Friday, April 6, 2007

Life after life

Dra. Myrna Gigantone during March 2006 Bethany Makati Bible college graduation Note: I wrote this article March 2006 but I am reprinting it here in view of Easter Sunday, the world's celebration of the resurrection of Jesus Christ, and on a more personal note, the death yesterday morning, after a two-year battle with cancer, of Dra. Myrna Gigantone, faithful member of Bethany Makati and beloved professor and guidance counselor of L.D. Woosley Bethany Colleges.

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One of the hit movies worldwide in the 1970’s was “Sunshine” starring Cristina Raines and Cliff de Young, I think, based on the tape-journals kept by a young mother dying of leukemia. I’m sure you have heard the movie’s theme song by John Denver. I watched this movie three times, I think, on TV reruns; hey, what can I say? I’m a sentimental kind of guy!

“Sunshine” is probably the only movie about death and dying that has become a huge box office hit. As the man on the street would say, “What kind of a movie is it if the hero dies at the end?” The story is told that in one Fernando Poe Jr. movie, moviegoers in Muslim Mindanao rioted when the character played by “Da King” died at the end of the movie.

Several weeks ago, we heard and saw on television news reports of the tragic story of former teen idol Darius Razon - losing his daughter in a fire several years ago, and three weeks ago, his son Denver in a car accident …

Somehow it seems unnatural for a man’s children to die ahead of him. Nature seems to dictate that parents are buried by their children, and not the other way around. I remember several years ago, there was a plane accident in Mindanao where all the passengers and crew died. During an interview, a grieving mother said of her college-age son (one of the passengers), “I didn’t think he would die at such at a young age.”

Death is an inescapable fact of life. Everyone who has ever lived died. Everyone living now will eventually die. I think it was Sigmund Freud, father of psychoanalysis, who said, “Death is the goal of life.” The late Peter Marshall, famous preacher and chaplain to the US Senate, once said, "Death is not a wall; it's a door." So it's really fitting to speak of "life after life" and not "life after death."

John Donne, poet and preacher to England’s monarchy two hundred years ago, described death this way,

“All mankind is of one author, and is one volume; when one man dies, one chapter is not torn out of the book, but translated into a better language; and every chapter must be translated. God employs several translators; some pieces are translated by age, some by sickness, some by war, some by justice; but God’s hand is in every translation, and his hand shall bind up all our scattered leaves again for that library where every book shall be open for one another.”
The Bible in Hebrews 9:27 says it simply but definitively: “For it is appointed unto men once to die, and after this, the judgment.”
In law school, I took a one-unit required, non-bar course called “Medical Jurisprudence.” My professor was a very kind medical doctor and who was the town vice-mayor at that time; he passed me even though I didn’t get to read through the textbook. But then again, in the late 70’s, I was a great fan of the TV series “Quincey, Medical Examiner” starring Jack Klugman. “Quincey” is the forerunner of the various “CSI” shows today. I learned a lot of forensics from watching “Quincey,” enough to pass the final exams in Medical Jurisprudence.

The only thing I can remember now from that course was that one way of determining death was to place a mirror near the patient’s mouth and nostrils. If the mirror wasn’t fogged, then the patient was deemed to have stopped breathing and then pronounced dead by the attending doctor. (Hmm, this could be the reason why women carry around with them a “compact” with face powder and a mirror in it. Some women would rather die than be caught in public without their make-up. Just kidding! I just couldn’t resist this kind of non-sequitur jokes and comments!)

The ancient Greeks, despite using the best means available to them, were puzzled as to why the human body weighed the same before and immediately after death. They wondered as to what was missing in the human body so that what was once alive was now dead.

Medical criteria in determining death

The medical community, here and abroad, has used several criteria by which to determine whether a person is dead or alive. These are:
(1) Heart-lung death: the irreversible cessation of spontaneous respiration and circulation
(2) Whole-brain death: the irreversible cessation of all functions of the entire brain, including the brain stem, even if the heart and digestive systems are still functioning
(3) Higher-brain death: the irreversible cessation of all cognitive functions such as personality, consciousness, uniqueness, memory, judgment, reason, enjoyment, worry, etc.
How does Philippine law define “death”? Republic Act 7170 or the “Organ Donation Act of 1991” in Section 2, paragraph (j), defines death this way:
j) “Death” - the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem. A person shall be medically and legally dead if either:

1) In the opinion of the attending physician, based on the acceptable standards of medical practice, there is an absence of national respiratory and cardiac functions and, attempts at resuscitation would not be successful in restoring those functions. In this case, death shall be deemed to have occurred at the time those functions ceased; or

(2) In the opinion of the consulting physician, concurred in by the attending physician, that on the basis of acceptable standards of medical practice, there is an irreversible cessation of all brain functions, and considering the absence of such functions, further attempts at resuscitation or continued supportive maintenance would not be successful in restoring such natural functions. In this case, death shall be deemed to have occurred at the time when these conditions first appeared.The death of the person shall be determined in accordance with the acceptable medical practice and shall be diagnosed separately by the attending physician and another consulting physician, both of whom must be appropriately qualified and suitable experienced in the care of such patients. The death shall be recorded in the patient’s medical record.
As far as my research goes, the Philippine legal definition of death was patterned after two American laws - the Uniform Anatomical Gift Act (1970) and the Uniform Determination of Death Act (1980). Please take note that the Philippine criteria is in the alternative; it is either heart-lung death OR whole brain death.

The issue of determining how and when death has occurred is a raging controversy because of the inter-related issues of euthanasia, the quality of life of a terminally-ill patient, organ transplantation and even racism. (Why racism? Black Americans are afraid that white American doctors might be trigger-happy, so to speak, in pronouncing them dead for the purpose of harvesting their organs for the lucrative business of transplantation of organs.)

Dr. David Anderson of Faith Baptist Church, Sarasota, Florida, has a very informative article entitled “A Brief Summary of End-of-Life Bioethics.”He provides clear and helpful definitions of the various terms like “patient self-determination,” “living will,” “advance directive,” “persistent vegetative state,” “do not resuscitate order,” etc. He also presents a point by point rebuttal of “physician-assisted suicide.”

Anderson also agrees with the “brain-death” criteria for determining whether a person is dead or alive. He says, “Using a clinical determination of brain death is a far more acceptable standard than using levels of consciousness, social interaction, or degrees of personhood. The brain death criteria is as an objective determination of death as is possible at this phase in medical science .... Brain death appears to be the most reliable standard for determining death.”

Paul A. Byrne, M.D. in his article “Understanding Brain Death” for the Vital Signs Ministries, however, disputes the validity, accuracy and the morality of the brain-death criteria for determining death. He says passionately right at the beginning of his article,
“All general criteria used as standard up to 1968 developed from the intention to make sure that a person who is still alive will not be treated as if dead. On the contrary, the new criteria are intended to prevent someone from being treated as alive when already dead. The new criteria are intended not only to decide as soon as possible when someone is dead, but among other options to clear the way for the excision of vital organs - action which, if a mistake has been made, is certain to kill the still-living patient. Since any criterion nowadays must subserve organ transplantation as well as other purposes, any new general criterion of death must be at least as certain as the older ones, since a mistake here would be lethal. Yet, the new criteria are far less certain than the older ones; they are not merely uncertain but certainly wrong in principle.”
Farther on in his article, Byrne states his preference for the heart-lung death criteria: “Before 1968, a patient was pronounced dead by a physician who observed no circulation, no breathing and no reflexes. While these observations and criteria for pronouncement of death were not infallible, they were very reliable.”

Byrne says that “cessation-of-brain-function laws, if followed by living will and death with dignity laws, will all be a part of, or lead to euthanasia.” In one of his conclusions, he states emphatically, “Death ought not to be declared unless the circulatory and respiratory systems and the entire brain have been destroyed, i.e. no longer having the capacity to function.”

Death, serious sickness or traumatic injuries can possibly come into the lives of our families or friends one of these days. I recommend that you read these articles by Anderson and Byrne so that you will be prepared in confronting the questions of organ donation, when to say “stop” in doctors’ attempts to resuscitate your loved one, euthanasia, the quality of life of a terminally-ill patient, etc.

My father’s and mother’s deaths

Sometime in 1976, my father, walking home alone after the Sunday morning service at the Mandaluyong Bible Baptist Church in Nueve de Febrero St. became dizzy and fell into a ditch. He had been lying in the ditch for some time before someone saw him and brought him to the nearby Waterous Hospital.

My mother, sisters and I rushed across the street to the hospital to see him. My father was conscious, with a deep, ugly wound on his forehead. I remember holding on to my father’s hand and praying, “Lord God, please don’t let my father die. I’m already in college but I really don’t know him, who he is, who and what he was like before I was born …”

God did spare my father’s life at that time. My father stayed at home for several months recuperating, and every chance I had, I stayed in the house, talking with him, or just letting him tell stories about his guerilla days in World War II, fighting the Japanese in the Ipo Dam campaigns. Sometimes, I would just stay near him, as he lay in bed, listening to his favorite radio personality Mel Tiangco. In 1986, my parents went to the US to live with my eldest sister. I kept in touch with my father intermittently through greeting cards and short phone calls. Sometime April 1991, he died of a heart-related problem.

From time to time after my father’s death, my mother would come home from the US for short visits. I looked forward to getting home in the afternoons, because I knew that my mother would be preparing something delicious - siopao, empanada, broccoli boiled in water with a little salt and then dipped in mayonnaise, etc. During the impeachment hearings against President Estrada, my mother and I would watch the proceedings on television for hours. My mother wanted to spend the rest of her days in a farm in Dumaguete but that wish didn’t come true. She died in the US August 2004 because of an inoperable, flattened heart vessel.

I think it was martyred missionary Jim Elliot who said, “When it’s your time to die, make sure that all you have to do is die.” What he says, I think, is not to leave any loose ends in your life - no words of love, affirmation or encouragement left unsaid; no hurts and heartaches inflicted by other people left unforgiven; none of your own sins and offenses against other people left unconfessed …

The Apostle Paul says in I Corinthians 15:51-58:
Behold, I shew you a mystery; We shall not all sleep, but we shall all be changed,

In a moment, in the twinkling of an eye, at the last trump: for the trumpet shall sound, and the dead shall be raised incorruptible, and we shall be changed.

For this corruptible must put on incorruption, and this mortal must put on immortality.

So when this corruptible shall have put on incorruption, and this mortal shall have put on immortality, then shall be brought to pass the saying that is written, Death is swallowed up in victory.

O death, where is thy sting? O grave, where is thy victory?

The sting of death is sin; and the strength of sin is the law.

But thanks be to God, which giveth us the victory through our Lord Jesus Christ.

Therefore, my beloved brethren, be ye stedfast, unmoveable, always abounding in the work of the Lord, forasmuch as ye know that your labour is not in vain in the Lord.
Christ is risen!

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