PHILIPPINE MEDICAL ASSOCIATION DECLARATION ON THE RIGHTS AND OBLIGATIONS

OF THE PATIENT

INTRODUCTION
The time honored relationship between Filipino physicians, their patients and the
community has undergone significant changes in recent times. The physician should
always act according to his conscience, for the best interest of the patient, and
must exert equal effort to guarantee patient autonomy, justice and participation in
the decision making. The following Declaration represents some of the principal
rights and obligations of the patient which the medical profession endorses and
promotes, Physicians and other persons or bodies involved in the provision of health
care have a joint responsibility to recognize and uphold these rights. Whenever
legislation, government action or any other administration or institution denies
patients these rights, physicians should pursue appropriate means to assure or to
restore them. On the other hand, legislating these rights will erode the basic
foundation that welds the patients and the physicians together trust and respect,
running counter to the best interests of the patients.

RIGHTS
1. Right to Good Quality Health Care and Humane Treatment
a. Every person has a right to good quality health care without any discrimination
and within the limits of the resources available for health and medical care.
b. In the course of such care, his human dignity, culture, convictions and integrity
shall be respected.
c. If the patient has to wait for care, he shall be informed by the health professionals
of the reason for the delay.
d. The patient shall always be treated in accordance with his best interests. The
treatment applied shall be in accordance with generally accepted medical
principles.
e. The patient has the right of continuity of health care.
f. An emergency patient who is immediate threat of dying or losing life or limb shall
be extended immediate medical care and treatment without any pecuniary
consideration until the emergency situation is over.

2. Right to Dignity
a. The patient's dignity, culture and value shall be respected at all times in medical
care and teaching.

b. Terminal ill patients are 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.
The Philippine Medical Association (PMA) in coordination with health care providers,
professionals and civic groups, the medical people's organizations, local
government units, and other government agencies and non-governmental
organizations shall conduct a nationwide information and education to make known
to people their rights as patients as provided in this Declaration. The health care
institutions shall 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.

4. Right to Choose His Physician

a. The patient is free to avail of the services of a physician or health institution of
his choice except when he chooses to be confined in a service ward. In this case, his
attending physician shall be the one who was on duty and who made the admitting
orders at the time of admission as appearing in the Doctor's Order Sheet of the
Medical Record.
b. The patient has the right to seek a second opinion.
c. The patient has the right to change his physician or other health care provider.

5. Right to Informed Consent

a. The patient has the right to self-determination, to make free decisions regarding
himself. The physician shall inform the patient of the consequences of his decisions.
b. Patient who is mentally competent and of legal age or in his incapacity or age of
minority his legal representative, has a right to a clear explanation, in layperson's
terms, of all proposed or contemplated procedures whether diagnostic or
therapeutic, including the identity and professional circumstances of the person or
persons who will perform the said procedure or procedures.
The explanation shall include that amount of information necessary and
indispensable for him to intelligently give his consent which may include, but may
not be limited to the benefits, risk and 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. In the explanation of the proposed
procedure or procedures, the comprehensive ability of the patient shall also be
considered taking into account his level of education, the dialect or language that
he speaks and understands and if possible, the use of anatomic sketch, or otherwise

the use of those materials or visual aids that may aid the patient or his legal
representative, in fully understanding the proposed procedure or procedures. The
right to informed consent shall likewise consider the voluntariness in which the
patient or his legal representative has given his consent seeing to it that the patient
or his legal representative was allowed to ask questions, or that he is given the
chance to consult his kin, or to seek another expert opinion.
c. The unconscious patient
1) If the patient is unconscious or unable to express his will, informed consent
must be obtained whenever possible from a legal representative.
2) When medical intervention is urgently needed, consent of the patient may be
presumed.
3) Physicians should always try to save the life of a patient unconscious due to a
suicide attempt.
d. The legally incompetent patient
1) If a patient is a minor or legally incompetent the consent of a legally
representative is required. Nevertheless the patient must be involved in the
decision making to the fullest extent allowed by his mental capacity.
A patient, who is eighteen years of age and above, shall be considered, for
purposes of this declaration, to be of legal age.
2) If the legally incompetent patient can make rational decisions, his decisions
must be respected, and he has the right to forbid the disclosure of information to
his legally representative.
3) If the patient's legal representative, forbids treatment but, in the opinion of the
physician contrary to the patient's best interest, the physician may challenge this
decision in court. In case of emergency, the physician will act in the patient's best
interest.
e. In case of emergency, when there is no one who can give consent in his behalf,
the physician can perform any emergency diagnostic or treatment procedure in the
best interests of the patient.

6. Right to Refuse Diagnostic and Medical Treatment

a. The patient has the right to refuse diagnostic and medical treatment procedures,
provided that the following conditions are satisfied:
1) He is of age twenty one and above, and mentally competent;
2) He is informed of the medical consequences of his refusal;
3) He releases those involved in his care from any obligation relative to the
consequences of his decision; and

4) His refusal will not jeopardize public health and safety.

b. An adult with a sound mind may execute an advance directive for physicians not
to put him on prolonged life support if, in the future, his condition is such that there
is little or no hope of reasonable recovery and the physician shall therefore allow
the natural course to happen. The qualifications listed as 1, 2, 3, and 4, of the
preceding provision 6,a., shall be considered as satisfied if a patient whose
condition makes him unable to express his will, has executed an advance directive.

7. Right to Refuse Participation in Medical Research

The patient has the right to be advised of plans to involve him in medical research
that may affect the care or treatment of his condition. The 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 minister of his chosen religion.

9. Right to Privacy and Confidentiality

The patient has the right to privacy and protection from unwarranted publicity. This
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,
medical teaching 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.
a. All identifiable information about a patient's health status, medical condition,
diagnosis, prognosis and treatment and all other information of a personal kind,
must be kept confidential, even after death. Except, in cases when descendants
may have a right of access to information that would inform them of their health
risks.
b. All identifiable patient data must be protected. The protection of the data must
be appropriate as to the manner of its storage. Human substance from which
identifiable data can be derived must be likewise protected.
c. Confidential information can be disclosed in the following cases:
1) When his mental or physical condition is in controversy in a court litigation and
the court in its discretion orders him to submit to physical or mental examination
by a physician;
2) When the public health and safety so demand;

3) When the patient or, in his incapacity, his legal representative expressly gives
the consent;
4) When his medical or surgical condition, without revealing his identity, is
discussed in a medical or scientific forum for expert discussion for his benefit or
for the advancement of science and medicine.
5) When it is otherwise required by law.

10. Right to Disclosure of, and Access to Information

a. In the course of his treatment and hospital care, the patient has the right to be
informed of the result of the evaluation of the nature and extent of his disease. Any
other additional or further contemplated medical treatment and surgical procedure
or procedures.
b. Disclosure of information may be withheld if the information to the patient will
cause mental suffering or further impair his health. Such disclosure may be withheld
or deferred at some future opportune time upon due consultation with the patient's
immediate family.
c. Information must be given in a way appropriate to the local culture and in waiver
the patient can understand.
d. The patient has the right not to be informed on his explicit request, unless
required for the protection of another person's life.
e. The patient has the right to choose who, if anyone, should be informed on his
behalf.
f. The patient has the right to examine and be given an itemized bill of the hospital
and medical services rendered.
g. The patient or his legal representative, has the right to be informed by the
physician or his delegate of his continuing health care requirements following
discharge, including instructions about home medications, diet, physical activity and
all other pertinent information.

11. Right to Correspondence and to Receive Visitors

The patient has the right to communicate with 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.

a. Upon the request of patient, the physician shall issue a medical certificate, a
clinical abstract to the patient upon discharge from the institution. Any relevant
document that the patient may require for insurance claims shall also be made
available to him within a reasonable period of time.
b. He has the right to view the contents of his medical records with the attending
physician explaining contents thereof and at his expense.
c. The patient may obtain from the health care institution a reproduction of his
medical record at his expense.

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 the available health services. The
education should 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. Physicians should have an obligation to
participate actively in educational efforts.

14. Right to Express Grievances

The patient has the right to express only valid complaints and grievances about the
care and services received. Patients may express their complaints and grievances
with the Ethics Committee of the Philippine Medical Association through its
component societies which shall afford all parties concerned with the opportunity to
settle amicably all grievances.

SOCIETAL RIGHTS OF PATIENTS

1. Right to Health
The patient has the right to access quality health care and to physicians who are
free to render clinical and ethical judgment without interference or outside pressure.
The patient has 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 practitioner must progressively contribute to realize.

2. Right to Access to Quality Public Health Care

The patient has a right from the national and local government a comprehensive
and integrated health care delivery system, providing the necessary manpower and
facility resources. The patient has the right to functioning public health and health
care facilities, goods and services and programs needed and sufficient quantity.
They shall likewise be provided with health facilities and services with adequate
provision of essential drugs, regular screening program, and appropriate treatment
of prevalent diseases, illnesses, injuries and disabilities, including provision of public
health insurance. Towards this end, the government shall approximate the
international standard allocation for the health sector as set by the World Health
Organization.

3. Right to Healthy and Safe Workplace

The patient has 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 use, drug use and other harmful substances.

4. Right to Medical and Education Information and Programs

The patient has the right to prevention, medical information and education
programs on immunization, prevention, treatment and control of diseases, behaviorrelated concerns, and disaster relief and emergency situations during epidemics and
similar health hazards. The government shall endeavor to provide these information
through lectures, symposia, tri-media, posters and the like.

5. 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.

6. Right to Access to Health Facilities

The patient has the right to be admitted to any primary, secondary, tertiary and
other specialty hospitals when appropriate and necessary.

7. Right to Equitable and Economic Use of Resources

The patient has the right to demand that government health facility resources must
be equitably distributed in all regions of the country.

8. Right to Continuing Health Care

The patient has the right from the national and local government programs to
ensure continuity of care in the form of hospice care, rehabilitation, chemotherapy,
and radiotherapy and similar modalities.

9. Right to Be Provided Quality Health Care in Times of Insolvency

The patients who are paupers have the right from the national and local
government provisions for quality medical care in spite of insolvency. The national
and local government must provide for a system of payment to health care facilities
and providers for all the valid and necessary medical expenses of their poor and
marginalized citizens.

DECLARATION OF OBLIGATIONS
1. Obligation to Know Rights
The patient shall ensure that he/she knows and understands what the patients'
rights are and shall exercise those rights responsibly and reasonably.

2. Obligation to Provide Adequate, Accurate and Complete Information

The patient shall provide, to the best of his knowledge, adequate, accurate and
complete information about all matters pertaining to his/her health, including
medications and past or present medical problems, ailments, medical history,
consultation with other physicians, results of Diagnostic work-up and treatment to
his/her health care provider.
It shall be the duty of every patient to report unexpected changes to his/her
condition or symptoms, including pain, to a member of the health care team.

3. Obligation to Report Unexpected Health Changes

It shall be the duty of every patient to report unexpected changes to his/her
condition or symptoms, including pain, to a member of the health care team.

4. Obligation to Understand Purpose and Cost of Treatment

The patient shall ensure that he/she understands the purpose and cost of any
proposed treatment or procedure before deciding to accept it. He/she shall notify
the health care provider or practitioner if he/she does not understand any
information about his/her care or treatment. The patient shall insist upon
explanations until adequately informed and consult with all relevant persons before
reaching a decision.

5. Obligation to Accept Consequences of Own Informed Consent

The patient shall accept all the consequences of the patient's own informed
consent. If he/she refuses treatment or do not follow the instructions or advice of
the health care provider or practitioner, he/she must accept the consequences of
his/her decision. He is obligated to forever free the physician of liability in his
exercise of his right to self-determination.

6. Obligation to Settle Financial Obligations

The patient shall ensure that financial obligations of his/her health care fulfilled as
promptly as possible, otherwise he/she shall make appropriate arrangements to

settle unpaid bills in the hospital and/or professional fees of the health care
provider. Failure is considered estafa. Patients must seek support from the national
and local government to provide a system of payment to health workers and
facilities.

7. Obligation to Respect the Rights of Health Care Providers

Patients are required to give due respect to the rights of health care providers most
especially their human rights. He is under obligation that his actions must be
considerate, cooperative and must never infringe on the rights and property of the
health care provider.

8. Obligation to Respect the Rights of Health Institutions

The patients are required to give due respect to rights of health care provider
institutions and must never infringe upon their rights. This includes the obligation to
know and follow the health institution's policies, rules and regulations.

9. Obligation to Respect the Rights of Other Patients

The patient is obligated to conduct himself/herself in harmony with, respect to and
must not interfere with the rights and property of other patients.

10. Obligation to Self

The patient is obligated to maintain a state of wellness.

11. Obligation to Have Adequate

Participate in His Treatment

Health

Information

and

Actively

The patient is obligated to know the basic health information. This adequate
knowledge is subsumed when a patient signs an informed consent. Patients are
obligated to actively obtain the necessary information to enable him to actively
participate in the formulation of his diagnostic and treatment plans.

12. Obligation to Respect the Right to Privacy of Health Workers and

Institutions
Patients have the obligation to address grievances to the proper authorities or
venue and not resort to unwarranted publicity in the media. Patients shall not
disclose to the public any alleged complain against health provider and institution
not fully decided by a court or administrative tribunal of proper jurisdiction.

13. Obligation to Exercise Fidelity on Privileged Communication

A patient-physician relationship is a fiduciary one where mutual trust, respect and
confidence is executed. All communications are privileged and the patient is
obligated not to breech this privileged communication especially if it involves a third
party.

14. Obligation Not to Force Physicians to Treat Him/Her

While patients have the right to choose their physicians, these patients are likewise
obligated to respect the physician's decision to choose whom he is going to serve or
to treat.

15. Obligation to Respect the Physician's Decision on Medical Reasons on

His Right to Religious Beliefs
Patients are obligated to respect and obey the health care provider's decision on
matters referable to medical reasons on his children not yet of legal age but whose
lives and health are affected by the parents' rights to religious belief. Patients are
obligated to respect the physician's religious beliefs.

16. Obligation to Medical Records

Patients are obligated to ensure the integrity and authenticity of his medical
records. Any attempt to alter his records is a criminal offense subject to the
provisions to this bill and to the Revised Penal Code.

17. Obligation to
Physicians

Participate

in the

Training

of

Competent

Future

Training of competent future physicians is a necessary development in the health

care delivery system of the country. Patients are, therefore, obligated to participate
in the training of these future health workers provided the necessary information
are provided him and the necessary ethical considerations employed.

18. Obligation to Inform

Patients are obligated to inform the health worker to any perceived or alleged
infraction of his rights by the health worker or institution through proper channels.
This is to provide a system of immediate rectification to promote mutual trust,
respect and confidence between the doctor and patient.

19. Obligation to Use Due Process and Exhaust Grievance Mechanisms

All grievances of patients must be coursed through proper channels and process.
The patient shall exhaust the grievance mechanism provided in this Act before filing
any administrative or legal action.

GRIEVANCE MECHANISM
Mediation
Any written complaint arising from violation of any of the right and obligations of
patients shall first be submitted to mediation with the Ethics Committee of the
Philippine Medical Association through its component societies which shall afford all
parties concerned with the opportunity to settle all grievances amicably.
The hearing procedure shall not be adversarial in nature. The patient and the health
care provider or practitioner shall be given the opportunity to discuss the cause of
complaint and efforts shall be made for its amicable settlement. No monetary
compensation shall be involved during this stage and neither shall a legal counsel
be present. The ethics committee of the local component societies shall be
constituted by three members of the said society, 3 members of the specialty
society corresponding to the case and one representative from the public or private
or religious sector.
The aggrieved party shall be given sixty (60) days from occurrence of incident to file
his/her written complaint to the appropriate grievance mechanism level.
Upon receipt of written complaint, the Chairperson shall give notice to the
respondent. Upon receipt of the written complaint, due notice to the respondent and
conciliation meeting, the Mediation Committee shall be given thirty (30) days to
resolve the said complaint. Otherwise, the complainant shall have the option to
proceed to the next level of grievance system. The Committee shall now constitute
themselves into an arbitration committee to hear and resolve the complaint.
Arbitration
If and when the complaint is not resolved through mediation within the prescribed
period, the complainant shall file a case of arbitration. Only complaints with physical
injuries shall proceed to the arbitration process.
The Committee shall base its decision on documentary evidence including
depositions. The Committee shall render a decision within thirty (30) days from
receipt of the position papers of both parties. The decision is binding to all parties.
Process
The Philippine Medical Association shall ensure the establishment of these
grievance mechanism and issue the necessary rules and regulations for its proper
operation and implementation.
These grievance mechanisms shall be sine qua non before filing any complaint with
the judicial body. All parties to the complaint shall be bound by the rules on
confidentiality on all levels of the Grievance Mechanism. All minutes of the
committee shall not be disclosed to any party unless authorized by the court of law.
Prescriptive Period

The time during which the case is submitted for mediation shall toll the running of
the prescriptive period for the filing of a civil or criminal case under the Revised
Penal Code or any administrative case.

MISCELLANEOUS PROVISIONS
Inclusion in School Curriculum and Licensure Examination
The provisions of the Act shall be included in the medical and medical related school
curriculum and licensure examinations.
Rules and Regulations
The Philippine Medical Association, in consultation with the Secretary of Health,
Philippine Hospital Association and concerned people's organizations like the
People's Health Watch, shall promulgate the rules and regulations for its
implementation.

Presented and submitted during the public hearing at the House of Representative on August 16, 2005.