One’s last breath
In the eventuality that you need to make a decision, do not resuscitate me. I do not want any wake to happen. Call a priest to say Mass before I get cremated and send a text message to everyone the next day to say I have passed on. Kindly request prayers so I can increase my chances to go to heaven. Lastly, please throw my ashes in a nice spot in Tagaytay.” After hearing my litany, my beloved brother turned to me and in a solemn tone said, “Can’t I just flush you down the toilet?” You could just imagine how hard we laughed. Months later, while driving through Tagaytay, he told me that he had found the perfect spot. When my eldest sibling heard about it, not only did she complain about the trip, knowing the traffic situation, but she also complained about the real possibility that the strong winds would result in them inhaling my remains. My reply was, “Wouldn’t you want that? At least I can really be a part of all of you.” That remark was met by fits of laughter and a request from my other mischievous sister that when her turn comes, she would want us, her immediate family members, to be in black leotards while dancing and singing to “Burn Baby Burn” during the cremation rites. While my brother would undoubtedly carry out my wishes, the throwing of my ashes would have to be overruled as it is against our religion. The dancing part requested of us would also have to be omitted. The manner that we chose to discuss such a sensitive matter was our own way of preparing ourselves for the pain of saying our final goodbyes to one another, and on a deeper level, providing the assurance that we would respect each other’s wishes.
Have you ever heard of people having their own advance directives? By definition, the Cambridge Dictionary defines it as a “written document in which a person says what type of medical treatment they would like or who can make decisions about their treatment if they become so sick that they are unable to make decisions or communicate their wishes themselves.”
This became a topic of reflection after we listened to several bioethics lectures, which touched on how one should approach decision-making for end-of-life issues involving both the young and the elderly, while respecting their autonomy and avoiding undue harm to them as our patients. Personally, it also brought into sharp focus how beneficial health-care directives can be, and helped reinforce the extent to which a doctor plays a role in the course of action that a family would take. I used the word beneficial as a directive can ease or even free the family from the burden of guilt, knowing that they acted in accordance with their loved one’s wishes. Regrets are one of the hardest things to live with. On the part of the physician, we have to remember that our main responsibility is not to be the one to make the final judgment call. Our role is to assist the patient and their family in arriving at a firm decision after having thoroughly explained the condition and, in the face of a terminal illness, having provided reasonable options. We have to respect their decision even if it may at times run contrary to our recommendations.
A question that you may ask is who gets to be the surrogate decision-maker for the patient. One of the lecturers provided a list in hierarchical order: first, a legal guardian with health-care decision-making; second, an individual with a given durable power of attorney for health-care decisions; third, a spouse; fourth, adult children of the patient who should all be in agreement; fifth, parents of the patient, and lastly, adult siblings of the patient, who should likewise be all in agreement. While this is the list that was given and surely must have a reference, he emphasized that the most important consideration would be to “choose someone whom you can trust enough to listen carefully to your values and preferences for future care, and who will be comfortable in making decisions in difficult situations.” This would then include other potential choices. It could be a partner, a friend, or a religious advisor. Armed with this information, hopefully, it can help avert potential conflicts and bring comfort to those who are unable or reluctant to decide.
Beginnings have endings, and that’s the way we should be able to accept our own mortality. We are all living on borrowed time. While we may be given choices, the ultimate decision will always come from the one who gave us the gift of life.
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