Life and death

In this season of ghosts – the traditional kind, not the scarier sorts in flood control – my thoughts are on death, and life. Specifically, the quality of life.

Thanks to advances in health care, more people are living longer. Sadly for many, the quality of that longer life leaves much to be desired.

Perhaps because of the ease of posting personal information, we’re hearing more stories about people coping with loved ones who are suffering from dementia and other degenerative diseases.

The latest story came from Sen. Robinhood Padilla, who posted photos of his wheelchair-bound mother together with his narration of her dementia.

From personal experience, I can sympathize with the senator, and attest to the agony of watching a loved one slowly disappearing inside a deteriorating body, losing large chunks of memories and motor abilities needed for day-to-day existence.

I know folks of my generation terrified of the prospect of developing dementia and being at the complete mercy of other people. Some of them are checking out the countries that allow euthanasia. At the first possible symptom of dementia, they intend to get a definitive medical diagnosis. If positive, they will plan their date with assisted death.

Obviously, these are folks with the means to pay for assisted dying overseas. They would argue for the right to die in their own country, but they know enough to see that such an idea will never fly in the Philippines, the only state apart from the Vatican without divorce.

For the many others without the means for euthanasia overseas, the only option is to live with whatever fate hands them in their twilight years.

And the option can be awful, without sufficient human support and resources.

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There was that report about an elderly / PWD care facility in Maramag, Bukidnon operated by the private Bukidnon Multi-Sectoral Services Foundation Inc., which was shut down last Oct. 11 after inspectors found the 17 residents living in filth and neglect.

Relatives reportedly paid P6,000 to P7,000 a month for the care of the residents who were rescued. Adult pampers alone would eat up a substantial chunk of that amount. The residents need vitamins, nutritious meals and sufficient clean water. Many of them likely need special medication.

You need several adults to take care of just one person with dementia or who, due to some other health conditions, can no longer walk or bathe or feed himself.

The country’s extended family system used to provide this kind of support for elderly family members. Families were large – having six to nine children was common – and households were multigenerational. The elderly in the household, described to be going through their second childhood, were assured of care by relatives.

But the Filipino family has followed global trends and is increasingly becoming nuclear. Many young couples no longer employ househelp and spend much of the day in the office. So it can be a challenge to care for debilitated family members.

Obviously, the problem is greater for low-income households. The government has an unimpressive record of providing full free care for the poor who can’t fend for themselves – street children, juvenile offenders, the elderly, persons with disabilities, mental health patients.

The situation in the Bukidnon home for the elderly/PWD is reminiscent of what Sen. Raffy Tulfo found in his surprise inspection of the National Center for Mental Health in April 2023. The conditions at the NCMH, Tulfo lamented, were “worse than a pigsty.”

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Apart from contemplating the quality of life versus long life, the period for remembering the dearly departed is also a good time for discussing personal preferences for one’s final exit. It may be a macabre topic, but anyone who has ever lost a loved one will understand the usefulness of having such a family conversation – the sooner, the better.

Some years ago when there was a much publicized story abroad about the issue of resuscitating critically ill or debilitated patients, I left instructions with my family to make sure that if ever I reached that stage, they should tell the hospital to pull the plug. Pronto, no ifs or buts.

My do-not-resuscitate stand was reinforced years ago when the mother of someone I know choked over lunch and landed in the ICU, unresponsive. The distraught daughter hoped her mother, who had dementia, could still recover, and kept the patient on life support. But even on that first day of hospitalization when I visited, one look at the patient told me she was just waiting to be permanently relieved of her misery.

I’m no doctor. But as a crime reporter, I saw so many people at various stages of dying, and bodies untreated by formalin, in the progressive stages of decomposition. Over two weeks in the ICU, the patient looked like she was already decomposing while still breathing.

Despite being pumped with painkillers, the patient must have been suffering, I thought. A colleague in his deathbed from cancer had wailed to us that death was better than the pain he was going through. He spent a month in hospital confinement before he got his death wish.

But I said nothing to the dementia-afflicted patient’s children, all of them adults, as they discussed with the patient’s siblings whether it was time to pull the plug.

When they finally decided to do so, the patient was already shriveled and looking black and blue.

I warned my relatives that if they allowed that to happen to me, I would not give them a day’s rest or a good night’s sleep from haunting.

In the meantime, we wait for scientists to develop medical interventions that can prevent or treat mental and physical degeneration, and allow humans to age in reasonably good health, with memories intact.

Hopefully, such interventions will soon be available, and accessible even to the poorest sectors.