Martial Law

September is usually remembered in the Philippines as the Month when Martial Law was declared.

Different sectors are planning to stage a rally on the anniversary of the declaration of Martial Law. But the government is quick to tolerate the rally. This is a big difference to the usual response of the government years before.

What would be great to remember on this day? Two sides argue. The benefits that we gained from the declaration. The inhumanities and crimes committed during the declaration. There will always be two sides.

History will be decided by those who write it. What power is left then to the readers of history?

God has been a witness to this page of our country's history. God obviously played a big role before, during and especially at the end of the Martial Law. How does Christian will understand this story in relation to their faith? Was it good or bad? Do we take a pessimistic or optimistic view?







Waiting for the news story... history to unfold...

Effective Altruism and the Ethics of Helping Others through Medical Missions

Effective altruism has been a major concern about the ethics of helping others. The discussion has centered on whether the help we offer has the greatest positive impact to the world. It scrutinizes whether the intent to help others is a valid reason enough to use our resources in certain activity. Such is the ethical questions that needs to be addressed by organizations thinking of maximizing their resources to help others through a medical mission. Here are Six Questions that needs to be answered before you organize a medical mission:

1. Is the medical mission needed in the area?
Many medical missions are conducted in areas that do not match the resources available to the needs in the area. One group once went to a depressed squatters area bringing antibiotics expecting many sick children. They found many to be sick with tuberculosis but do not have the medicines for it. Because medical missions often address acute medical needs, the timing and the location are important considerations for this activities. Another location might benefit the most with what you have to offer.


2. Are the recipients the neediest people who need the service?
This question is related to the first. Medical missions are often limited in their resources. It becomes important then to ask who will receive these limited resources? Do we give these to members of the organizations only? Do we invite our family and friends? Do we cater on a first come, first serve basis? Or do we exclusively limit it to the poorest people who needs the help the most?


3. Is the medical mission the best way to improve the health of the individual and the community at large?
Medical missions are useful when disaster strikes as the health care system is overwhelmed by the situation. Yet, in ordinary times there are existing health services that the government are offering. It might be more effective to help improve the existing health programs and services available in the community to have longer lasting impact in improving people's health and the community as well. It It is better to put your resources to a program that will provide the greatest benefit to most number of people.


4. Is the "medical mission" helping the local health system?
Each locality has an existing health care system. In low-to-middle income countries (LMIC) like the Philippines, it might not be as effective as we want it. But are the medical missions we are conducting helping the system or are we competing against them? Check if there are local health centers and health workers in the area. It will be unfortunate to conduct medical missions without their participation. You might miss creating a bigger and lasting impact.


5. Is the medical mission highly dependent on donations?
Do you conduct the medical missions on a regular basis or only when the resources are available? How will this impact continuity of health care to the people? If the reason why the medical mission was done in the area is because medical services are really needed, what does it mean to provide only once in a "Blue Moon" health services to them or only when resources are available? Limited resources is better placed in programs with the greatest health outcomes for all.


6.  Is the group concern with the health of the people or are they just using it as leverage for their own purpose?
What could be the driving force for the medical mission? Some churches have conditions for the beneficiaries, they offer only medical services only after the beneficiaries have participated in a Bible Study by the group. Politicians leverage it for their election. Groups use it to promote their products. Or do they simply want to help improve the health of the most number of people regardless of nothing to gain in return?


Effective altruism does not question the intent of the people to help others. For many utilitarians like Dr. Singer, they question the impact and effectiveness of the help offered. Effective altruism, thus, puts into proper perspective how medical missions can effectively impact the health of the wider-community. Were the resources used properly? But for virtuous doctors, the question really is, can the medical missions effectively help me become a virtuous doctor? Are the medical missions the best venue in forming in me virtues that will make me an excellent doctor?  For Christian doctors, can these medical missions be the best way for us to achieve Christ-likeness? Will these activities form in me virtuous of magnificence? Do I practice generosity?

For in generosity, I am helping the best way I can to a person who needs me most.

Work or Charity?

Working hard has always been applauded as an admirable trait. The Proverbs seems to tell us that hardworking people will reap financial benefits. For some healthcare workers, "working hard" means "helping many sick people." But here is the problem. For many, the "working hard" they provide should be reciprocated with financial benefits. We can't deny the fact that the "work" people give is the means of income to support their family. Where do you draw the line where hard work is just plain and simple charity? What would be the source of financial wealth for those whose "work" are not compensated justly?

The Patient's Right

I was asked by my senior consultant what I thought about the issue of former Philippine President Gloria Arroyo wanting to seek medical consult abroad but the current government of President Noynoy Aquino denying her request. My quick reply was to agree with retired Roman Catholic Archbishop Oscar Cruz, that Gloria should be allowed to seek consult abroad with a guarantee that she will come back.

As Bishop Cruz pointed out, to which Department of Justice Secretary De Lima also acceded, every patient has the right to seek medical consult and to choose the doctor she wants.

It is a medical ethical issue whether to allow Gloria Arroyo to exercise her right to seek medical help and to choose where it will come from. (Click here for other ethical issues Young Doctors face). The ethical issue becomes bigger when the denial of such right is measured against the right of the people of the Philippines to justice. Critics want to be sure that Gloria will be present to face charges of electoral fraud in 2004. The justification is that the right of over 90 Million Filipinos is 90 Million times greater than her individual right.

Can the right of a person be greater than another that he/she can trump down another person's right? Doesn't my right ends when your right begins? Sometimes I wonder whatever happened to our Christian virtues? What will happen when people are guided by their virtues in making ethical decisions? Oh, just like heaven...

Doctor-Doctor Ethics

This essay is a Call for the Practice of Ethics by Nezer A. Soriano.

Ethics has been one of the common venue of discussion between medicine and theology. This is especially true in matters of medical ethics where the doctor and the patient relationship is at stake. But for today, let me focus in one aspect that is often relegated to the sides by most doctors. Relegated? You might ask. YES! Because most doctors throw out their ethics when it comes to doctor-doctor relationships.

Human pride is one of the pitfalls of human nature. But this is not an excuse to disrespect others. That is why a physician is virtuous enough to know what to do and how to foster good relationship with ones colleagues. Yet, young doctors and even their mentors get drunk of their title as doctors that they forget their ethics.

In the Ospital ng Maynila, the doctor-doctor relationship is amiss. I pray that this is the only place that ethics is an issue. But the reality is, even in PGH, Western Visayas MC and SPMC, ethics of doctors towards fellow doctors are problematic. (Often times a referral from a municipal health officer faces the same issue - added). Maybe these hospitals being government run is a factor to the problem. But that issue warrants another article.

At one time, a patient came in with a referral letter from a family physician for the pediatric patient to be admitted because of Dengue. The pediatrician refused the patient to be admitted because she did not see any indication for the patient to be admitted. The pediatrician may be right and she has all the right reasons for refusing the request for admission. What went out of bounds was her remark against the referring doctor. She commented that the referring doctor is ONLY a family physician and his decisions should not be accepted. Here, the pediatrician is obviously insinuating that the other doctor is inferior to her. More than that, she shows disrespect by maligning the knowledge and the decision of her colleague. Hers is one example of utter DISRESPECT that have plagued the medical practice in hospitals. We, as doctors, have forgotten the basic principle in our code of conduct - that we should work together in harmony and mutual respect.

Another example of disharmony in the workplace of doctors is the referral system in government hospitals. (For more ethical issues young doctors encounter, click here). I will emphasize the government hospitals, because these things rarely happen in the private setting. A surgeon refers his diabetic patient to the internist for control of the blood sugar and clearance for surgical procedure. The internist delays seeing the patient, as a retaliatory act to what he claims the surgeon is doing whenever he refers also for surgical clearance of his patients suspected of having surgical abdomen. The patient is the one suffering from such behavior of doctors. The patient, of course, complains his surgeon to the hospital authorities for not being able to refer and resolve his case quickly.

The most common problem perhaps, leading to the numerous malpractice suits, is the side comments doctors make to their colleagues. An example is the Internist who saw a Pulmonary TB patient who sought second opinion after being seen by a private doctor. The Internist comments to the patient, "do not seek consult to this doctor again. Did you know that it took him several years to finish medicine because he flunked his subjects. Look, he did not even recognize that you have tuberculosis. And why did he give you pulmonary medicines that can compromise your liver. That doctor will just make you more sick." Such comments are unwarranted, but in reality, such comments exist. What virtuous doctor in their right mind, would comment such derogatory remark about their colleague?

In the quest to advance the practice of medicine, doctors have forgotten about their virtues and ethics. Ethics has been neglected for a long time. It is now the time to check the virtues of our doctors. A virtuous doctor can never and will never intentionally hurt his/her fellow human being, regardless if he/she is a patient or a colleague. We can never go wrong with a virtuous doctor. I encourage you to push and demand for our doctors to check their ethics, and be virtuous!