A Do Not Resuscitate order is a hospital form duly signed by the patient’s next of kin authorizing the withholding of all life-saving measures in the enventuality of a cardio-pulmonary arrest. It is a decision that is almost taboo in Philippine society. No Filipino would want to be blamed for not having tried everything possible for a loved one. Even a poor Filipino family would risk indebtedness just to be able to finance all the medical attention which a family member may need. Thus to call it quits is deemed immoral. More often than not a Filipino family would only sign an DNR order upon receiving assurance from a priest or minister that it would be perfectly all right and that there would be no sin involved.
Anna C. Lily-Quibilan, MD and Luis F. Rivera “Case 8: Department of Pediatrics” (p. 67)
It has been said that the measure of love is to love without measure. The Filipino parent is proverbial on this – to the point many times of defending his/her child even when this child is clearly at fault. This attitude translates also into medical terms. The ardent plea of a desperate parent urging the physician to do everything possible to save his/her child is so commonplace that it becomes more the rule than the exception.
At the same time, however, the Filipino exhibits much trust in the mysterious and oftentimes incomprehensible ways of God. Thus the Filipino parent is also capable of showing resignation to the Divine Will. It is in making Filipino parents realize that the Divine Will regarding their child that medical professionals can be of great help. The death of a child is nobody’s fault. It is just part of the harsh realities of life. God has his own reasons for allowing such things to happen. And to the believer these reasons are always better than whatever the human heart may desire. In the Filipino context strengthening a person’s faith in God is the great contribution of the medical professional to humanity Ginah Eliza M. Ramos, MD and Czarina Atupan-Calderon, MD “Case 14: Department of Pediatrics” (p. 99)
n Rene T. Lagaya, Editor, Making Life Beautiful: A Bioethics Manual of Makati Medical Center (Makati City: Don Bosco Press, 2008)
Analysis for Kumamoto University:
Analysis for Kumamoto University:
Three level structure analysis of end of life care as described in two case studies in the bioethics manual of the Makati Medical Center, Makati City, Philippines
Rainier A. Ibana, Philippines
A Three level structural analysis
In the two cases cited above, the general rule is to save the life of the client: not to sign the Do Not Resuscitate Order and the ardent plea of desperate parents to save the life of their child. The principle at work is for family members to try everything, even at the risk of indebtedness or defending the child even if he or she is at fault, to provide the best possible health care for its members. The general theory employed, moreover, is to follow the Divine Will. Medical practitioners claim that “Strengthening a person’s faith in God is the great contribution of the medical professional to humanity.”
Mediation of Moral reasoning by the values of the family and religion
Moral reasoning in these cases is mediated by the cultural values of the family and religion. Even the medical professional does not talk about scientific or moral grounds for their actions but elevates their discourse with clients to the mysteries of the Divine Will. The family member will sign a Do not Resuscitate Order only upon receiving assurance from the authority of the priest or minister that it is all right and that a sin will not be committed.
This concern for the family and religion does not seem to make room for scientific rationality and moral reasoning. Too often, the cause of death is made post-mortem and not as a deliberative discourse in the attempt to save life. The medical practitioner does not explain why a Do not Resuscitate Order is necessary nor why the child no longer has a chance to survive. The “oftentimes incomprehensible ways of God” is implored instead of producing arguments and discourse. No one wants to take responsibility for the death of a family member: both the relatives and the medical professionals wash their hands from making decisions by elevating the problem at hand to God’s will.
In scholastic terminology, these types of arguments are immediately referred to the First Cause, and not mediated by the secondary causes of the laws of nature. This shows a lacuna in the understanding and appreciation of the natural and moral sciences. Medical professionals could have made it as their vocation to provide scientific explanations to their clients instead of relegating the experience of death to “the harsh realities of life.” These harsh realities could have been explained by means of scientific causes that could ease the burden of those who do not want to become mere passive victims of a God who “has his own reasons for allowing such things to happen.”
The modern enlightenment project has not yet been realized in Philippine society. Our attempts to modernize, during the failed Philippine revolution of 1896 against medieval Christianity, has not yet come to pass as people’s mindsets are still narrowed down by the interests of the family at the expense of the nation and humanity and human rationality has not yet replaced the inscrutable will of God.
The seeds of consequentialism and Universality
Consequentialism, however, can already be discerned in these cases as both family members and medical professionals are afraid of taking responsibility for their acts. But the rule that actions do have consequences is implicit in the family members’ refusal to sign the Do not Resuscitate Order and the medical practitioners’ attempt to elevate the death of the client, a natural consequence of the limitations of the current state of the medical sciences and technologies, as a matter of faith in God.
The principle of Universality, in the modern sense of the word, could have been applied beyond the members of the family by initiating a discourse by the medical professionals on the natural causes of death and the limitations imposed by science and technology. Death, therefore, is a fate for all human beings that must be confronted as a consequence of being embodied in matter, even if one believes in the possibility of a spiritual world beyond the human body.
Life after death
Discussions on end of life care naturally lead to the expectations of and belief in life after death. The human person’s search for meaning beyond the discontinuities of bodily existence requires for something or someone to hope for if one is not to die in vain. This is perhaps the reason why the memory that one leaves behind in the family and the anticipation for a life beyond death offered by religious traditions are of outmost importance to the extent that they overshadow scientific and moral reasoning. The emotional experience of loss and the fragility of biological existence can only be compensated for by something or someone who is greater than or beyond one’s life and death.
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