person from conception prohibits abortion as it is the suppression of prenatal life. This is a direct violation of the fundamental right to life of the human being and is an abominable crime (Holy See, Charter in the rights of the family). Unfortunately although most faiths do not condone abortion considering it as a vicious crime of murder, some countries have legalised abortion due to pressure from individuals in their own country. In Malaysia and Indonesia abortion is legal under certain vital conditions when the pregnancy itself may endanger the lives of the mother.
  2. Stem cell research: Stem cells can be divided into embryonic, umbilical and adult types. Stem cells are undifferentiated cells which own the potential to grow into various types of cells in the body.Embryonic Stem Cell Research should not be allowed because they are harvested from embryos which are then destroyed. Stem cells can be used to treat Alzheimer’s disease, Parkinsonism, repair damaged tissues in knee and myocardium, etc. Stem cell therapy has been used in Singapore for sometime.
  3. Assisted Reproduction: Procedures which assist the marital act to achieve its purpose are morally permissible but those which substituted for it are not.These procedures include IVF (in vitro fertilisation), FIVET (fertilisation in vitro with embryonic transfer), IVM (in vitro maturation) where the ovum is allowed to mature in the lab before it is fertilised, ICSI (intra cytoplasmic injection), GIFT (gamette intra fallopian tube transfer) and LTOT (lower tubal ovum transfer). GIFT involves transferring the gamettes (oocyte and sperm) collected and then transferred by laparoscopy for fertilisation to take place. Some consider this method as illicit. LTOT involves transferring the ovum that cannot get into the blocked fallopian tube to a lower position in the tube or the womb so as to make fertilisation possible. It may be considered morally acceptable as long as the sperm is collected by methods not contrary to nature. With regards to IVF a recent survey on 118 Indonesian Catholic Doctors from Jakarta and Surabaya showed that 52.5% of catholic doctors knew before hand that the Catholic Church has taught about the immorality of IVF. However 73.7% did not agree with this Teaching.IVF is immoral because it does not respect the unitative aspect of the conjugal act (Charter for Health Care workers).However IVF is widely acceptable in Indonesia within its own target market and has recently made inroads into Malaysia.
  4. Contraception: This is defined as a means to avoid conception with the help of drugs or devices.Types of contraception include condom, diaphragm, spermicide, contraceptive pills, contraceptive injections like depo provera, implants, intra uterine devices, vasectomy, tubectomy, etc. Different countries prefer using different methods. Unfortunately in the Philippines a staunch Catholic country of late contraception has been legalised with the passing of the RH (Reproductive Health) Bill. To counter the negative effect of contraception Natural Family Planning Methods are used and are accepted by the Church.Their success depend on regulating sexual activity to the wife’s immediate fertile state, to postpone or to even to achieve pregnancy. The Billing’s Ovulation Method (BOM) is widely practised in Asia and has a high success rate. Another Method is the Creighton Model System and Napro Technology discovered by Dr. Hilgers at St. Paul VI Institute in the U.S. It is being used in Taiwan and Japan. Both Methods involve examination of the cervical mucus by the woman herself feeling its changes from cloudy and sticky to stringy and slippery. This slipperiness is used as a marker for ovulation. In the Creighton and Napro Method the couples are taught that whilst genital contact is to avoided during the days of fertility, sexual contact(activity) should never be avoided as this will lead to a respect for the dignity of woman and marriage.
  5. Cloning: Cloning is a technique of creating offspring with the same genetic code as its parent. It duplicates the same genetics as an organism and replace the nucleus of the ovum with the nucleus of another cell. Life begins at the time of fertilisation and interventions such as abortion, IVF, embryonic stem cell research and cloning in some way or other interfere with this process.
  6. Prenatal diagnosis: The ever expanding knowledge of intrauterine life and the development of instruments granting access to it has made it possible to diagnose prenatal life thus opening the way for more timely and effective interventions. Its purpose should always be for the benefit for the Child and the Mother and to make possible therapeutic interventions, to bring assurance and peace to women who are tortured by doubts about foetal abnormalities and tempted to have an abortion. If the prognosis is an unhappy one the mother should be given proper counselling so as to prepare for the welcoming of the handicapped child.

(B) End of Life Issues:

What is Euthanasia? By Euthanasia is meant an act or omission which by its nature or intention causes death in order that all suffering may be eliminated. The pity aroused by the pain and suffering of terminally ill patients, abnormal babies, the mentally ill, the elderly and those suffering from incurable disease does not authorise any form of Euthanasia either active or passive. It is not a question of helping a sick person but rather the intentional killing of a person. Health Care personnel should always remain faithful to the task of giving service to the service of life and assisting it to the end. Dysthanasia is defined as the undue prolongation of life 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 done for fear of a malpractice lawsuit. Orthothanasia: means correct dying. The patient is allowed to die in a dignified way. Human life must be protected and even dutifully prolonged but should not be unduly or uselessly prolonged. It is not a form of passive euthanasia. It is important to differentiate between allowing death to occur and intending death to occur.

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. For a dying patient in severe pain e.g. prostate cancer it is licit to administer to relieve the pain even when the result is decreased consciousness and shortening of life. A DNR (do not resuscitate) order is usually given when death is imminent. Life sustaining treatment is withdrawn from a patient either in a terminal condition or a permanently unconscious state when a medical practitioner sign a DNR order on the request of the patient or his representative if the patient lacks capacity. The life sustaining treatment typically withheld is cardiopulmonary resuscitation (CPR).

(C) Organ Transplant:
Organ transplant for the purpose of transplantation is good and is to be encouraged as it can save lives. However all risks and harm to the donor and the recipient must be kept to a minimum. Buying and selling an organ is wrong and is against the dignity and worth of a person.It is a known fact that kidneys are sold in India for a price.

(D) Death Penalty:
In certain Asian countries including Malaysia the death penalty is given to murderers and drug traffickers by hanging. However I understand that Malaysians and Indonesians are trying to convince their respective Parliaments to abolish the Death penalty for drug traffickers and replace it with one of life imprisonment.

Conclusion : Different issues concerning Beginning of Life and End of Life with reference to the situation in Asia has been briefly discussed. With the exception of the Philippines, the Catholic population of the Asian countries are small and relatively insignificant. However with the help of the other communities i.e. our Muslim, Buddhist, Hindu brothers and sisters we hope to influence our respective Governments to give added value to life from its beginning to its end. It is the duty of the Catholic Doctors from our various Catholic Doctors Associations to teach their fellow members as well as the other Catholic Health Care Workers including priests, nurses and medical students to update them on the various bioethical issues confronting the Catholic Fraternity and respond to them according to the Teachings of the Magisterium.

INTERESTED READERS may also wish to access our archives for other related articles: AUGUST 2010 (Billings Ovulation)
MAY 2009 (Stem Cells)
October 2007 (Bioethics)

New AFCMA OFFICE BEARERS

AT THE 15th AFCMA CONGRESS IN BALI, the following were elected as office bearers: President : Dr. Ignatius Widjaja – Indonesia Proposed by: Dr. Freddie Loh Seconded by : Dr. John Lee Immediate Past President : Dr. Freddie Loh – Malaysia. Vice president : Dr. Peter Au Yeong – Hong Kong Proposed by : Rev. Fr. Gino Seconded by : Dr. Edna Monzon Dr. Edna Monzon – Philippines Proposed by: Rev. Fr. Gino Seconded by : Dr.Peter Au Yeong Dr. Anthonysamy – Malaysia Proposed by: Rev. Fr. Gino Seconded by: Dr.Ignatius Dr. Joon Ki Kang – Korea Proposed by: Dr.John Lee Seconded by: Dr. Freddie Loh Secretary: Dr.Angela Abidin – Indonesia Proposed by: Dr.Ignatius Widjaja Seconded by: Dr. Albert Hendarta Treasurer: Dr.Buichi Ishijima – Japan Proposed by: Dr. John Lee Seconded by: Dr. Albert Hendarta Medical Mission : Dr. John Lee – Singapore Dr. Hon Kwong Ma – Taiwan Membership Committee : Dr. Keong Lyon Jo – Korea FIAMC Representative : Dr. Sis Mary Lou Dr.Freddie Loh Ecclesiastical Advisor : Rev. Fr. Gino Henrigues The VENUE FOR THE 16th AFCMA CONGRESS will be hosted by Japan and will be held in Kyoto, Japan in 2016.