FEU Public Intellectual Lecture Series | Dr. Maria Fidelis Manalo | Part 1

Summary

In this Far Eastern University lecture, Dr. Lisa C. Manalo, a palliative care specialist, delves into bioethics, focusing on life's beginning and end. She emphasizes ethical principles like the Natural Moral Law and the sanctity of life, discussing dilemmas in euthanasia, abortion, and physician-assisted suicide. Dr. Manalo highlights the importance of patient autonomy, dignity, and the physician's role in providing comfort, not causing harm, even when faced with requests for euthanasia.

Takeaways

• 📚 Bioethics is the application of ethical principles to matters concerning life, from the beginning to the end, including controversial topics like abortion, euthanasia, cloning, and stem cell research.
• 🌟 Dr. Lisa C. Manalo, a palliative care specialist, highlights the importance of understanding bioethics for medical professionals to make decisions that can impact life and death.
• 🤔 Ethical dilemmas in medicine often involve gray areas, requiring a deep understanding of natural moral law to guide decisions between right and wrong.
• 🗣️ Truth-telling is a critical aspect of medical ethics; Dr. Manalo advocates for transparency with patients about their conditions to allow them closure and resolution.
• 🏥 In the Filipino culture, there's a belief that informing patients of their terminal conditions might lead to depression and hasten death, creating an ethical conflict for medical practitioners.
• 🚫 Dr. Manalo emphasizes that the right to life and human dignity are fundamental, and medical interventions should not merely prolong life without considering quality of life.
• 🤰 The debate on the beginning of life is highlighted, with Dr. Manalo asserting that life begins at conception, challenging the idea of moving the starting point to implantation.
• 🚫 She discusses the complexity of ethical decisions in cases of rape and health risks, advocating for the protection of the unborn child and the mother's well-being.
• 🏠 Financial and social circumstances can influence requests for euthanasia, as seen in a case where a family, unable to afford care, requested it due to poverty.
• ❌ Euthanasia and physician-assisted suicide are strongly opposed by Dr. Manalo, who promotes palliative care as a way to manage end-of-life suffering without ending life.

Q & A

What is bioethics and why is it significant for the general public?

Bioethics is the application of ethical principles to matters concerning life, from its beginning to its natural end, which includes issues like abortion, euthanasia, cloning, and stem cell research. It is important for the general public to understand bioethics because it guides decisions about life and death, where errors can have severe consequences.

What are the fundamental principles that guide ethical decision-making in bioethics?

The fundamental principles guiding ethical decision-making in bioethics include the natural moral law, which is the innate human ability to discern right from wrong. This principle helps navigate the gray areas often encountered in bioethical dilemmas.

How does Dr. Lisa C. Manalo define a 'good death' in the context of palliative care?

Dr. Lisa C. Manalo shares that a 'good death' is defined by patients as being at peace with God, according to a study conducted in PGH. This contrasts with the medical perspective, which often focuses on pain and symptom control.

What ethical dilemmas arise when patients are no longer lucid and cannot make decisions for themselves?

When patients are no longer lucid, the ethical dilemmas involve balancing the right to life and human dignity. It's crucial to consider the quality of life and the potential for natural death without aggressive life support measures that may cause undue suffering.

What is the medical perspective on when life begins, and how does it relate to bioethical discussions?

From a medical standpoint, life begins at conception, as taught in medical schools and embryology. This perspective is significant in bioethical discussions, especially concerning the beginning of life, such as in debates on abortion and reproductive rights.

How does Dr. Manalo view the practice of artificial contraception in relation to bioethics?

Dr. Manalo discusses artificial contraception as a topic of debate, often redefining the beginning of life to justify its use, contrasting with the Catholic Church's recommendation of Natural Family Planning.

What are the ethical considerations when advising women who have become pregnant due to rape or health risks?

The ethical considerations involve recognizing the rights of both the mother and the unborn child. Dr. Manalo emphasizes that the fetus is innocent, harmless, and defenseless, and that the strong should protect the weak, even when the pregnancy is a result of rape or poses health risks to the mother.

How does Dr. Manalo differentiate between euthanasia and palliative care?

Dr. Manalo differentiates euthanasia, which she describes as 'mercy killing,' from palliative care by stating that the latter aims to eliminate suffering without eliminating the sufferer, unlike euthanasia, which ends the patient's life to end their suffering.

What is physician-assisted suicide, and how does it conflict with the medical profession's ethical oath?

Physician-assisted suicide involves a doctor providing the means for a patient to end their own life. This conflicts with the medical profession's ethical oath, which is to respect and save the lives of patients, not to aid in causing their death.

Can you provide an example of a real-life situation where a request for euthanasia was misunderstood?

Dr. Manalo recounts a case where a son requested euthanasia for his mother, who was on a mechanical ventilator. The son was overwhelmed by the financial and care burden. Dr. Manalo clarified that euthanasia requires the patient's full knowledge and consent, and instead, discussed the option of allowing a natural death with palliative care to manage the patient's comfort.

Outlines

00:00

🎓 Introduction to Bioethics

The lecture begins with an introduction by Rita Kusho from the political science department at Far Eastern University, setting the stage for a discussion on bioethics. Dr. Lisa C. Manalo, a palliative care specialist and member of hospital ethics committees, is welcomed as the guest speaker. Bioethics is defined as the application of ethical principles to matters concerning life and death, including controversial topics like abortion, euthanasia, cloning, and stem cell research. The importance of understanding bioethics is emphasized for making informed decisions, especially since errors in judgment can have severe consequences on life.

05:02

🌟 Ethical Decision-Making in Bioethics

Dr. Manalo explains the principles that guide ethical decision-making in bioethics. She discusses the concept of natural moral law, which is inherent in humans to discern right from wrong. The lecture highlights the complexity of ethical dilemmas in bioethics, often involving shades of gray rather than clear-cut answers. The conversation touches on the importance of truth-telling in medical practice, especially in palliative care, where patients' understanding of their conditions is crucial for achieving peace and closure. Cultural differences in approaching end-of-life care are also explored, with a focus on the Filipino culture's reluctance to disclose the truth about impending death.

10:03

👶 The Beginning of Life and Ethical Dilemmas

The discussion shifts to the beginning of life, focusing on the question of when life begins. Dr. Manalo asserts that life starts at conception, as taught in medical schools, but acknowledges the societal shift to redefine the beginning of life to justify practices like abortion. The debate between artificial contraception and Natural Family Planning is mentioned, with a critique of the latter's moral implications. The lecture addresses the ethical considerations surrounding pregnancies resulting from rape or posing health risks to the mother, emphasizing the sanctity of life and the complexity of balancing the rights of the mother and the unborn child.

15:03

🚫 The Impact of Abortion and Euthanasia

Dr. Manalo delves into the psychological and emotional trauma associated with abortion, countering the notion that it empowers women. She shares a personal account of counseling a woman who suffered long-term effects from an abortion following rape. The conversation moves to euthanasia and assisted suicide, with Dr. Manalo clarifying the difference between relieving suffering and ending a life. She argues for the importance of palliative care in reducing requests for euthanasia and criticizes the concept of physician-assisted suicide as a violation of the doctor's oath to preserve life.

20:03

🏥 Real-Life Encounters with Euthanasia Requests

Dr. Manalo recounts a poignant case from her training in PGH, where a son requested euthanasia for his indigent mother who was dependent on a mechanical ventilator. The son's request was driven by the family's inability to afford the cost of care and the lack of adequate living conditions to support his mother's needs. Dr. Manalo emphasizes the importance of considering the broader social and economic context when making ethical decisions in end-of-life care. She stresses the need for a non-judgmental approach and the importance of providing comfort and pain management without resorting to euthanasia.

25:05

🛑 The Ethics of Allowing Natural Death

The final paragraph discusses the ethical considerations of allowing natural death in terminally ill patients, as opposed to aggressive life support measures that can impose financial burdens on families. Dr. Manalo argues against the unethical nature of euthanasia, advocating instead for palliative care that ensures comfort and dignity in dying. The lecture concludes with a reflection on the importance of understanding and applying bioethical principles in real-life situations, acknowledging the complexity and emotional weight of such decisions.

Keywords

💡Bioethics

Bioethics is the study of ethical issues arising in the fields of biology, medicine, and health care. It encompasses a wide range of topics, including abortion, euthanasia, cloning, and stem cell research. In the video, Dr. Lisa C. Manalo discusses bioethics in the context of making decisions about life and death, emphasizing the importance of ethical principles in medical practice.

💡Palliative Care

Palliative care is a branch of medicine that focuses on providing relief from the symptoms and stress of serious illnesses, improving the quality of life for both the patient and the family. Dr. Manalo, a palliative care specialist, discusses the ethical dilemmas faced in this field, such as truth-telling to dying patients and the concept of a 'good death'.

💡Euthanasia

Euthanasia, often referred to as 'mercy killing,' is the practice of intentionally ending a life to relieve pain and suffering. The video script touches on the ethical debate surrounding euthanasia, with Dr. Manalo arguing against it and advocating for palliative care as a means to manage suffering without ending life.

💡Assisted Suicide

Assisted suicide is the act of intentionally ending one's own life with the aid of another person, often a physician. The video discusses the ethical implications of assisted suicide, contrasting it with the medical profession's duty to preserve life and the potential psychological trauma it can cause.

💡Natural Moral Law

Natural moral law is a philosophical and theological concept that certain moral norms are inherent by virtue of human nature and can be understood through human reason. In the video, Dr. Manalo refers to natural moral law as a guiding principle for ethical decision-making in bioethics, emphasizing the innate human ability to discern right from wrong.

💡Informed Consent

Informed consent is a principle in medical ethics that requires healthcare providers to disclose all relevant information to patients, enabling them to make informed decisions about their treatment. The video script mentions informed consent in the context of euthanasia, stressing the importance of a patient's full knowledge and consent before any medical intervention.

💡Right to Life

The right to life is a fundamental human right, recognized in many national and international human rights instruments. In the video, Dr. Manalo discusses the right to life in the context of both the beginning and the end of life, arguing for the protection of both the mother and the unborn child in cases of pregnancy.

💡Human Dignity

Human dignity refers to the inherent worth or value of every person, regardless of their abilities, achievements, or circumstances. The video emphasizes the importance of maintaining human dignity, especially in end-of-life care, where the focus should be on quality of life and comfort rather than merely prolonging life.

💡Truth-telling

Truth-telling in medical ethics refers to the obligation of healthcare providers to provide patients with accurate and complete information about their health condition. Dr. Manalo discusses the importance of truth-telling in palliative care, advocating for transparency with patients about their impending death to allow for closure and resolution.

💡Pro-life

Pro-life is a stance in the abortion debate that believes in the legal protection of embryos or fetuses from the moment of conception. The video script mentions the pro-life perspective, with Dr. Manalo arguing that the antonym of pro-life is 'pro-death,' highlighting the belief in the sanctity of life from conception.

💡Physician-Assisted Suicide

Physician-assisted suicide is a form of assisted suicide where a doctor provides the means for a patient to end their own life. The video discusses the ethical concerns of physician-assisted suicide, questioning the role of doctors in such practices and the potential violation of the Hippocratic Oath.

Highlights

Introduction to bioethics as a field that deals with ethical issues from the beginning to the end of life.

Importance of understanding bioethics for making decisions on life and death matters.

Discussion on the natural moral law as a basis for ethical decision-making in bioethics.

The concept of a 'good death' from the perspectives of patients, families, and doctors.

Ethical dilemmas in truth-telling to patients, especially in palliative care.

The rights of patients, particularly when they are no longer able to make decisions for themselves.

The debate over the beginning of life and the implications for practices like artificial contraception.

The ethical considerations in cases of pregnancy resulting from rape or when the mother's health is at risk.

The psychological and physical trauma associated with abortion and its long-term effects on women.

The advancement of medicine and the role of specialists in high-risk pregnancies and neonatology.

The difference between euthanasia and palliative care, with a focus on relieving suffering without ending life.

The ethical implications of physician-assisted suicide and the doctor's role in preserving life.

Personal encounters with patients requesting euthanasia and the importance of understanding their situations.

The social and economic factors that can influence requests for euthanasia and the need for a holistic approach in care.

The importance of allowing natural death and avoiding aggressive life support measures when the prognosis is poor.

Reflections on the ethical principles that guide medical practice and the value of life.

Transcripts

[Music]

good day welcome to the Far Eastern

University public intellectual lecture

series my name is Rita kusho and I'm

from the political science

department today we are going to discuss

one of the most interesting if not

controversial areas in the field of

Applied ethics so when we talk of issues

like abortion euthanasia cloning stem

cell research we're actually going into

a field called bioethics and today we

are very privileged to have with us an

esteemed doctor a researcher and a

professor in this

field Our Guest is a paliative care

specialist who is currently the head of

the supportive and paliative Care

section of the medical City where she's

also a member of the hospital Ethics

Committee she's also an assistant

professor a regular active consultant

and member of the Ethics Committee of

feu nikanor medical foundation's Medical

Center and Institute of medicine she's

none other than Dr Lisa C Manalo good

day Dr Manalo good day Rita and everyone

thank you very much for inviting me to

the feu intellectual lecture series and

thank you doc also for accommodating us

despite your very busy schedule you're

most welcome and I'm I'm be glad to

share whatever knowledge I have with our

students here in Fu thank you doc so

let's start with the basics doc what is

bioethics and why is it important for us

ordinary citizens to know about this

well obviously the bigger picture would

be ethics and when people talk about

ethics ultimately one has to make a

decision as to this particular action

would be right or wrong so when you talk

about bioethics it's the application of

ethical principles in matters pertaining

to practically the beginning of Life up

to the end of life which is natural

death and in between for that matter no

so um and therefore the the student and

all all people in general should be able

to come up with certain principles that

will guide him to make the right

decision so I suppose what I'm

clarifying here is that especially in

the field of bioethics you're dealing

with life and death there's practically

no room for error either you save a

patient's life or because of negligence

on your part you actually led to the

untimely death of your patient no so

that's why they have to be well grounded

not only in the knowledge of medicine in

the art of medicine but in the ethical

issues governing life and death oh

that's that's very interesting because I

think all of us will will have to go

through a case in our lives where we

have to deal with bioethics issues

correct all right so when when people

are in in that situation wherein they

have to they have to handle or they are

faced with a case on bioethics what are

the principles that should guide them in

making ethical decision make in making

ethical decisions well in the first

place uh one of the things is for you to

know if you're on the right you have to

have a standard right so um and

therefore as far as ethics is concerned

the standard that we actually follow is

what we call Natural moral law moral

meaning what guides man in choosing what

is right and what is wrong but it's it's

natural in the sense that it comes

naturally to a human being to to choose

what is good rather than to choose what

is evil so knowing natural moral law

therefore um then when a person is faced

with some ethical dilemma and many times

the ethical dilemma is not actually pure

black and white no so there's a lot of

Gray Zone in between if she's

knowledgeable about the teachings of

natural moral law then you might say she

will be guided along that path what what

am I talking about something so simple

as being truthful for example we face

that all the time in when we're faced

with patients no I am a paliative care

doctor and therefore I take care of

dying patients so I always tell my

students you only die wants so I suppose

all of us would want a good death right

and we actually did a study um in PGH

about this and when we ask patients what

you consider a good death would you

believe their answer was to be at peace

with God so that was wow amazing that's

what they meant by a good death as

doctors we thought ah good pain control

good symptom control etc etc but for

them it's about a good death is being at

peace with God when we ask the family

members taking care of them that the

answer was the same so it's like wow

really amazing but when we asked the

doctors would you believe what the

answer was something very medical like

good pain control good symptom control

etc etc so then I realized that that's

the reason why what the patients want

and what the doctors give them is not

one and the same so as I was saying as

far as truth telling is concerned it's

my personal advocacy to make sure that

everybody who dies knows that he's dying

because there's such a thing as closure

there might be some things that I want

to finish in my life I want to resolve

in my life before I go right but

especially in the Filipino culture they

always think that when you tell the

patient that she is near death that

she's actually her time is limited then

they will start worrying about the

patient becoming depressed the patient

not eating anymore hastening death in

the process and therefore they would

actually tell the doctors to keep the

truth from the patient that's one

ethical dilemma because because we

should tell the truth to the patient

because it's the patient's life and

death but the family tells us no and

sometimes they would even then what I

would even ask them uh what if they

really ask me doctor how much time do I

have I suppose you don't expect me to

lie because there's such thing as maybe

I will not tell the whole truth now but

on the other hand I cannot lie that's

deception so that's just a little of the

ethical dilemma that we Face dayto day

in our

practice your field is very you know

it's very difficult in the sense that

you are dealing with people who are very

emotional and who are also very

physically ill at the same time and I

wonder um what are the rights of the

patients especially if there are cases

when the patients are no longer Lucid if

they cannot make decisions for

themselves what are the processes that

you have to go through in order to

arrive at something that is ethical mhm

of course the the most basic fundamental

right of all is the right to life okay

but on the other hand we know that we

won't be alive forever right meaning uh

death is as natural as living know all

of us will die eventually but uh aside

from the right to life also is the right

to human dignity meaning it's not just a

matter of keeping me alive but I have to

have the quality of life in such a way

that I will be able for example to

interact with other people to be able to

carry on my usual duties and

responsibilities no it's not just a

matter of keeping people alive on

ventilators I mean until you don't even

know when like so because artificially

we can keep them alive for months if not

years and it brings with it a lot of

pain and suffering not only to the

patient but to the family taking care of

them no so so those are some of the

things that we encounter actually in in

our practice in at the end of

life and there are also issues you've

mentioned earlier about beginning of

Life no correct so it's actually the

expanse of human life no correct and

what are the usual dilemas that people

have to go through or people have to

resolve along with their doctors as far

as the beginning of Life is concerned

well that very question when does Life

Begin okay so you might say as far as

medical students are concerned we know

our biology embriology very well we were

taught in medical school our medical

textbooks tell us that life begins at

conception when the egg cell and the

sperm cell meets that's already a two

cell stage that's already a fertilized

egg the chromosomal makeup of the person

is already completed 46 chromosomes

which dictates that you are a human

being so therefore even at that

microscopic stage in the person's

development it's already a human being

unfortunately through the years

especially with the Advent of of the

sexual

Revolution um there was a lot of um free

love going on and therefore quote

unquote unplanned unwanted pregnancy

they wanted to justify the fact that um

I have to get rid of this baby so

therefore to somehow pacify their

conscience they had to redefine the

beginning of life so instead of of uh

following what we've always known in

biology in medicine that life begins at

concep

they sort of moved it up later on in the

in the stage of a person's development

and they set it at implantation which

biologically is already at the 7th to

10th day of life so one week old na you

baby inside the mother's womb of course

nobody would know about it maybe the

pregnancy test will not yet be positive

at that point in time but that doesn't

stop the fact that the the the pregnancy

has occurred and you have a human being

there developing in your womb so one of

the things that um that is you might say

debatable even up to now is the practice

for example of artificial contraception

no as opposed to Natural Family Planning

which is what is always been recommended

by the Catholic church for example no so

as you know the RH bill was debated on

for practically 10 if not 13 years no

because there were really two camps

fighting on this issue no about pro-

lifee and pro-choice

uh but H the pro-life would always say

the antonym of pro-life is actually Pro

death there's no such thing as a pro

choice because anybody in her right mind

would always choose life over death but

I think The Advocates of pro pro-choice

just to look at it from another

perspective would say that usually women

make certain choices because let's say

they got pregnant because of let's say

rape correct or they got pregnant and uh

there's a threat to their physical

to their health what would normally be

the process that doctors will have to go

through in order to advise women who go

through such a through such a case so I

began by saying that one of the

fundamental human right is the right to

life right so whenever you have a

pregnancy you're actually dealing with

two

lives two human beings not just the life

of the mother but also the life of The

Unborn and actually the tricky thing

here is is of course you might say the

mother in principle is already grown up

an adult who's able to make choices

whose intellectual function is already

mature no whereas the fetus The Unborn

Child is actually still in the process

of development physical and mental

development uh and therefore you might

say is totally dependent on the mother

for its nutrition even for its oxygen

and for its growth in general so

therefore

um we always say that the fetus is

actually

innocent harmless and defenseless no so

normally you might say um in the right

scheme of things the strong one should

be protecting the weak ones because

precisely they are unable to defend

themselves so when you talk about um

women's lib and saying that it's my life

it's my choice it's my body of course we

very well um say that's correct but

being pregnant you can no longer say

it's just your body because inside your

body is a developing fetus right so you

might say um where your your right ends

is where the other right begins so the

limitation there is yes you you are free

to do with whatever you want with with

your life but unfortunately there is

another person's life who is entirely

dependent on you and the way I always

teach it to my medical students would be

if you watch um Animal World in cable TV

what you would usually say would be for

example a mother cat uh taking care of

the cats right uh like u a dog

taking care of the puppies right and the

moment you touch the cat the

kittens and you play with them or the

doggy

like that no the the mother cat or the

mother dog will really bite your hand

for for even touching the kittens and

the the puppies right so they think that

their puppies or their kittens lives are

in danger and therefore you're the

aggressor you're the predator and that's

why we always say we are supposedly the

wisest of the animal kingdom man and

therefore if in the lower farms in the

animal kingdom the the parents protect

the young because the young is

defenseless and innocent and harmless

then there is really uh a big question

in our mind how come the wisest of

Creatures Animal creatures doesn't seem

to follow that natural moral law of the

strong defending the weak okay so but

what if there are health risks correct

so you were saying rape and then um

health risk okay so for example in the

case of rape obviously the woman has

been

victimized but and she got PR pregnant

in the process right so that's very very

unfortunate but in in as much that she

is a

victim the child is equally a victim

right so when she considers abortion to

get rid of that unwanted unplanned

pregnancy ultimately you might say the

one who would suffer the death penalty

is the innocent harm Harless and

defenseless child who is the victim like

she is the one who should receive the

capital punishment is actually the

rapist so it's a lie when you a doctor

proposes abortion to a person who has

been raped in fact you will double her

trauma she suffered the trauma of rape

now she will suffer the trauma of

abortion because there are a lot of

studies that say that no matter how

Brave a front a woman puts up she will

never ever be the same again after an

abortion I have personally counseled

women who have who have gone through an

abortion exactly in this condition um

she was in in Subic and she was raped

she was still an adolescent and she was

raped and of course the rapist was

telling her if you tell anyone I'm going

to kill you so she didn't tell anyone

that she has been raped and she actually

got pregnant and she had an abortion so

uh move forward to many years until I

actually saw her maybe 10 years have

passed and she's relatively successful

she had made a name for herself and she

came to me complaining of abdominal pain

and um some dermatologic complaints she

felt itchy all over so and all the test

that we run were normal and then I so I

had to relate to her that you know uh oh

your tests are normal there's really

nothing wrong that inside you that could

pain your symptomss to to say that you

how come you're in pain and then how

come you're itchy until I actually

started counseling and that's when she

revealed to me the fact that she had an

abortion and then she said that the

reason why she always felt pain here was

the pain of losing the child and the

reason why she was always itchy was

because she felt so unclean about having

been raped and about having gone through

an abortion so there's a psychological

trauma definitely nobody goes to an

abortion and scap you'll always suffer

from it physically mentally emotionally

if not actually spiritually

you'll later on maybe they'll suffer

from extreme guilt most of them go

through major depression so that's why

they we always say it's a lie to assure

w women that abortion is pro women no it

destroys their lives they're never the

same again in the case of a medical

condition for example

medicine has advanced to such an extent

that we have all the specialist you need

to make sure that you go through

pregnancy successfully so there's a

doctor um who has specialized in

high-risk pregnancy and there's another

doctor who has specialized in high-risk

neonatology meaning newborn baby who are

at risk of dying because of their

they're too preterm for example so

between those two Specialists more and

more we are able to save lives

so there's no need to quote unquote kill

the baby to save the life of the child

because no matter how you quote it

abortion is none other than killing an

innocent def defenseless and harmless

Child by the mother that's the saddest

thing the mother any good mother would

give her life for her child a woman who

goes through abortion kills her own

child all right that's a very powerful

statement uh no but I think the same

issues arise when we talk of the end of

life uh care no because I I have read

that in the United States for instance

and in other uh Western European

countries they have already legalized uh

euthanasia and there's a new term which

is called assisted suicide corre can you

please elaborate on that because I

believe that that's also part of the

topics that you discuss in bioethics so

the way of course they would say

euthanasia is none other than mercy

killing at least they are clear about it

it you're killing someone and usually uh

most of the patients who ask for

euthanasia are suffering from a chronic

or terminal illness that is causing them

a lot of suffering sometimes not just

physical but mental emotional and you

might even say what we call existential

distress they always ask themselves why

me what have I done I've always been

good so how come I'm suffering like this

so all those are the the way they

manifest their hopelessness and

helplessness no so

euthanasia as the proponents would

describe it would be to relieve the

suffering of people who are well in

these conditions no that they are

totally bad readen there's no hope of

for a cure so ultimately you might say

euthanasia is none other than

eliminating the sufferer to eliminate

the

suffering so in that's what we do in

paliative care we're going to eliminate

your suffering without eliminating the

sufferer in other words I don't have to

kill you to make sure you're painfree

right and you might say that's why the

popes have always uh said and they're

really encouraging that more doctors

pursued the specialization of paliative

care because with the Advent of

paliative care the requests for

euthanasia have drastically gone down

because ultimately you ask any San

person would you want to live in in fact

our patients beg us doc do everything

possible to save my life so for anybody

who would ask you do kill me something

is Gravely wrong there and then you say

why they want to end your life and then

they would say because I'm suffering so

much doc then I would say what if I

relieve your suffering you would just

still want to end your life and they

would say of course not doc I I have to

I have to be keeping myself alive and

healthy for the sake of my family so

they have their goals to keep in mind

mind still so there so and physician

assisted suicide is you might say very

evil because you might say to be a

doctor you have sworn by the oath of

hypocrates to always um respect your

patient to save their lives no because

they have entrusted their lives to you

with physician assisted suicide it's the

patient who will kill herself right but

you are the Doctor Who prescribed the

medications with which you will kill

herself so so that's what we mean by

physan physician assisted suicide uhhuh

so CU they will not we have access to

those medications if you not you did not

make the prescription for them MH so in

your case PA there there was no request

you're a paliative care doctor so have

you encountered any any patient who have

requested for yes I always remember them

they are very few but each encounter is

something that you to consider lengthily

and even pray about I I would distinctly

recall that incident in our during our

training in PGH where there was an old

man looking for me old because he looked

old but in reality I suppose he's not

that old except that he was he was um an

Indigent person and I suppose really

they were having such a hard time making

making ends meet no so so he came to me

and and he said in the Tagalog doc

Nang n doc would you mind giving my

mother an injection her mother was under

her his mother was under our care we

took care of her for a long period of

time uh we practically pulled her out of

death's door but she was on mechanical

ventilator but she was fully awake and

able to to communicate to us of course

by hand signs and by writing but she

needed a mechanical ventilator to be

able to breathe so and but we were

discharging already because she's been

in PGH for a month already and

unfortunately in government hospitals

you always need the bed for to make room

for for another very sick patient so

it's time to send her home and then we

were really arranging I'm going to bring

her home in the in the phj ambulance and

then there and then all of a sudden the

son came to me and said doc would you

mind injecting my mother so it's

like

uh inject what are we supposed to inject

her with so and then he he started

crying then doc please inject my mother

and then I said uh

tatti um let me get this clear you want

me to inject something to your mother

what is it exactly that you want me to

inject to your mother so bottom line he

started crying he couldn't cry and he

couldn't tell me anymore he started

sobbing well in the end he was asking

for euthanasia for the mom and then I

said actually po even in Western

countries where euthanasia is legal the

patient had to know that that euthanasia

will be performed on her and she's

asking for euthanasia you cannot just

come over and inject a person without

her full knowledge and full consent

about it so it's not even euthanasia

that's homicide at the first degree

right so by her own doctors right so and

then until he explained to me the whole

situation that they actually live by the

reles they don't even have a home they

don't have electric

their house that the nurses station in

PGH is bigger than their house there's

no flooring everything is soil and the

question is where will you attach the

ventilator and the ventilator cost 500

pesos a day to keep it going so and and

only one person is earning and they're

not even earning minimum wage so how

much is the minimum wage is less than

500 pesos so how will they eat so bottom

line is like it's not just a problem for

the p patient but for the entire family

then that that's when it began to sink

on me that oh my goodness why didn't we

consider this in the care for this

particular patient precisely because for

example if a patient's prognosis is very

poor and the outcome is not very good

there's such a thing actually is

allowing natural death we need not have

employed all those aggressive means of

life support that entailed a lot of

expense on the part of the family and

now that the patient is Alive and

Kicking then we're going to kill her

that is unethical there is nothing

unethical about a terminally ill patient

dying a natural death as long as we keep

them as comfortable and pain-free as

possible but you don't kill a living

human being who's not at death's door so

that's what euthanasia is all about so

rarely we encounter them and uh it's a

matter of not judging them ABA you want

to commit a crime and you want me to to

be part of that crime no we cannot be

judgmental each person has their story

to tell and usually it's a sub story

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even

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