JURIS PRUDENCE RIGHTS OF PATIENTS

DR. REBOSA
RIGHTS OF DOCTORS RIGHT TO DISCLOSURE OF INFORMATION
- the right to choose patient
- the right to limit practice - patient has the right to know what transpired in fact
- right to compensation practically everything that has transpired
- kailangan malaman ng pasyente ano ang
RIGHTS OF PATIENTS nangyayare, ano ang nangyare at ano ang pwedeng
- If doctors can choose patients, likewise patients can mangyare
choose their doctors - this is easier said than done, the most difficult part is, do
- Infact they can terminate doctor-patient relationship you really disclose?
anytime - For example, patient A was operated 3 weeks ago by my
bestfriend who is an OB-GYN, after 3 weeks the patient
8 CARDINAL RIGHTS OF PATIENTS: again is suffering from an acute abdomen, naoperahan
1) Right to consent siya 3 weeks ago for cesaraean hysterectomy
2) Right to confidential information - Then the patient consulted me as a surgeon, during
3) Right to disclosure of information my surgery, there was a gauze left inside the
4) Right to privacy abdomen:
5) Right of religion
6) Right to treatment
7) Right to refuse treatment  Scenario A
o I will disclose to the patient that there was a
RIGHT TO TREATMENT AND RIGHT TO REFUSE TREATMENT gauze left inside the abdomen, and the
presumption is, if the last doctor who opened
- you cannot treat a patient unless the patient will consent the patient, siyaangnakaiwan, so if I will disclose
- but if a patient refuse treatment, even if may mean dying, can that to the patient, the patient will sue my
you proceed with your treatment? NO bestfriend and I will stand in court as a witness
- you have to stop there, do everything to convince the patient and probably would lead to the conviction of my
for the treatment and if still would refuse the treatment then bestfriend
let them sign the waver
- Let them right in the chart:
 “ayaw po naming maoperahan, inexplain po ni doctor,  Scenario B
pwede po akong mamatay.” o I will not disclose it, pipilitinkoitago but at the
 Let the patient sign end of the day, pipilitinkongitago but at the end
of the day nalamanngpasyente, my bestfriend
But there is no such thing as the RIGHT TO DIE and I will be sued together, sa akin concealment
- But there are some places in the globe, there is such protecting another colleague
thing as the right to die, in Portland, US à if patient is  Scenario C
inflicted with a terminal disease, the patient may actually o I will not disclose it, and nobody will ever learn
ask the doctor to kill him or to kill the patient and the about it, isalangangkalabankoconsensya
doctor will escape any liability
- conditions: retained gauze inside the patient- “RES IPSA LOQUITUR”The thing
- after 3 consecutive consultations speaksfor itself
orwith 2 independent doctors
- and the diagnosis is too fatal and the - Advise: at the earliest opportune time à disclose it!
patient will die, the doctor can kill - Ex. Napatawagnayung surgeon sa court, tatanunginang
the patient which we call surgeon,
↓↓↓ - “when you open up the patient, what did you see doctor?“
 active euthanasia - “There was a gauze left inside the abdomen”
- “Do you think, it was left by the last doctor who open up
- but in our country, you kill the patient, what crime will you the patient?”
be prosecuted?MURDER - “Probably yes”
- “Was he negligent because the gauze left inside the
- binigaymoyunglasonparamagpakamataysiya– ASSISTING abdomen?”
TO SUICIDE - “I cannot say your honour, I was not the one who
performed the surgery, there might have been reasons or
IN OUR JURISDICTION: factors why the gauze was left inside the abdomen”
- the one who help the person to commit suicide, is theone - let the doctor explain it, why the gauze was left inside the
criminally liable abdomen but before you disclose it, if you have means to
- the one who attempted suicide is NOT liablefor any disclose it to the other doctor… INFORM THE OTHER
ground DOCTOR already. Para mapaghandaanniya
- the law said“ikaw ang nasa sane mind, maayos ang - Doc may gaza, sasabihinba naming? Wala pa
pag iisip pero tinulak mo pa siya magpakamatay” ponakakaalam…
- Cannot containt the environment that no one will inform
ASSISTING TO SUICIDE – if a doctor gives an injurious substance the patient

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 JURIS PRUDENCE RIGHTS OF PATIENTS
DR. REBOSA
- Ancillary procedure done was CT scan à result:
MESHLIKE NETWORK MASS inside the abdomen
- Ok, you will not disclose it but the patient will ask what
is that mesh like network mass in the abdomen?
- Taposnungbinuksanmobiglangnawala (kasitinagong
surgeon at itinapon
- Dislose it! Para hindikamaipit
o As soon as possible
o The longer you delay it, the more it becomes
suspicious
RIGHT TO PRIVACY
- history taken up by the clerk
- intern, residente, fellow, consultant, nurse in charge
- a total of 5 history!
- don’t ask private questions which are not relevant to
the clinical condition of the patient
- in research projects you cannot divulge the privacy of
the patient, you go to their houses without go signal
CONFIDENTIAL INFORMATION
- you cannot divulge it
- dumating yung police, magtatanong ang police, the only
thing you can tell to the police is “Yes there is a patient
admitted in our hospital by the name of Albert Rebosa
under the service of Dr. Antonio Rebosa”
- Do not divulge anything as to the treatment, surgical
procedures performed
- let the patient divulge it to the police
- you have confidential information
- the right of patient to confidential information is not only
provided by law but likewise provided by code of ethics
- if confidential information is provided
by the code of ethics you call that
↓↓↓
ethical privelege communication
by law you call that
↓↓↓
statutory privileged communication
UNDER THE LAW OF CIVIL CODE
 Very specific, except in criminal cases or except inthe
interest of justice, the communication gathered in a
doctor patient relationship CANNOT BE DIVULGED
especially so if it is to blackened the moral character of
the patient
UNDER THE CODE OF ETHICS
 The communication between a doctor and a patientis
dimmed confidential even after death,
kahitpataynaangpatiente, hindimopwedeikwento
 That’s why in grand rounds, morbidity and mortality is
presented as:
 ABR, 25 year old patient from (exact address)
 this is breech of confidentiality, true!
 Naka initials langsyaperonandunyung address,
nandunyungsakitniya so mapipinpointmoparin kung
sinosiya make it a habit that you use:
 patient A patient B from Manilafrom Mandaluyong
from Valenzuela
 parahindimotalagakilala kung sinoangpasyente
3 INSTANCES THAT YOU CAN BREECH CONFIDENTIALITY
1) WAVER OF CONFIDENTIALITY
o “sigepo doctor, ikalatmolangna may HIV ako”
o let the patient sign the waver
2) IMPLIED WAVER
3) PUBLIC WELFARE
 Dana is a pilot and she was diagnosed with Unstable angina, I,
as his doctor was asked by Dana not to tell it to the airline
company because she has 10 kids and no husband
o “Please doctor, don’t tell it, I am the sole bread
winner” o can I divulge it to the administrators?
o Yes, because of public welfare, the lives of 10
children is subordinate to the lives of 300 airline
passengers
o You can breech confidentiality
Another exception to confidentiality
Dr. Abet: “Dana and I are couples”
- I am a very loyal Huband to my wife Dana
- Nagpunta si Dana sa obgyn
- I was with her
- Sabi ni Dana sa akin “Abet, dyan ka lang sa labas, ako lang
ang papasok sa clinic”
- Pag labas ni Dana, I went straight to the OBGYN and asked
the OBGYN “Doc, ano po ang sakit ng asawa ko?”
- Let’s say my wife DANA (punyeta kinikilig ako!!!!), was
diagnosed without my knowledge to be suffering from
sexually transmitted disease
- And let’s presume that I don’t have STD (although that’s
not a presumption, that’s a fact)
- So if I don’t have STD and my wife has, the conclusion is
my wife is having an extramarital affair
- Now, if I ask the OBGYN can the OBGYNE divulge it to me?
 Let us look at the exceptions:
 Was there a waver on the part of Dana? – NONE
 Had it been that Dana allowed me to get inside the
examination room or consultation room that would
have plainly constituted an implied waver
 Public welfare?
 Public welfare will not come in to the picture
 Take note, DANA is my wife;She is only for myprivate
consumption,AKIN LANG SIYA!<3
Infact prostitutes can invoke confidentiality because prostitution is
illegal in our country
Ex. In Las Vegas, if the doctor found out that his patient which is a
prostitute is positive for STD, he can disclose it because it is for
public welfare. Because it is legal in Las Vegas
If a prostitute here in the Philippines will consult you and nalaman
mo na positive for STD, hindi mo pwede ikalat because the
presumption is she is not a prostitute because there is supposedly
no prostitute in the Philippines because it it is illegal here in the
Philippines, the prostitute can actually invoke confidentiality
So san sya papasok?
In the interest of justice which is except in criminal cases because if
the doctor will not disclose it to me, I will be likewise be infected, I
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 JURIS PRUDENCE RIGHTS OF PATIENTS
DR. REBOSA
will be injured so a crime will be committed. Physical injury, So mag
papasasak ako ng ceftriaxone IV…. Etc
Another example:
18 year old patient, single, living with
parents inultrasound ko
pregnancy uterine 10-20 weeks AOG not in labor
pumasok na ngayon ang tatay nya na general and mommy na na si
Miriam defensor after ng ultrasound
“ano ang ultrasound ng anak ko?”
Can I divulge it to the senator? You may not because you have to
maintain confidentiality (because there is no implied waver)
Tell them: “naibigay ko na po ang resulta sa anak nyo, paki kuha nalang
po sakanya”
What if the patient is a 17 year old?
Yes, you should divulge it because in the first place you cannot
proceed without the consent of the parent
Another example
o The girl let her mother inside the clinic and found out that she is
pregnant.
- Implied waver (you can divulge it because the daughter let her in)
CONFIDENTIALITY EXTENDS TO MEDICAL RECORDS AND OTHER
DOCUMENTS RELATING TO THE PATIENT
MEDICAL CERTIFICATE
- pag inissue nyo ang medical certificate make sure you issue that
to the patient
- wag nyo iissue kung kanikanino kahit asawa
- imagine you issued a med cert telling that “patient A is diagnosed
of STD etiologic agent N. Gnorrhea” then you gave it to the
husband who just came back from Saudi Arabia… hindi pa sila nag
mmake love kasi kanina pa dumating tapos inabutan nyo ng
medical certificate (that is breech of confidentiality)
MEDICAL RECORDS IS ALSO INCLUDED IN CONFIDENTIALITY
- nag tae yungbatakumainsacarinderiananay asked for a
financial help sa may aringcarinderiathe owner of the
carinderia went to the hospital and asked for a certificate
if indeed the patient was suffering for food
poisoning(walanayung mag nanayumuwina)certificate:
Acute Gastroenteritis with modern signs of dehydration
owner: “Bakitkobabayaran eh acute gastroenteritis
namanpala”
- remember! Do not give it to anyone. Medical
records are owned by the Hospital, it is not us
doctors who will provide the patient records
- when they asked for medical records you channel them
to the medical record custodian of the hospital for them
to get a copy
- when a case is filed against a doctor, angpinaka
documentary evidence naten is a medical record, what is
not written is presumably never done
RIGHT TO RELIGIOUS BELIEF
 take note, the patient is the one who willinvoke RIGHT to
religious belief not the DOCTOR
 the patient Is a member of Jehovah’s witness patient said:
“ayokopomasalinanngdugo, so you cannot tranfuseblood”
 but even if the patient refused, you still have to put
the order in the chart, “patient for blood transfusion”
 kahitayawngpasyenteipilitninyosa order and then the
patient now will sign the waver
 kayahindinatuloyyung order mokasi may waver
 ground: RELIGIOUS BELIEF
- but if I were the member of Jehovah’s witness, my
patient is a catholic from postpartum hemorrhage and
need BT, I cannot invoke religious belief
- but if time is not of essence and it is not a matter of life
and death, doctor can actually invoke right of religion
- kunwaresiDANAgravida 10 para 10, “doc i-BT monaako…”
- Doc Abet: “ay bawalyansarelihiyonko eh, pwedebasi doc
Tony Rebosanalang?” because if I will not perform it the
patient will not die. (not an emergency, and
pwedemaipasasaibang doctor)
ANOTHER EXAMPLE: RH LAW
- I am a government doctor
- As a catholic I am not a proponent of RH law but since
there is already that RH law, we have now mandated as a
government doctors to implement family planning
program by any means other than rhythm method and
that is against our religion as a catholic, can I refuse
implementing the programs of the government? Can I
invoke right of religion?
- I cannot, because as a government employee I
am a property of the government so I have to
do or perform my job description
- The only thing that I can do is to ask my supervisor to
transfer me to another program which is not against my
religion and if there is no available position that I can be
transferred the other option is resignation
- That is a limitation, not provided by religious belief but a
limitation provided by law
- Right to limit practice is a limitation provided by law
CONFIDENTIALITY EXTENDS TO: (PRIVILEGED
COMMUNICATION)
- Priest penitent
o but if “father forgive me because tonight, I will
kill the bishop, the priest can go to the police
officer in the interest of justice, abort the crime”
- Husband and wife
o you cannot force to testify against your
husband or wife kahit na eye witness ka pa
o but if for example, nirape yung anak mo. The
wife can testify against the husband (right itself
is committed sakanila)
o extends even after the dissolution of marriage
(annulment)
- Lawyer and client
Trans by shanna rebosa
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