Dear Attorney,
I hope this letter finds you well. I am writing to inquire if it is possible for me to seek your guidance in the process of writing a living will. I understand that this legal document is critical in outlining my wishes concerning medical treatments and other related decisions, should I be unable to make them myself.
I would appreciate your expert advice on how to proceed, particularly in ensuring that the document is in compliance with all applicable laws in the Philippines. Your assistance in navigating the specific legal requirements and considerations for a living will would be greatly beneficial.
Thank you for your time, and I look forward to your guidance.
Sincerely,
A Concerned Individual
A Comprehensive Legal Guide to Living Wills Under Philippine Law
A Living Will, also referred to as an Advance Healthcare Directive, is a legal document that enables an individual to outline their medical preferences in the event they become incapacitated and are unable to communicate or make decisions regarding their medical care. In the context of Philippine law, living wills are becoming increasingly relevant as they allow individuals to exercise their autonomy over health-related decisions and ensure that their wishes are respected when they can no longer express them.
In this article, we will comprehensively explore the concept of living wills within the Philippine legal framework. We will examine relevant laws, the process of drafting a living will, the legal enforceability of such documents, and various other factors that individuals must consider when preparing an advance healthcare directive.
1. Legal Basis for Living Wills in the Philippines
The Philippines does not have a specific law governing living wills, unlike countries like the United States that have statutes on "advance directives" or "healthcare proxies." However, the creation and use of living wills in the Philippines are grounded in the principle of autonomy and the right of individuals to make informed decisions regarding their healthcare. This principle is enshrined in various legal instruments, such as:
The Constitution of the Philippines (Article III, Section 1): This constitutional provision guarantees that no person shall be deprived of life, liberty, or property without due process of law. The right to self-determination regarding healthcare decisions is often derived from this fundamental right to liberty.
The Civil Code of the Philippines (Republic Act No. 386): Various provisions within the Civil Code support the idea of personal autonomy and respect for an individual's decisions. Although the Civil Code does not specifically mention living wills, Articles related to obligations, contracts, and consent can be interpreted to allow for the creation of advance directives.
The Doctrine of Informed Consent: This is a foundational principle in medical practice and medical law. Under Philippine law, no medical treatment can be administered without the patient’s informed consent. A living will can be seen as an extension of this principle, as it serves as preemptive consent or refusal for medical interventions in situations where the patient cannot give explicit consent at the moment.
While there is no explicit statutory framework, jurisprudence in the Philippines has increasingly recognized the importance of respecting patients' wishes in end-of-life care, though these cases typically deal with guardianship or family consent for medical procedures rather than living wills per se.
2. What Can Be Covered by a Living Will
A living will typically contains directives concerning the type of medical treatments or life-sustaining measures an individual would prefer or refuse under certain conditions. The document serves to guide healthcare providers and loved ones when the individual can no longer communicate their wishes. Here are the common matters that a living will may address:
Life-Sustaining Treatment: This includes instructions on whether to withhold or withdraw treatments that prolong life in situations where recovery is unlikely, such as terminal illnesses or irreversible comas. Examples of life-sustaining treatments include mechanical ventilation, dialysis, and artificial nutrition and hydration.
Do Not Resuscitate (DNR) Orders: A DNR directive specifies that no resuscitation should be attempted if the individual's heart stops beating or they stop breathing. This can be a critical component of a living will, ensuring that a patient’s wish for a natural death is respected.
Pain Management and Palliative Care: Many individuals include directives regarding the administration of pain relief and comfort care. These instructions may specify the level of intervention desired, such as whether they wish to receive strong medications for pain relief, even if such medications hasten death.
Organ Donation: Some living wills include provisions on whether the individual wishes to donate their organs after death, for transplant or research purposes. This can be an important aspect of the living will, as it ensures that the person’s intent is clear regarding this often-sensitive subject.
Appointment of a Healthcare Proxy: While not strictly part of the living will, many individuals may include a directive appointing a healthcare proxy or agent—a trusted person who can make healthcare decisions on their behalf if they are incapacitated. This is particularly important in situations where the living will does not cover every possible scenario, and the proxy can make real-time decisions in accordance with the individual's known wishes.
3. Process of Creating a Living Will in the Philippines
Given that Philippine law does not have a specific statutory procedure for living wills, the process of drafting this document is similar to other private documents that convey the wishes of an individual. However, to ensure that the living will is legally valid and enforceable, several best practices should be followed:
1. Written Form: A living will must be in writing. While verbal declarations of healthcare preferences may be respected in certain situations, a written document ensures that the individual’s wishes are clearly documented and can be referred to by healthcare providers.
2. Clear and Specific Directives: The directives in the living will must be clear and unambiguous. General statements such as “I do not want to suffer” or “I want to die with dignity” may be open to interpretation, which could lead to confusion or disputes among healthcare providers and family members. Instead, the document should include specific instructions regarding treatments that the individual would accept or refuse under particular medical conditions.
3. Capacity to Make Decisions: The person drafting the living will must have legal capacity at the time of its execution. This means that the individual must be of sound mind and must understand the nature and consequences of the decisions being made. If there is any question about the individual’s mental state, medical professionals or witnesses may be called upon to certify the person's capacity at the time the will was made.
4. Witnessing and Notarization: While Philippine law does not mandate notarization or witnesses for a living will, it is highly advisable to have the document witnessed by at least two disinterested individuals and, ideally, to have it notarized. Notarization provides a higher degree of authenticity and makes it more likely that healthcare providers and courts will respect the document.
5. Regular Updates: The living will should be reviewed and updated periodically, especially if there are significant changes in the individual’s health or medical preferences. A living will that was drafted many years ago may not reflect the person’s current wishes or take into account advances in medical technology.
4. Legal Enforceability of a Living Will
One of the key concerns for individuals creating a living will is whether it will be legally enforceable when the time comes. In the absence of specific legislation on living wills in the Philippines, the enforceability of these documents depends largely on the willingness of healthcare providers and family members to honor them.
Family Consent: In practice, healthcare providers in the Philippines often defer to the family when making decisions about a patient’s care, particularly when the patient is incapacitated. While a living will can serve as a guide, it may not always be followed if the family objects. This can lead to disputes, especially if family members are not in agreement with the patient’s documented wishes.
Judicial Intervention: In cases where there is a dispute between the healthcare provider and the family, or among family members, a court may need to intervene to determine whether the living will should be followed. Given the lack of specific laws on living wills, Philippine courts will typically refer to general legal principles such as informed consent, autonomy, and the best interests of the patient when resolving such disputes.
5. Ethical and Practical Considerations
When drafting a living will, individuals must consider not only the legal aspects but also the ethical and practical implications of their decisions. Some of these considerations include:
Religious Beliefs: Many Filipinos have strong religious beliefs that may influence their decisions regarding life-sustaining treatment and end-of-life care. It is important for individuals to reflect on their personal values and, if necessary, consult with religious advisors when drafting their living will.
Family Dynamics: In the Philippines, family plays a central role in decision-making, particularly in medical and end-of-life situations. Individuals drafting a living will should consider discussing their preferences with family members ahead of time to reduce the likelihood of conflict later on.
Medical Developments: Advances in medical technology mean that treatments that were once considered extraordinary or futile may now be effective. Individuals should remain open to revisiting their living will and updating their directives as new medical treatments become available.
Conclusion
Although the Philippines does not yet have a specific legal framework for living wills, the increasing recognition of personal autonomy and the right to refuse medical treatment makes it possible to create a living will that is both ethically and legally sound. By clearly outlining one's medical preferences, a living will can help ensure that the individual's wishes are respected, even in situations where they are unable to communicate them directly.
However, given the absence of codified law, it is crucial to follow best practices when drafting such a document, including having it in writing, ensuring clarity, and seeking appropriate witnesses or notarization. It is also advisable to consult with an
attorney who can help navigate the legal complexities and ensure that the living will is properly executed.
For individuals concerned about ensuring that their medical wishes are respected, a well-drafted living will can provide peace of mind and reduce the burden on loved ones in making difficult healthcare decisions.