Thursday, June 23, 2005

EUTHANASIA- a view from Fr Clarence Dass

Following is an extract of an articlequoting Fr Clarence Dass's views on EUTHANASIA that appeared in THE SUN (20th June 2005)

Catholic priest and moral theologian, Rev Clarence Devadass: "Life is sacred. Life originates from God and only God determines when life comes to an end. We do not decide when a person should die.

"The normal reaction to suffering and pain is to find ways to end it so the patient starts thinking, why not just die and not suffer. People in pain may not be in the right frame of mind to make requests to die. Furthermore, suffering is part of life, much as you want to avoid it.

"There is the argument focused on the quality of life today and many of us have forgotten the sanctity of life.

"Some people say if a person is old and sick, or disabled, they are worthless but who determines the worth of a person's life? What makes you think that a person with one arm less has a lower quality of life? For that person, that is the fullness of his life. Each of us has our own defects but God loves us just the same.

"Can people say you are old and sick and worthless so we might as well just kill you? We cannot be playing God. Medicine is there to help people. It is a gift from God. It is God working through science and technologies. They are instruments of God's healing, an aid to society not a hindrance. If the prognosis is bad and treatment is of no help, we may say 'No' to extra-ordinary treatment like those in advanced stages of cancer because you will only be prolonging the agony. Nevertheless, basic nutrition and hydration must be provided and cannot be withheld or withdrawn.

"'What about costs?' people ask. Well, society should not wash away its responsibility over an individual in a society. Society is responsible to an individual as much as an individual is responsible to society. Healthcare costs are escalating and the state has to provide for the well-being of its citizens. So it has to help people who cannot afford healthcare. If not then there is something wrong with the system.

"People sometimes call it mercy-killing, but how can you kill somebody out of mercy or love? It is a contradiction in itself. It does not make sense. Life is sacred and this applies in all circumstances. It is absolute. The problem is, people are seen in terms of their usefulness. We look at youth or the usefulness of a person to society as a measure of a person. Only if you are of any use to society will it take care of you. If you burden me and are of no use to me, you can die. That seems to be the trend today. Fortunately, still has a strong sense of God and religion. So it is hoped that cases like Terri Schiavo's do not happen in Malaysia. Thank God euthanasia is not allowed in Malaysia.

From the recent AFCMA Congress in Taipeh, 2004

Reflections of the Christian Spirit in Caring for the Elderly-Challenges and Perspectives

By Freddie Loh M.D. Family Physician

(This talk was presented by Dr. Freddie Loh at the 13th AFCMA Congress in Taipei Nov. 2004)

Who are the elderly? The World Health Organisation defines an elderly person as anyone aged 65 years and older. This was decided as the age of benefit in Germany in 1873 and perpetuated in the retirement regulations of other countries which followed. There was never any physiological basis for the decision nor for the cut off of 60 years old which the United Nations demographics adopted.

Ageing has been defined as a progressive loss of adaptability with the passage of time so that the individual is less and less able to react adaptively to the challenges from the internal or external environment. With time the individual becomes progressively more frail and in need of increasing support to maintain her autonomy.

Facts about Ageing. A demographic revolution is underway throughout the world . Today worldwide there are around 600 million person aged 60 years and over. This total will double by 2025 and will reach virtually 2 billion by 2050 – the vast majority (two thirds) of them are in the developing world - See graph . Source: UN 2002

Women outlive men in virtually all societies, Malaysia has a population of 25.6 million, with 850,000 Catholics or 3.5% of the population. We have about 1 million who are aged 65 years or more i.e. 4% of the gross population.

Here is a list of major chronic conditions affecting older people according to source: WHO 1998.

Cardiovascular diseases (such as coronary heart disease)





Chronic obstructive pulmonary disease

Musculoskeletal conditions such as arthritis and osteoporosis

Mental health conditions (mostly dementia and depression)

Blindness and visual impairment

Unfortunately in Malaysia we do not have any national health insurance schemes unlike the developed countries.

The challenge…

So how can we as Catholic doctors, nurses and other healthcare givers respond to the challenge of looking after the elderly who are not only increasing in numbers but are also continuing to live longer, i.e. grow older. Allow me to share with you my personal experiences in looking after elderly people in a Christian setting .

I have been blessed to have been able to help the Little Sisters of the Poor Old Folks Home in Cheras, Malaysia run their clinic . Together with a few doctors we have been taking turns to treat the sick which include the residents , sisters, priests, helpers, and workers of the Home. During my 18 years at the Home I have learned much from the Little Sisters for the dedication and love that they show towards the elderly.

However after 25 years, it was decided to rebuild a new home as the building was leaking and needed constant expensive repairs.

The new home , on the same site is now called the St. Francis Xavier for the Aged which was declared officially opened on 19 March 2004 by his Grace Most Rev. Murphy Pakiam, Archbishop of Kuala Lumpur. Their home complete with lifts is fully equipped with modern facilities to provide a comfortable, convenient and safe environment for the aged residents .

There are 10 sisters and and 20 full time staff running the home. Volunteers consist of .

Doctors, nurses, dentist, physiotherapist and other general helper from the public. These volunteers are important and they form an integral part of our team in caring for the elderly. They help the residents with the arts and crafts, taking them out to the shopping center or to attend a show, wheeling the infirm out into the garden etc.

Ever since the Little Sisters of the Poor started their work in 1839 in France, they depended entirely on charity from the public to run their Home. So when the new \home was built everybody chipped in including our Catholic Doctors who organised a charity golf competition to raise funds for the building.

Criteria for admission to the Home: In order to gain admission to the Home one must be poor and above 65 years of age. The Home is open to anyone irrespective of race or religion . However a large proportions of the residents who had no religion or other religions do convert to Catholicism after witnessing the great love and care they received from the Sisters. Presently we have 51 residents staying at the Home , and eventually there will be 70 plus 30 day care persons.

Tips on caring for the elderly

In caring for the elderly we must be guided by our church teachings
1) we must show respect for the human dignity of the elderly person even when he is physically or mentally disabled.

2) We must show respect for life by strongly opposing the practice of euthanasia

3) we must be aware that the elderly in the home is lonely and feels insecure and sometimes all he needs is someone to talk to and listen to what he has to say or simply by holding his hand to show him that someone cares for him.

4) We must assure the elderly that they will be cared for in health and in sickness until the very end.

Here it will be helpful for us to remember the Beatitudes from the sermon on the mount Mathew 5: 3-11

Happy are those who are spiritually poor; the Kingdom of Heaven belongs to them!

Happy are those who mourn; God will comfort them!

Happy are those whose greatest desire is to do what God requires;God wil satisfy them fully!

Happy are those who are merciful to others; God will be merciful to them!

Happy are the pure in heart; they will see God!

Happy are those who those who are persecuted because they do what God requires;

The kingdom of Heaven belongs to them!

Other tips…

In caring for the elderly it is not sufficient just to look after their physical needs. We also need to give them the joy of feeling useful and making their life more pleasant. At the home residents are given optional small household task like setting the dining table, sewing, gardening made in charge of something e.g. the store, newspapers, library etc. In doing so we are following Jesus teaching in John 10 :10 Jesus the Good Shepherd who looks after his sheep, with love and care.

I came so that they might have life and have it more abundantly”!! He wants us to allow them enjoy life to the fullest.

Now allow me to show you two of the residents of the home which will give you an insight as to how we care for the elderly there-

Case No. 1

This is Mr. Jonathan Koh Boon Nam. He is a 78 year old bachelor who migrated to MalaysiaChina in 1942. Prior to his admission to the Home 8 years ago, he worked as a coffee shop assistant. He suffers from high blood pressure which is readily stablised with tenormin 50mg. He is physically active and represents the healthy aged group. He keeps himself useful by pushing the wheelchair for those who are wheelchair bound for their meals in the dining room. He also helps to look after the garden outside and in the chapel during the liturgy. I remember one year he dressed up as a Chinese warrior with his huge sword at one of the shows put up by the residents of the Home.


Case No. 2

This is Mr. Joseph Michael Yap. He was 74 years bachelorand a devout Catholic. from Kuala Pilah. His parents were rubber tappers. When he was 8 years old, a herd of elephants trampled and destroyed his house and killed his entire family, i.e. his parents and 8 other siblings. He survived in spite of his injuries and was saved by a military van which brought him to the Singapore General Hospital. He was eventually adopted by a Eurasian male nurse who educated him. He was working in Malaysia until his retirement. (He applied to join the Home a few years ago but his application was rejected because he had some money in the bank.) However, a few months ago he was diagnosed as having terminal cancer of the colon with secondaries in his lungs and he was no longer able to walk.

Through the BEC Basic Ecclesiastical Community and the Catholic Doctors help, he was accepted by the Mother Superior of the Home on humanitarian grounds so that Mr. Joseph’s final death wish could be granted. This picture was taken on the day he was discharged from University Hospital and transferred to the Home.. Although he was in severe pain, due to cancer, and needed morphine injections repeatedly, he was blissfully happy. 3 days later Mr. Joseph was called to join the Lord and the Sisters shared the night vigil with him till the very end.

Mr. Joseph’s case teaches us that we must show compassion, flexibility and humility especially towards the very ill and not be controlled by rigid man made rules. Instead we should be guided by Jesus teachings in Mathew 25: 35-40 (The Final Judgement)

for I was hungry and you gave me food ……..ill and you cared for me ….. whatever you did for one of the least brothers of mine, you did for me’.


2 cases representing how the elderly were cared for in health and in sickness at the Home were briefly described and discussed. As Catholic doctors and nurses and other health care givers, we must be firm in our faith and guided by our Church’s teachings when we are called upon to treat and/ or care for someone especially the aged.

At the Home we have seen cases who have been comatosed and unable to eat for weeks and months due to stroke and cancer etc.. These cases challenge our perceptions as Catholic health care givers. When faced with such challenges, we must remember that Jesus said ‘whatever you do to the least of my brethren, you do to me’ . It is Jesus whom we are caring for!

In March 2004, in his speech to the 400 participants of Life sustaining treatment and vegetative state, scientific advances and ethical dilemmas the Holy Father Pope John Paul 11 said that ‘a man even if he is gravely ill or limited in the exercise of his higher functions, is and will always remain a man. He will never become a vegetable or an animal! Our brothers and sisters , who are in the clinical condition of “vegetative state” preserve all their human dignity. God the father continues to look upon them lovingly, recognizing them as his children, especially in need of assistance. Therefore the sick person in a vegetative state awaiting recovery or his natural end has the right to basic health care and to the prevention of complications to his state. The prolongation of vegetative state cannot justify ethically the abandonment or interruption of the minimal care to the patient including food and water. Death by hunger and thirst is the only possible result should these be suspended. If caused in a conscious and deliberate manner it is genuine euthanasia by omission’ the Pontiff concluded.

In August 2004 thirty bioethics and health care experts gathered at a colloquium hosted by the Canadian Catholic Bioethics Institute to study Pope John Paul 11's speech on life sustaining treatment and the vegetative state. They discussed the implication of the general moral principles that was reaffirmed in the papal speech and applied to artificial nutrition and hydration (ANH) in persistent vegetative state (PVS) or post coma unresponsiveness (PCU) and focused on the most common medical conditions affecting the elderly such as stroke, Alzheimer disease, Parkinson’s disease and end stage cancer.

They pointed out that contrary to some early interpretation presented by the media, the Papal speech did not propose that ANH is always morally obligatory in a patient in a PVS or PCU or in any medical condition for that matter. What the Papal speech stated was that ANH should be considered in principle, ordinary and proportionate and as such morally obligatory.

Nevertheless the Papal speech is consistent with our Catholic moral tradition in which ANH and other life sustaining measures are to be assessed in terms of the benefits and burdens of the intervention to the patient in any medical condition including PVS and the disabled.


So where do we go from here? Some questions still remain unanswered such as what shall ANH be considered? Is it care or medical treatment? Is it beneficial or burdensome to the patient? Who decides to withdraw ANH and when? How to handle ‘advance directives’? etc These will be the challenges faced by our Catholic health givers with no clear cut answers in sight in the near future. I will end by borrowing the prayer that Pope John Paul 11 made to the Little Sisters of the Poor at the 150 anniversary of the foundation ‘May Christ the Redeemer and his blessed Mother help the Catholic Doctors, nurses and other health care givers to bear witness to God’s tenderness towards the elderly’ Amen.

Tuesday, June 07, 2005

NIAS Hospital Project- an proposal by Dr John Lee, AFCMA

Dear All,

FIAMC has developed a project with PERDHAKI to provide relief to Aceh and Nias. Nias in addition to being affected by the Tsunami was devastated by an earthquake on Easter Monday. During the course of discussion we have establish that there is a need to develop a hospital in Nias. We need to proceed on to the next level from here and there is a need to involve a few relevant parties in the discussions. This would include Prof Gian Luigi Gigli (President FIAMC) Dr Francois Blin (Hon Secretary FIAMC)Prof Kwang-ho Meng (President AFCMA) Dr Simon Castellvi (Spain) Dr Robert Walley (Matercare International) Dr Freddie Loh (Co-chair Missions AFCMA) Dr Kurniawan , Dr Albert Hendarta and Dr Widjo (Indonesian Catholic Doctors' Community) Dr Sally Ho and Dr Joseph Ong (Singapore) The people involved in this information group are concerned Catholic doctors who have indicated a desire to help in any project to relieve the sufferings of the vctims of Tsunami.

The proposal at the moment is to develop a hospital suitable for the needs of the people of NIAS. Dr Felix Kunawan will drive the project as he has been involved full time in the Tsunami relief and has the resources and local knowledge. We have negotiated with the diocese of Gunong Sitoli/Nias for the diocese to donate the land. This is important not only financially but because it signifies a commitment of the diocese to the project. Dr Felix has indentified a religious congregation FSGM Sister Congregation who will administer the hhospital and see to the recruitment of scarce medical personnel. FIAMC will help to coordinate the project and where necessary bring in foreign expertise. This is a massive project which will require the assistance of everyone.

As a necessary first step, Dr Felix will develop a project proposal which would include a simple need analysis (eg population served) and rough costing. He will also sign a MOU with the diocese of Gunong Sitoli/Nias agreeing to the donation of the land for a hospital. As we are all members of FIAMC I would suggest that the MOU be between FIAMC and diocese of Gunong Sitoli/Nias.

Rob, Felix has asked if you will agree to go to Nias and design the hospital layout which will include a maternity and children wing. (I am sorry that we have no funds for that at the moment. Can only promise free lodging in Singapore and maybe Indonesia if Felix can arrange it) We will also need some architectural and civil engineer input to ensure that the building is sound and able to withstand future earthquakes. If there is no suggestion of capable and willing individuals, I will source from Singapore. Experts from Indonesia will be better as they are more familiar with the culture and local conditions. I agree with Felix that the hospital should not be too big and sophisticated. However it must have the capability to perform surgery like Caesarean, appendisectomies, fracture reductions etc.

Any comments or suggestions from anybody?

Thank you for your interest in helping. God bless,
John Lee

Vatican's view on CLONING

Vatican Official Urges Halt to Cloning TechniqueBishop Sgreccia Responds to Reports From England and Korea VATICAN CITY, MAY 24, 2005 ( Reports of "therapeutic" cloning of embryos in England and South Korea highlight the need for international organizations and political authorities to halt this practice, says a Vatican official.Bishop Elio Sgreccia, president of the Pontifical Academy for Life, sounded that warning Saturday on Vatican Radio.Echoing a report in The Times newspaper the day before, Vatican Radio explained that a team at Newcastle University, headed by Alison Murdoch and Miodrag Stojkovic, created three blastocysts, namely, the clones of human embryos in the first stage.Last year, the Human Fertilization and Embryology Authority of Great Britain authorized the university's team to work on "therapeutic" cloning.The British scientists worked on 36 ovules donated by 11 women who underwent treatment for in vitro fertilization. The nucleus of each ovule was replaced by a skin stem cell. The ovules were then subjected to an electric discharge to initiate the growth process."Custom-made"From 10 ovules, the researchers were able to create three blastocysts. The attempt to extract stem cells had not yet been successful as clones had not lived for more than five days. According to the researchers, the experiment was carried out to prove that ovules taken from women who have undergone treatment for in vitro fertilization are adequate to produce clones.The news from Newcastle paralleled that of another research group of the University of Seoul and the University of Pittsburgh, in Pennsylvania, directed by Woo Suk Hwang.The research was published online on "Science-Express." Adult skin stem cells were extracted from 11 individuals -- men and women -- affected by various illnesses. Eleven human embryos were obtained from this.At the blastocyst stage, the embryos were then destroyed to obtain "custom-made" stem cells. The objective is to transplant them to the 11 patients, theoretically to replace their sick cells, such as in the case of diabetes, reported the Italian episcopate's newspaper Avvenire.Compared to a previous experiment, in this test the technique continues to be "the nuclear transference of somatic cells." The 11 stem groups were obtained from transferring the genetic material of the patients' skin cells into the ovules of the donor women. The ovules are deprived of their original nucleus.The novelty this time is that, having obtained the human embryos, once their cells were extracted, the embryos were destroyed, noted Avvenire.5 days of lifeThe newspaper continued: "The procedure of cloning by transfer of the nucleus of a somatic cell into a little ovule deprived of its own nucleus is identical to that which could lead to the birth of a child if the embryo were transferred to the uterus of a woman capable of carrying the pregnancy to its term."Instead, the embryo generated by nuclear cloning is cultivated only up to 5 days of life. ... On this point, the one conceived artificially -- similar in everything to an embryo originated by fertilization, as studies on animals show -- is destroyed to extract a number of cells from its interior -- embryonic stem cells."Without these cells the embryo "cannot live and develop," the Italian newspaper said.For his part, Bishop Sgreccia observed: "What they have done is something that the U.N. declared illicit some time ago and with great firmness. … Sadly it is only a declaration of principle."Commenting on the cloning of human embryos in Great Britain and Korea, the prelate added: "It seems that from the scientific point of view it is but the repetition and multiplication of a type of cloning carried out on man, to which flippancy and indifference are added.""I read a headline that stated: 'Is It a Hope or an Exaggeration?'" he said. "There are those who say that financial incentives underpin it all. The laboratories that make the greatest impact probably attract more funding for research."ManipulationThe Vatican official emphasized that "from the moral point of view, we well know that so-called therapeutic cloning by nucleus transfer is but a procedure -- the most artificial one imaginable -- to give life to a human being without roots even in the paternal and maternal gametes."It is "agamic and asexual fertilization, 'driven' only by the pride of reproducing a being in order to manipulate it, because afterward it is killed and eliminated," he said."Therefore, there is not only the transgression of reproducing artificially, but also the suppression and manipulation, perhaps even the commercialization, of the product," noted Bishop Sgreccia."It must be emphasized that here we see transgressed the meaning of the rights of man," he said. "Hence, an ever more robust awareness is needed, on the part of both international organizations as well as political authorities, to put an end to this, which is a bad sign of moral decay in the scientific terrain" and thus "also offends science." ZE05052420

Wednesday, June 01, 2005

Beyond the Terri Schiavo Case

Here is an extract from Zenit regarding vegetative states, hydration and nutrition, which may interest you and the medical profession:-

LONDON, MAY 28, 2005 ( During their visit to Rome last week Terri Schiavo's parents, Bob and Mary Schindler, thanked the Pope and Vatican officials for the Church's help in their attempts to keep their daughter from being starved to death.

The withdrawal of food and water that led to Schiavo's death in Florida last March 31 was condemned in a statement by Vatican spokesman Joaquín Navarro Valls. In a declaration issued the day of her death Navarro Valls described the event as "an arbitrary hastening of death." He also expressed the hope that the experience would lead public opinion to a greater awareness of human dignity and to improved legal protections for life.

The Schiavo case is by no means an isolated instance. Shortly afterward the Telegraph newspaper in British reported April 17 on an 81-year-old widow from the American state of Georgia, Mae Magouirk. In spite of having drawn up a living will she was deprived of food and water for 10 days after being admitted to hospital for heart problems, which, according to the Telegraph, were considered treatable by doctors.

The widow was not comatose or even in a so-called vegetative state. But a problem arose when her granddaughter, named in the living will as her guardian, decided that Magouirk was "ready to go home with Jesus." Her life was saved when other members of the family successfully took legal action to restore nourishment.

Last week the issue of withdrawal of food and water also came up in Britain, with what the Guardian newspaper described May 16 as "one of the most important right-to-life appeals to come before the English courts in recent years."

The case involves Leslie Burke, who suffers from a progressive degenerative disease. He fears that in the future, once his situation has deteriorated, doctors will decide to stop feeding him. Burke won a high court ruling last July, which declared the guidelines by the General Medical Council to doctors on the withholding of life-prolonging treatment were unlawful in some aspects.

Who decides?

The General Medical Council is now appealing the ruling and last week both sides presented their arguments before three appeals court judges. According to Burke's attorney, Richard Gordon, the issue was about "who decides," the BBC reported May 18. In the original case Burke argued that the General Medical Council advice, which gives doctors in cases such as his the final say on what treatment to give a patient in the final stages, was an infringement of his human rights.

In his ruling last year Justice James Lawrence Munby agreed with Burke, saying that if a patient is competent -- or, if incompetent, has made an advance request for treatment -- doctors have a duty to provide artificial nutrition or hydration.

A lawyer for Patricia Hewitt, the British health secretary, told the appeal court that the National Health Service should not have to give life-prolonging treatment to every patient who requests it "because that would mean a crippling waste of resources," reported the Times newspaper May 19. The Health Department is supporting the appeal against last year's ruling.

The government's position was criticized by Derrick Wilson, reported the Times. Wilson has a son who for the last eight years is in a "vegetative state" and he has refused to give doctors permission to end his life.

"I think this is the thin end of the wedge for euthanasia -- not only for people like Duncan but for people like me who are just getting old," he said. "It stinks of euthanasia, the government backing something like this. It's very distressing."

Last year's judgment does, however, have some defects, noted the Catholic bishops' conference of England and Wales. A note released May 17 by the Catholic Communications Network explained that the bishops are intervening in the appeal because they are concerned that by elevating the principle of patient autonomy to the level of an absolute, there could be "potentially dangerous implications for assisted suicide and euthanasia."

The declaration did stress, however, that the bishops are not opposed to Burke's attempts to ensure he will continue to receive nourishment.

Patients deprived of food and water die first of thirst, and this is not a pleasant experience, noted Dr. David Stevens, executive director of the Christian Medical Association in the United States.

On March 23, in the context of the Schiavo case, Stevens rejected claims made by some that dying in these circumstances is not painful. Based on his 13 years of work in Africa, where he saw many die of dehydration, Stevens criticized the "so-called experts" who have not seen someone die in this manner. "Contrary to those that try to paint a picture of a gentle process, death by dehydration is a cruel, inhumane and often agonizing death," he said.