VIDEO 1: ETHICO LEGAL
Justice - equality for all ; you being fair to
CONSIDERATIONS
3 MAIN Laws of Nursing Practice
1. RA 9173 or the Philippine Nursing Act of 2002
(because not knowing this, could have your
license invoked)
2. RA 315 or the Revised Penal Code (because not
knowing this could land you in jail)
3. RA 386 or the New Civil Code of the
Philippines (because not knowing this could take
all your money in civil damages). There are
other laws
Situation 17: NLE Question. Safe nursing practice
involves an understanding of the law.
Number 81. In the Philippines, this law is:
➔ The Philippine Nursing Act of 2002 or RA
9173 correct answer
➔ RA 7164 - old law, thus incorrect ; New law
repeals old law
➔ IRR - Implementing Rules and Regulations
The ethical or bioethical principles are not laws; rather
they are guidelines in the conduct of a nurse. By
following them, not only does the nurse become an
excellent nurse, and a good person in general, the nurse
also wittingly follows the laws.
THE ETHICAL PRINCIPLES OR BIO-
ETHICAL PRINCIPLES
1. Beneficence
- Doing good
- Ex: advocating for pt’s rights ( making
sure that informed consent is complete)
159. Tricia, a staff nurse working in a cancer unit, is
considered a role model not only by her colleagues but
also by her patients. She goes out of her way to help
others. She is very active in their professional
organization and she practices what she teaches. What
ethical principles is she practicing?
A. Beneficence
B. Autonomy
C. Advocacy
D. Justice
160. You are commuting to work riding the LRT. An
older person collapsed and nobody seem to notice her.
The security guard tried to make her sit down but she
remained unconscious. You saw what happened and you
decided to help. With help, you brought the patient to the
nearest hospital. You learned later that woman was
diabetic. She was on her way to the diabetes clinic to
have her fasting blood sugar tested. She developed
hypoglycemia. You were able to save a life. felt good.
What principle was applied?
A. Advocacy - fight for patient’s right
B. Beneficence - doing good
C.
patients
D. Autonomy - promoting self determination
2. Non-maleficence
- doing no harm
- lessening the harm done
- BEST Ex: be cautious during surgery
(there is some harm here for example
the surgeon has to use scalpel to cut but
he has a duty to just minimize the
damage or harm done)
Case 9: “The doctor who proceeded with NSVD or
attempted of a pre-eclamptic woman”
Case of Rogelio Nogales v Capitol Medical Center, Dr.
Oscar Estrada et al.
(GR 142625, Dec 19, 2006)
- A pregnant mother was admitted with
preeclampsia, a condition characterized by
severe hypertension with risk for convulsions
accompanying the pregnancy. In jurisprudence,
the mother with pre-eclampsia is usually made
to birth by Caesarian Section for her safety, not
through NSVD (normal spontaneous vaginal
delivery); she may even legally undergo
abortion to terminate and expel the fetus-to save
her life.
That is probably why, in this case, the anesthesiologist
of Capitol Medical Center offered his services to Dr
Oscar Estrada. But Estrada refused the services of the
anesthesiologist and proceeded with the NSVD, as
documented by the nurse in the nurses notes (good job
for the nurse). Nevertheless, the good anesthesiologist
remained in the hospital to monitor the situation. Indeed,
the worst happened: the blood pressure of the mother
spiked and she experienced convulsions. Magnesium
sulfate was injected to her, to no avail.
Doctor Estreda pulled the baby out by forceps delivery,
tearing a chunk of the mother's cervical tissue and
injuring the baby's head in the process (the baby came
out pale and apneic).
A series of medical treatments was done with many
specialists involved, but the mother ultimately died of
postpartum haemorrhage. The Supreme Court upheld the
decision reached by the RTC (Regional Trial Court)
after eleven (11) years of trial: that it was the
malpractice of Dr. Oscar Estrada and the negligence of
Capitol Medical Center that caused the patient's death.
As a result, Capitol Medical Center is made vicariously
liable with Dr. Estrada for Php 105,000 for actual
damages, and Php 700,000 for moral damages.
When you say vicarious liability means solidarily liable
which means the patient or the family of the patient will
go after the doctor or will go after the hospital.
Actual damages is for value of the life estimated by the
courts
Moral damages is for the pain, the suffering, mental
anguish that the injury has caused upon the patient’s
family.
Personal observation:
This case has everything to do with respiratory
assessment. The Preeclamptic mother with hypertension
and convulsion, is obviously in danger of cardiovascular
and pulmonary complications. It is the doctor who is in
charge of thorough assessment and opting for surgery in
this case, not the nurse. But that does not mean that the
nurse should just stand by and let herself be legally
implicated and damned. She did what she was supposed
to do: document the doctor's actions and defend herself.
Clearly, not far away from proper assessment respiratory
or otherwise is defensive and accurate documentation.
See events, per documentation:
For the documentation of the nurse, this is what
happened:
- On 26 May 1976, Corazon was admitted at 2:30
a.m. at the CMC after the staff nurse noted the
written admission request of Dr. Estrada. Upon
Corazon's admission at the CMC, Rogelio
Nogales ("Rogelio") executed and signed the
"Consent on Admission and Agreement" and
"Admission Agreement." Corazon was then
brought to the labor room of the CMC.
- Dr. Rosa Uy “Dr. Uy, who was then a resident
physician of CMC, conducted an internal
examination of Corazon. Dr. Uy then called up
Dr. Estrada to notify him of her findings.
Based on the Doctor's Order Sheet, around 3:00 a.m., Dr.
Estrada ordered for 10 mg. of valium to be administered
immediately by intramuscular injection. Dr. Estrada later
ordered the start of intravenous administration of
syntocinon admixed with dextrose, 5%, in lactated
Ringers' solution, at the rate of eight to ten micro-drops
per minute.
According to the Nurse's Observation Notes, Dr. Joel
Enriquez ("Dr. Enriquez"), an anesthesiologist at CMC,
was notified at 4:15 a.m. of Corazon's admission.
Subsequently, when asked if he needed the services of
an anesthesiologist, Dr. Estrada refused. Despite Dr.
Estrada's refusal, Dr. Enriquez stayed in the hospital to
observe Corazon's condition.
- [ Galinato: Personally, although not written in
records, I think there is a quarrel between the
anesthesiologist and the surgeon. Parang may
issue sa kanila ba, between Dr. Estrada, who is
the surgeon and the anesthesiologist, Dr.
Enriquez. Enriquez parang good guy, he offered
services to Estrada but etong si Estrada, parang
may issue kay Enriquez, he refuse his services,
endangering the life of the patient ]
At 6:00 AM, Corazon was transferred to Delivery Room
No. 1 of the CMC. At 6:10 AM, Corazon's bag of water
ruptured spontaneously. At 6:12 a.m., Corazon's cervix
was fully dilated. At 6:13 AM, Corazon started to
experience convulsions.
At 6:15 AM, Dr. Estrada ordered the injection of ten
grams of magnesium sulfate (to lower BP). However,
Dr. Ely Villaflor ("Dr. Villaflor"), who was assisting Dr.
Estrada, administered only 2.5 grams of magnesium
sulfate.
At 6:22 AM, Dr. Estrada, assisted by Dr. Villaflor,
applied low forceps to extract Corazon's baby. In the
process, a 1.0 x 2.5 cm. piece of cervical tissue was
allegedly torn. The baby came out in an apnic, cyanotic,
weak and injured condition. Consequently, the baby had
to be intubated and resuscitated by Dr. Enriquez and Dr.
Payumo.
At 6:27 AM, Corazon began to manifest moderate
vaginal bleeding which rapidly became profuse.
Corazon's blood pressure dropped from 130/80 to 60/40
within five minutes. There was continuous profuse
vaginal bleeding. The assisting nurse administered
hemacel through a gauge 19 needle as a side drip to the
ongoing intravenous injection of dextrose.
At 7:45AM., Dr. Estrada ordered blood typing and cross
matching with bottled blood. It took approximately 30
minutes for the CMC laboratory, headed by Dr. Perpetua
Lacson ("Dr. Lacson"), to comply with Dr. Estrada's
order and delivers the blood.
- [ 30 minutes is the standard time to comply for
blood matching. Legally, there’s nothing wrong
there.]
• At 8:00 AM, Dr. Noe Espinola ("Dr. Espinola"), head
of the Obstetrics Gynecology Department of the CMC,
was apprised of Corazon's condition by telephone. Upon
being informed that Corazon was bleeding profusely Dr.
Espinola ordered immediate hysterectomy.
Rogelio was made to sign a "Consent to Operation."
• Due to the inclement weather then, Dr. Espinola, who
was fetched from his residence by an ambulance, arrived
at the CMC about an hour later or at 9:00 a.m. He
examined the patient and ordered some resuscitative
measures to be administered. Despite Dr. Espinola's
efforts, Corazon died at 9:15 a.m. The cause of death
was "hemorrhage, post partum."
- [ We nurses know that when resuscitative
measures like CPR are undertaken, usually,
more than 90% chance that the patient is not
gonna make it. ]
3. Veracity
- Vera means truth ; act of telling the truth
- benevolent deception: withholding of a truth that
may harm the client
- (often with the consent/ at the request of the
family members)
4. Fidelity
- being faithful to promises, patient, hospital,
colleagues
- being loyal
- speaking well of others
- Ex: I'll come back in 5 minutes (honesty)
29. Benny elaborated on the concept of informed
consent. He determines that the nurses need more
explanation if their response is one of the following:
a. the consent should provide a description of
alternative treatments or procedures
b. the consent should offer a thorough
explanation of the procedures to be done and
the consequences of it. [ informed consent
should state the procedure as simple as possible
for the patient to understand, it shouldn’t be that
thorough ; men are not familiar with the detailed
medical-surgical procedures so it should be
simplified otherwise pt will be ill informed. ]
c. the consent should include the medical diagnosis
and explanation of the wondershare patient's
condition
d. the consent should describe the prognosis if the
recommended care is refused.
5. Justice
- the obligation to be fair and just
- equitable distribution of goods/ resources
- EX: first come, first serve (used medical
missions, feeding programs)
- nurse must not accept gifts [which might be
interpreted as capitalizing the patient
"(c) decline any gift, favor or hospitality which might be
interpreted as capitalizing on patients." (PARAGRAPH
C, section 11, Code of Ethics, Board of Nursing Res
220, Series of 2004)
- [ Galinato: receiving small and inconsequential
gifts is okay [out of respect]; if it may not be
interpreted as capitalizing on patients [ex:
kopiko, you can accept that])
- In law there is equity, fairness. Equity fills the
blanks in the lines of law. For example, you will
accept the gift of kopiko, I don’t think the judge
will punish you for accepting such miniscule gift
out of respect plus its part of our culture, not to
disrespect patients. But kopiko along with the
keys for house and lot, that’s another story ; it
would be a violation of the Board of Nursing
Resolution 220.
JUSTICE is also ensuring that scarce resources are
allocated to those who would most benefit from it
- Example, TRIAGE:
● immediate case: red (they have
increased survival rate)
● delayed: yellow (attended to in a matter
of hours)
● minimal cases: green (attended to a
matter of days)
● expectant: lack expected to die/dead) ;
no longer treated
● psychological trauma: blue
6. Respect
- the belief to that a person should be treated as a
person
- given to all clients
- especially for:
● dying clients
● Elderly
● mentally
7. Responsibility
- the obligation to correctly perform one's
assigned duties
- stick to standards ( a basic structure in which
competent care is measured)
- EX: minimum safety protocols expected of a
nurse
8. Accountability
- answerable to oneself and others for one's own
actions
 - Ex: can delegate responsibility of taking vital
signs to nursing aide, but the accountability is all
yours (RN)
Case: The nurse who failed to check the patient's
respiratory status
Case of Our lady of Lourdes Hospital v Spouses
Romeo and Regine Capanzana
(GR 189218, March 22, 2017)
- A nurse neglected to assess the respiratory status
of a patient experiencing respiratory distress,
and whose significant others is complaining that
such patient's oxygen tank is running empty. As
a result, the patient suffered cardiopulmonary
arrest which caused her brain damage and
subsequent vegetative state, to wit: "hypoxic
encephalopathy due to pulmonary cardiac arrest
on the background of pulmonary edema."
- [Pt’s relatives was constantly telling the nurse
that the oxygen tank is running low. The nurse,
instead of calling the management, disregarded
the relatives. Pt suffered from lack of oxygen.
The hospital is also to blame for that because
they do not have enough oxygen tanks available
so they are held liable. Doctors also have a
mistake in this case. Upon assessment by the
physician, it was discovered that the pt had a
heart problem. No precautionary measures,
based on record, were instituted. In this case it
was the nurses and the hospital who were to pay
the amount of liability.
The nurse was held liable along with the hospital for:
Php 299,102.04 for actual damages
Php 1,530,296.80 for compensatory damages,
Php 100,000 for mor damages
Php 100,000 for attorney's fees
The doctors in the above case got out scot-free, even if
the RTC found out that they failed to assess the patient's
heart disease - a rheumatic heart disease with mitral
stenosis - which led to the patients pulmonary
hypertension, then pulmonary edema, and eventual
respiratory arrest; all because the nurse didn't assess the
respiratory function of the patient; an assessment which,
in my humble asseveration, could, and should, have been
done with greater accuracy and thoroughness by the
admitting physician.
LESSON:
For me, is that nurses must do everything in their power
not to be the "fall guy", the "stodge", or the "scapegoat."
They must assess each patient like their jobs, liberty, and
dignity depend on it; and must never rely solely on the
good doctor's proclamation that the "coast is clear."
Case: The anesthesiologist who failed to keep track of
the patient's vital signs
Case of DR. EDUARDO AQUINO (anesthesiologist)
VS heirs of RAYMUNDA CALAYAG
G.R. No. 158461
When his wife Raymunda went into labor pains and
began bleeding, respondent Rodrigo Calayag brought
her to St. Michael's Clinic. After initial examination, the
doctor told Rodrigo that Raymunda had to have a
caesarean section for her baby but this had to be done at
the better-equipped Sacred Heart Hospital (SHH),
owned and operated by petitioner E. Alberta Reyes (Dr.
Reyes) SHH admitted on the same day.
To prepare her, the attending anesthesiologist, petitioner
Dr. Eduardo Aquino injected with a preliminary
"Hypnotic" and he administered an anesthesia on her
spine. A few minutes later, Dr. Unite delivered a
stillborn eight-month-old baby. A few minutes later the
operating team noticed that Raymunda had become
cyanotic and her blood darkened for lack of oxygen and
suddenly her vital signs were gone.
• Fortunately, she was restored. It was found that
suffered a cardiac arrest during the operation which
explained her comatose state and was advised to move
her to a better-equipped hospital. Raymunda was moved
to Medical Center Manila where Dr. Libarnes, a
neurologist, found her in a "vegetative state" having
suffered from an anoxic injury due to cardio-respiratory
arrest. Her condition worsened and she never regained
consciousness, prompting her MCM doctors to advise
Rodrigo to take her home since they could do no more to
improve her condition. MCA discharged her and she
died 15 days later.
Rodrigo filed, together with his seven children, a
complaint damages for Dr. Unite, Dr. Aquino and Dr.
Reyes claiming that Dr. Unite and Dr. Aquino failed to
exercise the diligence required for operating Raymunda
while Dr. Reyes, as Rodrigo averred, was negligent in
supervising the work of the two doctors.
ISSUE:
● Whether or not Dr. Unite (the surgeon) and Dr.
Aquino (the anesthesiologist) acted negligently
in handling Raymunda's operation, resulting in
her death; and
● Whether or not Dr. Reyes is liable, as hospital
owner, for the negligence of Dr. Unite and Dr.
Aquino.
SUPREME COURT RULING: Yes
- Dr. Unite (surgeon) and Dr. Aquino
(anesthesiologist) are liable. The cause of action
against the doctors in these cases is commonly
 known as medical malpractice and to
successfully mount a medical malpractice
action, the plaintiff should establish four basic
things:
(1) Duty
(2) breach
(3) Injury
(4) proximate causation.
The evidence should show that the physician or surgeon,
either failed to do something which a reasonably prudent
physician or surgeon would have done, or that he or she
did something that a reasonably prudent physician or
surgeon would not have done; and that the failure or
action caused injury to the patient. To prove the doctors
negligence, Rodrigo presented Dr. Libarnes who
explained that it was the lack of oxygen in the brain that
caused Raymunda's vegetative state and it could be
traced to the anesthetic accident that resulted when Dr.
Aino placed her under anesthesia.
Furthermore, Dr. Libarnes blamed the doctors who
operated on Raymunda for not properly keeping track of
her vital sign during the caesarean procedure resulting in
their failure to promptly address the cyanosis when it set
in. The damage could have been averted had the
attending doctors promptly detected the situation and
resuscitated her on time.
In this case, there is no evidence that the hospital acted
in a way that made Raymunda and her husband believe
that the two doctors were in the hospital's employ. There
appears no concrete proof to show that Dr. Unite and Dr.
Aquino were under the hospital's payroll. Indeed, Dr.
Aquino appeared to be a government physician
connected with the Integrated Provincial Health Office
of Bulacan while Dr. Unite appeared to be a self-
employed doctor. No evidence has been presented that
Raymunda suffered her fate because of defective
hospital facilities of poor staff support to the surgeons.
This means that, in order for the hospital to be held
vicariously liable, you need to prove that the eering
doctors or the doctors who made a mistake are
employees of the hospital. Often you do that by payroll,
by their contracts and often it is not accessible to
plaintiffs.
➔ Usually employer - employee relationships
either actual or implied are established by
circumstantial evidence. For example, hospital’s
manifestations: if the name is written or placed
at the lobby of the hospital, that is a good
indicator that the doctors are employees of the
hospital, either actually or constructively.
➔ There was no evidence that the hospital was
negligent in handling the issue.
➔ How do you prove it?
➔ Good way to prove this is the lack of
investigation. In order for it to have an
investigation, you have to report it to the
hospital or the hospital have the knowledge of
the injury either actual or constructive. If there is
proof that the hospital knew of the injury that
happened, if there is the nurse who documented
what happened, in this case it wasn’t shown that
the nurse documented what happened but there
was records on the anesthesia which were
missing, 5 mins interval that the anesthesiologist
did not record VS.
➔ No one recorded any errors committed by
surgeons, the hospital couldn’t have know of the
error so the hospital couldn’t be held liable.
PSI vs Agana - case wherein hospital held solidarily
liable because there was evidence on record of the
mistake of the surgeons, recorded by the nurses, but
hospital failed to make investigation, so hospital was
held negligent.
9. Autonomy
- auto: self/ nomos: governance
- ability to decide own destiny, free from coercion
- this is the essence of informed consent
4. A nurse who supports a patient and family's need to
make a decision that is right for them is practicing which
of the following ethical principles?
A. Autonomy - through informed consent
B. Confidentiality
C. Privacy
D. truthfulness
Case: The doctor who failed to explain that the patient
may have dissem inated intravascular coagulation and
die as a result of chemotherapy.
Case of DR. RUBI LI vs. SPS. SOLIMAN
GR No. 165279 June 7, 2011
651 SCRA 32
FACTS:
- Angelica Soliman, the daughter of Sps. Soliman
underwent a biopsy of the mass located in her
lower extremity at the St. Luke's Medical Center
(SLMC).
- Results showed that Angelica was suffering
from a highly malignant cancer of the one.
Angelica's right leg was amputated in order to
remove the tumor.
- To eliminate any remaining cancer cells,
chemotherapy was administered by herein
petitioner Dr. Rubi Li, a medical oncologist.
Angelica was admitted to SLMC. However, she died 11
days after the administration of the first cycle of the
chemotherapy regimen. Respondents filed a damage suit
against Dr. Li and other doctors and against SLMC,
charging them with negligence and disregard of
Angelica's safety, health and welfare by their careless
administration of the chemotherapy drugs, their failure
to observe the essential precautions in detecting early the
symptoms of fatal blood platelet decrease and stopping
early on the chemotherapy, which bleeding led to
hypovolemic shock that caused Angelica's untimely
demise.
Petitioner denied having been negligent in administering
the chemotherapy drugs to Angelica and asserted that
she had fully explained to respondents the effects of
chemotherapy. On her supposed non-disclosure of all
possible side effects of chemotherapy, including death,
petitioner argues that it was foolhardy to imagine her to
be all-knowing. While the theoretical side effects of
chemotherapy were explained by her to the respondents,
as these should be known to a competent doctor,
petitioner cannot possibly predict how particular
patient's body constitution would respond to the
treatment.
These are obviously dependent on too many known,
unknown and immeasurable variables, thus requiring
that Angelica be closely monitored during the treatment.
Petitioner asserts that she did everything within her
professional competence to attend to the medical needs
of Angelica.
ISSUE:
Whether the petitioner can be held liable for failure to
fully disclose serious side effects to the parents of the
child patient who died while undergoing chemotherapy,
despite the absence of finding that petitioner was
negligent in administering the said treatment.
SUPREME COURT RULING: No
There are four essential elements a plaintiff must prove
in a malpractice action based upon the doctrine of
informed consent:
(1) the physician had a duty to disclose material
risks; [DUTY]
(2) he failed to disclose or inadequately disclosed
those risks; [BREACH OF DUTY]
(3) as a dire and proximate result of the failure to
disclose, the patient consented to treatment sne
otherwise would not have consented to;
[PROXIMATE CAUSE]
(4) plaintiff was injured by the proposed treatment."
[INJURY]
The gravamen in an informed consent case requires the
plaintiff to "point to significant undisclosed information
relating to the treatment which would have altered her
decision to undergo it."
In this case, there was adequate disclosure of material
risks inherent in the chemotherapy procedure performed
with the consent of Angelica's parents. On the other
hand, the suing parents failed to establish the existence
of the risks or side-effects Dr. Li should have disclosed
to them in the use of chemotherapy in the treatment of
osteosarcoma
The mistake of the parents is that they didn't present an
expert witness. In medical case, you need a medical
witness when the case is so technical that you cannot
rely on the doctrine of res ipsa loquitur.
Another important point is that (1) no one contradicted
Dr. Li that the pt died of disseminated intravascular
coagulation. DIC cannot be prevented and it cannot be
cured. It is a systemic bleeding disorder wherein the
platelets are wasted on one particular side so there is a
decrease of platelet to the other side so there was
bleeding.
In law, it is considered as an unforeseeable and
unpreventable event.
The doctor presented as witness does not qualify as
expert testimony to establish the standard of care in
obtaining consent for chemotherapy treatment.
Testimony was not given much weight by the court.
• In the absence of expert testimony in this regard, the
Court felt hesitant in defining the scope of mandatory
disclosure in cases of malpractice based on lack of
informed consent. Thus, the Court has no factual basis to
declare that the chemotherapy administered by the
petitioner proximately caused Angelica's death.
10. Paternalism
- the restriction of the patient's autonomy to
protect him/her from harm
- the undesirable effect of beneficence
- ex: state's duty to detain in mental institutions
those who are insane.
STATE needs: court order testimony of chief medical
officer / head of city health office that person is insane
before detaining them
• NLE questions:
Situation 8 - Many hospitals form bioethical review
committees to ensure better quality of life of patients.
You are invited by the nursing service department to
participate in their bioethical review committee. You are
expected to know the purpose and apply bioethical
principles.
156. Which of the following is the purpose of the ethical
review committee?
A. Promote implementation of general standards
B. Enhance health care provider's liability
C. Increase individuals responsibility for decision
making
D. Decrease public scrutiny of health care
provider's action
157. Daria who is admitted to the hospital with
autoimmune thrombocytopenia and a platelet count of
20,000/æL develops epistaxis and melena. Treatment
with corticosteroids and immunoglobulin has not been
successful. Her physician recommended splenectomy.
Daria states "I don't need surgery. This will go away on
its own." In considering your response to Daria, you
must depend on the ethical principle of:
A. Beneficence.
B. Justice
C. Autonomy - cannot force pt
D. Advocacy
58. Zorayda is terminally ill and is experiencing severe
pain. She has bone and liver metastasis. She has been on
morphine for several months now. Zorayda is aware that
they are having financial problems. She decides to sign a
DNR form. What ethical principle did Zorayda and her
family utilize as the basis for their decision to sign a
DNR.
A. Justice
B. Autonomy
C. Benefice
D. Advocacy
Ethics
- methods of inquiry that assists an individual to
understand the morality of human behavior
- morality: subjective perception of right and
wrong
- bioethics: ethics applied to care
Topic: Therapeutic Abortion topic: "double effect/two
fold effect"
- exists when a situation has a good and bad effect
4 conditions of double effect
1. action must be morally good
2. good effect is willed; bad effect merely allowed
3. good effect must not come from evil action
4. good effect > bad effect
In law, therapeutic abortion has legal consequence
because abortion is illegal in the Philippines. Even when
woman was raped, she was pregnant and she aborts the
child, that’s considered a crime.
However there are exceptions to the rule (these come
from emergency situations):
● If pregnancy threatens the mother, then
pregnancy can be aborted in order to save the
life of the mother. Legally that’s the significance
of DOUBLE EFFECT.
● Paragraph 4, Article 11 - justifying
circumstances, there’s no crime, there’s no
criminal, there’s certainly no civil liability
Ex: Therapeutic abortion.
• In the Philippines, abortion is a crime, punished by
Article 256, 257, 258, and 259 of the Revised Penal
Code (RA 3815); but it can be justified (meaning no
criminal liability) if it is done to save the life of the
mother (ex: preeclampsia, eclampsia), under paragraph
4, Article 11 of RA 3815, to wit:
• "Article 11. Justifying Circumstances. The following
do not incur any criminal liability:
Paragraph 4. Any person who, in order to avoid an evil
or injury, does an act which causes damage to another,
provided the following requisites are present:
(1) First. That the evil sought to be avoided actually
exists;
(2) Second. That the injury feared be greater than
that done to avoid it;
(3) Third. That be be no other practical and less
harmful means of preventing it
• 74.A mother who is pregnant and has ovarian cancer
has to undergo surgery to treat the cancer. In the process
the fetus died. The doctrine that justifies the death of the
fetus is:
a. Justice
b. Anatomy
c. exception to the role
d. double effect
.67. RhoGAM is given to Rh-negative women to prevent
maternal sensitization from occurring. The nurse is
aware that in addition to pregnancy, Rh-negative women
would also receive this medication after which of the
following?
a. Unsuccessful artificial insemination procedure
b. Blood transfusion after hemorrhage
c. Therapeutic or spontaneous abortion with
d. Head injury from a car accident
(June 07 NLE)
Note: There is civil liability under paragraph 4, Article
11, RA 3815, to wit:
"In cases falling within subdivision 4 of Article 11, the • (RA 10951: An act adjusting the amount or the value
persons for whose benefit the harm has been prevented, of property and damage on which a penalty is based, and
shall be civilly liable in proportion to the benefit which the fine imposed under the revised penal code, amending
they may have received." (Article 101, RA 3815). for the purpose Act No. 3815, otherwise known as "the
revised penal code", as amended)
- Although the mother is civilly liable, no benefits
were taken in fact, there is loss, loss of a child. Ethical dilemma
- In practicality, no one will sue the mother for - exists when the nurse is confronted with 2
therapeutic abortion. conflicting principles
REVISED PENAL CODE (RA 3815) - common in ICU because:
➔ a client's legal right co-exists with the
articles on abortion
nurse's professional obligation
Article 256 to Article 259 of RA 3815:
- ex: euthanasia
A. Article 256: Intentional abortion by any person
- pt: autonomy
(1) who cause violence upon person of
- nurse: beneficence/ non maleficence
pregnant woman: Reclusion temporal
(12yrs 1 day to 20 years)
Euthanasia is not legal in Philippines; charged with
(2) who without using violence, shall act
murder.
without the consent of the woman:
prision mayor (6 yrs 1 day to 12 yrs)
(3) if woman shall have consented: prision
Is Suicide a crime?
correccional in med and max period ap
Firstly, suicide is not a crime.
to 6 yrs)
Why? Because there is no law punishing it; "nullum
B. Article 257: Unintentional abortion
crimen, nulla poena sine lege", that is, there is no crime
- by any person who shall cause abortion by
when there is no law punishing it (p 36, Luis B. Reyes,
violence, but unintentionally: prision
Criminal Law, Book 1, 2017).
correccional min and medium periods (~4 yrs
imprisonment)
Article of 3 of RA 3815 puts it: "acts and omissions
punishable by law are felonies."
C. Article 258: Abortion practiced by the woman herself
- But giving assistance to suicide is a crime.
or by her parents
Under current laws, doctors (and nurses)
- abortion by woman upon herself or shall consent
assisting a patient to die can be imprisoned and
that any other person should do so: prision
charged with malpractice, to wit:
correccional in its medium and maximum
periods (up to 6 yrs)
Article 253 of RA 3815: Giving Assistance to Suicide.
- if practiced by woman to conceal her dishonor:
- Any person who shall assist another to commit
prision correccional in its minimum and medium
suicide shall suffer the penalty of prision mayor
periods (~4 yrs)
(up to 12 yrs);
- if the crime be committed by the parents of the
- if such person lends his assistance to another to
pregnant woman or either of them, and they act
the extent of doing the killing himself, he shall
with the consent of said woman for the purpose
suffer the penalty of reclusion temporal (up to
of concealing her dishonor: prision correccional
20 yrs [just like the penalty for homicide]).
in its medium and maximum periods (up to 6
yrs)
However, if the suicide is not consummated, the penalty
of arresto mayor in its medium and maximum periods
D. Article 259: Abortion practiced by a physicial or
shall be imposed (up to 6 mos).
midwife and dispensing of abortives
- physician or midwife who, taking advantage of
LESSON: Suide is not a crime. Giving assistance to
their scientific knowledge or skill, shall cause an
suicide is.
abortion or assist in causing the same: penalties
in art 256 in its maximum period (up to 6 yrs [if
Situation 1:
woman consented]; up to 12 yrs [without
Mr. Martin, 71 years old was suddenly rushed to the
violence, without consent of woman]; up to 20
hospital because of severe chest pain. On admission, he
yrs [with violence, without consent of woman])
was diagnosed to have acute myocardial infarction and
was placed in the ICU.
• any abortive shall suffer arresto mayor (up to 6 mos)
and a fine not exceeding 1000 pesos (now Php 100,000
[section 59, RA 10951])
2. After one day, the patient's condition worsened and (4) EO 292 (Administrative Code of 1987 on the
feeling hopeless. He requested the nurse to remove the Civil Service Commission
oxygen. The nurse should: (5) Glover, Jacqeline, Ethical Decision Making
A. follow the patient because it is his right die Guidelines and Tools, 2015
gracefully (6) Luis B. Res, The Revised Penal Code, Criminal
B. follow the patient as it is his right to determine Law, Books 1-2, 2017
the medical regimen he needs (7) Occupational Safety and Health Standards,
C. refuse the patient and encourage him to DOLE, 1989
verbalize hid feelings (8) PD 442 (Labor Code of the Philippines)
D. refuse the patient since euthanasia is not (9) RA 3815 (Revised Penal Code of the
accepted in the Philippines Philippines)
3. Euthanasia is an ethical dilemma which confronts (10) RA 386 (New Civil Code of the
nurses in the ICU because: Philippines)
A. the choices involved do not appear to be clearly (11) RA 7305 (Magna Carta for Public
right or wrong Health Workers)
B. A client's legal right co-exist with the nurse's (12) RA 9173 (Philippine Nursing Act of
professional obligation (NCLEX question) 2002)
C. decisions has to be made based on societal (13) Rodel apure, Atty-MID, Legal
norms. Prescription for Doctors, Philippine Journal of
D. decisions has to be mad quickly, often under Internal Medicine, 47:1V, May-June, 2009
stressful conditions (Dec 06)

What if someone tried to commit suicide by jumping

from a tall building, fell on a pedestrian, and killed the
latter instead? Is there a crime?

ANS: No. "When a person has not committed a felony,

he is not criminally liable for the result which is not
intended" (p 64, Reyes in explaining Article 4, RA 3815)
- Theoretical scenario common in law school.
Will jumper be liable? No. His initial act, if
proven that it is indeed suicidal, since it was not
a crime, then the consequence of his act, which
is not a crime, is also not a crime even though
there is injury.

LESSON: Walking in street look left, right, up, down.

Article 4. Criminal liability. Criminal liability shall be

incurred:
1. By any person committing a felony (delito)
although the wrongful act done be different from
that which he intended.
2. By any person performing an act which would
be an offense against person or property, wore it
not for the inherent impossibility of its
accomplishment or on account of the
employment of inadequate or ineffectual means.

• (felonies are acts and omissions punishable by the

Revised Penal Code [p33, Reyes] in relation to Article 3,
RA 3815)

• Sources:
(1) 1987 Philippine Constitution
(2) 2012 Nursing Core Competency Standards
(3) Board of Nursing Resolution No. 220, Series of
2004