University of Santo Tomas

Faculty of Arts And Letters

A Study on the Awareness of Patients in theSelected Public Hospitals in Manila

regarding their Legal Rights

Submitted By:
Libiran, Jared Ruiz A.
Montemayor, Anna Carmela B.
November 6,2015

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CHAPTER 1
The Problem and its Background
This chapter presents the introduction, objectives, theoretical framework, conceptual
framework, statement of the problem, hypothesis, significance of the study, scope and
limitations, and definition of terms.

1.1.Introduction
Beggars cannot be choosers; so are patients in the public hospitals.
The situation of the Philippine public healthcare is alarming.With the lack of public
hospitals, the poor accommodation and sub standard facilities in these hospitals add up
to the problem.
Dr. Rusty Jimenez of the Private Hospitals Association of the Philippines said that there
are only 1,800 hospitals in the country both private and government-owned with a total
bed capacity of 77,000.Jimenez added that with the population of 100 million people, the
bed to patient ratio in Philippine hospitals is at one bed for every 1,000 patients.
(Dagooc, 2014)
Increasing migration of health professionals has also largely depleted the pool of health
practitioners. Doctors and nurses are leaving the country at an ever faster rate.
Dr. Melchor Rey Santos, president of the Philippine Medical Association (PMA), reported
that of the 35,000 doctors in the PMA roster, 6,000 are now working abroad. Another
4,000 have opted to retrain and shift to the nursing profession, in preparation for an
overseas job as a nurse.(Diez, 2010).

3
In the statistics of the Philippine HRH Master Plan and Nursing Workforce Management
of the Institute of Health Policy and Development Studies, University of the Philippines
Manila-National Institutes of Health, 221,323 out of 421,467 nurses who passed the
Board were unemployed in 2012,It is also estimated that from 2001 to 2011 there were
132,943 overseas-employed nurses, and only 67,202 were locally employed.
(Ermitanio&Alviar,2014)

Despite the Department of Healths vibrancy in promoting the selling and buying of
generic medical products, the cheapest generics are still unaffordable by many of the
average Filipinos. (Picazo, 2012)
Moreover, Philippine College of Physicians president Dr. Anthony Leachonpointed out in
their health forum last 2014 that the underprivileged in the Philippines have low health
literacy. Most of the marginalized Filipinos are not educated and inferior in terms of
understandingthe basic health information and services resulting to a higher death rate
in the country.
Lack of facilities and practitioners, high cost of medicine and hospitalization and the
inadequacy of dissemination of basic health information; these are violations of human
rights as Filipino patients are seemingly deprived of those.
The Commission on Human Rights of the Philippines defines human rights as the
supreme, inherent, inalienable rights to man as a human being and those which he may
legally inherit or acquire by title as necessary to his life, liberty, dignity and self
development, including those that may accrue to him in the course of his existence,
resulting either from the dynamic, ever-changing complexities of modern living, or those

4
bestowed upon him that make him a more revered human being of even greater stature
than before.
Clear enough, when medical treatment were not availed due to the said existing
problems, it could be considered as deprivation of the patients inherent right to life,
especially for those who have serious illness who are badly in need of medical
assistance.
This study is about the awareness of the patients in the selected public hospitals in
Manila regarding their legal rights. In this study, the researchers assessed the current
state of patients rights and its implementation in the selected public hospitals in Manila.
The researchers chose Manila as the location of the study for it is the most diverse and
populous city in the Philippines. The factors affecting the patients unawareness
regarding their legal rights are also determined.
1.2. Objectives of the Study
The primary objective of this study is to assess the current state of patients rights and its
implementation in the selected public hospitals in Manila.
1.2.1 Specific Objectives
The researchers also have the following as specific objectives:
-

Find out the laws and jurisprudence establishing patients rights in the Philippines
Determine the factors affecting the patients unawareness regarding their legal

rights in the selected public hospitals in Manila

Assess the development and implementation of policies regarding patients rights

of the selected public hospitals in Manila

Raise awareness in the need to address the problem regarding the patients
unawareness of their legal rights

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1.3. Theoretical Framework
1.3.1. Immanuel Kants Theory on Rights
According to Immanuel Kants Theory on Rights, human rights, within the perspective of
politics, are provided by the government. These rights guarantee the freedom of its
constituents and from that freedom, the constituents derive other rights.
The development, creation and implementation of rights are primarily dependent on the
government and its respective branches. In order for a society to be able to function
properly, the state must give and enhance fundamental rights, laws, and entitlements.
According to Kants teachings, these laws are founded upon 3 rational principles:
1. The liberty of every member of the society as a man
2. The equality of every member of the society with every other, as a subject
3. The independence of every member of the commonwealth as a citizen
The first principle is based upon the idea of liberty of individuals. Kant emphasizes the
importance of the liberty of individuals as the state or commonwealth is not allowed to
dictate the lives of individuals.
The second principle introduces the idea of the equality of every member of society.
Equality for each member within the state under the guidance of a ruler is important for
there to be a common basis for everyone within the state. Everyone must possess the
same rights within the state so that laws can be evaluated and be applied in the same
equal manner for everyone. Equality, as stated by Kant, therefore, is the basis from
which rights for every human being originate.

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The last principle is the idea that every member of the state is independent as a citizen.
Rights develop from this principle because it is up to the individual to act independently if
a right or law is to be practiced. If a member of society is incapable of acting
independently without the guidance of the commonwealth, rights would not be needed.

1.3.2. Jean-JaquesRosseaus Social Contract Theory

The Social Contract Theory is the theory in which the persons moral and legal
obligations are dependent upon a contract or agreement among them to form the society
in which they live.
In Rosseaus Social Contract Theory, he further describes the theory by giving the
historical process in which man began in a state of nature and over time progressed
into civil society. Rosseau further explained his theory by explaining that before civil
society was formed, people lived solitary and uncomplicated lives. The abundance of
nature and the relatively small size of the population, competition were non-existent, and
men rarely see each other, much less had reason for conflict or fear. Man, therefore, was
not inclined to bring harm to one another.
However, as time passed, their population increased. The means by which people could
satisfy their needs began to change. People began living in small communities.
Discoveries and inventions have made life easier and the concept of leisure time arose.
Such leisure time inevitably led people to make comparison between themselves and
others resulting in making public values.

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The invention of property, Rosseau further states, should be regarded as the fall from
grace out of the State of Nature for it had brought greed, competition, vanity, inequality
and vice.
With the introduction of property, conditions of inequality became more pronounced
which led to the development of social classes and the eventual formation of the
government.
Rosseau stated in his work that the formation of the government cements the
inequalities property has produced. He then proposed the idea that men are endowed
with freedom and equality by nature; however their nature has been corrupted by their
history. Men can overcome this corruption, however, by invoking their free will to
reconstitute themselves politically, along strongly democratic principles.

1.3.3. Abraham Maslows Hierarchy of Needs

According to Maslows Hierarchy of needs, men are motivated to achieve certain needs.
Maslow devised a hierarchy of human needs that is based on two groupings: deficiency
needs and growth needs. In the deficiency needs, each lower need must first be
satisfied in order to move to the next level. Once each of these needs have been
satisfied, and if at some future time a deficiency is detected, the individual will
immediately act to remove the deficiency. The first four levels are:
1. Physiological hunger, thirst, bodily comforts, etc.;
2. Safety or security security from danger;
3. Belongingness and Love Affiliation with others, acceptance;

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4. Esteem to achieve, competence, gain approval, and recognition.
Maslow further explained his theory by stating that an individual is ready to act upon the
growth need when deficiency needs are met. Maslows initial conceptualization included
only one growth need however; Maslow later differentiated the growth need of selfactualization. Maslow identified two of the first growth needs as part of the more general
level of self-actualization and one beyond the general level that focused on growth
beyond that oriented towards self. The following are:
5. Cognitive the urge to know, to understand, and explore;
6. Aesthetic appreciation for symmetry, order, and beauty;
7. Self-actualization to find self-fulfillment and realize ones potential; and
8. Self-transcendence to connect to something beyond the ego or to help
others find self-fulfillment and realize their potential.

1.3.4. Principle of Autonomy

The concept of Autonomy is one of the four traditional pillars of Bioethics. It refers to
the capacity to think, decide and act on ones own free initiative. In the perspective of the
medical field, physicians and family members are obligated to help the patient come to
their own decision by providing full information; they should also uphold a competent,
adult patients decision, even if it appears medically wrong.

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1.4. Conceptual Framework

Theory of Rights

Laws

Social Contract Theory

Hospitals

Patients Rights

Principle of Autonomy

Hierarchy of Needs
Theory

Patients
in
selectedp
ublic
hospitals
in Manila
Survey Method

Interview Method

Patients in the selected

hospitals in Manila are not
aware of their legal rights

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According to the Theory of Rights, rights must be given or enhanced by the government
through enactment and implementation of laws in order to have a fully functioning state.
These laws gave the moral and legal obligations to hospitals and health practitioners to
promulgate the rights of patients following the social contract theory stating that rights
are acquired by agreement between the government and the people.
The patients in the selected public hospitals in Manila on the other hand, must be able to
know their legal rights by the virtue of the principle of autonomy, stating that all patients
must have knowledge about their current status so he may be able to decide for himself
without force or coercion; and the hierarchy of needs theory which demands the
satisfaction of physiological need in which health satisfaction belongs.
In this study, the researchers want to prove through interview and survey method that
patients in the selected public hospitals in Manila are not aware of their legal rights, and
determine the factors of their unawareness.
1.5 Statement of the Problem
In order to achieve the objectives and realize the significance of the study, the
researchers formulated the following problems:
1.5.1. General Problem
Whether or not patients in selected public hospitals in Manila are aware of their rights as
patients
1.5.2. Specific Problems
1. Are the laws concerning patients rights adequate?

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2. What are the factors affecting the patients unawareness regarding their legal rights in
the selected public hospitals in Manila?
3. Is the implementation of the policies of the selected public hospitals in Manila
regarding the patients rights sufficient?

1.6. Hypothesis
1.6.1 Hypothesis for the General Problem
H0: The patients in the selected public hospitals in Manila are unaware of their legal
rights.
H1: The patients in the selected public hospitals in Manila are aware of their legal rights.
1.6.2 Hypotheses for the Specific Problems
1. H0: Philippine laws that govern patients welfare and rights are adequate.
H1: Philippine laws that govern patients welfare and rights are not adequate.
2. H0: The factors affecting the unawareness of patients to their legal rights are
brought about by the government and the hospital
H1:The factors affecting the unawareness of patients to their legal rights are
not brought about by the government and the hospital
H2 : The factors affecting the unawareness of patients to their legal rights are
brought about by the government only

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H3 : The factors affecting the unawareness of patients to their legal rights are
brought about by the hospital only
3. H0: The implementation of the policies of the selected public hospitals in
Manila regarding the patients rights is insufficient
H1: The implementation of the policies of the selected public hospitals in
Manila regarding the patients rights is sufficient.
1.7. Significance of the Study
The researchers deemed that the study would prove to be significant to the following
groups and entities:
First and foremost, the study would greatly benefit patients as this study aims to improve
the lives of patients, especially the ones who are in public hospitals.
Second, this study will provide the legislative body of the Philippines the facts which
would be useful for the creation and development of policies that would genuinely benefit
patients.
Third, the study may contribute to the assessment and implementation of policies of
public hospitals that would affect the patients welfare and the improvement of their
accommodation and service to patients.
Fourth, the University of Santo Tomas would also benefit as the study would contribute
to its intellectual property.
Fifth, this study may serve as a reference for future researchers who wish to conduct a
study regarding patient rights in the Philippines.

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Sixth, through this study, the researchers would to raise awareness to the general public
of their rights as patients
Lastly, the student researchers would greatly benefit as this study is essential to the
fulfillment of the requirements needed in the completion of their bachelors degree in
Legal Management.

1.8.Scope and Limitations

The researchers study aims to determine whether or not the patients in public hospitals
in the city of Manila are aware of their rights and the factors that affect their knowledge
on the matter. The study is only concerned about the patients rights which are given in
the Philippine jurisprudence
The rights which the researchers refer to are the rights that are stated in the bill of rights,
laws passed by congress, and regulations and ordinances of the leading medical
associations in the Philippines.
The researchers have conducted their study on patients who are not terminally ill, have
discernment and are of sound mind, and who are confined in selected public hospitals in
the city of Manila only, namely,
The researchers will use survey forms and would be conducting interviews to the
patients, medical practitioners and government agencies which are involved in the
development and implementation of policies concerning patients rights. No other
methods will be used.
The research was conducted from August 2015 to April 2016.

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1.9. Definition of Terms

Autonomy is defined as a moral or ethical principle which means a patients right to self
determination without outside control.
Bioethics is defined as ethics concerning life.
Hierarchy of needs is a theory formulated by Abraham Maslow which states that men
are motivated by their needs. Maslow further explained his theory by formulating a
pyramid where men must satisfy the lower ranking needs in order for them to satisfy the
needs that Maslow has placed on top of his pyramid.
Hospital is an institution that devoted primarily to the maintenance and operation of
facilities for the diagnosis, treatment, and care for individuals suffering from illness,
disease, injury or deformity, or in need of obstetrical or other medical or nursing care.
Rights are privileges that individuals, by legislation or their inherent nature, are entitled
to.
Malpractice is the improper performance of professional duties; a failure to meet the
standard of care that resulted in harm to another person.
Negligence is the failure to act as an ordinary prudent person; a person is harmed as a
result of the failure to act.
Patient is defined as an individual who receives medical treatment.
Patients' rights are right enjoyed by the patient.

15
Public Hospital is defined as a hospital that is operated and maintained either partially
or wholly by the government or any other political subdivision, or by any department,
division, board or other agency thereof.
Slovin's Formula is the formula used by the researchers to determine the sample size
of a population that must be taken for a specific study.
Social Contract Theory is a theory formulated by Jean-JaquesRosseauwhich states
that the persons moral and legal obligations are dependent upon a contract or
agreement among them to form the society in which they live.
Survey Method is a method used in quantitative researches that uses surveys where
the respondents would answer.
Theory of Rights is a theory by Immanuel Kant which states that in order to have a fully
functioning state; the government must develop and enhance rights that their
constituents would enjoy.

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Chapter 2
2.2.1.Health and human rights resource guide (2013). Harvard School of Public
Health- Harvard University
In a resource guide published by Harvard University, they defined patient care as the
prevention, treatment, and management of illness and the preservation of physical and
mental well-being through services offered by health professionals and those, which
even though were non-professionals, has supervision to the patients. A patient has an
access to such care whether he or she is healthy or sick.
The resource guide also cited six basic aspects of patients rights, which one may
exercise upon availing patient care; the right to information of their rights,

right to

medical treatment, right to refuse medical treatment, right to dignity and autonomy, right
to participate in making health care decisions, right to informed consent, and right to
confidentiality and privacy. All of which are patterned to the Universal Declaration on
Bioethics and Human Rights
Moreover, the resource guide also addressed certain issues regarding these rights,
particularly in the right to information, right to confidentiality and privacy and the right to
informed consent.
In the right to information, the resource guide cited a study conducted at four hospitals in
Lithuania, where it was found out that 85% of the staff and 56% of the patients in those
hospitals said that they heard of and read about patients rights laws.
However, only 50% of professionals and 69% of patients thought it was necessary for
patients to have information about diagnosis, treatment results, and alternative modes of
treatment.
In addition, the resource guide cited another study in Macedonia where it was found that
82% of respondents stated that there are patient rights, but 56% did not know what their
rights were

17
The resource guide stated that the right to privacy and confidentiality are
crucialespecially

for patients seeking diagnosis and treatment of sexually related

illnesses, such as HIV/AIDS, and also mental illness; for those illnesses give other
people negative presumptions regarding the patient, consequently exiling them to the
society.
The resource guide suggested that health care centresshould only allow the patients,
and other specific providers, which would value the confidentiality of the patients to
access the patients health information. For example, a nurse who is vaccinating a
patient may not access that individuals private mental health records because the
information is not relevant to the treatment being provided at that current moment
Lastly, the resource guide defined Informed consent as not mere acceptance of a
medical intervention, but a voluntary and sufficiently informed decision, protecting the
right of the patient to be involved in medical decision-making, and assigning associated
duties and obligations to health-care providers. The right to informed consent is central
to the right to health.
Issues that arise concern the competency or legal capacity of the patient to consent,
respect for personal autonomy, the sufficiency and completeness of information, and
circumstances compelling limits on the need for informed consent, like those patients
who are in comatose and cannot give their consents.
In a study of 732 European surgical patients in obstetrics and gynecology during a sixmonth period, about 46% believed that the primary function of the written consent form
was to protect the hospital, and 68% thought that the form allowed doctors to take
control, while only 41% believed consent forms expressed their own wishes for
treatment.
Derogations, or departures, from the right to informed consent are necessary at times,
but the question of when derogations may be permitted is a complicated one. When a

18
patient is unconscious, medical providers must seek consent from a legally entitled
representative. However, if there is an emergency situation where the patients life is in
danger, medical providers may presume that consent is given. Issues of informed
consent also arise from public health policies that require compulsory testing,
compulsory vaccinations, or mandated quarantine during epidemics.
Procedural safeguards are crucial to derogations from informed consent, to ensure that
proper circumstances are met and to provide a means to challenge the departure from
the law.
2.2.2

Protecting

Patients'

Rights.

(2012).

Retrieved

from

http://www.cdc.gov/tb/education/ssmodules/module7/ss7reading2.htm
The US Center of Disease Control Prevention stated the four basic rights of patients to
protect their personal and private information relevant to their medical care. These are
the right to give or withhold authorization or disclosures, the right to maintain privacy, the
right to have autonomy, and the right to be given information. All of which are also
patterned to the Universal Declaration on Bioethics and Human Rights.
The right to withhold authorization or disclosure is the act of keeping,

revealing or

distributing personal information. A patient discloses his or her personal information to

the health care worker in order to receive appropriate treatment and quality care.

To the extent possible, the patient should have control over who will receive any
personal information, what information should be released to each requestor and the
duration of the authorization.The patient generally has the right to control who has
access to confidential information except as otherwise provided by law. The patient
needs to give specific authorization or permission to allow a third party to have access to
confidential information.

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Regarding the right to maintain privacy, the health care workers taking care of the
patients should protect information revealed during provider-health care worker
encounters, including all written or electronic records of these encounters. Only those
persons directly involved in the care of the patient's health problem should have access
to private information.
Autonomy is the right of a patient to determine what will be done with his or her body,
personal belongings, and personal information; this concept applies to any adult person
who is mentally competent. Sometimes the right to autonomy can be overridden in the
interest of protecting others who may be harmed by the patient's decisions.
Sometimes the right to autonomy can be overridden in the interest of protecting others
who may be harmed by the patient's decisions. For example, a patient who has a highlycontagious disease cannot invoke his right of autonomy to refuse medical treatment
because his disease might infect others as well.
Lastly, the patient has a right to be given information about his or her medical diagnosis,
treatment regimen, and progress. This allows the patient to make appropriate, informed
decisions about his or her health care.
In connection to this right, a patient also has a right to review the information in his or her
medical record. A patient may want this information, to learn more about his or her health
care or in preparation for a change of health care workers. If the record contains errors
or omissions, the patient can request a correction or amendment.
2.2.3 Mateo, I. (2014) Low health literacy level alarming, making Filipinos more
sick- doctor.GMA News online.Retrieved from:http://www.gmanetwork.com/ne
ws/story /366216 /lifestyle /healthandwellness/low-health-literacy-level-alarmingmaking-filipinos-more-sick doctor#sthash.tktmpQuB.dpufhttp://www.gmanetwork.

20
In a article published by Mr. Ibarra Mateo last June 18, 2014, it was stated that the low
health literacy of Filipinos, especially the poor, is one of the key drivers causing the
ranks of unhealthy and sick Filipinos to swell at an alarming rate.
Philippine College of Physicians president Dr. Anthony Leachonsaid that when a typical
Filipino patients come toto seek medical advice, they are very sick already. He said that
this is failure of health literacy
Health literacy, as defined by the US Center for Disease Control and Prevention (CDC),
is the degree to which an individual has the capacity to obtain, communicate, process,
and understand basic health information and services to make appropriate health
decisions.
The result of low health literacy, which is a higher rate of hospitalization to Philippine
medical centers, adds up to the lack of medical facilities and other medical health care
problems faced by the Philippines today.
Leachon said grinding poverty and the accompanying low level of education among poor
Filipinos aggravate the low health literacy among them, leading further to the dismal
health situation in the Philippines.
Underpriviledge sick Filipinos, who most of the time are suffering from chronic and
terminal illnesses, could not afford the medicines that they need due to their high price.
In addition,The shortage of medical doctors and other health professionals in rural areas,
coupled with the lack of health infrastructure in the countryside, intensify the impact of
the low health literacy.

Still, the Philippines is not the only country having to deal with the problems caused by
low health literacy.In the US, for example, the National Assessment of Adult Literacy
released by the US Department of Education in 2006 revealed that only 12 percent of
American consumers have proficient health literacy skills, suggesting that nearly nine out

21
of 10 adults may lack many of the skills necessary to sufficiently manage their health.

The CDC said that low health literacy can affect a persons ability to locate health care
providers and services, fill out health forms, share personal health information with
providers, manage chronic diseases, and engage in self-care.

About one-third of US adults have trouble reading and acting on health-related

information and that even those with higher health literacy skills want health information
that is understandable, meaningful to them, and easy to use.
In the end, Leachon suggested that the society needs to educate their children at the
very young age about health literacy. It was also stated by Leachon that the parents play
a vital role in educating their children, and it must start in educating them regarding to
what they should eat, for most of the illness is caused to what people intake to their
bodies.

2.2.4.Rajesh D.,AbhishekS., Mukul C., Gaurav S., Venkteshan M., Bhardwaj A.,
Balbir K. &Aggarwal O. (2013).Patients awareness, attitude, understanding and
perceptions towards legal nature of informed consent.J Indian Acad Forensic
Med: India.
This study was conducted to ascertain patients awareness, attitude and perceptions
towards legal nature of informed consent.
According to this study, Informed consent is an autonomous action by a subject or
patient that authorizes a professional either to involve the subject in research or to
initiate a medical plan for the patient. In simple terms, it is the fundamental mechanism
where the physician informs the patient about the options for the diagnosis and
treatment of the patient's illness.

22
Informed Consent originates from the legal and ethical rights of the patient have to direct
what happens to his body and from the ethical duty of the physician to involve the patient
in his/her health care.
The most important goal of informed consent is that the patient should have an
opportunity to be an informed participant in his health care decisions so it acts as a
safeguard to ensure the preservation of individual rights.
In this study, a structured interview to 555 patients was conducted in several Indian
hospitals from January to June 2011. The researchers of this study inferred that the
patients that they interviewed had several misconceptions regarding their giving of legal
consent.
In the results, 75% of the patients falsely believed that informed consent was a legal
requirement.They believe that without signing the informed consent, they would not be
treated anymore. In connection to this, 68.8% of the respondents thought that signing
the consent meant waving their rights to any compensation.
Meanwhile, 88 % of the patients under study thought that they had no right to change
their minds after signing the consent. 75.2% of the respondents alsobelieved that they
would be left to die had not they signed the consent. 83.8% signed the consent form so
that they can undergo required operative procedure
In the end, the study concludes that there exists a vast discrepancy between the
informed consent that perceived by patients. Current consent procedures seem
inadequate as a means for the expression of autonomous choice and their ethical
standing can be called into question.
2.2.5. Yaghobian M. ,Kaheni S. , Danesh M. &Abhar F.(2014) Association between
awareness of patient rights and patients education, seeing bill, and age: a crosssectional study.Global Journal of Health Science Vol. 6 (3).Canadian Center of
Science and Education: Canada

23
This study aims to determine the awareness ofpatients from four hospitals located Sari,
Iran regarding their legal rights in order to ascertain the effectiveness of their patients bill
of rights.
The study population consisted of 336 patients recruited from the hospitals affiliated with
Mazandaran University of Medical Sciences in Sari, through calculating the selection
quota of each hospital. Data were collected through face-to-face interview on discharge,
using a two-section questionnaire based on the bill of patient rights and with verified
reliability and validity.
The results indicate that out of 336 individuals, 55.4% were women and 44.6% were
men. Most patients were educated below high school level (36%); 25% were illiterate
and only 4.2% had a bachelors degree.
63.4% of the respondents answered negatively to the question inquiring whether or not
they had seen the charter of patient rights, and only 36.6% had seen the charter.
As for the source of information on the contents of the bill, out of 36.6% who had
responded positively, 28.3% mentioned the hospital as their source and only 1.5% had
received any information from public media.
In the second part of the questionnaire, the results indicate that the awareness score
ranging from 0 to 10 had a mean value of 3.226 and a standard deviation of 3.68. Most
patients (58.9%) had poor knowledge, 12% had intermediate knowledge, and 29.1% had
good knowledge
The researchers of this study concluded that patients are not sufficiently aware of their
rights, and this problem requires comprehensive planning to be resolved.

Rights of Patients in the International Community

24
The United Nations, through the United Nations Educational, Scientific and Cultural
Organization (UNESCO), have published several documents that emphasize the
importance of the rights of patients. The Universal Declaration on the Human Genome
and Human Rights, the International Declaration on Human Genetic Data, and the
Universal Declaration on Bioethics and Human Rights all have emphasized the
importance of the importance of the patients dignity and rights as a patient.
Rights of Patients in the Philippines
The 1987 Constitution of the Philippines have been the cornerstone of every law and
jurisprudence in the Philippines. Article III of the 1987 Constitution provides the rights
that are exercised by a Filipino citizen. It is obvious that these rights should as well be
enjoyed by any person that is under the jurisdiction of the Philippine laws even if they
are patients.
As stated under the following sections under the Article III of the Philippine Constitution:
Section 1:
No person shall be deprived of life, liberty or property without due
process of law, nor shall any person be denied the equal protection of the laws.
Section 3:
1. The privacy of communication and correspondence shall be inviolable
except upon lawful order of the court, or when public safety or order requires otherwise
as prescribed by law.
2. Any evidence obtained in violation of this or the preceding section shall
be inadmissible for any purpose in any proceeding.

25
It is the patients right to give informed consent and in order for this to be observed, the
physician must inform the patient of their diagnosis, the general nature of the
contemplated procedure, the risks involved, the prospect of success, the potential
danger if the procedure is not applied, the alternative methods if there are any.
Generally, the patient is the only one who can give informed consent however; there are
conditions to be fulfilled in giving informed consent. The patient must be of legal age and
of sound mind.
If the patient is unable to give the informed consent because of his inability to fulfil the
given conditions, his spouse, children, parents or siblings may give consent in his behalf
provided that they are legal age and are of sound mind.
If the listed persons above are not able to give consent, the patients next of kin may
give consent or even the state, represented by the City Health Officer, the Municipal
Health Officer, or the Medical Director, if the listed persons above are absent or are
unable to give consent.
There are instances where informed consent requires more disclosure of facts. One
instance is when the procedure entails much risk. The other is when the procedure is
innovative and experimental in character.
There are also instances where a detailed disclosure of facts is not required. One
instance is when the disclosure of facts would cause emotional distress to the patients
and the other is when the medical procedure is publically known.
This right is based on the fiduciary relationship of the patient and physician, the human
beings right to self-determination, and the contractual nature of the patient-physician
relationship.

26
This right protects the patient from unnecessary or unwarranted medical procedure
without his consent, and to protect the physician from any consequence for failure to
comply with legal requirements.
However, there are instances where the patients consent is not needed. In cases of
emergency, where the patient is unconscious and there is no one who can give consent
in his behalf. Another case is when the law makes it compulsory for everyone to submit
to the procedure. An example of this is the Presidential Decree 996, where it mandates a
compulsory basic immunization for infants and children who are below eight years of
age.
The patients right to religion is also respected by the hospital. The patient may refuse
treatment if the procedure goes against the teachings of his church. A member of the
Jehovas Witness may refuse blood transfusions.
The patient also has the right to privacy,
Intrusion may occur in the following ways:

When the patient is expected to be alone

Publishing information about the patient which might be objectionable or

offensive to ordinary persons

Appropriating for commercial purposes some aspects of personality or
facets of the patients life

The right to privacy of a patient, however, may be violated for the purpose of protecting
the public. The police power of the state is far more supreme than the welfare of the
patient.
According to Republic Act No. 7610, The Act Providing for Stronger Deterrence and
Special Protection Against Child Abuse, Exploitation and discrimination, Providing

27
Penalties for its Violation, and for other Purposes, the best interests of the children
should be paramount in all actions concerning them, whether undertaken by public or
private social welfare institutions, courts of law, administrative authorities, and legislative
bodies. Therefore the patients right to privacy may be disregarded if it goes against the
childs best interests.
Executive Order No. 212, a statute that amends Presidential Decree No. 169, states that
the attending physician of any hospital, medical clinic, sanitarium or other medical
establishments, or any other medical practitioner, who has treated any person for
serious or less serious physical injuries as these injuries are defined in Articles 262, 263,
264 and 265 of the Revised Penal Code shall report the fact of such treatment promptly
to the nearest government health authority.
Rule 130, Section 21(c) of the Rules of Court provides:
A person authorized to practice medicine cannot in a civil case without the consent of
the patient cannot be examined as to any information which he may have acquired in
attending such patient.
There are instances where the right to privacy of the patient is violated when there is a
lawsuit filed by the patient against the doctor.
The patient has the right to be treated.
According to Republic Act No. 6615, An Act requiring Government and Private Hospitals
and Clinics to Extend Medical Assistance in Emergency Cases, states that all hospitals,
whether private or public, and clinics that are duly licensed are required to render
immediate emergency medical assistance and to provide facilities and medicine within
its capabilities to patients in emergency cases who are in danger of dying and/or who
may have suffered serious physical injuries.

28
Republic Act No. 8344, An Act Penalizing the Refusal of Hospitals and Medical Clinics to
Administer Appropriate Initial Medical Treatment and Support in Emergency or Serious
Cases, Amending for the Purpose Batas Pambansa Bilang 702, states that:
In emergency or serious cases, it shall be unlawful for any proprietor, president, director,
manager or any other officer, and/or medical practitioner or employee of a hospital or
medical clinic to request, solicit, demand or accept any deposit or any other form of
advance payment as a prerequisite for confinement or medical treatment of a patient in
such hospital or medical clinic or to refuse to administer medical treatment and support
as dictated by good practice of medicine to prevent death or permanent disability:
Provided, That by reason of inadequacy of the medical capabilities of the hospital or
medical clinic, the attending physician may transfer the patient to a facility where the
appropriate care can be given, after the patient or his next of kin consents to said
transfer and after the receiving hospital or medical clinic agrees to the transfer: Provided,
however, That when the patient is unconscious, incapable of giving consent and/or
unaccompanied, the physician can transfer the patient even without his consent:
Provided, further, That such transfer shall be done only after necessary emergency
treatment and support have been administered to stabilize the patient and after it has
been established that such transfer entails less risks than the patient's continued
confinement: Provided, furthermore, That no hospital or clinic, after being informed of the
medical indications for such transfer, shall refuse to receive the patient nor demand from
the patient or his next of kin any deposit or advance payment: Provided, finally, That
strict compliance with the foregoing procedure on transfer shall not be construed as a
refusal

made

punishable

by

this

Act.

29
Republic Act No.9439, an Act Prohibiting the Detention of Patients in Hospitals and
Medical Clinics on Grounds of Nonpayment of Hospital Bills or Medical Expenses,
prohibits any hospital or medical clinic in the country to detain or to otherwise cause,
directly or indirectly, the detention of patients who have fully or partially recovered or
have been adequately attended to or who may have died, for reasons of nonpayment in
part or in full of hospital bills or medical expenses.
The Hippocratic Oath
I SWEAR in the presence of the Almighty and before my family, my teachers, and my
peers that according to my ability and judgement I will keep this Oath and Stipulation.
To RECKON all who have taught me this art equally dear to me as my parents and in
same spirit and dedication to impart knowledge of the art of medicine to others. I will
continue with diligence to keep abreast of advances in medicine. I will treat without
exception al who seek my ministrations, so long as to treatment of others is not
compromised thereby, and I will seek counsel of particularly skilled physicians where
indicated for the benefit of my patient.
I WILL FOLLOW the method of treatment which according to my ability and judgement, I
will consider for the benefit of my patient and abstain from whatever is harmful or
mischievous. I will neither prescribe nor administer a lethal dose of medicine to any
patient even if asked nor counsel any such thing nor perform the utmost respect for
every human life from fertilization to natural death and reject abortion that deliberately
takes a unique human life.
WITH PURITY, HOLINESS AND BENEFICIENCE I will pass my life and practice my art.
Except for the prudent correction of an imminent danger, I will neither treat any patient
nor carry out any research on any human being without the valid informed consent of the

30
subject or the appropriate legal protector thereof, understanding that research must have
as its purpose the furtherance that research, must have its purpose the furtherance of
health of that individual. Into whatever patient setting I enter, I will go for the benefit of
the sick and will abstain from every voluntary act of mischief or corruption and further
form the seduction of any patient.
WHATEVER IN CONNECTION with my professional advice or not in connection with it
may see or hear in the lives of my patients which ought not to be spoken abroad, I will
not divulge, reckoning that all such should be kept secret.
WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life
and the practice of the art and science of medicine with the blessing of Almighty and
respected by my peers and society, but should I trespass and violate this Oath, may the
reverse by my lot.
Administrative Oath
I hereby solemnly swear that I will support and defend the constitution of the Philippines;
That I will obey the laws, legal order and decree promulgated by the duly constituted
authorities of the Republic of the Philippines; and that I impose this obligation upon
myself voluntarily, without mental reservation or purpose of evasion.
I further solemnly swear that at all times and places, I will adhere to the ethical and
professional rules generally accepted by the medical profession in the Philippines;
And I will faithfully discharge to the best of my ability the duties and obligations
incumbent upon a legally authorized medical practitioner.

31
Chapter III
Research Methods
3.0

Research Designs
The information with regards to the research methods employed in the study on

the subject of Teenage pregnancy: A Growing Problem among the Youth of NCR will be
thoroughly explained in this chapter. The procedure of survey through the use of written
questionnaires will be utilized in order to gather the data needed for the accomplishment
of the research. The questionnaire that was formed used questions involving the use of
Likert scale, Dichotomous questions, and Close-ended statements as designs with the
purpose of measuring the respondents point of view when it comes to the continuous
proliferation of teenage pregnancy in the Philippines, specifically NCR. Those were
intentionally employed in order to determine whether the factors specified, particularly
(1) social media, (2) peer pressure, (3) family and, (4) liberality, have a significant
relationship with regards to the continuous rise on the rate of pregnant adolescents.
The survey will be conducted among the students of University of Santo Tomas,
particularly those students from the Faculty of Arts and Letters. For the fulfilment of the
course Research Methods and Proposal Writing, only twenty (20) students from the said
faculty will be the respondents to answer the data collecting instrument prepared.
This research is quantitative in nature. To be specific, it is correlational for the
reason that it establishes a relationship among the independent variables, particularly (1)
social media, (2) peer pressure, (3) family and, (4) liberality, and the growing problem of
teenage pregnancy among the youth of NCR which is the dependent variable of this
study. Moreover, the nature of this research is quantitative because it employed the
process of survey through the use of written questionnaires to objectively gather data.

32
The use of graphs, tables and charts will enable the researchers as well as the readers
to see and appreciate the results that will be gathered.
To distinguish whether or not there is a relationship between the dependent and
independent variable,Pearson Product-Moment Correlation will be employed as the main
statistical tool. Likert scale, weighted mean and the computation of percentage will also
be utilized as supplementary to support the analysis of data. Furthermore, graphs will be
applied to further demonstrate and exemplify the data gathered from the respondents
through the use of questionnaires.
3.1

Sampling Size and Sampling Design

The rise of pregnancy among the youth is rampant in the Philippines specifically

in NCR. This is the main reason why the data needed only covered the part of the
National Capital Region as in accordance with the scope and limitation which was
previously discussed in chapter 1. The National Statistics Office has recorded the
highest population of Filipinos situated in NCR, wherein it accounted 11,796,873.
Moreover, 300,820 are females aging from 15-19.
To be able to know the sample size needed, the Slovins Formula will be utilized.

Using the Slovins Formula

females in NCR and

N
1+ N e 2

, whereNis the total population of teenage

is the margin of error specified as 5% or 0.05, the researchers

would be able to find the

or the sample population needed as respondents.

33
Therefore, using the formula, the sample population will be obtained through the
following computations:

n=

n=

N
2
1+N e

n=

300,820
2
1+ ( 300,820 ) ( 0.05 )

300,820
754

n=399.47 female teenagers

n=399 female teenagers

The respondents needed to participate in the performance of the survey with

regards to the research is 399 females aging from 15-19 as found using the Slovins
Formula.
For the accomplishment of the course Research Methods and Proposal Writing,
only twenty (20) students from the Faculty of Arts and Letters of the University of Santo
Tomas were selected as participants for the survey. The researchers will conduct
surveys on the 23rd and 24th of March 2015 wherein the participation of the said students
will provide the responses needed.
3.2

Data Collection Instrument

The researchers have constructed a data collecting instrument which will be used

in the conduct of surveys. Compared to face-face interviews, the use of written

34
questionnaires is more cost-effective and time saving. This is evident in such a way that
it can cover a large number of the respondents population in a short period of time and
in a relatively cost-effective way. It can also reduce the bias opinions and perceptions of
the researchers for the reason that the data collection instrument that will be used on the
surveys will be uniform and precise. Lastly, the results of the questionnaires can be
quantified quickly and easily by the researchers.
The data collection instrument was comprised of several questions which were
formulated to assess the respondents perception on whether or not there is a
relationship between the rising number of teenage pregnancy among the youth situated
in NCR and among the four factors which are the following: (1) Peer pressure, (2) Media,
(3) Family, and (4) Liberality.
The instrument incorporated is composed of three main parts which are as
follows: (1) questions involving the use of Likert Scale, (2) Dichotomous questions, and
(3) close-ended questions. The said instrument was comprised of 26 questions, 8 under
the Likert scale, 10 under the dichotomous test and 8 for the close-ended questions, all
related to the groups thesis topic: Teenage Pregnancy: A Growing Problem among the
Youth of National Capital Region.
The Likert Scale was employed in order for the researchers to assign quantitative
value to qualitative data in order to make it amenable to statistical analysis. Through this
way, the respondents attitude towards the research will be accounted.
Dichotomous questions, on the other hand, were used in order to provide the
participants with a contingent market of choices. With this type of questions, the
researchers will be able to simplify the data coding and analysis.

35
The last type of questions were classified as the close-ended questions which
were useful for it is easily quantifiable. This responses that will be gathered will be easier
to compare with one another. Another is that the respondents are most likely to answer
sensitive questions. Lastly, this type of questioning is convenient for both the
researchers and the respondents for it is easy to be crafted and as well as to be
answered by the respondents.
Through the application of the following designs, the researchers will be able to
gather data that will be of much help in the investigation and fulfilment of the research.
3.3

Data Gathering Procedure

To know if there is a significant relationship between the continuous rise of the

rate of teenage pregnancy among the Filipino youths situated at NCR and the factors
mentioned such as (1) Peer pressure, (2) Media,(3) Family, and (4) Liberality, a survey
will be conducted.
The use of survey is preferred in this research because of its advantages. First,
surveys offer a high level of capability when it comes to representing a huge number of
respondents population. Second, surveys are cost-effective. The researchers only need
to prepare and provide the budget needed for the production of the copies of the data
collecting instrument. Third, surveys provide a good statistical significance. Due to the
large number of representatives that a survey can cover, the researchers can easily find
a statistically significant results compared to other data gathering methods. Lastly, the
researchers own biased perceptions can be eliminated due to the standardization of the
questionnaires that will be presented to the respondents. Through this, a precise result
can also be obtained (Treadwell, 2014).

36
The data that will be used in the research will be gathered through conducting
the process of survey using a data collecting instrument. The questionnaires were
created using suitable and modified questions arranged from the simple to the more
complicated questions to answer, formulated by the researchers themselves.
The copies of the data collecting instrument will be distributed randomly among
20 female students of the Faculty of Arts and Letters of the University of Santo Tomas,
regardless of their year and major. The respondents consciousness may affect their
honesty and effectiveness in answering the survey which is why the researchers will not
require the respondents to write down the students actual names. They will also
assurethe confidentiality of the respondents answers, using it only for academic and
classroom purposes.
3.4

Data Analysis
To scrutinize the data gathered through the conduct of surveys, the researchers

will employ the use of different statistical tools, graphs, tables and charts. These
methods will directly help the researchers in illustrating and analysing the data gathered
from the questionnaires. It will also be of much help in conveying knowledge to its
readers.
To communicate and further demonstrate a research finding, one must use a
statistical method. Statistical methods and analyses also give credibility to research
methodology and conclusion as well. The use of several statistical tools are significant to
determine the reliability and precision of the data collected with regards to the fulfilment
of the study. Furthermore, statistical analysis tools are required for a systematic and
scientifically valid analysis of the information collected through the surveys conducted.

37
To test and authenticatethe data gathered, five statistical analysis tools will be employed
and these are the following:
A. Pearson Product-Moment Correlation
Since this research aims to establish the relationship between the
proliferation of pregnant teenagers located in NCR and the factors such as (1)
Peer pressure, (2) Media,(3) Family, and (4) Liberality, the Pearson ProductMoment Correlation will be utilized as a statistical tool. As defined by the
dictionary, Thesaurus, Pearson Product-Moment Correlation is the most
commonly used method of computing a correlation coefficient between variables
that are linearly related.
According to Taylor (1990), the Pearson Product-Moment Correlation can
range from - 1.00 to + 1.00. A + 1.00 correlation means that the dependent and
independent variables are perfectly related in a positive direction. This only
means that as one variable increases, the other variable also increases. A - 1.00
correlation, on the other hand, only shows that as one variable increases, the
other variable decreases. A correlation of 0 only proves that there is no
relationship or connection between the variables. These interpretation only
indicate the direction of the variables. But regardless of the direction, the stronger
the connection, the more there is a linear relationship between the variables.
The formula to be utilized in order to determine whether or not there
exists a relationship between the variables is:

38
2

r=

x ( x)
N [ N y 2( y )]

N xy( x)( y )

Where:
N = number of pairs of scores
xy = sum of the products of paired scores
x = sum of x scores
y = sum of y scores
x = sum of squared x scores
y = sum of squared y scores
B. Likert Scale
Likert scale is employed to further analyse the information collected through
the questionnaires. It is defined as a psychometric scale which are commonly
used in surveys in order to measure directly the attitudes of the respondents with
regards to the topic of the study (McLeod, 2008). A four-point-scale was assigned
to obtain an accurate gage on the respondents outlook towards the variables
involved in the research.
The table below shows how each scale is rated:

39

Scale

Range

Interpretation

3.1-4.0

Strongly Agree

2.1-3.0

Agree

1.1-2.0

Disagree

0-1.0

Strongly Disagree

C. Weighted Mean
According to Manikandan (2011), mean is the most commonly used method
to measure central tendency. It is defined as the average of all the data gathered.
The computation of weighted mean is vital for the reason that in order to utilize
Likert scale, the researchers must first accomplish the calculation of the weighted
mean. It is computed by adding all the values in the data set and later on divided
by the number of observations involved.
The formula to be used for the weighted mean is:

X w =

WiXi

Wi

Where:

X w = Weighted Mean

W i = Weight given to each Data Value or each Number of Responses

40

X i = Data Value/ Number of Responses

= Summation

D. Percentage
To further examine the data collected through the conduct of surveys, the
researchers utilized the computation of percentage. The perspective of the
respondents will definitely be taken into account. Computing the percentage will
be substantial for the investigation of whether or not there is a significant
relationship between the variables involved in the study. The formula employed to
acquire the percentage needed is:

N
F / 100
P=

Where:
P= Percentage (%)
F= Frequency
N= Total Number of Population
E. Frequency Distribution
Through the employment of written questionnaires as the instrument for the
collection of data, scores in the answers of the respondents will be efficiently
given. The use of frequency distribution is vital in the research for it is helpful in

41
the tabulation of data which will be effective in conveying the substantial
information acquired through the responses of the respondents concerning the
research.
Graphs were also employed to further illustrate the data gathered through the
surveys conducted beforehand. Charts and tables will be utilized as well in order
for the researchers and the readers, as well, to easily see and appreciate the
results of the survey.
The use of graphs, charts and tables are of much help in further illustrating
the data gathered according to Rodrigues (2013). First, they serve as a powerful
communication tools for they are comprehensive and they can easily impart
knowledge to the readers and the researchers as well. Second, it emphasizes
important information in a way that data are statistically organized which makes it
easier for the readers to locate substantial facts regarding the study. Third, it
visually presents the significant results of the data thus, making it more
understandable. Fourth, it clarifies complicated points because it is well-ordered.
And lastly, it is useful in illustrating key points about the results of the data
collected.
Three kinds of graphs will be specifically used and these are the following:
A. Scatter Plot
As defined by Gotauco (2012), scatter plot is a set of points plotted on the
horizontal and vertical axes of a graph. It shows the relationship between the two
sets of data. The researchers employed this graph because it has the capability
of showing whether or not there is an affiliation between the dependent and
independent variables present in the study.

42
B. Pie chart
Pie chart will be utilized because aside from the fact that it is appealing, they
display data in percentage which can be more appreciated by the readers.It also
shows significant dissimilaritiesamong groups which are included under one
variable. Pie charts are divided into different segments in which each segment
represent the relative size of each value (Gotauco, 2012).
C. Bar Graph
A bar graph displays discrete data in a separate column which makes it
easier for the researchers to compare and contrast the data gathered (Gotauco,
2012). This is the reason why the researchers find it suitable to be utilized in the
representation of the collected information through the use of written
questionnaires.
Graphs are preferred to be used by the researchers due to the reason that
they are more effective at helping the readers of the research visualize the data
rather than reading from the text itself. Through the illustrations created, the
researchers can easily impart the information gathered regarding the study, thus,
establishing a well-rounded research.

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