August 2002 Vol. 2 Issue 14

An Internet Newsletter publication of the American Society of CIM Alumni, Inc.

THE ASOCIMAI OFFICERS:

Dominador Ong, M.D.
President
Maida Antigua, M.D.
Vice-President
Dolores Lao, M.D.
Treasurer
Epifania Aranas, M.D.
Secretary
Clem S. Estrera, Jr., M.D.
P. R. O.
Anita Avila, M.D.
Auditor

Board Members:

Horace Cabasares, M.D.
Perry, GA
Ramiro A. Cadag, M.D.
Kings Point, NY
Mike Espiritu, M.D.
Okeechobee, FL
Elie Gonzales, M.D.
Oswego, NY
Cecilio Delgra, M.D.
Charleston, WV
Rosario B. Gonzaga, M.D.
Cumberland, MD
Teresita Varona, M.D.
Oakbrook, IL

CME Coordinator:
Rise Faith E. Dajao, M.D.
Portsmouth, VA

Ways and Means Committee
Diana Amores, M.D.
Charleston, WV

Lagrimas Sadorra, M.D.
Charleston, WV

Maria Luna Tan-Navarro, M.D.
Charleston, WV

Ma. Teresita Antigua-Martinez, M.D.
Charleston, WV

Judith Nacua-Bacalso, M.D.
Markham, Ontario

Ailyn U. Tan, M.D.
Chicago, Illinois

Bradford Tan, M.D.
Chicago, Illinois

BRAIN WAVES STAFF:

Editorial Board:

Maida Antigua, M.D.
Boston, MA
Horace Cabasares, M.D.
Perry, Georgia
Eli Estabaya, M.D.
Yuma, Arizona

Editor and Technical Adviser:
Clem S. Estrera, Jr., M.D.
Petersburg, VA

Staff Correspondents:
Roland Pasignajen, M.D.
New Jersey
Henry L. Yu, M.D.
Cebu, Philippines
Ernesto Yu, M.D.
Buffalo, New York

Wilmo C. Orejola, M.D.
Pompton Plains, N J

Marie Belen Rosales, M.D.
San Diego, California

Guest Correspondents:
Tito Alquizola, M.D.
Tampa, Florida
Anny Misa-Hefti
Bern, Switzerland
Deo Delfin
Los Angeles, California

Send news, articles, pictures, announcement, obituary, etc., to:clems3ra@adelphia.net

Editor's Column

    "Keep away from people who try to belittle your ambitions. Small people always do that, but the really great make you feel that you, too, can become great." -- Mark Twain

Human Behavior (Part 2)

A Surprising Turn of Event
     I really thought my boss would chew me up and so I was prepared for anything he would throw at me. I made up my mind that no matter what happens, I would keep my cool and my sense of humor. But to my surprise, as soon as I was seated, he gently asked like he was pleading for an answer, "What's wrong with me, Dr. Estrera?" In such a short period of time, he was transformed into like a man who was about to die and had to confess and plead for mercy and forgiveness. I took pity on him. He was so pathetic. I told him that he had not outgrown his childish behavior of being a bully. He still believes that the only way to get what he wants is by being angry - and to threaten and intimidate everyone. He looked at me as though he had seen something he didn't see before, perhaps a real coconut. Then he thanked me for being frank and honest and for making him aware of his intolerable behavior.

    Since then, we became friends and he mellowed considerably. He seemed to have recovered at least some of his instincts of being human. He must have finally realized that he doesn't really need flame to make people do their job and cooperate for light alone would suffice. Light, not heat, produces better results. It brings out the best of everyone. Light soothes, flame burns. But it was too late for him. He had already done irreparable damage to his reputation that a couple of years later, he was forced to retire even if he wanted very much to stay at the age of 68. For otherwise he would have been fired. He could not even ask anyone to sing with him, "You and me against the world…"

    There are men or women who desire to be obeyed at their every command, to see others tremble at the sound of their voice, and to notice others quiver like a spider when a human passes by, at the hint of their irritation. They seem to always bare their teeth; when not scolding or criticizing, they're yelling or screaming. They don't attempt to realize that an authority that is being imposed with rigidity would ultimately lose its gravity. The distress it carries only makes everyone sullen, and the misery it creates makes everyone ugly. It draws blind obedience, not cooperation; resentment, not respect, and the loyalty it hopes to achieve won't come from the heart.

Change, Challenge and Choice
    In about 6 or 7 years that my boss was with us, I have seen different physicians who came and went, Korean, Chinese, Vietnamese, American, Pakistani and Indian. They didn't last but a year or two at most. Two left even if they didn't have a job waiting for them yet. Only two of us out of the four physicians were able to stay and put up with our boss' radioactive temper and nasty behavior. My Indian colleague had no choice but to stay and survive because he had problems with alcohol. He was on detox program and because my boss and the psychiatrist did not trust him to comply with his medication, my boss was the one who was giving him his antabuse every day.

    As to myself, I did not have much choice either unless I would want to move to another state and that, I had already ruled out. I was waiting for the approval of my permanent resident visa and green card the hospital sponsored me for. The Immigration was chasing my tail and so I decided that I might as well hang on so I could wiggle my tail freely in the land of milk and honey. Working with my boss was one hell of a challenge, but a hell whole lot better than shoveling shits in Camotes. Nevertheless I figured out that if I could learn to deal with such ugly behavior and perhaps tame the animal that is more experienced and educated than me, then any other animal would be a piece of cake. He was the lion king but without the lion heart. I was also hoping that perhaps I could help him recover the tender emotions, if he had any, that were lost to the demons of prejudices and delusions. I believed that once light enters the mind, the demons leave the heart. One could then acquire just enough goodness to dilute his harshness so that even if one maintains a rough mind, he should still be able to possess a gentle heart.

     Many of us are ignorant of things we ought to know, and we know things of which we ought to be ignorant. We know how to hate, insult and criticize, but many of us are not aware that love and kindness are parts of wisdom, and permission to do wrong is part of love. No, I'm not referring to folks in high life where there are lions who send love letters to camels. I'm talking about real love and real kindness in real life and real world. There are people whose mind had been disfigured by shame, sarcasm and criticism in childhood, but such mind can be transfigured by love, understanding and kindness in adulthood. Sometimes all they need is someone like a friend to help them reform and transform.

The past that counts
    The problem with those physicians who left was that, they spent the days in their job creating discord and distress for everyone. They lost the internal monitors of caring about their professional or working relationship that cause most of us to feel guilt, worry or anxiety when we hurt others' feelings or when we behave like a-holes for no good reason. They took their frustrations with our boss on the nursing staff and other employees. They were critical of everyone and everything like it's the worst place to work for. It probably was at the time, but it should not be the reason for uncalled for behavior. These physicians were younger than me and yet they never considered the possibility that they might need the job years down the road in case things don't turn out well wherever they are going. If we don’t understand everything, then we should not criticize anything.

    About five years ago, a couple of them applied for a vacant position we had. They wanted to leave their group practice because according to them, they are working twice as hard and they make less and less money every year. Unfortunately, when it comes to physicians' job in a state facility in which a good working relationship with other staff is essential, not too many administrators and department heads forgive and forget bad behavior. So their applications were not even screened for interview. They went directly to the shredding machine. Ironically, years previously, every time we've met in some CME conference, these doctors would redicule me for having got stuck in the state system.

    But things do change except perhaps for death and taxes. These doctors' situation has changed and so with the condition of our hospital. Life's situation and survival are not constant; they're variable. They change as a continued process with peaks and valleys like our game of golf and tennis. Sometimes we can anticipate change and make it more favorable if we learn to look a little farther into the future. But if we cannot foresee the spark, then we cannot predict the flash.

    It always makes me wonder why many professionals like doctors would not care about their record and reputation in the work place when they are frustrated and dissatisfied with their job particularly if they want to leave. It's like trying to escape from jail. Once their urge has surged, they don't seem to care who they bump, bruise and contuse. They would focus solely on getting out and they never think of a possibility that their choice of another job might run out of advantages later on. They came, they saw and they burned their bridges as if they wanted to say what Rhed Butler said in the movie Gone with the Wind, "Frankly, my dear, I don't give a damn!" But this is not about love and loss, failures and disappointments. This is about track to look back, and record to refer to in the future. Our past is permanent. We cannot go back to correct it. (To be continued)

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     YOUR ATTENTION PLEASE! There has been a big misunderstanding of our association's role with regards to our fellow alumni coming from the Philippines to attend our reunion. In the Reunion issue of CIM Brain Waves, July 2002 Vol. 2 Issue 12, I mentioned that fellow alumni who come from the Philippines to attend our reunion will have their hotel accommodation paid by our association during the duration of the reunion. Sorry, boys and girls, I made a bad mistake. Hopes were dashed, I believe. I'm really sorry. Apparently, the customary practice was that, the members of their own class organization here in the U.S. would chip in to pay for the hotel accommodation of their classmates from the Philippines who come for the reunion. It's still being practiced, I'm told. It's definitely a good practice. There is friendship, fellowship, recognition and honor among classmates. Nevertheless our fellow alumni from the Philippines will remain free from paying any of the reunion activities including the Grand Ball and the CME.

    Now here is something for the CIM Class 1970. Marie Belen Flores-Rosales of the Class 1970, has offered to any of her classmates preferably those from the Philippines, to stay in her house. She can accommodate 3 couples or 6 persons. She lives in San Diego, California and she would be happy to have the couples stay with her and her husband during the reunion. The longest drive to any of the hotels that our reunion may be held from her house is 30 minutes. So contact Belen at this address: mroz0913@yahoo.com. If there are no takers from the class 1970 in the Philippines, Belen would take the ones in the U.S. and then any of her fellow alumni on the first-come first-serve basis. We'll set the deadline on March 30, 2003 for those classmates in the Philippines and April 30, 2003 for those classmates in the U.S. and then after that, any alumni from any class can contact Belen to stay in her house. Fair enough? So those of you in the Philippines from the class 1970, if you have any inkling at all about attending our reunion in San Diego, contact Belen now. Don't procrastinate. Time moves so fast. In fact, the leaves of some trees have already started to turn brown. It's probably from drought. But many of the leaves are falling anyway and it's getting colder early in the morning. I know because I sometimes wake up early to jog. Early bird gets the worm.

    Newsletter Format. If you have a flat screen computer monitor, our newsletter title images at the top would look narrower or smaller, not in proportion to the page. It's because I've made our newsletter format using the traditional computer monitor. But it could also be due to the viewing size of the monitor. If you have a traditional computer monitor, the table at the left hand where the names of the officers, correspondents, board and committee members and others are listed will have a longer blank space down. It's because I'm using a flat screen monitor now to fit our newsletter. I'm going to leave our format like it is with the logo images until perhaps 3-5 years from now when many of our alumni will probably have to change their computer and computer monitor to flat screen. I don't know if this would make it everyone change their computer set in the near future, but 3 years from now, electronic, entertainment and television industries will all be using digital analog. The law requires it. In the video movie industry, the VHS format will start phasing out in the next 3-5 years and all movies will be in DVDs. Many TVs are now in flat screen and wide screen format. They are still too expensive, but soon their prices will drop like a rock. When DVD started to come out, DVD players cost you a fortune, if not an arm and a leg. Now you can get one for a song. That's the result of the evolution of products and the revolution of prices. So what you do is wait for the revolution and buy "when blood is on the street."

    ATTENTION OFFICERS, BOARD AND COMMITTEE MEMBERS! The fall meeting will be on November 2, Saturday, at the residence of our President Dr. Dominador Ong in Philadelphia. Please let Doming know as soon as you decide to come. He would prefer for you to come early Friday because he plans a trip for us to Atlantic City. No, he is not planning to give us chips to play in the casino. He just takes us there, but on our way, he'll get us some nacho and potato chips with the flavor of your choice. Any interested member can join with us.

    Wedding. Congratulation to Dr. and Mrs. Ernesto Yutiamco of the CIM Class 1966 from West Virginia and our best wishes to their daughter Ruth Mahusay Yutiamco who is going to get married to Robert Joseph Baxter on September 1, 2002 in Boston, MA. So, Mom, please don't cry. Ruth will come and see you like the way it has been. It's not going to be easy for her not to miss the "country road that used to take her home to the place she belonged. Almost Heaven, West Virginia."

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    The last four ex-US Presidents are caught in a tornado, and off they spin to OZ. They finally make it to the Emerald City and come before the Great Wizard.
    "WHAT BRINGS YOU BEFORE THE GREAT WIZARD OF OZ?"
    Jimmy Carter steps forward timidly: "I've come for some courage."
    "NO PROBLEM!" says the Wizard. "WHO IS NEXT?"
    Ronald Reagan steps forward, "Well. . . I. . .think I need a brain."
    "DONE" says the Wizard.
    "WHO COMES NEXT BEFORE THE GREAT AND POWERFUL OZ?"
    Up steps George Bush sadly, "I'm told by the American people that I need a heart."
    "I'VE HEARD IT' S TRUE!" says the Wizard. "CONSIDER IT DONE."
     There is a great silence in the hall. Bill Clinton is just standing there, looking around, but doesn't say a word. Irritated, the Wizard finally asks, "WHAT DO YOU WANT?"
    "Is Dorothy here?"

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    A doctor prescribed suppositories for a man suffering from constipation but a week later the man returned to the doctor and complained that the treatment wasn't working.
    "Have you been taking them regularly?" asked the doctor.
     "What do you think I've been doing?" snapped the man. "Shoving them up my ass?"

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     According to a news report, a certain private school in Victoria, Australia, was recently faced with a unique problem. A number of girls were beginning to use lipstick and would put it on in the toilet block. That was fine but, after they put on their lipstick, they would then press their lips to the mirror, leaving dozens of little lip prints. Every night, the school janitor would remove them and, the next day, the girls would put them back.
     Finally, the principal decided that something had to be done. She called all the girls to the toilet block and met them there with the maintenance man. She explained that all these lip prints were causing a major problem for the janitor who had to clean the mirrors every night. To demonstrate how difficult it was to clean the mirrors, she asked the janitor to clean the mirrors in front of the students. He took out a long-handled squeegee, dipped it in the toilet, and cleaned the mirror with it.
   Since then, there have been no lip prints on the mirror. There are Teachers, and then there are Educators.

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MINISTERS OF LIFE

from Vicente Villa Jr., M.D. Class 1968

    1. The work of health care persons is a very valuable service to life. It expresses a profoundly human and Christian commitment, undertaken and carried out not only as a technical activity but also as one of dedication to and love of neighbor. It is a form of Christian witness. Their profession calls for them to be guardians and servants of human life.
     Life is a primary and fundamental good of the human person. Caring for life, then, expresses, first and foremost, a truly human activity in defense of physical life.
     It is to this that professional or voluntary health care workers devote their activity. These are doctors, nurses, hospital chaplains, men and women religious, administrators, voluntary care givers for those who suffer, those involved in the diagnosis, treatment and recovery of human health. The principal and symbolic expression of their vigilant and caring presence at the sickbed. It is here that medical and nursing activity expresses its lofty human and Christian value.

    2. Health care activity is based on an interpersonal relationship of a special kind. It is “a meeting between trust and conscience.” The “trust” of one who is ill and suffering and hence in need, who entrusts himself to the “conscience” of another who can help him in his need and who comes to his assistance to care for him and cure him. This is the health care worker.
    For him the sick person is never merely a clinical case-an anonymous individual on whom to apply the fruit of his knowledge-but always a ‘sick person,’ towards whom he shows a sincere attitude of sympathy, in the etymological sense of the term.
    This requires love: availability, attention, understanding, sharing, benevolence, patience, dialogue. Scientific and professional expertise is not enough; what is required is personal empathy with the concrete situations of each patient.

    3. To safeguard, recover and better the state of health means serving life in its totality. In fact, sickness and suffering are phenomena which, when examined in depth, ask questions which go beyond medicine to the essence of the human condition in this world. It is easy to see, therefore, how important in socio-medical service is the presence of workers who are guided by an holistic human vision of illness and hence can adopt a wholly human approach to the suffering patient.
   In this way, the health care worker, if animated by a truly Christian spirit, will more easily become aware of the demanding missionary dimension of his profession: his entire humanity comes into play here and nothing less than complete commitment is required of him.
    To speak of mission is to speak of vocation: the response to a transcendent call which takes shape in the suffering and appealing countenance of the patient in his care. To care lovingly for a sick person is to fulfill a divine mission, which alone can motivate and sustain the most disinterested, available and faithful commitment, and gives it a priestly value. When He presents the heart of His redemptive mission, Jesus says: “I came that they may have life, and have it abundantly” (Jn 10:10). It is precisely in this ‘life’ that all the aspects and stages of human life achieve their full significance.
    The health care worker is the good samaritan of the parable, who stops beside the wounded person, becoming his neighbor in charity (cf Lk 10:29-37).
    ** John Paul II: In exercising your profession, you are always dealing with the human person, who entrusts his body to you, confident of your competence as well as your solicitude and concern. It is the mysterious and wonderful reality of the life of a human being, with his suffering and his hope, that you are dealing with.

    4. This means that health-care is a ministerial instrument of God’s outpouring love for the suffering person; and, at the same time, it is an act of love of God, shown in the loving care for the person. For the Christian, it is an actualized continuation of the healing love of Christ, who “went about doing good and healing everyone” (Acts 10:38). And at the same time it is love for Christ: He is the sick person—“I was sick”—who assumes the face of a suffering brother; since He considers as done to Himself—“you did it to Me”—the loving care of one’s brother (cf Mt 25:31-40).
    Profession, vocation and mission meet and, in the Christian vision of life and health, they are mutually integrated. Seen in this light, health care assumes a new and more exalted meaning as service to life and healing ministry. Minister of life, the health care worker is the minister of that God, who in Scripture is presented as ‘a lover of life’ (Wis 11:26). To serve life is to serve God in the person: it is to become a collaborator with God in restoring health to the sick body and to give praise and glory to God in the loving welcome to life, especially if it be weak and ill.

    5. The Church, which considers service to the sick as an integral part of its mission, assumes it as an expression of its ministry. The Church has always seen medicine as an important support for its own redeeming mission to humanity. In fact, service to man’s spirit cannot be fully effective except it be service to his psycho-physical unity. The Church knows well that physical evil imprisons the spirit, just as spiritual evil subjects the body.
    ** John Paul II: The Lord Jesus Christ, physician of our souls and bodies, who forgave the sins of the paralytic and restores him to bodily health, has willed that His Church continue, in the power of the Holy Spirit, His work of healing and salvation even among her own members. This is the purpose of the two sacraments of healing: the sacrament of Penance and the sacrament of the Anointing of the Sick.
    It follows that the therapeutic ministry of health care workers is a sharing in the pastoral and evangelizing work of the Church. Service to life becomes a ministry of salvation, that is, a message that activates the redeeming love of Christ. Doctors, nurses, other health care workers, voluntary assistants, are called to be the living image of Christ and of His Church in loving the sick and the suffering: witnesses of “the gospel of life.”

    6. Service to life is such only if it is faithful to the moral law, which expresses exigently its value and its tasks. Besides technico-professional competence, the health care worker has ethical responsibilities. “The ethical law, founded on respect for the dignity of the person and on the rights of the sick, should illuminate and govern both the research phase and the application of the findings.” In fidelity to the moral law, the health care worker actuates his fidelity to the human person whose worth is guaranteed by the law, and to God, whose wisdom is expressed by the law.
    The health care worker draws his behavioral directives from that field of normative ethics which nowadays is called bioethics. Here, with vigilant and careful attention, the magisterium of the Church has intervened, with reference to questions and disputes arising from the medical advances and from the changing cultural ethos. This bioethical magisterium is, for the health care worker, Catholic or otherwise, a source of principles and norms of conduct which enlighten his conscience and direct him especially in the complexity of modern biotechnical possibilities—in his choices, always respecting life and its dignity.
    ** John Paul II: “The advance of science and technology, this splendid witness of the human capacity for understanding and for perseverance, does not dispense humanity from the obligation to ask the ultimate religious questions. Rather it spurs us on to face the most painful and decisive of struggles, those of the heart and of the moral conscience” (Veritatis splendor, l).

    7. The continuous progress of medicine demands of the health care worker a thorough preparation and on going formation so as to ensure, also by personal studies, the required competence and fitting professional expertise.
    Side-by-side with this, they should be given a solid ethico-religious formation, which promotes in them an appreciation of human and Christian values and refines their moral conscience. There is need to develop in them an authentic faith and true sense of morality, in a sincere search for a religious relationship with God, in whom all ideals of goodness and truth are based. 22.
    ** John Paul II: Especially significant is the reawakening of an ethical reflection on issues affecting life. The emergence and ever more widespread development of bioethics is promoting more reflection and dialogue—between believers and non-believers, as well as between followers of different religions—on ethical problems, including fundamental issues pertaining to human life” (EV 27).
    ** John Paul II: “In today’s cultural and social context, in which science and the practice of medicine risk losing sight of their inherent ethical dimension, health-care professionals can be strongly tempted at times to become manipulators of life, or even agents of death” (EV 89).
    ** Cong. Doct. Faith: “It is illusory to claim that scientific research and its application are morally neutral. On the other hand, guiding criteria cannot be deduced from merely technical efficacy, nor from the usefulness to some to the detriment of others, nor, worse still, from the dominant ideologies. Science and technology require, by their very inner significance, unconditional respect for the fundamental criteria of morality; they must be at the service of the human person, of his inalienable rights, of his true and integral good, in conformity with God’s plan and will”.
    All health care workers should be taught morality and bioethics. To achieve this, those responsible for their formation should endeavor to have chairs and courses in bioethics put in place.

    8. Health care workers, especially doctors, cannot be left to their own devices and burdened with unbearable responsibilities when faced with ever more complex and problematic clinical cases arising from biotechnical possibilities—many of which are at an experimental stage—open to modern medicine, and from the socio-medical import of certain questions.
    To facilitate choices and to keep a check on them, the setting up of ethical committees in the principal medical centers should be encouraged. In these commissions, medical competence and evaluation is confronted and integrated with that of other presences at the patient’s side, so as to safeguard the latter’s dignity and medical responsibility itself.
    ** John Paul II: “The Church is aware that the issue of morality is one which deeply touches every person; it involves all people, even those who do not know Christ and His Gospel or God Himself. She knows that it is precisely on the path of the moral life that the way of salvation is open to all. No darkness of error or of sin can totally extinguish in the human person the light of God the Creator. In the depths of his heart there always remains a yearning for absolute truth and a thirst to attain full knowledge of it. This is eloquently proved by man’s tireless research in all fields and in every sector. His search for the meaning of life proves it evenmore”.

    9. The sphere of action of health care workers consists, in general, of what is contained in the terms and concepts of health and medicine especially.
    The term and concept of health embraces all that pertains to prevention, diagnosis, treatment and rehabilitation for greater equilibrium and the physical, psychic and spiritual well-being of the person. The term and concept of medicine, on the other hand, refers to all that concerns health policy, legislation, programming and structures.
    The full concept of health reflects directly on that of medicine. In fact, institutions are very important and indispensable; however, no institution can of itself substitute for the human heart, human compassion, human love, human initiative, when it is a question of helping another in his suffering.
    The meeting and the practical synthesis of the demands and duties arising from the concepts of health and medicine are the basis and way for humanizing medicine. This must be present both at the personal-professional level—the doctor-patient relationship—and at the socio-policy level so as to safeguard in institutional and technological structures the human-Christian interests in society and the institutional and technological infrastructures. The first but not without the second, since such humanization as well as being a love-charity task is an obligation of justice. [This humanization strengthens] the bases of the ‘civilization of life and love,’ without which the life of individuals and of society itself loses its most genuinely human quality.

    10. The present charter wants to guarantee the ethical fidelity of the health care worker: the choices and behavior enfleshing service to life. This fidelity is outlined through the stages of human existence: procreation, living, dying, as reference points for ethical-pastoral reflections.
    ** John Paul II: “The humanization of medicine is a duty of justice, and its implementation cannot be entirely delegated to others, since it requires the commitment of all. Its operative field is very vast: it goes from health education to the creation of greater sensitivity in those in public authority; from direct involvement in one’s own workplace to forms of cooperation—local, national and international—which are made possible by the existence of so many organizations and associations which have among their purposes the call, direct or indirect, for a need to make medicine ever more human.”

Taken from the Charter for Health Care Workers, issued by the Pontifical Council for Health Care Workers.

v.villa hcare1vv.doc

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The Search for the Standards of Reasonableness in Public (Service) Administration

By: Deogracias S. Delfin
University of Southern California
School of Policy Planning and Development
Masters in Health Administration
 

Life is affected, one way or the other, by our human decisions, including the lives of those without the ability to decide. What life on Earth could have been were there no humans who made decisions? The grasses, the trees, the insects, the animals -- all would have lived and grown towards nowhere and what for? By his decisions man can avail of the present and can chart the future of living – gives quality and purpose to life.

    Decision-making goes on indispensably with human life. While it may not be the cause why life goes on, it may be why life can go on well enough. And living life well may be the very reason for being. Otherwise, surviving must be like hell where existence should better be avoided. But decision-making is never easy. Its repetition, which cannot be avoided, does not make the process any easier. Some guiding principles of conduct must help develop a process of deciding reasonably, to act reasonably and attain reasonable results. There must be certain standards of reasonableness.

    In most fields of human activities, where there are various influences from changing moods and mores, to varying attitudes and opinions, to conflicting interests and inclinations, especially in public services, or even in private businesses, it is necessary that certain norms, policies or techniques, must guide the interaction of people’s needs, wants, demands and desires, with their duties, responsibilities and obligations..

    Justice Benjamin N. Cardozo, in his lectures on “The Nature of the Judicial Process”, said that there are many judges in many courts deciding many cases daily. Then he answered with authority the following questions he posed: What is it that I do when I decide a case? To what sources of information do I appeal for guidance? In what proportions do I permit them to contribute to the results? In what proportions ought they to contribute? If a precedent is applicable, when do I refuse to follow it? If no precedent is applicable, how do I reach the rule that will make a precedent for the future? If I am seeking logical consistency, the symmetry of the legal structure, how far shall I seek it? At what point shall the quest be halted by some discrepant custom, by some consideration of the social welfare, by my own or the common standards of justice and morals?

    Justice Cardozo’s lectures focused on decision-making in the courts of justice. However, the discussions of the processes and principles to reach a reasonable decision are largely applicable to decision-making in the open court of human interactions. The ideas discussed here may have been inspired by, or lifted, or are attempts to develop from, the ideas in the lectures. It might as well be applied to human life, in general, and to public services in particular. They are necessary as they are relevant.

    For a standard to encompass life, what in the first place, is reasonable? Reasonableness is supposed to be the objective of every decision, be it in court, in public offices or in any market place of human activities.

    What is reasonable might be illustrated most simply, thus: One liter of water is transferred from one glass container to another glass container. After the transfer, it would be logical to infer that the water in the second container is one liter, more or less. By verifying the facts first, there were power and ability to understand: that it was water that had to be transferred; that its quantity was one liter; and, that there was no spillage when it was poured into another container.

    What is reasonable, therefore, is when the inference from understood facts, is endowed with reason, logic or common sense. Reasonableness is almost synonymous with the truth. The inference that is true according to the natural order of things is a conclusion that the inference is reasonable.

    The standard of reasonableness should initially conform to the inexorable balance that nature decrees -- that what one puts in is what one expects to find in there. The quantity of water poured into a container is about the same quantity there is stored in it.

    The quantity and quality of services one renders in the performance of a public duty should be the basis of compensation a public position holds. The euphemism for it is: Equal work for equal pay.

    This principle of balance between performance and compensation can apply to almost every facet of human activity. Even in crime and punishment, the severity of penalty must be equaled by the gravity of the crime. In credit transactions, the payment must be tantamount to the indebtedness.

    Public servants ought to serve the public not according to their personal conveniences, but in compliance with the duties they are employed to render. Public servants must consider the fact that their employment was made possible because of the needed services that the employment opportunity existed to serve. The public usually enjoys the privilege under the law to be served by public servants.

     But this dictum of equality is easier said than done. There are always complexities in every case, conflicting interests in every situation. In the application of the laws, precedents, principles, policies, and concepts, that must compete to establish equality in favor of one or the other, there are always gaps or interstices that only the decision-maker must fill. Because those gaps are seen by no other eyes, except their own.

     The power placed in the hands of the decision-maker is great, and subject, like all power, to abuse. Even so, the power to decide is also coupled with the power to legislate. Thus, Erlich said, that in the long run, “there is no guaranty of justice except the personality of the judge.”

    There are also forces that work to modify on whatever standards of conduct there are. Arnold said: “There is not a creed which is not shaken, not an accredited dogma which is not shown to be questionable, not a received tradition which does not threaten to dissolve.”

     There are momentous changes that are not merely to supplement or modify; they have been to revolutionize and transform. “For every tendency, one seems to see a counter-tendency, for every rule its antimony. Nothing is stable. Nothing absolute. All is fluid and changeable. There is an endless ‘becoming’”.

     The standard of reasonableness suggested in the discussion above, is no guaranty of its preeminence. It is only basic foundation to initiate a quest for an inference. There are methods or principles of selection that compete with any standard, guidelines or with each other in the choice of guides to reasonable judgment. Cardozo identified them thus: “The directive force of a principle may be exerted along the line of logical progression; this I will call the rule of analogy or the method of philosophy; along the line of historical development; this I will call the method of evolution; along the line of the customs of the community; this I will call the method of tradition; along the lines of justice, morals and social welfare, the mores  of the day; and this I will call the method of sociology.”

     In the rule of analogy or method of philosophy, there is primacy that comes from natural and orderly and logical succession. “It would be gross injustice to decide alternate cases on opposite principles.” In the conflict of reasons, the better principle must prevail. This is illustrated in Riggs v. Palmer, 115 N.Y. 506. That case decided that a legatee who murdered his testator would not be permitted by the court to enjoy the benefits of the will. Over other principles of greater generality and universal sentiments of justice, the principle that no man should profit from his inequity or take advantage of his own wrong had prevailed. The choice of the better principle is an exercise in reasonableness.

     The expansion of other principles is limited by its history. History makes the path of logic clear. In illuminating the past, and in illuminating the present, history illuminates the future. “There were fields where there was no progress without history. The system of feudal tenures, and the law that went with it, were built up by history. The law on contracts, debts, covenants and assumpsit, quasi-contracts, use of seal and many other legal developments had prevailed as historical growth.” Surely their dominance in the legal system had influenced the legal decisions in many important ways.

     Where history and philosophy did not serve to fix the direction of a principle, custom stepped in. Custom served as tests and standards that determined how established rules were to be applied.

     The great inventions that embodied the power of the steam and electricity, the railroad and the steamship, the telegraph, the telephone, have built up new customs and new laws.

     A slight extension of customs identified it with customary morality, the prevailing standard of right conduct, and the mores of the time. Such were the influence of customs in the life of society – more so in court decisions.

    The greatest force of them all was the power of social justice which found expression in the method of sociology. The final cause of law is the welfare of society.

     In the question of how far existing rules were to be extended or restricted, it was the welfare of society that fixed the path, its direction and distance. Properties, like every other social institution, were regarded with social function to fulfill.

     The concept of social justice rightly dominated in the judgments of the courts, as in the quality of legislation. Such principles, until now, are a major influence in decisions of major impact on society. Social welfare is a potent influence in any democratic country.

     Finally, the judge that renders decisions of cases in his court is another indispensable factor in the process of decision-making. How shall the judge be affected by the methods and principles that are unavoidable influences to his functions? How shall he react to the forces that may be part of his verdict?

     There are no two exactly identical cases, as there are no exactly identical persons, even if they are identical twins. There are always differences as there are gaps and interstices in the facts, the laws, the principles involved and in the other nuances of a case.

     These are situations that legislation by judges becomes inevitable reality. And in this is the occasion where things, good or bad, come from the personal side of the judge, such as ego, probity and devotion to duty. It is not easy to decide a case, even as a judge is honest and dedicated.  How much more difficult would it be if mischief shall tempt the juror in his judgment?

    Justice Cardozo said in his lectures: “A brief experience on the bench was enough to reveal to me all sorts of cracks and crevices and loopholes in my own opinions when picked up a few months after delivery, and reread with due contrition.”

     The need of the judge for guidance is imperative, as lectured by Justice Benjamin N. Cardozo. With more urgency and reason is the necessity for public servants to be guided by a standard of reasonableness in the discharge of their public functions.

    "Dream as if you'll live forever...live as if you'll die today." - James Dean

    "All men and women are born, live suffer and die; what distinguishes us one from another is our dreams, whether they be dreams about worldly or unworldly things, and what we do to make them come about... We do not choose to be born. We do not choose our parents. We do not choose our historical epoch, the country of our birth, or the immediate circumstances of our upbringing. We do not, most of us, choose to die; nor do we choose the time and conditions of our death. But within this realm of choicelessness, we do choose how we live." --Joseph Epstein

    "I would rather be ashes than dust! I would rather that my spark should burn out in a brilliant blaze than it should be stifled by dry rot. I would rather be a superb meteor, every atom of me in magnificent glow, than a sleepy and permanent planet. The proper function of man is to live, not to exist. I shall not waste my days in trying to prolong them. I shall use my time." -- Jack London

    "Get over the idea that only children should spend their time in study. Be a student so long as you still have something to learn, and this will mean all your life." -- Henry L Doherty

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Hearts of gold

from Anny Misa-Hefti

    A SUICIDE bomber claimed the lives of nine persons in northern Israel a week ago today, one more act of sacrificial violence in a land already drenched in the blood of martyrs and victims. The dead included Filipino caregivers Adelina Cunanan and Rebecca Ruga, whose fate it was to stand right beside the bomber inside the crowded bus.

    When the specialists at the Abu Kabir morgue asked Mottie Elkavetz to describe Cunanan in an attempt to identify her remains, he replied: "Look for a person with a heart of gold."

    Elkavetz knew Cunanan well, because she had been taking care of his 80-year-old mother Miriam for many years. His mother "did not stop crying," an Israeli newspaper reported the day after the bombing. "She left her children behind to come and care for old people," she was quoted as saying. "All she wanted (was) to help us."

     Ruga's 72-year-old ward, Sima Kakun, paid similar tribute to her caregiver, calling Ruga "the woman who was always there to help."

    For the families Cunanan and Ruga had to leave behind in order to work in Israel, their loss is impossible to plumb. Only last week, Cunanan's daughter Gladys was exchanging text messages with her mother about their plans for her debut next year. Ruga's sister Febe, herself a caregiver in Israel, had to break the news to her family in stages. That they will be unable to open the coffins for obvious reasons only adds to the depth of their sorrow. "What pains us more is the way she died," Ruga's mother Rosario said last week. "We won't even be able to see her burned remains." We dare to hope, however, that they find no small measure of consolation in the outpouring of grief and affection that has marked the passing of the two friends, on both sides of the continent. Yesterday's front-page photo, showing grieving Filipinos and Israelis sending off Cunanan and Ruga at the Ben Gurion airport in Tel Aviv, was nothing less than a family portrait of two extended families: the employers they had worked for, and the overseas contractuals they had worked with.

    Out of their tragedy, however, inspiration has emerged. The country has found not only horror in their life story, but hope. Indeed, their personal narrative is positively biblical: they joined the modern Filipino exodus of overseas workers, wandered for years in the desert of poverty, died as innocents in the Holy Land. Their self-sacrifice was stark, but in their poverty they managed to become not only the breadwinners but the vital center of thriving if scattered families.

    The town council of Minalin, Pampanga, where Cunanan hails from, has passed a resolution declaring her "a modern-day heroine," hailing "her courage to work under perilous circumstances." We know the same can be said of Ruga, and salute both of them.

    Close to home

    Quite literally, the deaths of Adelina Cunanan and Rebecca Ruga have brought the Palestinian-Israeli conflict home to the Philippines. Much of international news coverage about the strife in parts of Israel and Palestine has necessarily focused on the violence: the suicide bombings and the full-throttle Israeli military response. After a while, the pictures and the video footage begin to look the same: it is the banality of evil, in a new context.

    Cunanan and Ruga give the life-or-death struggle, in particular the Israeli victims of Palestinian suicide bombings, an unexpected Filipino face. (More than 600 Israelis have died in 235 acts of violence in the last two years.)

    It is worth noting, however, that Cunanan and Ruga were standing right next to the suicide bomber inside the bus. It was fate that brought them together, the common fate of the poor and powerless. Out of desperation, Palestinians have created a generation of suicide bombers. In similar straits, Filipinos have reinvented themselves as overseas workers.

    We do not mean to make an idle comparison between the Palestinian struggle for nationhood and our own continuing war on poverty. We only want to belabor the obvious: More often than not, it is the small people who end up on the altar of sacrifice.

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Forgiveness Is All, and Nothing More…

by: Marie Belen C. Flores-Rosales, MD MPH (CIM ’70)

    I was standing in line for a good three quarter of an hour at the Cathay Pacific check-in counter at the Los Angeles Airport. In front of me were mounds upon mounds of balikbayan boxes, two of which were mine, as is SOP of Filipinos going home. This was some few years ago in one of my annual trips to the Sinulog in Cebu.

    The people right behind me were a family of three generations. The mother, a comely woman in her early sixties, looked anxious and scared. The daughter, a very lovely Jackie Lou Blanco look-alike in her late thirties, was very pleasant and friendly. The grandson, a handsome young man in his early twenties, didn’t speak nor understand any Bisaya whatsoever, but was very intent in listening in my conversation with his mom. This was their first trip to the Philippines in 22 years. The mother suggested that we travel together, especially that the flight had a 6 hours lay over in Hongkong. I obliged to that suggestion as I, myself, was traveling alone.

    Spending 18 hours with that family was destined to be, to give me one lesson of a lifetime. I remembered asking them one question - why it took them 22 years to go home to the Philippines. The daughter, with all sincerity and with no reservations, bared to me the story of her life.

    This is their story…. Carol, the mother, was widowed when her daughter, Remy, was 11 years old. She has three older children. She earned her living as lavandera in her Pasil neighborhood. As raising four children on her own was tough, she had Remy adopted by her well-to-do godparents. Remy was well provided for by her new family – she was loved, especially by her godfather, to a point that he slept with her at least twice a week. At age 16, Remy got pregnant. To hide the shame and the scandal, Remy was sent to the US to live with her godmother’s sister. Carol followed her daughter within a year. Remy bore a son, Jeremy, now twenty one years old, and a US marine.

    After 22 years, Remy’s godmother begged her to return home, with her son, as her godfather is dying of cancer. He needed to see her, he needed to see his son, he needed to ask for forgiveness.

    “Is this why you’re coming home?” I asked. “Yes”, she answered – and she said it with no hesitation, with a smile beaming on her face, and her eyes looking straight into mine. I looked right back at her in disbelief, and in awe. Her face was still there smiling as she started talking about faith, fortitude and forgiveness. She made it sound so easy, twenty two years of faith and of fortitude was all it took to be able to forgive someone who hurt her in way one can only imagine. She said she found peace.

     If I were not a direct participant to this encounter, I would have said it was a script for a Lifetime movie and I could have just buried that conversation somewhere. But Remy was real, Remy is real … and I cannot bury this conversation somewhere. I have told this story over and over again to friends. Now, it has to be written, it has to be shared.

    Forgiving is easier said than done. I often ask myself – if I were Remy, and if I were in her shoes, could I possibly do what she had done! I don’t know… maybe yes, maybe no. Only saints do that, I certainly am not.

    Forgiving requires a higher level of moral maturity, looking for patterns, good or bad, in our lives. I don’t know about you, but I often have the tendency to see life as a series of unrelated snapshots--- for example, I did this wrong, I did this right, I failed here, I could have done better there. Forgiving also requires a long inner journey to one’s self to realize that life is a series of changes – and changes often come without warning. As changes come, we have to take our hurts one day at a time. Like the man who was told to eat the elephant and found the whole job overwhelming, we have to tell ourselves we can do it, and take one bite at a time.

    I was hurt, once, and intensely so, that it turned my life upside down. I grieved and hang on to every single bit of memory of the hurt, and never did let go… for years and years…. until I clammed up the courage to forgive myself, to tell myself that no matter how lame and stupid I was in a world that sucked, I still have that influence and capability to make a difference, regardless my inadequacies and imperfections. And I let go… yes, I did, gladly and willingly.

    In forgiveness, there is peace. In forgiveness, there is grace. Forgiving is everything and all… and we need nothing more.

    (Author’s Note: This article was written with Remy’s knowledge and permission. She is now happily married and lives in Anaheim, California.)

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