THIRTEENTH CONGRESS OF THE REPUBLIC ) 
OF THE PHILIPPINES 
First Regular Session 
‘ Introduced by Senator Miriam Defensor Santiago 
EXPLANATORY NOTE 
Adult persons have the fundamental right to decide their own health care, including the 
decision to have life-sustaining treatment withheld or withdrawn in instances of a terminal 
condition or permanent unconscious condition. 
Modern medical technology has made possible the artificial prolongation of human life 
beyond natural limits. Such prolongation of the process of dying for persons with a terminal 
condition or permanent unconscious condition may cause loss of patient dignity, and 
unnecessary pain and suffering, while providing nothing medically necessary or beneficial to the 
patient. Physicians and nurses should not withhold or unreasonably diminish pain medication for 
patients in a terminal condition where the primay intent of providing such medication is to 
alleviate pain and maintain or increase the patient’s comfort. 
There exists considerable uncertainty in the medical and legal professions as to the 
legality of terminating the use or application of life-sustaining treatment where the patient having 
the capacity to make health care decisions has voluntarily evidenced a desire that such treatment 
be withheld or withdrawn. 
In the interest of protecting individual autonomy, and in recognition of the dignity and 
privacy which patients have a right to expect, our laws should recognize the right of an adult 
person to make a written directive instructing such person’s physician to withhold or withdraw 
life-sustaining treatment in the event of a terminal condition or permanent unconscious 
condition. A person’s right to control his or her health care may be exercised by an authorized 
representative who validly holds the person’s durable power of attorney for health care. 


THIRTEENTH CONGRESS OF THE REPUBLIC ) 
OF THE PHILIPPINES 
First Regular Session 
Introduced by Senator Miriam Defensor Sdntiago 
AN ACT 
RECOGNIZING THE FUNDAMENTAL RIGHT OF ADULT PERSONS TO DECIDE THEIR 
TREATMENT WITHHELD OR WITHDRAWN IN INSTANCES OF A TERMINAL 
CONDITION OR PERMANENT UNCONSCIOUS CONDITION 
OWN HEALTH CARE, INCLUDING THE DECISION TO HAVE LIFE-SUSTAINING 
Be it enacted by the Senate and the House of Representutives of the Philippines in 
Congress assembled:. 
SECTION 1. Title. - This Act shall be known as the “Natural Death Act of 2005.” 
SECTION 2. Declaration of Policy. - It is the policy of the State to value the dignity of 
every person and guarantees full respect for human rights. 
SECTION 3. Dejnition of Terms. -For purposes of this Act: 
(a) “Adult person” means a person who has attained the age of majority, and who 
has the capacity to make health care decisions. 
(b) “Attending physician” means the physician selected by, or assigned to, the 
patient who has primary responsibility for the treatment and care of the patient. 
(c) “Directive” means a written document voluntarily executed by the declarer 
generally consistent with the guidelines of this Act. 
(d) “Health facility” means a hospital or a nursing home, a home health agency or 
hospice agency, or a boarding home. 
(e) “Life-sustaining treatment” means any medical or surgical intervention that 
uses mechanical or other artificial means, including artificially provided nutrition and 
hydration, to sustain, restore, or replace a vital function, which, when applied to a 
qualified patient, would serve only to prolong the process of dying. “Life-sustaining 


treatment” shall not include the administration of medication or the performance of any 
medical or surgical intervention deemed necessary to alleviate pain. 
(f) “Physician” is a person licensed by the Professional Regulation Commission 
to practice medicine. 
(9) “Permanent unconscious condition” means an incurable and irreversible 
condition in which the patient is medically assessed within reasonable medical judgment 
as having no reasonable probability of recovery from an irreversible coma or a persistent 
vegetative state. 
(h) “Qualified patient” means an adult person who is a patient diagnosed in 
writing to have a terminal condition by the patient’s attending physician, who has 
personally examined the patient, or a patient who is diagnosed in writing to be in a 
permanent unconscious condition in accordance with accepted medical standards by two 
physicians, one of whoni is the patient’s attending physician, and both o f  whom have 
personally examined the patient. 
(i) “Terminal condition” means an incurable and irreversible condition caused by 
injury, disease, or illness, that, within reasonable medical judgment, will cause death 
within a reasonable period of time in accordance with accepted medical standards, and 
where the application of life-sustaining treatment serves only to prolong the process of 
dying. 
SECTION 4. Directive to Withhold or Withdraw Lqe-Sustaining Treatment. - 
(1) Any person of legal age and sound mind may execute a directive directing the 
withholding or withdrawal of life-sustaining treatment in a terminal condition or 
permanent unconscious condition. The directive shall be signed by the declarer in the 
presence of two witnesses who: 
(a) are not related to the declarer by blood or marriage; 
(b) would not be entitled to any portion of the estate of the declarer upon 
declarer’s decease under any will o f  the declarer or codicil thereto then existing 
or, at the time of the directive, by operation of law then existing; 


(c) shall not be the attending physician; 
(d) shall not be an employee of the attending physician or a health facility 
in which the declarer is a patient; or 
(e) have no claim against any portion of the estate of the declarer upon 
declarer’s decease at the time of the execution of the directive. 
(2) The directive shall be duly notarized. 
(3) The directive, or a copy thereof, shall be made part of the patient’s medical 
records retained by the attending physician, a copy of which shall be forwarded by the 
custodian of the records to the health facility when the withholding or withdrawal of life- 
support treatment is contemplated. The directive may be in the following form, but in 
addition may include other specific directions: 
HEALTH CARE DIRECTIVE 
Directive made this __ day of 
(month, year). 
1 
, having the capacity to make health care decisions, 
willfully and voluntarily make known my desire that my dying shall not be artificially prolonged 
under the circumstances set forth below, and do hereby declare that: 
(a) If at any time I should be diagnosed in writing to be in a terminal condition by the 
attending physician, or in a permanent unconscious condition by two pliysicians, and where the 
application of life-sustaining treatment would serve only to artificially prolong the process of my 
dying, I direct that such treatment be withheld or withdrawn, and that I be permitted to die 
naturally. I understand by using this form that a terminal condition means an incurable and 
irreversible condition caused by injury, disease, or illness, that would within reasonable medical 
judgment cause death within a reasonable period of time in accordance with accepted medical 
standards, and where the application of life-sustaining treatment would serve only to prolong the 
process of dying. I further understand in using this form that a permanent unconscious condition 
means an incurable and irreversible condition in which I am medically assessed within reasonable 
medical judgment as having no reasonable probability of recovery from an irreversible coma or a 
persistent vegetative state. 
(b) In the absence of my ability to give directions regarding tlie use of such life- 
sustaining treatment, it is my intention that this directive shall be honored by my family and 
physician(s) as tbe final expression of my legal right to refuse medical or surgical treatment and I 
accept the consequences of such refusal. If another person is appointed to make these decisions 
for me, whether through a durable power of attorney or otherwise, I request that the person be 
guided by this directive and any other clear expressions of my desires. 
(c) If I am diagnosed to be in a terminal condition or in a permanent unconscious 
condition (check one): 
0 
I DO want to have artificially provided nutrition and hydration. 
0 
I DO NOT want to have artificially provided nutrition and hydration 


(d) If I have been diagnosed as pregnant and that diagnosis is known to my physician, 
this directive shall have no force or effect during the course of my pregnancy. 
(e) I understand the full import of this directive and I am emotioiially and mentally 
capable to make the health care decisions contained in this directive. 
(f) I understand that before I sign this directive, I can add to or delete from or otherwise 
change the wording of this directive and that I may add to or delete from this directive at any time 
and that any changes shall be consistent with Philippine law to be legally valid. 
(g) It is my wish that every part of this directive be fully implemented. If, for any reason, 
any part is held invalid, it is my wish that the remainder of my directive be implemented. 
Signed. ............................. 
Residence Address .................... 
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  
. . . . . . . . . . . . . . .  
The declarer Itas been personally known to me and I believe him or her to be capable of 
making health care decisions. 
Witness. ............................. 
Witness. ............................. 
(ACKNOWLEDGMENT) 
(3) Prior to withholding or withdrawing life-sustaining treatment, the diagnosis of 
a terminal condition by the attending physician or the diagnosis of a permanent 
unconscious state by two physicians shall be entered in writing and made a permanent 
part of the patient’s medical records. 
(4) A directive executed in another political jurisdiction is valid to the extent 
permitted by Philippine law. 
SECTION 5. Revocation of Directive. -. 
(1) A directive may be revolted at any time by the declarer, without regard to 
declarer’s mental state or competency, by any ofthe following methods: 
(a) By being canceled, defaced, obliterated, burned, torn, or otherwise 
destroyed by the declarer or by some person in declarer’s presence and by 
declarer’s direction. 
(b) By a written revocation of the declarer expressing declarer’s intent lo 
revoke, signed, and dated by the declarer. Such revocation shall become effective 
only upon communication to the attending physician by the declarer or by a 


person acting on behalf of the declarer. The attending physician shall record in the 
patient’s medical record the time and date when said physician received 
notification of the written revocation. 
(c) By a verbal expression by the declarer of declarer’s intent to revoke the 
directive. Such revocation shall become effective only upon communication to the 
attending physician by the declarer or by a person acting on behalf of the declarer. 
The attending physician shall record in the patient’s medical record the time, date, 
and place of the revocation and the time, date, and place, if different, of when said 
physician received notification of the revocation. 
(2) There shall be no criminal or civil liability on the part of any person for failure 
to act upon a revocation made pursuant to this section unless that person has actual or 
constructive knowledge of the revocation. 
(3) If the declarer becomes comatose or is rendered incapable of communicating 
with the attending physician, the directive shall remain in effect for the duration of the 
comatose condition or until such time as the declarer’s condition renders declarer able to 
communicate with the attending physician. 
SECTION 6. Liability of Health Care Provider or Facility. - Any physician or health 
care provider acting under the direction of a physician, or health facility and its personnel who 
participate in good faith in the withholding or withdrawal of life-sustaining treatment from a 
qualified patient in accordance with the requirements of this chapter, shall be immune from legal 
liability, including civil, criminal, or professional conduct sanctions, unless otherwise negligent. 
SECTION 7. Procedures by Physician. - Prior to the withholding or withdrawal of life- 
sustaining treatment from a qualified patient pursuant to the directive, the attending physician 
shall make a reasonable effort to determine that the directive complies with Section 4 of this Act, 
and, if the patient is capable of making health care decisions, that the directive and all steps 
proposed by the attending physician to be undertaken are currently in accord with the desires of 
the qualified patient. 
SECTION 8. Effects of Carrying out Directive. 


(1) On Insurance. - 
(a) The withholding or withdrawal of life-sustaining treatment from a 
qualified patient pursuant to the patient’s directive in accordance with the 
provisions of this chapter shall not, for any purpose, constitute a suicide or a 
homicide. 
(b) The making of a directive pursuant to Section 4 shall not restrict, inhibit, 
or impair in any manner the sale, procurement, or issuance of any policy of life 
insurance, nor shall it be deemed to modifv the terms of an existing policy of life 
insurance. No policy of life insurance shall be legally impaired or invalidated in 
any manner by the withholding or withdrawal of life-sustaining treatment from an 
insured qualified patient, notwithstanding any term of the policy to the contrary. 
(c) No physician, health facility, or other health provider, and no health care 
service plan, insurer issuing disability insurance, self-insured employee welfare 
benefit plan, or nonprofit hospital service plan, shall require any person to execute 
a directive as a condition for being insured for, or receiving, health care services. 
(2) On Cause of Death. - The act of withholding or withdrawing life-sustaining 
treatment, when done pursuant to a directive described in Section 4 and which results in 
the death of the declarer, shall not be construed to be an intervening force or to affect the 
chain of proximate cause between the conduct of anyone that placed the declarer in a 
terminal condition or a permanent unconscious condition and the death of the declarer. 
SECTION 9. Criminal Conduct, Penalties. - 
(1) Any person who willfully conceals, cancels, defaces, obliterates, or daniages 
the directive of another without such declarer’s consent is guilty of a gross misdemeanor. 
(2) Any person who falsifies or forges the directive of another, or willfully 
conceals or withholds personal knowledge of a revocation, as provided in Section 4, with 
the intent to cause a withholding or withdrawal of life-sustaining treatment contrary to 
the wishes of the declarer, and thereby, because of any such act, directly causes life- 


sustaining treatment to be withheld or withdrawn and death to thereby be hastened, shall 
be subject to prosecution for murder as defined in Article 248 of the Penal Code. 
SECTION 10. Mercy Killing or Physician-Assisted Suicide Not Authorized. - Nothing in 
this Act shall be construed to condone, authorize, or approve mercy killing or physician-assisted 
suicide, or to permit any affirmative or deliberate act or omission to end life other than to permit 
the natural process of dying. 
SECTION 11. Discharge So That Patient May Die At Home. - If a qualified patient 
capable of malting health care decisions indicates that he or she wishes to die at home, the patient 
shall be discharged as soon as reasonably possible. The health care provider or facility has an 
obligation to explain the medical risks of an immediate discharge to the qualified patient. If the 
provider or facility complies with the obligation to explain the medical risks of an immediate 
discharge to a qualified patient, there shall be no civil or criminal liability for claims arising from 
such discharge. 
SECTION 12. Directive’s Validity Assumed. - Any person or health facility may assume 
that a directive complies with this Act and is valid. 
SECTION 13. Separability Clause. - If any provision of this Act is held invalid or 
unconstitutional, the remainder of the Act or the provision not otherwise affected shall remain 
valid and subsisting. 
SECTION 14. Repealing Clause. - Any law, presidential decree or issuance, executive 
order, letter of instruction, administrative rule or regulation contrary to or inconsistent with the 
provisions of this Act is hereby repealed, modified or amended accordingly. 
SECTION 15. EffecfiiiifJ) Clause. - This Act shall take effect fifteen (15) days after its 
publication in at least two newspapers of general circulation. 
Approved,