ETHICAL AND LEGAL ISSUES IN

THE PATIENT
CARE CONTINUUM
Dr. Hector Gerard C. Belisario
ABCD Law Firm
 “Legal”, “Moral”, “Correct”
 Natural Law
 Positive Law
 Anthropological
perspective
 Moral/Ethical context
 Foreign
jurisdiction/RCC,
other Christian groups
 Philippine statutory
environment
 “Dying”
 Terminal
 Legal definition of
Death
 Criminal/civil
implications
 Other important definitions
 Standard of Care
 Best Interest
 Irreversible
 Philippine statutory environment
 Consti/Revised Penal Code/Special Laws
 Homicide/Murder/Abortion/Quasi delict
 Intent
 To cause death?
 To relieve the burden of the dying process?
 Take life
 Of another
 No “Suicide” proscription
 Organ Donation Act
 Other special law relating to health care
 “Patient”

 Rights
 Autonomy, “informed
consent”
 Patient - Doctor
Relationship, Medical Profsn
 Sui Generis, Parents, Parens
Patriae
 Proxy decision making ,
advance directives
 Standard of Care –
negligence/malpractice
Non Sequitur
 Euthanasia
 Voluntary
 Involuntary
 Physician Assisted Suicide
 Cause of Death – fatal act
not the disease
 Passive forms: (no moral
dilemma in resource
deficits). Compare:
 Intentional withholding of
useless treatment
 Intent..withholding of
potentially useful treatment
HEALTH CARE CONTINUUM

PREVENTIVE-
THERAPEUTIC PALLATIVE COMFORT DIGNITY POSTMORTEM
WELLNESS
 http://www.mediafire.com/?lxmqcmvsx1abwyc/Rtrt.2011.BRRip_mediafiremoviez.com.mkv.003

Health Care Continuum

 Preventive/Wellness
 Primum non nocere
 Standard of care
 Cost Benefit (Political
Economy)
 Herd immunity
 Holistic – Community
resource model
 Controversies
 http://www.mediafire.com/?lxmqcmvsx1abwyc/Rtrt.2011.BRRip_mediafiremoviez.com.mkv.003

Health Care Continuum

 Therapeutic
 Primum non nocere
 Standard of care
 Cost Benefit (Political
Economy)
 Holistic – Family
resource model
 Cost/benefit
 “Best Interest”
 Health Care Continuum
 Pallative
Primum non nocere
 Standard of Care

(“Clinical trials”)
 Cost Benefit
 Family – Holistic
resource model
 Quality of life
 Best interest
 Health Care Continuum
 Comfort
 Primum non nocere
 Pain management
(non-”therapeutic”
levels)
 Euthanasia/Assisted
Suicide
 Withdrawal/Non
intervention (NHM)
 Standard of Care
 Cost/benefit
 “Best interest”
 Care Continuum
 Dignity
 Religious (consti - bill
of rights)
 Fulfilment/Closure
issues eg presence of
family (hospital
policy on visitors-
strangers)
 “...seeks care to
“live””
 Care Continuum
Aftercare
 Non-object of
commerce
 Civil custody of body
 “Encumbrances”
 Custodia legis
 Interventions
 “Extraordinary”
measures
 “Burdensome”
 Pain/Suffering
 Cost/Benefit
 Quality of Life
Costs
 To patient
 To family
 To health care system
 To community
 Common Dillemma
 Resource base
 “Burdensome”
 “Disproportionate”
 BLS/ALS
 Cost/Benefit
 Quality of life
 DNR/NHM
 Do Not
Resuscitate/No
Heroic Measures
 1st person, proxy
 Voluntariness,
Wilfulness
 Written
 Witnessed
 Simple language
Praxis
 Active Withdrawal
 Passive, watchful
waiting
 Forms
 Written
 Witnessed
 Clear and Concise
 Language known
 Extent of residual care
 Cardiac
 Respiratory
 Nutrition
 Pain control
 Basic nursing services
Thank You.