PATIENT’S BILL OF

RIGHTS
•To support the principle of
autonomy, it is apt to consider
the litany of rights of patients
 PROTECTING THE FILIPINO PATIENT’S
PRIVACY AND CONFIDENTIALITY: WHAT
POLICIES ARE IN PLACE?
 THESE ARE SOME OF THE POLICIES WE HAVE IN
PLACE, PROTECTING THE FILIPINO PATIENT’S
PRIVACY AND CONFIDENTIALITY:
• THE BILL OF RIGHTS IN OUR 1987 CONSTITUTION
• REPUBLIC ACT 10175 OR THE CYBERCRIME PREVENTION
ACT OF 2012
• REPUBLIC ACT 10173 OR THE DATA PRIVACY ACT OF 2012
• THE MAGNA CARTA OF PATIENT’S BILL OF RIGHTS AND
OBLIGATIONS
 "MAGNA CARTA OF
PATIENT'S RIGHTS AND OBLIGATIONS ACT OF 2017."

1. RIGHT TO GOOD QUALITY HEALTH CARE AND HUMANE TREATMENT – EVERY

PERSON HAS A RIGHT TO A CONTINUITY OF GOOD QUALITY HEALTH CARE WITHOUT
DISCRIMINATION AND WITHIN THE LIMITS OF THE RESOURCES, MANPOWER AND
COMPETENCE AVAILABLE FOR HEALTH AND MEDICAL CARE. IN THE COURSE OF SUCH
CARE, HIS HUMAN DIGNITY, CONVICTIONS, INTEGRITY, INDIVIDUAL NEEDS AND CULTURE
SHALL BE RESPECTED.
• IF A PATIENT CANNOT IMMEDIATELY BE GIVEN TREATMENT THAT IS MEDICALLY
NECESSARY, HE SHALL BE INFORMED OF THE REASON FOR THE DELAY AND BE TREATED
IN ACCORDANCE WITH HIS BEST INTERESTS: PROVIDED, THAT THE TREATMENT APPLIED
SHALL BE IN ACCORDANCE WITH GENERALLY ACCEPTED MEDICAL PRINCIPLES.
• EMERGENCY PATIENTS SHALL BE EXTENDED IMMEDIATE MEDICAL
CARE AND TREATMENT WITHOUT REQUIRING, AS A PREREQUISITE
THEREOF, ANY PECUNIARY CONSIDERATION.
2. RIGHT TO DIGNITY - THE PATIENT'S DIGNITY, CULTURE AND VALUE SHALL
BE RESPECTED AT ALL TIMES IN MEDICAL CARE AND TEACHING. LIKEWISE,
TERMINALLY ILL PATIENTS SHALL BE ENTITLED TO HUMANE TERMINAL CARE
TO MAKE DYING AS DIGNIFIED AND COMFORTABLE AS POSSIBLE.
3.RIGHT TO BE INFORMED OF HIS RIGHTS AND OBLIGATIONS AS A
PATIENT -EVERY PERSON HAS THE RIGHT TO BE INFORMED OF HIS RIGHTS
AND OBLIGATIONS AS A PATIENT. IN LINE WITH THIS, THE DEPARTMENT OF
HEALTH, IN COORDINATION WITH HEALTH CARE PROVIDERS, PROFESSIONAL
AND CIVIC GROUPS, THE MEDIA, HEALTH INSURANCE CORPORATIONS,
PEOPLE'S ORGANIZATIONS AND LOCAL GOVERNMENT ORGANIZATIONS,
SHALL LAUNCH AND SUSTAIN A NATION WIDE INFORMATION AND
EDUCATION CAMPAIGN TO MAKE KNOWN TO THE PEOPLE THEIR RIGHTS AS
PATIENTS, AS PROVIDED IN THIS ACT.
• IT SHALL ALSO BE THE DUTY OF HEALTH CARE INSTITUTIONS TO
INFORM PATIENTS OF THEIR RIGHTS AS WELL AS OF THE
INSTITUTION'S RULES AND REGULATIONS THAT APPLY TO THE
CONDUCT OF THE PATIENT WHILE IN THE CARE OF SUCH
INSTITUTION. THESE RIGHTS AND RULES AND REGULATIONS SHALL BE
POSTED IN A BULLETIN BOARD CONSPICUOUSLY PLACED IN A HEALTH
CARE INSTITUTION
4. RIGHT TO CHOOSE HIS PHYSICIAN / HEALTH INSTITUTION - THE
PATIENT IS FREE TO CHOOSE THE SEI-VICES OF A PHYSICIAN OR
HEALTH INSTITUTION OF HIS CHOICE EXCEPT WHEN HE CHOOSES TO
BE CONFINED IN A CHARITY WARD. IN THIS CASE, THE ATTENDING
PHYSICIAN SHALL BE THE CONSULTANT UNDER WHOSE SEI-VICE THE
PATIENT WAS ADMITTED AS APPEARING IN THE DOCTOR'S ORDER
SHEET OF THE MEDICAL RECORD, THE PATIENT SHALL HAVE THE RIGHT
TO SEEK A SECOND OPINION AND SUBSEQUENT OPINIONS, IF
NECESSARY, FROM ANOTHER PHYSICIAN OR HEALTH INSTITUTION, AND
TO CHANGE HIS PHYSICIAN OR HEALTH INSTITUTION
5. RIGHT TO INFORMED CONSENT - THE PATIENT HAS A RIGHT TO SELF
DETERMINATION AND TO MAKE FREE DECISIONS REGARDING
HIMSELF/HERSELF, HOWEVER, THE ATTENDING PHYSICIAN SHALL INFORM
THE PATIENT OF THE CONSEQUENCES OF HIS/HER DECISIONS.
>MUST BE MENTALLY COMPETENT AND IS OF LEGAL AGE/ LEGAL
REPRESENTATIVE
>THE EXPLANATION SHALL INCLUDE THE AMOUNT OF INFORMATION
NECESSARY AND INDISPENSABLE FOR HIM TO INTELLIGENTLY GIVE HIS
CONSENT, INCLUDING, BUT NOT LIMITED TO, THE BENEFITS, RISK, SIDE
EFFECTS AND THE PROBABILITY OF SUCCESS OR FAILURE, AS A POSSIBLE
CONSEQUENCE OF SAID PROPOSED PROCEDURE OR PROCEDURES,
INCLUDING THE IMPLICATIONS OF WITHHOLDING CONSENT.
 >PROVIDED HOWEVER, THAT WHEN MEDICAL INTERVENTION IS
URGENTLY NEEDED, THE CONSENT OF THE PATIENT MAY BE PRESUMED;
PROVIDED FURTHER, THAT A PHYSICIAN SHOULD ALWAYS TRY TO SAVE THE
LIFE OF A PATIENT WHO IS UNCONSCIOUS DUE TO SUICIDE ATTEMPT.
>IN THE CASE OF A PATIENT WHO IS LEGALLY INCOMPETENT OR IS
A MINOR, THE CONSENT OF A LEGAL REPRESENTATIVE IS REQUIRED;
PROVIDED HOWEVER, THAT THE PATIENT MUST BE INVOLVED IN THE
DECISION MAKING PROCESS TO THE FULLEST EXTENT ALLOWED BY HIS
MENTAL CAPACITY. IF THE LEGALLY INCOMPETENT PATIENT CAN MAKE
RATIONAL DECISIONS, HIS/HER DECISIONS MUST BE RESPECTED, AND
HE/SHE HAS THE RIGHT TO FORBID DISCLOSURE OF SUCH INFORMATION
TO HIS/HER LEGAL REPRESENTATIVE.
 >IF THE PATIENT'S LEGAL REPRESENTATIVE FORBIDS TREATMENT,
BUT, IN THE OPINION OF THE PHYSICIAN, IT IS CONTRARY TO THE
PATIENT'S BEST INTEREST, THE PHYSICIAN MAY CHALLENGE THIS
DECISION IN COURT; PROVIDED HOWEVER , THAT IN EMERGENCY
CASES, THE PHYSICIAN SHALL ACT IN THE PATIENT'S BEST INTEREST;
PROVIDED FURTHER, THAT IN EMERGENCY CASES WHERE THERE IS NO
ONE WHO CAN GIVE CONSENT ON THE PATIENT'S BEHALF, THE
PHYSICIAN CAN PERFORM ANY EMERGENCY DIAGNOSTIC OR
TREATMENT PROCEDURE IN THE BEST INTEREST OF THE PATIENT.
6. RIGHT TO REFUSE DIAGNOSTIC AND MEDICAL
TREATMENT - THE PATIENT HAS THE RIGHT TO REFUSE DIAGNOSTIC AND
MEDICAL TREATMENT PROCEDURES, PROVIDED THAT THE FOLLOWING
CONDITIONS ARE SATISFIED;
1. THE PATIENT IS OF LEGAL AGE AND IS MENTALLY COMPETENT;
2. THE PATIENT IS INFORMED OF THE MEDICAL CONSEQUENCES OF HIS/HER
REFUSAL;
3. THE PATIENT RELEASES THOSE INVOLVED IN HIS CARE FROM ANY
OBLIGATION RELATIVE TO THE CONSEQUENCES OF HIS/HER DECISION; AND
4. THE PATIENT'S' REFUSAL WILL NOT JEOPARDIZE PUBLIC HEALTH AND
SAFETY.
7. RIGHT TO REFUSE PARTICIPATION IN MEDICAL RESEARCH - THE
PATIENT HAS THE RIGHT TO BE ADVISED OF PLANS TO INVOLVE HIM/HER IN
MEDICAL RESEARCH THAT MAY AFFECT THE CARE OR TREATMENT OF HIS/HER
CONDITION. ANY PROPOSED RESEARCH SHALL BE PERFORMED ONLY UPON THE
WRITTEN INFORMED CONSENT OF THE PATIENT.

8. RIGHT TO RELIGIOUS BELIEF AND ASSISTANCE - THE PATIENT

HAS THE RIGHT TO RECEIVE SPIRITUAL AND MORAL COMFORT, INCLUDING THE
HELP OF A PRIEST OR MINISTER OF HIS/HER CHOSEN RELIGION. HE/SHE ALSO HAS
THE RIGHT TO REFUSE MEDICAL TREATMENT OR PROCEDURES WHICH MAY BE
CONTRARY TO HIS RELIGIOUS BELIEFS, SUBJECT TO THE LIMITATIONS DESCRIBED IN
PARAGRAPH 6 OF THIS SECTION.
9. RIGHT TO PRIVACY AND CONFIDENTIALITY - THE PATIENT
HAS THE RIGHT TO PRIVACY AND PROTECTION FROM UNWARRANTED
PUBLICITY. THE RIGHT TO PRIVACY SHALL INCLUDE THE PATIENT'S RIGHT
NOT TO BE SUBJECTED TO EXPOSURE, PRIVATE OR PUBLIC, EITHER BY
PHOTOGRAPHY, PUBLICATIONS, VIDEO-TAPING, DISCUSSION, OR BY
ANY OTHER MEANS THAT WOULD OTHERWISE TEND TO REVEAL HIS
PERSON AND IDENTITY AND THE CIRCUMSTANCES UNDER WHICH HE
WAS, HE IS, OR HE WILL BE, UNDER MEDICAL OR SURGICAL CARE OR
TREATMENT.
• CONFIDENTIAL INFORMATION CAN BE DISCLOSED IN THE
FOLLOWING CASES;
I. WHEN THE PATIENT'S MEDICAL OR PHYSICAL
CONDITION IS IN CONTROVERSY IN A COURT LITIGATION
AND THE COURT, IN ITS DISCRETION, ORDERS THE PATIENT TO
SUBMIT TO PHYSICAL OR MENTAL EXAMINATION OF A
PHYSICIAN;
II. WHEN PUBLIC HEALTH OR SAFETY SO DEMANDS;
 III. WHEN THE PATIENT, OR IN HIS INCAPACITY, HIS/HER
LEGAL REPRESENTATIVE, EXPRESSLY GIVES THE CONSENT;
IV. WHEN THE PATIENT'S MEDICAL OR SURGICAL
CONDITION IS DISCUSSED IN A MEDICAL OR SCIENTIFIC
FORUM FOR EXPERT DISCUSSION FOR HIS/HER BENEFIT OR
FOR THE ADVANCEMENT OF SCIENCE AND MEDICINE;
PROVIDED HOWEVER, THAT THE IDENTITY OF THE PATIENT
SHOULD NOT BE REVEALED; AND
V. WHEN IT IS OTHERWISE REQUIRED BY LAW.
10. RIGHT TO DISCLOSURE OF, AND ACCESS TO. INFORMATION - IN
THE COURSE OF THE PATIENT'S TREATMENT AND HOSPITAL CARE, THE
PATIENT OR HIS/HER LEGAL GUARDIAN HAS THE RIGHT TO BE
INFORMED OF THE RESULT OF THE EVALUATION OF THE NATURE AND
EXTENT OF HIS/HER DISEASE. ANY OTHER ADDITIONAL OR FURTHER
CONTEMPLATED MEDICAL TREATMENT ON SURGICAL PROCEDURE OR
PROCEDURES SHALL BE DISCLOSED AND MAY ONLY BE PERFORMED
WITH THE WRITTEN CONSENT OF THE PATIENT.
• THE DISCLOSURE OF INFORMATION MAY BE WITHHELD IF GIVING THE
INFORMATION TO THE PATIENT WILL CAUSE MENTAL SUFFERING OR FURTHER
IMPAIR HIS HEALTH
• THE PATIENT HAS THE RIGHT TO CHOOSE WHO HE/SHE DESIRES SHOULD BE
INFORMED ON HIS BEHALF
• THE PATIENT HAS THE RIGHT TO BE GIVEN, AND EXAMINE, AN ITEMIZED BILL
FOR HOSPITAL AND MEDICAL SERVICES RENDERED.
11. RIGHT TO CORRESPONDENCE AND TO RECEIVE VISITORS - THE PATIENT
HAS THE RIGHT TO COMMUNICATE WITH HIS/HER RELATIVES AND OTHER
PERSONS AND TO RECEIVE VISITORS SUBJECT TO REASONABLE LIMITS
PRESCRIBED BY THE RULES AND REGULATIONS OF THE HEALTH CARE
INSTITUTION.
12. RIGHT TO MEDICAL RECORDS - THE HEALTH CARE INSTITUTION
AND THE, PHYSICIAN SHALL ENSURE AND SAFEGUARD THE INTEGRITY
AND AUTHENTICITY OF THE MEDICAL RECORDS.
❑THE PATIENT, UPON HIS/HER REQUEST, IS ENTITLED TO A MEDICAL
CERTIFICATE AND CLINICAL ABSTRACT. HE/SHE HAS THE RIGHT TO
VIEW, AND OBTAIN AN EXPLANATION OF, THE CONTENTS OF
HIS/HER MEDICAL RECORDS FROM THE ATTENDING PHYSICIAN,
EXCEPT FOR PSYCHIATRIC NOTES AND OTHER INCRIMINATING
INFORMATION OBTAINED ABOUT A THIRD PARTY.
13. RIGHT TO HEALTH EDUCATION - EVERY PERSON HAS THE RIGHT
TO HEALTH EDUCATION THAT WILL ASSIST HIM IN MAKING INFORMED
CHOICES ABOUT PERSONAL HEALTH AND ABOUT AVAILABLE HEALTH
SERVICES. THE EDUCATION SHALL INCLUDE INFORMATION ABOUT
HEALTHY LIFESTYLES AND ABOUT METHODS OF PREVENTION AND
EARLY DETECTION OF ILLNESSES. THE PERSONAL RESPONSIBILITY OF
EVERYBODY FOR HIS OWN HEALTH SHOULD BE STRESSED.
14. RIGHT TO LEAVE AGAINST MEDICAL ADVICE - THE PATIENT HAS
THE RIGHT TO LEAVE A HOSPITAL OR ANY OTHER HEALTH CARE
INSTITUTION REGARDLESS OF HIS PHYSICAL CONDITION; PROVIDED,
THAT:
➢ I. HE/SHE IS INFORMED OF THE MEDICAL CONSEQUENCES OF
HIS/HER DECISION;
➢ II. HE/SHE RELEASES THOSE INVOLVED IN HIS/HER CARE FROM
ANY OBLIGATION RELATIVE TO THE CONSEQUENCES OF HIS/HER
DECISION; AND
➢ III. HIS/HER DECISION WILL NOT PREJUDICE PUBLIC HEALTH AND
SAFETY.
15. RIGHT TO EXPRESS GRIEVANCES. - EVERY PATIENT HAS THE RIGHT
TO EXPRESS VALID COMPLAINTS AND GRIEVANCES ABOUT THE CARE
AND SERVICES RECEIVED AND TO KNOW THE DISPOSITION OF SUCH
COMPLAINTS, IN ACCORDANCE WITH SECTIONS 7-8 OF THIS ACT.
 SEC. 5. SOCIETAL RIGHTS OF
PATIENTS. - IN ADDITION TO THE
INDIVIDUAL RIGHTS OF PATIENTS, THE
PATIENT HAS LIKEWISE THE
FOLLOWING SOCIETAL RIGHTS;
A. RIGHT TO HEALTH - THE PATIENT HAS THE RIGHT TO
ACCESS QUALITY HEALTH CARE AND PHYSICIANS WHO ARE
FREE TO RENDER CLINICAL AND ETHICAL JUDGMENT
WITHOUT INTERFERENCE OR EXTERNAL PRESSURE. HE HAS
LIKEWISE THE RIGHT TO REGAIN/AND OR ACQUIRE THE
HIGHEST ATTAINABLE STANDARD OF HEALTH IN A NON-
DISCRIMINATORY, GENDER SENSITIVE AND EQUAL MANNER
WHICH HEALTH AUTHORITIES AND HEALTH CARE PROVIDERS
MUST PROGRESSIVELY CONTRIBUTE TO REALIZE.
• B. RIGHT TO ACCESS TO QUALITY PUBLIC HEALTH CARE - THE
PATIENT HAS THE RIGHT TO A COMPREHENSIVE AND INTEGRATED
HEALTH CARE DELIVERY SYSTEM WITH THE NECESSARY MANPOWER
AND FACILITY RESOURCES. HE SHALL ALSO HAVE THE RIGHT TO A
FUNCTIONING PUBLIC HEALTH AND HEALTH CARE FACILITIES,
NEEDED PROGRAMS, SUCH AS PUBLIC HEALTH INSURANCE, GOODS
AND SEI-VICES IN SUFFICIENT QUANTITY.
• C. RIGHT TO A HEALTHY AND SAFE WORKPLACE - THE PATIENT AS
THE RIGHT TO A HEALTHY NATURAL WORKPLACE ENVIRONMENT
WITH ADEQUATE SUPPLY OF SAFE AND POTABLE WATER AND BASIC
SANITATION, INDUSTRIAL HYGIENE, PREVENTION AND REDUCTION
OF EXPOSURE TO HARMFUL SUBSTANCES, PREVENTIVE MEASURES
FOR OCCUPATIONAL ACCIDENTS AND DISEASES, AND AN
ENVIRONMENT THAT DISCOURAGES ABUSE OF ALCOHOL,
TOBACCO AND DRUG USE, AND THE USE OF OTHER HARMFUL
SUBSTANCES.
• D. RIGHT TO MEDICAL INFORMATION AND EDUCATION
PROGRAMS - THE PATIENT HAS THE RIGHT TO MEDICAL
INFORMATION AND EDUCATION PROGRAMS ON IMMUNIZATION;
PREVENTION, TREATMENT AND CONTROL OF DISEASES; BEHAVIOR
RELATED CONCERNS; AND DISASTER RELIEF AND EMERGENCY
SITUATIONS DURING EPIDEMICS AND SIMILAR HEALTH HAZARDS.
TLIE STATE SHALL ENDEAVOR TO PROVIDE THESE INFORMATION
THROUGH LECTURES, SYMPOSIA, TRI-MEDIA, POSTERS AND THE
LIKE.
• E. RIGHT TO PARTICIPATE IN POLICY DECISIONS - THE
PATIENT HAS THE RIGHT TO PARTICIPATE IN POLICY
DECISIONS RELATING TO PATIENT'S RIGHT TO HEALTH AT
THE COMMUNITY AND NATIONAL LEVELS.
• F. RIGHT TO ACCESS TO HEALTH FACILITIES - THE PATIENT
HAS THE RIGHT TO BE ADMITTED TO PRIMARY, SECONDARY,
TERTIARY AND OTHER SPECIALTY HOSPITALS WHEN
APPROPRIATE AND NECESSARY.
• G. RIGHT TO AN EQUITABLE AND ECONOMICAL USE OF
RESOURCES - THE PATIENT HAS THE RIGHT TO AN EQUITABLE AND
ECONOMICAL USE OF RESOURCES SUCH THAT HEALTH
INSTITUTIONS, PROJECTS AND PROGRAMS OF THE STATE ARE
EQUITABLY ESTABLISHED AND IMPLEMENTED IN VARIOUS REGIONS
OF THE COUNTRY.
• H. RIGHT TO CONTINUING HEALTH CARE - THE PATIENT HAS THE
RIGHT TO AVAIL OF OR SECURE ACCESS TO PROGRAMS THAT WILL
ENSURE CONTINUITY OF CARE IN THE FORM OF HOSPICE CARE,
REHABILITATION, CHEMOTHERAPY, RADIOTHERAPY ARID OTHER
SIMILAR MODALITIES.
• I. RIGHT TO BE PROVIDED QUALITY HEALTH CARE IN
TIMES OF INSOLVENCY - THE PATIENT HAS THE RIGHT, AT
ALL TIMES, TO ACCESS QUALITY MEDICAL CARE IN SPITE OF
INSOLVENCY. THE STATE MUST PROVIDE FOR A SYSTEM OF
PAYMENT TO HEALTH CARE INSTITUTIONS AND PROVIDERS
FOR ALL THE VALID AND NECESSARY MEDICAL EXPENSES
OF THE. POOR AND MARGINALIZED CITIZENS.
 BILL OF RIGHTS, PHILIPPINE
CONSTITUTION 1987
• IN THE PHILIPPINES’ 1987 CONSTITUTION, THE FILIPINO
PATIENT’S RIGHT TO PRIVACY AND CONFIDENTIALITY IS
GUARANTEED UNDER ARTICLE 3, SECTION 3:
• “ THE PRIVACY OF COMMUNICATION AN
CORRESPONDENCE SHALL BE INVIOLABLE EXCEPT UPON
LAWFUL ORDER OF THE COURT, OR WHEN PUBLIC SAFETY
OR ORDER REQUIRES OTHERWISE, AS PRESCRIBED BY LAW.”
 REPUBLIC ACT 10175: CYBERCRIME PREVENTION
ACT OF 2012
• UNDER THE CYBERCRIME LAW, PERTINENT SECTIONS THAT
PROTECTS PATIENT PRIVACY ARE UNDER CHAPTER II, SEC. 4.
CYBERCRIME OFFENSES.
— THE FOLLOWING ACTS CONSTITUTE THE OFFENSE OF
CYBERCRIME PUNISHABLE UNDER THIS ACT:
(A) OFFENSES AGAINST THE CONFIDENTIALITY, INTEGRITY AND
AVAILABILITY OF COMPUTER DATA AND SYSTEMS:
(1) ILLEGAL ACCESS. – THE ACCESS TO THE WHOLE OR ANY
PART OF A COMPUTER SYSTEM WITHOUT RIGHT.
 REPUBLIC ACT 10175: CYBERCRIME PREVENTION
ACT OF 2012
(2) ILLEGAL INTERCEPTION. – THE INTERCEPTION MADE BY
TECHNICAL MEANS WITHOUT RIGHT OF ANY NONPUBLIC
TRANSMISSION OF COMPUTER DATA TO, FROM, OR WITHIN A
COMPUTER SYSTEM INCLUDING ELECTROMAGNETIC EMISSIONS FROM
A COMPUTER SYSTEM CARRYING SUCH COMPUTER DATA.
(3) DATA INTERFERENCE. — THE INTENTIONAL OR RECKLESS
ALTERATION, DAMAGING, DELETION OR DETERIORATION OF COMPUTER
DATA, ELECTRONIC DOCUMENT, OR ELECTRONIC DATA MESSAGE,
WITHOUT RIGHT, INCLUDING THE INTRODUCTION OR TRANSMISSION
OF VIRUSES. …”
 REPUBLIC ACT 10173: DATA PRIVACY ACT OF
2012
• UNDER THE DATA PRIVACY ACT, PROTECTION OF PATIENT PRIVACY AND
CONFIDENTIALITY IS PROTECTED UNDER THE FOLLOWING:
• “SECTION 13. SENSITIVE PERSONAL INFORMATION AND PRIVILEGED
INFORMATION. THE PROCESSING OF SENSITIVE PERSONAL
INFORMATION AND PRIVILEGED INFORMATION SHALL BE PROHIBITED,
…EXCEPT IN THE FOLLOWING INSTANCES: DATA SUBJECT CONSENT;
EXISTING LAWS AND REGULATIONS; TO PROTECT THE LIFE AND
HEALTH OF DATA SUBJECT;
CONT…
• LAWFUL AND NONCOMMERCIAL OBJECTIVES OF PUBLIC
ORGANIZATIONS AND ASSOCIATIONS; MEDICAL TREATMENT;
PROTECTION OF LAWFUL RIGHTS AND INTEREST OF NATURAL OR
LEGAL PERSON IN COURT PROCEEDINGS; OR THE ESTABLISHMENT,
EXERCISE, OR DEFENSE OF LEGAL CLAIMS; OR, WHEN PROVIDED TO
GOVERNMENTS OR PUBLIC AUTHORITY.”
CONT…

• SEC 19. NON APPLICABILITY. THE …PRECEDING SECTIONS ARE NOT

APPLICABLE IF THE PROCESSED PERSONAL INFORMATION ARE USED
ONLY FOR THE NEEDS OF SCIENTIFIC AND STATISTICAL
RESEARCH….THE PERSONAL INFORMATION SHALL BE HELD UNDER
STRICT CONFIDENTIALITY AND …USED ONLY FOR THE DECLARED
PURPOSE.
CONT…
• CHAPTER V. SECURITY OF PERSONAL INFORMATION.
SEC. 20. SECURITY OF PERSONAL INFORMATION. –
• (A) THE PERSONAL INFORMATION CONTROLLER MUST
IMPLEMENT REASONABLE AND APPROPRIATE ORGANIZATIONAL,
PHYSICAL AND TECHNICAL MEASURES INTENDED FOR THE
PROTECTION OF PERSONAL INFORMATION AGAINST ANY
ACCIDENTAL OR UNLAWFUL DESTRUCTION, ALTERATION AND
DISCLOSURE, AS WELL AS AGAINST ANY OTHER UNLAWFUL
PROCESSING.
CONT…
• (B) THE PERSONAL INFORMATION CONTROLLER SHALL IMPLEMENT
REASONABLE AND APPROPRIATE MEASURES TO PROTECT
PERSONAL INFORMATION AGAINST NATURAL DANGERS SUCH AS
ACCIDENTAL LOSS OR DESTRUCTION, AND HUMAN DANGERS SUCH
AS UNLAWFUL ACCESS, FRAUDULENT MISUSE, UNLAWFUL
DESTRUCTION, ALTERATION AND CONTAMINATION.
CONT…
• (C) THE DETERMINATION OF THE APPROPRIATE LEVEL OF
SECURITY UNDER THIS SECTION MUST TAKE INTO
ACCOUNT THE NATURE OF THE PERSONAL INFORMATION
TO BE PROTECTED, THE RISKS REPRESENTED BY THE
PROCESSING, THE SIZE OF THE ORGANIZATION AND
COMPLEXITY OF ITS OPERATIONS, CURRENT DATA PRIVACY
BEST PRACTICES AND THE COST OF SECURITY
IMPLEMENTATION.
 CONT…
• SUBJECT TO GUIDELINES AS THE COMMISSION MAY ISSUE FROM TIME TO TIME,
THE MEASURES IMPLEMENTED MUST INCLUDE:
• (1) SAFEGUARDS TO PROTECT ITS COMPUTER NETWORK AGAINST
ACCIDENTAL, UNLAWFUL OR UNAUTHORIZED USAGE OR INTERFERENCE WITH
OR HINDERING OF THEIR FUNCTIONING OR AVAILABILITY;
• (2) A SECURITY POLICY WITH RESPECT TO THE PROCESSING OF PERSONAL
INFORMATION;
• (3) A PROCESS FOR IDENTIFYING AND ACCESSING REASONABLY
FORESEEABLE VULNERABILITIES IN ITS COMPUTER NETWORKS, AND FOR
TAKING PREVENTIVE, CORRECTIVE AND MITIGATING ACTION AGAINST
SECURITY INCIDENTS THAT CAN LEAD TO A SECURITY BREACH; AND
CONT...

• (4) REGULAR MONITORING FOR SECURITY BREACHES AND

A PROCESS FOR TAKING PREVENTIVE, CORRECTIVE AND
MITIGATING ACTION AGAINST SECURITY INCIDENTS THAT
CAN LEAD TO A SECURITY BREACH. (D) THE PERSONAL
INFORMATION CONTROLLER MUST FURTHER ENSURE THAT
THIRD PARTIES PROCESSING PERSONAL INFORMATION ON
ITS BEHALF SHALL IMPLEMENT THE SECURITY MEASURES
REQUIRED BY THIS PROVISION.
CONT...
• (E) THE EMPLOYEES, AGENTS OR REPRESENTATIVES OF A PERSONAL
INFORMATION CONTROLLER WHO ARE INVOLVED IN THE
PROCESSING OF PERSONAL INFORMATION SHALL OPERATE AND
HOLD PERSONAL INFORMATION UNDER STRICT CONFIDENTIALITY IF
THE PERSONAL INFORMATION ARE NOT INTENDED FOR PUBLIC
DISCLOSURE. THIS OBLIGATION SHALL CONTINUE EVEN AFTER
LEAVING THE PUBLIC SERVICE, TRANSFER TO ANOTHER POSITION
OR UPON TERMINATION OF EMPLOYMENT OR CONTRACTUAL
RELATIONS.
CONT...

• (F) THE PERSONAL INFORMATION CONTROLLER SHALL PROMPTLY

NOTIFY THE COMMISSION AND AFFECTED DATA SUBJECTS WHEN
SENSITIVE PERSONAL INFORMATION OR OTHER INFORMATION
THAT MAY, UNDER THE CIRCUMSTANCES, BE USED TO ENABLE
IDENTITY FRAUD ARE REASONABLY BELIEVED TO HAVE BEEN
ACQUIRED BY AN UNAUTHORIZED PERSON, AND THE PERSONAL
INFORMATION CONTROLLER OR THE COMMISSION BELIEVES (BAT
SUCH UNAUTHORIZED ACQUISITION IS LIKELY TO GIVE RISE TO A
REAL RISK OF SERIOUS HARM TO ANY AFFECTED DATA SUBJECT.
CONT...
• THE NOTIFICATION SHALL AT LEAST DESCRIBE THE NATURE OF THE BREACH, THE
SENSITIVE PERSONAL INFORMATION POSSIBLY INVOLVED, AND THE MEASURES
TAKEN BY THE ENTITY TO ADDRESS THE BREACH. NOTIFICATION MAY BE
DELAYED ONLY TO THE EXTENT NECESSARY TO DETERMINE THE SCOPE OF THE
BREACH, TO PREVENT FURTHER DISCLOSURES, OR TO RESTORE REASONABLE
INTEGRITY TO THE INFORMATION AND COMMUNICATIONS SYSTEM.
(1) IN EVALUATING IF NOTIFICATION IS UNWARRANTED, THE COMMISSION MAY
TAKE INTO ACCOUNT COMPLIANCE BY THE PERSONAL INFORMATION
CONTROLLER WITH THIS SECTION AND EXISTENCE OF GOOD FAITH IN THE
ACQUISITION OF PERSONAL INFORMATION.
 CONT…
• (2) THE COMMISSION MAY EXEMPT A PERSONAL
INFORMATION CONTROLLER FROM NOTIFICATION WHERE, IN
ITS REASONABLE JUDGMENT, SUCH NOTIFICATION WOULD
NOT BE IN THE PUBLIC INTEREST OR IN THE INTERESTS OF THE
AFFECTED DATA SUBJECTS. (3) THE COMMISSION MAY
AUTHORIZE POSTPONEMENT OF NOTIFICATION WHERE IT
MAY HINDER THE PROGRESS OF A CRIMINAL INVESTIGATION
RELATED TO A SERIOUS BREACH.”
 OTHER PROTECTION
• ENTITIES LIKE THE PHILHEALTH AND OTHER ACCREDITING AGENCIES (E.G., ICO, JCIA)
DID NOT WAIT FOR THE PATIENT’S BILL OF RIGHTS TO BE SIGNED INTO LAW, AND
REQUIRED THAT THE SAME RIGHTS BE COMMUNICATED TO THE PATIENT IN A FORMAL
EDUCATION MATERIAL. PATIENT RIGHTS TO PRIVACY AND CONFIDENTIALITY, DATA
SECURITY, AS WELL AS INFORMED CONSENT ARE TENETS THAT ARE FOLLOWED EVEN
WITHOUT AN ENABLING LAW.
• IN ADDITION, MAJOR HOSPITALS, ASIDE FROM THE PMA CODE OF ETHICS, ALSO HAVE
WRITTEN CODES OF PROFESSIONAL CONDUCT FOR STAFF TO FOLLOW. THE SAME IS
TRUE FOR THE SUBSPECIALTY SOCIETIES SUCH AS THE PHILIPPINE COLLEGE OF
PHYSICIANS AND THE PHILIPPINE ACADEMY OF OPHTHALMOLOGY, WHICH ESPOUSE
THE TENETS OF PROTECTING PATIENT CONFIDENTIALITY AND PRIVACY.
THE END
 REFERENCES:
• HTTPS://WWW.OFFICIALGAZETTE.GOV.PH/CONSTITUTIONS/1987-CONSTITUTION/:
ACCESSED OCTOBER 19, 2020
• HTTPS://WWW.OFFICIALGAZETTE.GOV.PH/2012/09/12/REPUBLIC-ACT-NO-10175/
:ACCESSED OCTOBER 19, 2020
• HTTPS://WWW.PRIVACY.GOV.PH/DATA-PRIVACY-ACT/ :ACCESSED OCTOBER 19, 2020
• HTTP://LEGACY.SENATE.GOV.PH/LISDATA/2577422144!.PDF :ACCESSED OCTOBER 19, 2020
• HTTP://EYES.HEALTH-CHANNEL.COM/PROTECTING-THE-FILIPINO-PATIENTS-PRIVACY-AND-
CONFIDENTIALITY/ :ACCESSED OCTOBER 19, 2020
1. Define the 3 types of ethical theory.
2. Describe the different approaches used for
each ethical theory.
3. Understand the frameworks used for ethical
decision making.
4. Apply the frameworks in decision making
following the process.
1) Consequentialist theories
❖ which are primarily concerned with the
ethical consequences of particular actions;
❖ the consequences of an action determine
its moral value.
2) Non-consequentialist theories
❖ concerned with the intentions of the
person making ethical decisions about
particular actions;
3) Agent-centered theories
❖ concerned with the overall ethical status of
individuals, or agents, and are less
concerned to identify the morality of
particular actions.
❖ Moral Agent - an individual who consciously
acts and can therefore be held responsible
for his/her actions.
❖ Capacity for agency includes, consciousness,
sense of self, ability to reason (degree
depending on what is necessary for the task
at hand), and the ability to interact and form
relationships with others.
1) The Utilitarian Approach
◦ it instructs us to weigh the different amounts of
good and bad that will be produced by our
action.
◦ This conforms to our feeling that some good
and some bad will necessarily be the result of
our action and that the best action will be that
which provides the most good or does the least
harm, or, to put it another way, produces the
greatest balance of good over harm.
◦ Ethical environmental action, then, is the one
that produces the greatest good and does the
least harm for all who are affected—government,
corporations, the community, and the
environment.
2) The Egoistic Approach
◦ is known as ethical egoism, or the
ethics of self- interest.
◦ In this approach, an individual often
uses utilitarian calculation to produce
the greatest amount of good for him or
herself.
3) The Common Good Approach

◦ The most influential modern proponent of this

approach was the French philosopher Jean-
Jacques Rousseau (1712-1778), who argued
that the best society should be guided by the
“general will” of the people which would then
produce what is best for the people as a whole.
◦ This approach to ethics underscores the
networked aspects of society and emphasizes
respect and compassion for others, especially
those who are more vulnerable.
1. The Duty-Based Approach
◦ sometimes called deontological ethics, is
most commonly associated with the
philosopher Immanuel Kant (1724-1804),
who emphasized the importance of the
personal will and intention (and of the
omnipotent God who sees this interior
mental state) to ethical decision making.
◦ Kant argued that doing what is right is not
about the consequences of our actions but
about having the proper intention in
performing the action.
1. The Duty-Based Approach
◦ The ethical action is one taken from
duty
 it is done precisely because it is our
obligation to perform the action.
2. The Rights Approach
▪ derived from Kantian duty-based
ethics,
▪ This approach stipulates that the
best ethical action is that which
protects the ethical rights of those
who are affected by the action.
▪ It emphasizes the belief that all
humans have a right to dignity.
2. The Rights Approach
▪ This is based on a formulation of
Kant’s categorical imperative that
says: “Act in such a way that you
treat humanity, whether in your own
person or in the person of another,
always at the same time as an end
and never simply as a means to an
end
3. The Fairness or Justice Approach
▪ The Law Code of Hammurabi in Ancient
Mesopotamia (c. 1750 BCE) held that all
free men should be treated alike, just as
all slaves should be treated alike.
▪ The most influential version of this
approach today is found in the work of
American philosopher John Rawls
(1921-2002), who argued, along
Kantian lines, that just ethical principles
are those that would be chosen by free
and rational people in an initial situation
of equality.
▪ Fairness of starting point is the principle
for what is considered just.
4. The Divine Command Approach
▪ This approach sees what is right as
the same as what God commands,
and ethical standards are the creation
of God’s will.
▪ Following God’s will is seen as the
very definition what is ethical.
1. The Virtue Approach
▪ Ethical actions should be consistent with
ideal human virtues.
▪ Aristotle, for example, argued that ethics
should be concerned with the whole of a
person’s life, not with the individual discrete
actions a person may perform in any given
situation.
▪ A person of good character would be one
who has attainted certain virtues.
▪ It takes the process of education and
training seriously, and emphasizes the
importance of role models to our
understanding of how to engage in ethical
deliberation.
1. The Virtue Approach
▪ Ethical actions should be consistent with
ideal human virtues.
▪ Aristotle, for example, argued that ethics
should be concerned with the whole of a
person’s life, not with the individual discrete
actions a person may perform in any given
situation.
▪ A person of good character would be one
who has attainted certain virtues.
▪ It takes the process of education and
training seriously, and emphasizes the
importance of role models to our
understanding of how to engage in ethical
deliberation.
 What is decision-making?
 How is moral decision-making different?
 Why do we need a model specific to
ethics and mental health?
 What is decision-making?

◦ identifying and choosing alternatives

based on values and preferences.
◦ process of sufficiently reducing
uncertainty and doubt about
alternatives to allow a reasonable
choice to be made.
 How is moral decision-making
different?

◦ process for dealing with moral

uncertainties
◦ introduces a degree of rationality
and rigor into our moral
deliberations
 Whydo we need a model/
framework?

◦ ethical problems are unique

issues that requires examination,
through filters (organizational,
social, personal, legal)
 The Consequentialist Framework;
 The Duty Framework; and
 The Virtue Framework.
1) The Consequentialist Framework;
◦ We focus on the future effects of the possible
courses of action, considering the people who
will be directly or indirectly affected.
2) The Duty Framework;
◦ we focus on the duties and obligations that
we have in a given situation, and consider
what ethical obligations we have and what
things we should never do. Ethical conduct is
defined by doing one’s duties and doing the
right thing, and the goal is performing the
correct action.
3) The Virtue Framework.
▪ we try to identify the character traits
(either positive or negative) that might
motivate us in a given situation.
▪ We are concerned with what kind of
person we should be and what our
actions indicate about our character.
1. Recognizing an Ethical Issue
▪ One of the most important things to do at
the beginning of ethical deliberation is to
locate, to the extent possible, the
specifically ethical aspects of the issue at
hand.
2. Consider the Parties Involved
▪ Another important aspect to reflect upon
are the various individuals and groups who
may be affected by your decision.
▪ Consider who might be harmed or who
might benefit.
3. Gather all of the Relevant Information
▪ Before taking action, make sure that you have gathered
all of the pertinent information, and that all potential
sources of information have been consulted.
4. Formulate Actions and Consider
Alternatives
▪ Evaluate your decision-making options by
asking the following questions:
1) Which action will produce the most good and do
the least harm? (The Utilitarian Approach)
2) Which action respects the rights of all who have a
stake in the decision? (The Rights Approach)
3) Which action treats people equally or
proportionately? (The Justice Approach)
3. Formulate Actions and Consider
Alternatives
▪ Evaluate your decision-making options by
asking the following questions:
4) Which action serves the community as a
whole, not just some members?
(The Common Good Approach)
5) Which action leads me to act as the sort
of person I should be? (The Virtue
Approach)
4. Make a Decision and Consider It
▪ After examining all of the potential actions,
which best addresses the situation?
▪ How do I feel about my choice?
5. Act
▪ Take action.
6. Reflect on the Outcome
▪ What were the results of my decision?
▪ What were the intended and unintended
consequences?
▪ Would I change anything now that I have seen
the consequences?
Application of Bioethical
principles to the Care of
the Sick

http://www.free-powerpoint-templates-design.com
DEATH
AND
DYING
http://www.free-powerpoint-templates-design.com
CONTENTS:
EUTHANASIA AND SUICIDE
01 Discuss moral issues about euthanasia and suicide

DYSTHANASIA
02 Comprehensively define what is Dysthanasia

ORTHOTHANASIA
03 Discuss what is Orthotanasia and it’s difference to Dysthanasia
and Euthanasia

ADM. OF DRUGS TO THE DYING

04 Elaborate the issues about administrating drugs to dying
patients

ADVANCE DIRECTIVES
05 Provide different types of advance directives that are currently
used
EUTHANASIA
“MERCY KILLING”
 DEFINITIONS:
-The act of deliberately ending a
EUTHANASIA person’s life to relieve suffering.
- The act of inducing an easy death
Referring to acts which terminate or
shorten life painlessly in order to
end suffering where there is no
“GOOD prospect of recovery.
DEATH”

“GENTLE AND
EASY DEATH”
ORIGIN:
Comes from the Greek word:
‘Eu’ means good
‘Thanatos’ means death
- It was first used in medical context by Francis
Bacon(17th Century)
- “physician’s responsibility to alleviate the ‘physical
sufferings’ of the body”
- Most active area of research in contemporary
bioethics

Arises in three
occasions:
1. At birth
2. Terminal stage
3. Unforeseen mishap
 WORLD MEDICAL ASSOCIATION
deliberate and intentional action with a clear intention to end
another person’s life under the following conditions:

THREE
ONE The person who is acting
The subject is a competent knows about the state of this
informed person with person and about his wish to
incurable illness die and is doing this action
with an intention to end life of
this person
EUTHANASIA
TWO FOUR
Who voluntary asked for The action is done with
ending his life compassion and without
any personal profit
TYPES OF
EUTHANASIA
ACTIVE OR POSITIVE

Involves specific actions (e.g. lethal drugs

or injections) intended to bring about
death.

Positive merciful act to end useless

sufferings and a meaningless existence

An act of commission for example by

giving large doses of a drug to hasten
death.
PASSIVE OR NEGATIVE

Generally judged to be legal, where

patients are allowed to die by withdrawing
treatment nourishment.

Common practice is when a patient is

signing a ‘Do Not Resuscitate’ (DNR)
document.

Discontinuing or not using extraordinary

life sustaining measures to prolong life.

Includes act of omission such as failure to

resuscitate a terminally ill or incapacitated
patient (e.g. a severely defective newborn
infant)
INVOLUNTARY

Occurs when ‘no consent’ or wish to die

as expressed by the sufferer

Practiced against the will of the person

Where patients can express a wish to die

but don’t (this equates to murder)
NON-VOLUNTARY

Patients cannot express a wish to die

Infants, profoundly mentally retarded,

severely brain damaged, cases of
extreme senile dementia, those who
cannot communicate for other reasons.

Patient in comas
 OREGON  HAWAII
 WASHINGTON  SWITZERLAND
 CALIFORNIA  GERMANY
 COLORADO  JAPAN
 MONTANA
 NETHERLANDS
 VERMONT
 BELIUM
 COLOMBIA
 CANADA
 SUICIDE
•Direct willfull destruction of one’s
own life
•It is deliberate
•Voluntary
•Intentional
•Terminating one’s own life
•Destructive and violent
•The person is healthy when it comes
to physical condition
•Sudden interruption or destruction of
life process
•Non-medical reasons
 ASSISTED SUICIDE
the act of deliberately assisting or encouraging another
person to kill themselves.

ASSISTED
S U I C I D E
CAUSES OF SUICIDE ACROSS THE HISTORY
ROMAN JAPANESE
CATHOLICS SHINTOIST
IRISHMENT AND
BUDDHIST

JAPANESE’S
HARAKIRI
KAMIKAZE
PILOTS
DURING
WORLD WAR II
 Causes of
Suicide:
1. Personal reasons
2. Financial reasons
3. Social reasons

PROS OF SUICIDE
CONS OF SUICIDE
•Socrates
•Epicurus
•Lucius Sinea •Flavius Josephus
•Michael de Montaigne •St. Augustine
•John Donne •St. Thomas Aquinas
•Baron de
Montesquieu
•David Hume
APPLIED ETHICAL THEORIES
Natural Law of Ethics
•Principle of stewardship
•Suicide is a sin

Utilitarian’s Principle
•Whenever one has become a burden
and liability to the greatest number of
people, its justifiable to commit suicide

Kant’s Ethics
•Categorical Imperative
Treat individuals not as means only but
also as ends
•
Principle of autonomy/self-determination
Has the right to decide whether to commit
suicide or not
DYSTHANASIA
“DIFFICULT DEATH”
The etymology of the term is from the Greek language: δυσ,
dus; "bad, difficult" + θάνατος, thanatos; "death".

WHAT IS
DYSTHANASIA?
• Etymologically, dysthanasia means faulty, imperfect death.
It may be defined as the medical process through which
the moment of death is postponed by all means available.
• Dysthanasia is the undue prolongation of life – of
dying -, the postponement of death.
• The fundamental ethical distinction to apply in the case of the
terminally ill is the distinction between ordinary and extraordinary
means of treatment. In the words of the National Conference of
American Bishops, ordinary or proportionate means “are those
that in the judgment of the patient offer a reasonable hope of
benefit and do not entail an excessive burden or impose
excessive expense on the family or the community.”
On the other hand, extraordinary or
disproportionate means refer to “those
that in the patient’s judgment do not offer
a reasonable hope of benefit or entail an
excessive expense on the family or the
community.”

Another important and enlightening

distinction on the case refers to the kind
of treatment, which can be:

BENEFICIAL
U S E L E S S
DOUBTFUL
 DYSTHANASIA

BENEFICIAL DOUBTFUL
If the treatment is beneficial it When the doctor is not
must be generally given, USELESS sure if it is beneficial or
except when it is too Useless treatment is useless, the treatment is
burdensome for the patient futile treatment, which is called doubtful treatment.
or the family not really beneficial.
MORALITY OF
DYSTHANASIA
Human life must be protected and
dutifully prolonged. From a humanist
and Christian perspective, human When the medical treatment is
beings are obliged to take care of and doubtful or uncertain, the “best-
prolong their lives through ordinary, interest of the patient” principle
proportionate, beneficial means. For 02 seems to demand providing
01
believers in God, the use of beneficial treatment, which has a potential
treatment is connected with the 05 benefit – to health and life.
principle of stewardship, which states
that we are stewards of our life which When the treatment is futile, or too
belongs to God, our creator, who is 03 burdensome, it is not obligatory to
the Lord of life and death. use it, but generally optional.
However, it appears more humane
0 and Christian not to try a useless
therapy
The poet Jorge Manrique wrote: Que
querer hombre vivir / cuando Dios
WHO DECIDES TO USE OR NOT
quiere que muera / es locura (“For man USE DISPROPORTIONATE
to want to live when God wants him to MEANS OF TREATMENT?
die is madness”). Therefore, death
should not be caused, neither should it
be absurdly delayed (Spanish • When possible, the patient gives
Episcopal Conference). informed consent: the patient gives
free and responsible consent after
Dysthanasia is generally unethical knowing and understanding his
because it is not the due prolongation medical facts, treatments available
of life, but the undue postponement of to him and their consequences).
death, which usually ends up in an
“undignified death,” after an abusive • When not possible, proper
use of extraordinary means of surrogates (the closest relative
treatment, provoked by the or the family representative)
technological imperative. provide proxy or substitute
consent, which must respect
The doctor is obliged to treat, but the principle of the best interest
not to over-treat. of the patient.
THERE IS A TIME TO LIVE
AND A TIME TO DIE

For each one of us, there is a time to

die (Ecl3:2), neither earlier through
euthanasia, nor later through
dysthanasia.
DEFENSIVE
MEDICINE
• The reason for being of dysthanasia
has been bestowed on defensive
medicine, a physician response, fully
or partly prompted, to protect him
from an incrimination of bad medical
practice.
• In the first case the physician carries out unnecessary procedures to guard
against that accusation, while in the second situation he avoids the
procedures to safeguard from the same accusation

• In defensive medicine, the physician procedures result not from his deep rooted
values and beliefs but from the self-protection against charges of malpractice, in the
event of an unfavorable outcome of treatment, by the society.
 CONFLICT OF VALUES

The collision of values can also explain the

therapeutic obstinacy. This can be found out in the
universal Declaration of Human Rights, signed on
10th December of 1948 by the United Nations
General Assembly. In Article 3, it states that
“Everyone has the right to life, liberty and security of
person”, while in Article 5 it says that “No one shall
be subjected to torture or to cruel, inhuman or
degrading treatment or punishment” (Universal
Declaration Human Rights, 1948) . These two articles
are facing each other especially when apparently it is
a situation of therapeutic obstinacy. It is a situation of
conflict of values and rights and thus, an ethical
conflict since what is at stake is opposing imperatives.
 The impact of technology in the conceit of death, changed thoroughly, in the
developed countries, the way of staring the end of life.Through the intervention of
technology, the moment of death has been heralded by the process of death. These
two moments―the moment of death and the process of death―beget different
feelings.

EXISTENTIALISM
AND METAPHYSICS
 DYSTHANASIA

As for the moment of death, according to

Ernest Becker “The fall into self-cons- ciousness,
the emergence from comfortable ignorance in
nature, had one great penalty for man: it gave
him dread, or anxiety.” (Becker, 1973) .However,
Ernst Bloch denies this anguish of death and
refuses the failure, having in mind that there is
always an exit―the hope (Block, 1982) . This
escape from anguish conceived by the moment
of death and hope bring in transcendence in the
process of death can explain the use of
technology in dystanasia.
 DYSTHANASIA

The dignity and the protection of human

life is the supreme value in the civilized world.
Even before the dawn of modern civilization, the
eagerness for perennial life or the quest for
eternity was searched through the exercise of
medicine. The science of medicine evolved
gradually throughout the centuries, from an
empiric to an evidence based science. However,
we should bear in mind that medicine is a
science of probabilities and not an exact science,
and, as such, its practice has inherent to it the
uncertainty.
ORTHOTHANASIA
“
WHAT IS
ORTHONASIA?
• The word orthothanasia was used for the first time in the
1950s. It means correct dying, or allowing to die or letting
die
• In allowing to or letting die, therefore, death is neither directly
caused nor intended or postponed. It merely happens. It is an
event, part of the temporal life of every human being. Hence,
allowing to die is anti-euthanasia, which unethically anticipates
death, and anti-dysthanasia, which unduly postpones it.
 3 POSSIBILITIES
When the prolongation of life or the
postponement of death is unduly
burdensome in the first place for
When the treatment to prolong life is the patient. On this point, the
useless or futile for the patient, and Catechism of the Catholic Church
therefore ought not to be given. We summarizes the traditional teaching
remember the world of the poet: For of the magisterium: “Discontinuing
man to want to live when God wants medical procedures that are
him to die is madness. 02 burdensome, dangerous,
01
extraordinary, or disproportionate to
05 the expected outcome can be
legitimate; it is the refusal of ‘over-
When the patient needs painkillers 03 zealous’ treatment. Here one does
or medical sedation, which does not not will to cause death; one’s
intend the death of the patient. inability to impede it is merely
These painkillers 0
accepted” (CCC, 2278).
HOW ABOUT
DOUBTFUL TREATMENT?
If treatment is beneficial to the patient
and not unduly burdensome, it ought to be
given: we are to administer our life well. If
treatment is truly useless, generally it should
not be given. Moreover, if the treatment is
doubtful or uncertain, the “best-interest of the
patient” principle suggests providing
treatment for it might have a potential benefit:
in doubt, it is good to be on the side of life.
HOW MAY WE
UNDERSTAND “DEATH
WITH DIGNITY”?
It is often understood wrongly as
“death without pain,” as if those who die with
pain cannot have a death with dignity. The
word dignity is often – as someone put it –
“high-jacked” by those who favor euthanasia.
For believers and others, to die with dignity
means respect for the dying, preparing for
death and accepting it when it comes. The
saintly Pope John Paul II says that the elderly
– and all human beings – have “the right to a
worthy life and to a worthy death.” Palliative
or comfort, or hospice are is a way to a
worthy death, or a death with true dignity.
HOW COMATOES
PATIENTS?
Certainly, these permanently comatose
patients have to be given beneficial and not too
aggressive or undue burdensome treatment. Food
and drink should always be given. These are not
medical treatment, but a human need of every
person. The basic teaching of the Church is well
formulated by the American Bishops (USA) in their
significant Ethical and Religious Directives for
Catholic Health Care Services: “There should be a
presumption in favor of providing nutrition and
hydration to all patients, including patients who
require medically assisted nutrition and hydration,
as long as this is of sufficient benefit to outweigh
the burdens involved to the patient.”
ADMINISTRATION OF
DRUGS TO THE DYING
WHAT IS
HOSPICE?
• a facility or program designed to provide
a caring environment for meeting the
physical and emotional needs of the
terminally ill

• a lodging for travelers, young persons, or

the underprivileged especially when
maintained by a religious order
HOSPICE MOVEMENT
An umbrella term for the growth of
end of life and palliative care services in the
UK over the past 50 years or so – both in the
voluntary and statutory sectors.

HOSPICE PROGRAMS
Set up to provide palliative care,
abatement of pain, and an environment that
encourage dignity, but do not cure or treat
intensively.

PALLIATIVE CARE
Specialized medical care for people
living with a serious illness. This type of care is
focused on providing relief from the symptoms
and stress of the illness. The goal is to improve
quality of life for both the patient and the family.
 THE DIFFERENCE BETWEEN
PALLIATIVE CARE AND HOSPICE

HOSPICE CARE
PALLIATIVE Both palliative care and
hospice care provide
CARE comfort. Hospice care
begins after treatment of the
Both palliative care disease is stopped and
when it is clear that the
and hospice care person is not going to
provide comfort survive the illness. Hospice
care is most often offered
only when the person is
expected to live 6 months or
less.
DYING
TWO PHASES:

PRE-ACTIVE
A pre-active dying phase usually
lasts two weeks

DYING
B dying phase three days.
 DIFFERENT SIGNS
SIGNS OF THE
SIGNS OF THE PRE- DYING PHASE
ACTIVE DYING PHASE
INCLUDE ABNORMAL BREATHING
PATTERNS (EG, APNEA)
INCREASED RESTLESSNESS

BEING UNCOMFORTABLE IN ONE DIFFICULTY SWALLOWING

POSITION, INCREASED TIREDNESS AND
PERIODS OF SLEEP DYING
BEING UNRESPONSIVE (INCLUDING
DECREASED FOOD AND LIQUID COMA)
INTAKE AND EDEMA.

COLD EXTREMITIES
LOW BLOOD PRESSURE
 TALKING ABOUT
THE END OF LIFE

Pharmacists often have to Many patients who are in the Causes of terminal When known causes
support family members of dying phase of a terminal illness restlessness include have been discounted,
patients who are dying, even experience “terminal biochemical abnormalities as drug treatment (eg,
when they themselves may restlessness” (agitation and body organs failing, opioid benzodiazepine or
have little first-hand confusion) that can be toxicity, pain, drug antipsychotic) may be
experience of death. distressing for themselves and interactions and appropriate.
their families. hypercalcaemia
END-OF-
LIFE CARE
Formally defined
as ‘palliative care given
within the last year of life’
but frequently refers to
care in the last days of
life
 ANTICIPATORY
PRESCRIBING
THE PROACTIVE PRESCRIBING OF MEDICINES
THAT ARE COMMONLY REQUIRED TO
CONTROL SYMPTOMS IN THE LAST DAYS OF
LIFE.
(four distinct stages:)

1. Initiating the conversation with the patient

and their family;
2. Writing the prescription;
3. Dispensing the medicines;
4. Administering the medicines to the patient
 COMMUNITY NURSES AND
NURSES IN CARE HOMES
3. Ideally placed to
recognise and
1. Play an ongoing and diagnose when
prominent role in end-of- patients are nearing
life care the end-of-life, in order
to initiate appropriate
discussions related to
2. Nurses also end-of-life care,
have a key role in including anticipatory
activating medication for
anticipatory symptom control, with
prescriptions the patient and their
family.
 FOR IMMEDIATE ACCESS TO
SYMPTOM CONTROL SHOULD THE
PATIENT’S CONDITION CHANGE. Just in
c a s e ’
(JIC) box

THESE MEDICINES ARE

ADMINISTERED BY A
HEALTHCARE PROFESSIONAL,
MOST COMMONLY A NURSE

IN CERTAIN CIRCUMSTANCES IT MAY BE

APPROPRIATE FOR A FAMILY MEMBER TO
ADMINISTER SPECIFIC MEDICATIONS,
CLEAR INSTRUCTIONS ARE IMPERATIVE.
SYMPTOMS THAT ARE MOST LIKELY TO PRESENT AS
PATIENTS NEAR THE END OF THEIR LIFE INCLUDE:

TERMINAL
RESTLESSNESS
NAUSEA AND
VOMITING

PAIN

DELIRIUM AND
AGITATION

RESPIRATORY
SECRETIONS
ADVANCE DIRECTIVES
WHAT IS AN
ADVANCE DIRECTIVES ?
• Advance directives are legal documents that allow you to
spell out your decisions about end-of-life care ahead of
time. It gives a way to tell your wishes to family, friends,
and health care professionals and to avoid confusion later
on.
ETHICAL DILEMMA OF
ADVANCE DIRECTIVES
“Although advance directives may
serve arguably as the most direct
attempt to maximize patient
autonomy, to predict every situation “In the majority of situations, the
or potential medical intervention patient does not have the medical
would be impossible, and as a result, 02
01 experience or background to
advance directives are often still realize the extent of possible
vague and require difficult decisions 05
outcomes or complications from a
to be made by surrogates, family given operation and must rely on a
members, and physicians.” proactive approach by the
physician to make an informed
decision regarding any advance
0 directive statements.”
WHAT IS THE
LAW BEHIND?
• The Patient Self-Determination Act (PSDA),
passed in 1990 and instituted on December 1,
1991, encourages all people to make choices and
decisions now about the types and extent of
medical care they want to accept or refuse should
they become unable to make those decisions due
to illness.
The PSDA requires all health care agencies
(hospitals, long-term care facilities, and home
health agencies) receiving Medicare and Medicaid
reimbursement to recognize the living will and
power of attorney for health care as advance
directive
WHAT IS THE
LAW BEHIND?
•The PSDA does not create new rights for patients
but reaffirms the common-law right of self-
determination as guaranteed by the Fourteenth
Amendment. Under the PSDA, health care
agencies must ask you whether you have advance
directives and must provide you with educational
materials about your rights under state law.
WHAT THE
LAW STATES?
• The Constitution, Article 2, Section 15 provides:
"The State shall protect and promote the right to
health of the people and instill health
consciousness among them.“

• Thus, this bill directs the Secretary of Health,

directly or through grants, contracts, or interagency
agreements, to develop a national campaign to
inform the public of the importance of advance care
planning and of an individual's right to direct and
participate in his ,or her health , care decisions.
The comprehensive public education campaign
shall raise awareness of the importance of
planning for care near the end of life.
 A durable power of attorney for health
care, also known as a medical power of
TYPES OF ADVANCE attorney, is a legal document in which
you name a person to be a proxy (agent)
DIRECTIVES to make all your health care decisions if
you become unable to do so. Before a
medical power of attorney can be used
to guide medical decisions, a person's
physician must certify that the person is
LIVING WILL unable to make their own medical
decisions

• INFORMED NONCONCENT DURABLE POWER OF

ATTORNEY FOR HEALTH CARE
• DO NOT RESUCITATE (DNR)
ORDERS
• BABY DOE
• ORGAN DONATION
•The living will is a legal document used
to state certain future health care
decisions only when a person becomes
unable to make the decisions and
choices on their own. The living will is
only used at the end of life if a person is
terminally ill (can't be cured) or
permanently unconscious

BENEFICIAL
U S E L E S S
DOUBTFUL
 INFORMED NONCONSENT

Informed consent is the process by

which the treating health care provider
discloses appropriate information to a
competent patient so that the patient may
make a voluntary choice to accept or refuse
treatment.
 DO NOT RESUCITATE (DNR)
ORDERS

Do Not Resuscitate, also known as

no code or allow natural death, is a legal
order, written or oral depending on country,
indicating that a person does not want to
receive cardiopulmonary resuscitation if that
person's heart stops beating. Sometimes it
also prevents other medical interventions
 ORGAN DONATION

Organ donation is the process when

a person allows an organ of their own to be
removed and transplanted to another
person, legally, either by consent while
the donor is alive or dead
APPLICATION OF
BIOETHICAL
PRINCIPLES TO THE
CARE OF THE SICK
 INFORMED CONSENT

INFORMATION

❑includes disclosure and understanding of the

essential information
- nature of the health concern and prognosis
if nothing is done
- description of ALL treatment options
- benefits, risks, consequences of the
various treatment alternatives
CONSENT

❑implies the freedom to accept or reject

❑must be voluntary, without coercion, force, or

manipulation
 INFORMED CONSENT

❑gives patients the opportunity to autonomously

choose a course of action in regard to plans for
health care
❑provides legal protection of a patient’s right to
personal autonomy
❑discussed in:
- surgeries
- complex procedures
- common interventions with undesirable
effects
❑exceptions include:
- emergency cases
- waivers by patients who do not want to
know their prognosis or risks of treatment
COMPONENTS

1. Patient must have the capacity to make the

decision.
2. The medical provider must disclose the information
on the treatment, tests, or procedure in question,
including the expected benefits, risks, and the
likelihood that the benefits and risks will occur.
3. The patient must be able to comprehend the
relevant information.
4. The patient must voluntarily grant consent, without
coercion or duress.
NURSING ROLES AND RESPONSIBILITIES

1. Ensuring that all criteria for autonomous

decision making are met.
2. Notifying the physician and requesting for
further information for the patient or stopping
the process until it is ensured that the decision
can be made autonomously.
3. Obtaining the patient’s signature on a consent
form.
4. Witnessing a patient’s signature on a consent
form.
5. Nurses in advanced practice roles are
accountable for providing information and
obtaining informed consent for interventions that
they initiate under their scope of practice.
 ADVANCE DIRECTIVES

❑instructions that indicate health care

interventions to initiate or withhold, or that
designate someone who will act as a surrogate
in making such decisions

❑help ensure that patients have the kind of end-

of-life care they want
LIVING WILL

❑a legal document giving directions to health care

providers related to withholding or withdrawing
life support if certain conditions exist

❑guides decisions by indicating a person’s

desires regarding life-sustaining interventions
DURABLE POWER OF ATTORNEY

❑allows a competent person to designate another

as a surrogate or proxy to act on her or his
behalf in making health care decisions in the
event of the loss of decision-making capacity

❑must be in writing and must be signed and dated

by the person making the designation and two
witnesses other than the designated surrogate
NURSING ROLES AND RESPONSIBILITIES:

1. Be aware with the state’s statutes and

institutional policies and procedures.
2. Explore patient and family understanding of
advance directives.
3. Be familiar with the patients’ directives for care
and ensure that care is consistent with the
patient’s wishes as expressed in the advance
directives.
4. Inform other members of the health care team of
the presence and content of advance
directives.
5. Intervene in behalf of the patient when wishes
expressed in advance directives are not being
followed.
6. Increase public awareness about advance
directives through patient and community
education, research and education of nurses
and other health care providers.
DO NOT RESUSCITATE ORDERS

❑not to initiate CPR in the event of a cardiac or

pulmonary arrest

❑written directives placed in a patient’s medical

record indicating that the use of CPR is to be
avoided

❑DNR decisions require open communication

among the patient/surrogate, the family, and the
health care team
❑apply only to resuscitation

❑require nurses to become more focused on

providing supportive and comfort interventions
and to ensure that there is no reduction in the
level of care
NURSING CONSIDERATIONS

1. Nurses need to know which patients under their

care have DNR orders, and these orders need
to be documented clearly in a patient’s chart.
2. The nurse should document the request in the
patient’s chart and bring this to the immediate
attention of the physician if a patient or
surrogate indicates to the nurse they desire not
to be resuscitated and there is no order in the
chart.