Filipino families rarely talk about death at the dinner table, yet a recent column in the Inquirer argues that this silence costs us dearly when a loved one lies dying in a hospital ward. Published on October 25, 2026, the piece, written from the perspective of a physician reflecting on bioethics lectures, makes a direct case for advance directives: written instructions that state what medical treatment a person wants, and who may decide for them, if they become too sick to speak for themselves.
The column arrives at a moment when end-of-life care is becoming a pressing public health question in the Philippines, where families routinely bear the guilt of deciding whether to resuscitate a parent or withdraw life support, often without ever having heard the patient's own wishes.
Learning to say goodbye, with laughter first
The Inquirer writer opens not with policy but with family. The author recounts a conversation with a brother about final wishes: no resuscitation, no wake, a Mass said by a priest before cremation, a simple text message announcing the passing, and ashes scattered in a scenic spot in Tagaytay.
The brother's deadpan reply, asking whether he could not simply flush the writer down the toilet, set off fits of laughter. A sister objected later that strong Tagaytay winds might blow the ashes back into the mourners' faces. The writer's answer: inhaling the remains would mean finally becoming part of the family in every sense.
Another sibling, in the same mischievous spirit, asked that her own family perform in black leotards, singing and dancing to a disco hit during her cremation rites. The writer notes, soberly, that the ash-scattering request would have to be overruled because it goes against Catholic teaching, and the dancing would likely be omitted too. The joking, the writer explains, was the family's own way of preparing for the pain of final goodbyes and of assuring one another that each person's wishes would be respected.
What is an advance directive?
According to the definition cited in the Inquirer column, drawn from the Cambridge Dictionary, an advance directive is a written document in which a person states what type of medical treatment they would like, or who can make decisions about their treatment, if they become so sick that they cannot decide or communicate for themselves.
The writer, a physician, says the topic came into focus after attending several bioethics lectures on decision-making for end-of-life issues involving both the young and the elderly. The lectures stressed two duties that sit at the heart of medical ethics: respecting the patient's autonomy and avoiding undue harm.
Why the family benefits most
The column's central argument is that a directive is not really for the dying person. It is for the family left behind. The writer uses the word beneficial deliberately: a directive can ease, or even free, the family from the burden of guilt, because relatives know they acted according to their loved one's explicit wishes.
Regrets, the writer notes, are among the hardest things to live with. In Philippine hospital culture, where children often insist on aggressive treatment for a dying parent out of filial duty, that guilt can last a lifetime. A written instruction lifts the weight of the decision off the shoulders of a son or daughter at the bedside.
For physicians, the column draws a firm line. The doctor's main responsibility is not to make the final judgment call. The physician's role is to explain the condition thoroughly, lay out reasonable options in the face of terminal illness, and then assist the patient and family in arriving at a firm decision. Even when that decision runs contrary to the doctor's own recommendations, the writer says, it must be respected.
Who decides when the patient cannot?
The column also lays out a hierarchy of surrogate decision-makers, as presented in one of the bioethics lectures. First in line is a legal guardian with authority over health-care decisions. Second is a person holding a durable power of attorney for health care. Third comes the spouse. Fourth are the patient's adult children, who must all agree. Fifth are the patient's parents, and last are adult siblings, who likewise must be of one mind.
But the lecturer emphasized that the ranking matters less than the choice itself. The key, as quoted in the column, is to choose someone you trust enough to listen carefully to your values and preferences for future care, and who will be comfortable making decisions in difficult situations.
That opens the list beyond blood and marriage. A partner, a close friend, or a religious advisor can all serve. For many Filipino families, where a parish priest may already counsel the household through illness and loss, that last option is worth naming out loud.
A question of faith and acceptance
The writer closes on a note that will resonate with a Catholic readership. Beginnings have endings, the column says, and we should be able to accept our own mortality. We are all living on borrowed time. While we may be given choices along the way, the ultimate decision belongs to the one who gave us the gift of life.
The tension the writer acknowledges personally, wanting ashes scattered in Tagaytay while knowing the Church forbids it, mirrors a broader Filipino reality. Many of our wishes about death collide with doctrine, and talking about them early, with laughter where possible, is how families sort the two apart before crisis forces the conversation.
Frequently asked questions
What does an advance directive contain?
It states the medical treatment a person wants or refuses, and names who may decide on their behalf, if they become too sick to communicate their wishes themselves.
Who can serve as a surrogate decision-maker?
Under the hierarchy cited in the Inquirer column, the order runs from a legal guardian, to a holder of durable power of attorney, to the spouse, then adult children in agreement, then parents, then adult siblings in agreement. A trusted partner, friend, or religious advisor may also serve.
Does the Catholic Church allow cremation?
Yes, but Church teaching requires that cremated remains be treated with respect and interred, not scattered, which is why the Inquirer writer expected the Tagaytay request to be overruled.