V<s REPRESS
Republic of the Philippines Z° “4X
HOUSE OF REPRESENTATIVES fs
~)
(S Server

Quezon City, Metro Manila

NINETEENTH CONGRESS
Third Regular Session

10899

HOUSE BILL NO.

Introduced by Representative Jaime R. Fresnedi

EXPLANATORY NOTE

This proposed legislation aims to integrate palliative care into the Philippine health
system through the creation of a National Palliative Care Policy. It seeks to establish a standard
of quality palliative care services to patients suffering from life-threatening, complex and
chronic illness.

Over the years, palliative care has become more of @ luxury than it is a standard
component of healthcare. This specialized type of care aims to alleviate symptoms, manage
pain as well as physical and mental stress usually caused by their serious health conditions,
Although global awareness of palliative care has increased, its implementation in our country
has remained limited and inaccessible

According to data from the World Health Organization (WHO), an estimated number
of 56.8 million people, including 25.7 million in the last year of life, are in need of | palliative
care each year. Across the world, only 14% of those in need of palliative care actually receive
it. In our country, hospice homes were first introduced in October 1991 by the late Dr. Mita
Pardo de Tavera, then president of the Philipines Cancer Society, Inc. (PSI). This effort led to
the creation of various hospices throughout the country and the founding of the National
Hospice and Palliative Care Council of the Philippines (NHPCCP), also known as Hospice
Philippines in 2004. Since then, hospice care has been recognized as an essential component
in the care for patients suffering with ESRD (end-stage renal disease), advanced heart, liver
and respiratory diseases, dementia, and acquired immunodeficiency syndrome or AIDS.
Despite this recognition, access to this type of healthcare has remained expensive due to the
limited number of trained professionals in this field, the availability of resources like access to
pain medications and the maintenance of specialized facilities

Article XIII, Section 11 of the 1987 Constitution provides:

The State shall adopt an integrated and comprehensive approach to health
development which shall endeavor to make essential goods, health and other
social services available to all the people at affordable cost. There shall be
priority for the needs of the underprivileged sick, elderly, disabled, women, and
children. The State shall endeavor to provide free medical care to paupers.

It is therefore the responsibility of the State to provide accessible and affordable
healthcare services even for those with severe illnesses. Through this legislation we will be



It is therefore the responsibility of the State to provide accessible and affordable
healthcare services even for those with severe illnesses. Through this legislation we will be
able to assure these individuals that they will be able to receive the compassionate and
comprehensive care they need and rightfully deserve in order to manage their symptoms and
improve their quality of life. This initiative underscores our dedication to supporting all
patients, regardless of their condition

In view of the foregoing, the immediate passage of this bill is earnestly sought.

JAIME EDI
Representative
Lone District, Muntinlupa City


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

|ETEENTH CONGRESS
Third Regular Session

nouse BiLt xo. 10893

Introduced by Rep. Jaime R. Fresnedi

AN ACT
ESTABLISHING A NATIONAL PALLIATIVE CARE POLICY FOR THE PURPOSE OF
ENHANCING THE DELIVERY OF INTEGRATED PALLIATIVE CARE SERVICES,
PROMOTING AND PROTECTING THE RIGHTS OF PERSONS UTILIZING PALLIATIVE
CARE SERVICES, APPROPRIATING FUNDS THEREFOR, AND FOR OTHER PURPOSES

Be it enacted by the Senate and the House of Representatives of the Philippines in Congress
assembled:

SECTION 1. Short Title. - This Act shall be known as the “National Palliative Care Act.”

Sec. 2. Declaration of Policy. ~ The State affirms the basic right of all Filipinos to palliative
and hospice care as well as the fundamental rights of people who require palliative and hospice care
services. The State shall comply with its obligations under the United Nations Declaration of Human
Rights, the Convention on the Rights of Persons with Disabilities, al other relevant international and
regional human rights conventions and declarations, the Republic Act No. 7277, as amended, otherwise
known as the “Magna Carta for Disabled Persons”, Republic Act No. 11223 otherwise known as the
“Universal Health Care Act” and Republic Act No. 11215 otherwise known as the “National Integrated
Cancer Control Act”.

Towards this end, itis the policy of the State to promote the well-being and quality of life of
people by ensuring that palliative care is valued, promoted, and protected. Towards this end, the state
shall adopt

(a) An integrated and comprehensive approach to ensure that all conditions requiring palliative
and hospice care are treated and palliated;

(b) A whole-of-system, whole-of-society, and whole-of-govermment approach in the
development and implementation of essential, timely, affordable and high quality palliative care for the
public; and

(c) A people-oriented approach for the delivery of palliative care assuring that palliative care
services are free from coercion and accountable to persons with palliative care needs and further
ensuring that persons needing palliative care are able to exercise the full range of human rights, to
participate fully in society and at work free from stigmatization and discrimination.


Sec. 3. Objectives. — The objectives of this Act are as follows:

(a)Strengthen effective leadership and governance for palliative care by, among others,
formulating, developing, and implementing national policies, strategies, programs, and regulations
relating to palliative care;

(b)Develop and establish a comprehensive, integrated, effective, and efficient national
palliative care program responsive to the needs of the Filipino people;

(c) Protect the rights and freedoms of persons with palliative care needs;
(a) Strengthen information systems, evidence, and research for palliative care;
(¢) Integrate palliative care in the basic health services; and

(f) Integrate strategies promoting palliative care in educational institutions, the workplace, and
in communities.

Sec. 4. Definitions. — As used in this Act, the following terms are defined as follows:

(a) Allied Healthcare Professional refers to non-palliative trained health professionals such as
physicians, social workers, nurses, physical therapists, counselors, nutritionists, among others;

(b) Carer refers to the person, who may or may not be the patient's next-of-kin or relative,
who maintains a close personal relationship and manifests concem for the welfare of the patient;

(©) Confidentiality refers to ensuring that all relevant information related to persons with
palliative and hospice care needs is kept safe from access or use by, or disclosure to, persona or entities
who are not authorized to access, use, or possess such information;

(d) Continuum of Care refers to delivery of comprehensive health care services, which
includes risk assessment, primary prevention, screening, diagnosis, treatment, survivorship,
rehabilitation and end-of-life care;

(©) Transitional Care refers to the support given to persons moving from care settings, such
as from hospital care to home care, and levels of healthcare, such as a shift in goals of care or in age
groups;

(Discrimination refers to any distinction, exclusion of restriction which has the purpose or
effect of nullifying the recognition, enjoyment or exercise, on an equal basis with others, of all human
rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field. It
includes all forms of discrimination, including denial of reasonable accommodation. Special measures
solely to protect, the rights or secure the advancement of persons with decision-making impairment
capacity shall not be deemed to be discriminatory;

(g) Hospice Care refers to a component of palliative care which deals with persons who are
not expected to survive more than six months, otherwise known as end-of-life care, wherein the main
goals are provision of peace, comfort, and dignity through holistic support which includes medical
psychological and spiritual support;

(h) Impairment or Temporary Loss of Decision-Making Capacity refers to a medically-
determined inability on the part of a palliative patient or any other person affected by a mental health
condition, to provide informed consent. A palliative patient has an impairment or temporary loss of



decision-making capacity when the palliative patient as assessed by a mental health professional is
unable to do the following:

(i) Understand information conceming the nature of an advanced life-limiting health
condition;

(ii) Understand the consequences of one's decisions and actions on one's life or health, or
the life or health of others;

(ii) Understand information about the nature of the treatment proposed, including
methodology, direct effects, and possible side effects; and

(iv) Effectively communicate consent to treatment or hospitalization, or information
regarding one's own condition;

(Informed Consent refers to content voluntarily given by a palliative patient to a plan for
‘management, after a full disclosure communicated in plain language by the attending palliative care
provider, of the nature, consequences, benefits, and risks of the proposed management, as well as
available alternatives;

@) Involuntary Treatment refers to a type of medical treatment that is undertaken without the
consent of the person being treated

(&) Mental Health refers to a state of well-being in which the individual realizes one's own
abilities and potentials, copes adequately with the normal stresses of life, displays resilience in the face
of extreme life events, works productively and fruitfully, and is able to make a positive contribution to
the community;

(). Mental Health Condition refers to a neurologic or psychiatric condition characterized by
the existence of a recognizable, clinically-significant disturbance in an individual's cognition, emotional
regulation, or behavior that reflects a genetic or acquired dysfunction in the neurobiological,
psychosocial, or developmental processes underlying mental functioning. The determination of
neurologic and psychiatric conditions shall be based on scientifically-accepted medical nomenclature
and best available scientific and medical evidence;

(m) Palliative Care refers to an approach of care that improves the quality of life of patients
and their families facing problems with life-threatening illness, through the prevention and relief of
suffering by means of early identification and impeccable assessment and treatment of pain and other
problems, physical, psychosocial and spiritual;

(n) Palliative Care Health Facility refers to any establishment, or any unit of an establishment,
which has, as its primary function, the provision of palliative care services;

(0) Palliative Care Professional refers to a medical doctor, psychologist, nurse, social worker
or any other appropriately-trained and qualified person with specific skills relevant to the provision of
palliative care services;

(p) Palliative Care Specialist refers to a medical doctor who received formal fellowship
training in palliative and hospice medicine and who has passed the subspecialty board examination for
the same;

(q) Palliative Care Service Provider refers to an entity or individual providing palliative care
services as defined in this Act, whether public or private, including, but not limited to, palliative care
professionals, specialists and workers, social workers and counselors, peer counselors, informal
community caregivers, palliative care advocates and their organizations, personal ombudsmen, and
persona or entities offering nonmedical alternative therapies;


(®) Palliative Care Health Services refer to physical, psychosocial or spiritual activities and
programs along the whole range of the palliative care support services including promotion, prevention,
treatment, and aftercare, which are provided by palliative care facilities and palliative care
professionals;

(s) Palliative Care Health Worker refers to a trained person, volunteer or advocate engaged in
palliative care health promotion, providing support services under the supervision of a palliative care
professional or specialist;

(t) Palliative Emergency refers to a condition presenting a serious and immediate threat to the
health and well-being of a palliative patient or any other person affected by advanced life-limiting health
condition, or to the health and well-being of others, requiring immediate medical intervention;

(u) Palliative Patient refers to a person diagnosed with any advanced life-limiting health
condition including persons who require, or are undergoing palliative, hospice or psychosocial care;

(v) Partial Hospital Care refers to a type of intensive, structured mental health treatment that
falls between in-patient (full hospitalization) and outpatient care. It is designed for individuals who
require a higher level of care than traditional outpatient therapy but do not need 24-hour supervision
provided in an inpatient setting,

(w) Patient Navigation refers to the provision of individualized assistance to patients and
families to help them overcome healthcare system barriers and facilitate timely access to quality medical
and psychosocial care from pre~diagnosis through all phases of the illness experience;

(x) Psychosocial Support refers to the assistance on nonmedical costs such as financial
assistance, transient housing, transportation, food and nutrition and the like;

(y) Restrictive Care refers to any intervention that restricts the rights and freedom of
‘movement of a person with disability.

(2) Support refers to the spectrum of informal and formal arrangements or services of varying
types and intensities, provided by the State, private entities, or communities, aimed at assisting a
palliative patient in the exercise of his or her legal capacity or rights, including: community services;
personal assistants and ombudsmen; powers of attomey and other legal and personal planning tools;
peer support; support for self-advocacy; nonformal community caregiver networks; dialogue systems;
alternate communication methods, such as nonverbal, sign, augmentative, and manual communication;
and the use of assistive devices and technology;

(aa) Supported Decision Making refers to the act of assisting a palliative patient who is affected
by an impairment or loss of decision-making capacity, in expressing a palliative care-related preference,
intention or decision. It includes all the necessary support, safeguards and measures to ensure protection
from undue influence, coercion or abuse;

(bb) Supportive Care refers to prevention and management of the adverse effects of advanced
life-limiting conditions and its treatment which includes management of physical and psychological
symptoms and side effects across the continuum of the disease experience; and

(cc) Surrogate Decision Maker or Healthcare Proxy refers to a person designated by the
palliative patient, appointed by a court of competent jurisdiction, or authorized by this Act or any other
applicable law, to act on the palliative patient's behalf. The legal representative may also be a person
appointed in writing by the palliative patient to act on his or her behalf through an advance directive.


CHAPTER II
RIGHTS OF PALLIATIVE PATIENTS AND OTHER STAKEHOLDERS

Sec. 5. Rights of Palliative Patients, - Service users shall enjoy, on an equal and non-
discriminatory basis, all rights guaranteed by the Constitution as well as those recognized under the
United Nations Universal Declaration of Human Rights and the Convention on the Rights of Persons
with Disabilities and all other relevant intemational and regional human rights conventions and
declarations, including the right to:

(a) Freedom from social, economic, and political discrimination and stigmatization, whether
committed by public or private actors;

(b) Exercise all their inherent civil, political, economic, social, religious, educational, and
cultural rights respecting individual qualities, abilities, and diversity of background, without
discrimination on the basis of physical disability, age, gender, sexual orientation, race, color, language,
religion or nationality, ethnic, or social origin;

Respect for their dignity, culture, and values at all times. Likewise, hospice care patients shall
be entitled to humane medical care to make end of life as dignified and comfortable as possible;

(©) Access to evidence-based treatment of the same standard and quality, regardless of age,
see, socioeconomic status, race, ethnicity or sexual orientation;

(a) Access to affordable essential health and social services for the purpose of achieving the
highest attainable standard of palliative care;

(e) Access to good-quality palliative care services and humane at all levels of the national
health care system within the limits of the resources, manpower, and competences available for medical
care;

(© Access to comprehensive and coordinated treatment integrating holistic prevention,
promotion, rehabilitation, palliation, care and support, aimed at addressing palliative care needs through
a multidisciplinary, patient-centered management plan;

(g) Access to palliative and hospice care in the least restrictive environment and manner,

(h) Access to aftercare and rehabilitation, when possible, in the community for the purpose of
social reintegration and inclusion;

(i) Access to adequate information regarding available multidisciplinary palliative care
services;

(j) Participate in palliative care advocacy, policy planning, legislation, service provision,
‘monitoring, research and evaluation;

(k) Confidentiality of all information, communications, and records, in whatever form or
medium stored, regarding the patient, any aspect of the patient's health condition, or any treatment or
care received by the patient, which information, communications, and records shall not be disclosed to
third parties without the written consent of the patient concemed or the patient's legal representative,
except in the following circumstances:

(i) Disclosure is required by law or pursuant to an order issued by a court of competent
jurisdiction;

(ii) The patient’has expressed consent to the disclosure;

5


(iii) A life-threatening emergency exists and such disclosure is necessary to prevent harm or
injury to the patient or to other persons;

(iv) The patient is a minor and the attending palliative care provider reasonably believes that
the patient is a victim of child abuse; or

(v) Disclosure is required in connection with an administrative, civil, or criminal case against
a palliative care provider or specialist for negligence or a breach of professional ethics, to
the extent necessary to completely adjudicate, settle, or resolve any issue or controversy
involved therein;

(0) Give informed consent before receiving treatment or care, including the right to withdraw
such consent. Such consent shall be recorded in the patient’s clinical record;

(m) To refuse diagnostic and medical treatment procedures provided that the refusal releases
those involved in the care from any obligation, docs not jeopardize public health and safety, and is from
‘a person or surrogate decision maker who is:

(i Of legal age and sound decision-making capacity;
(ii) Informed of the risks, benefits, and consequences of the refusal

(n) Participate in the development and formulation of the palliative care plan to be
implemented;

(0) Designate or appoint a person of legal age to act as his or her legal representative in
accordance with this Act, except in case a of impairment or temporary loss of decision-making capacity;

(p) Legal services, through competent counsel of the patient’s choice. In case the patient
cannot afford the services of a counsel, the Public Attomey's Office, or a legal aid institution of the
patient or representative's choice, shall assist the patient; and

(q)_ Information, within twenty-four (24) hours of admission to a health facility, of the patient's
rights including those enumerated in this section in a form and language understood by the patient.

Sec. 6. Rights of Family Members, Carers and Legal Representatives. — Family members,
carers and duly designated or appointed legal representative of the patient shall have the right to’

(a) Receive appropriate psychosocial and spiritual support from the relevant government
agencies;

(b) With the consent of the concemed patient, participate in the formulation, development, and
implementation of the patient's individualized management plan;

(©) Apply for release and transfer of the patient to home or an appropriate health facility
provided that:

(i) They are informed of the risks, benefits, and consequences of their decision;

(ii) They release from any obligation those involved in the care relevant to the
consequences of their decision;

(iii) Their decision will not jeopardize public health and safety; and


(@ Participate in palliative care advocacy.

Sec. 7, Additional Leave Benefits. — Immediate family members or relatives who are employed,
whether in the public or private sector and are assigned by the family to provide palliative care to a
‘riticlly-ill relative shall be granted an additional leave of fifteen (15) days aside from all existing leave
benefits granted by their employers, subject to the guidelines on the use of the said benefits.

Sec. 8. PhilHealth Benefit Package. ~ Pursuant to this Act, the PhilHealth shall increase its
present benefit package to include palliative care.

CHAPTER IIL
PALLIATIVE CARE SERVICES

Sec. 9. Quality of Palliative Care Services. — Palliative Care services provided pursuant to this
Act shall be

(a) Based on best medical practices, clinical standards of care, and scientific research findings;

(b)Responsive to the clinical, gender, cultural and ethnic and other special needs of the
individuals being served;

(c) Most appropriate and least restrictive setting;
(d) Age appropriate; and

(c) Provided by palliative care providers, specialists and workers in a manner that ensures
accountability and is aligned with the Department of Health Manual of Operations, Procedures, and
Standards for the National Palliative and Hospice Care Program.

Sec. 10. Palliative Care Services at the Community Level. - Responsive primary palliative care
services shall be developed and integrated as part of the basic health services at the appropriate level of
care, particularly at the city, municipal, and barangay level. The standards of palliative care services
shall be aligned with the DHOH Manual of Operations, Procedures, and Standards for the National
Palliative Care Program,

Every local govemnment unit (LGU) and academic institution shall ereate its own program in
accordance with the general guidelines set by the Philippine Council for Palliative Care, created under
this Act. LGUs and academic institutions shall coordinate with all concemed govemiment agencies and
the private sector forthe implementation of the program, aligned with the Department of Health Manual
of Operations, Procedures, and Standards for the National Palliative Care Program.

Sec. 11, Community-based Palliative Care Facilities. — The national government ‘through the
DOH shall fund the establishment and assist in the operation of community-based palliative care
facilities in the province, cities and cluster cof municipalities in the entire country based on the needs of
the population, t provide appropriate palliative care services, and enhance the rights-based approach
to palliative care.

Each community-based palliative care facility shall have a complement of palliative care
specialist. palliative care providers, allied professionals, support staf, trained barangay health workers
(BHWs), volunteer family members of patients or service users, basic equipment and supplies, and
adequate stock of medicines appropriate at that level, aligned with the Department of Health Manual of
Operations, Procedures, and Standards for the National Palliative Care Program.

See. 12. Reportorial Requirements, - LGUs through their health offices shall make a quarterly
reportin the Philippine Council fo Balliative Care through the DOH. The report shall include, among

7


others, the following data: number of palliative patients attended to and/or served, the respective kinds
of illness or disability, duration and result of the management, and patient's age, gender, educational
attainment and employment without disclosing the identities of such palliative patients for
confidentiality.

Sec. 13. Palliative Care Services in Regional, Provincial, and Tertiary Hospitals, - All regional,
provincial, and tertiary hospitals, including private hospitals shall provide the following palliative care
services:

(a) Short-term, in-patient hospital care in a palliative care ward for patients exhibiting acute
pain and non-pain symptoms needing palliative care;

(b) Partial hospital care for those exhibiting pain and non-pain symptoms or experiencing
difficulties vis-a-vis their personal and family circumstances;

(©) Out-patient services in close collaboration with existing palliative care programs at
primary health care centers in the same area;

(4) Home care services for palliative patients with special needs as a result of, among others,
long-term hospitalization, non-compliance with or inadequacy of treatment, and absence of immediate
family;

(c) Coordination with drug rehabilitation centers vis-a-vis the care, treatment, and
rehabilitation of persons suffering from addiction and other substance-induced mental health
conditions;

(® A referral system involving other public and private health and social welfare service
providers, for the purpose of expanding access to programs aimed at providing palliative and hospice
care to patients with advanced life-limiting conditions; and

(g) Hospital-based Palliative Care Registry that must record the personal identification of
palliative patients, type of advanced life-limiting condition, management received and its results and
other data that the DOH may prescribe. The information shall be treated with utmost confidentiality and
shall not be released to third parties, in accordance with Republic Act No. 10173 or the “Data Privacy
Act of 2012.” Submission of the Palliative Care registry data to the DOH shall be a requirement for the
renewal of a license to operate of a hospital.

Sec. 14. Duties and Responsibilities of Palliative Care facilities. — Palliative Care facilities
shall:

(a) Establish policies, guidelines, and protocols for minimizing the use of restrictive care and
involuntary treatment;

(b)Inform palliative patients of their rights under this Act and all other pertinent laws and
regulations;

(c) Provide every palliative patient, whether admitted for voluntary treatment or not, with
complete information regarding the management plan to be implemented;

(a) Ensure that informed consent is obtained from palliative patients prior to the implementation
of any medical procedure or plan of treatment or care, except during palliative emergencies or when the
palliative patient has impairment or temporary loss of decision-making capacity;

(@)Maintain a. register containing information on all medical treatments and procedures

administered to service users; and


(® Ensure that legal representatives are designated or appointed in accordance with the
provisions of this Act

Sec. 15. Public Awareness. - The DOH and the LGUs shall initiate and sustain a heightened
nationwide multi-media campaign to raise the level of public awareness on the protection and promotion
of palliative care and rights including, but not limited to, palliative care and nutrition, stress handling,
counselling, spiritual care and other elements of palliative care.

CHAPTER IV
EDUCATION, PROMOTION OF PALLIATIVE CARE IN EDUCATIONAL INSTITUTIONS
AND IN THE WORKPLACE

Sec, 16. Integration of Palliative Care into the Educational System. - The State shall ensure the
integration of palliative care into the educational system, as follows:

(a) Age-appropriate content pertaining to palliative care shall be integrated into the curriculum
at all educational levels; and

(b) Palliative and hospice care shall be required subjects in all medical and allied health courses,
including post-graduate courses in health,

Sec. 17. Palliative Care Promotion in Educational Institutions. — Educational institutions,
such as schools, colleges, universities, and technical schools, shall develop policies and programs for
students, educators, and other employees. Such policies and programs shall be designed to raise
awareness on palliative care issues, identify and provide support and services for patients, facilitate
access, including referral mechanisms of individuals needing palliative care to medical and
psychosocial support, and adopt initiatives that minimize or eliminate stigma and discrimination in
schools, colleges, and universities that are experienced by people with advanced life-limiting
conditions.

All public and private educational institutions shall be required to have a complement of
palliative care providers

Sec. 18, Palliative Care Promotion and Policies in the Workplace. — The Department of Labor
and Employment (DOLE), Civil Service Commission, and Technical Education and Skills Development
‘Authority, in coordination with the DOH, shall develop policies and provide technical guidance to
‘employers, employees associations and unions to

(a) Promote and facilitate integration of gender sensitive messages on cancer and/or chronic
disease risk factors, early signs and symptoms of cancer and chronic disease, prevention and control,
adoption of health lifestyles and healthy diets, in their communication initiatives, health and wellness
programs and employee development programs;

(b) Undertake mainstreaming of practical supportive care and psychosocial support programs
for people living advance life-limiting conditions and their family members;

(©) Integrate appropriate palliative care services in their health services and clinics; and

(d) Develop programs, initiatives or mechanisms that shall minimize or eliminate stigma and
discrimination in the workplace that is experienced by people living with advanced life-limiting
conditions and their families.

Employers shall develop appropriate policies and programs on palliative care in the workplace
These shall he designed ta raise awaroess an. palliative care issues, correct the stigma and

9


discrimination associated with advanced life-limiting conditions, identify and provide support to
palliative patients and their families, and facilitate access of individuals with advanced life-limiting
conditions and their families to medical and psychosocial support

See 19. Palliative Care Health Education and Promotion in Communities. ~ The Department
of Interior and Local Government (DILG) and LGUs, in collaboration with the DOH central and
regional offices, palliative care patient support organizations and professional societies, shall lead the
health education and promotion campaign in local communities, including out-of-school youth. The
DILG, in coordination with the Department of Social Welfare and Development (DSWD), shall conduct
and promote age appropriate and gender sensitive palliative-focused health education,

CHAPTER V
CAPACITY BUILDING, RESEARCH AND DEVELOPMENT

See. 20. Capacity Building, Reorientations, and Training. — In close coordination with health
facilities, academic institutions, and other stake holders, palliative care providers, specialists, and other
service providers shall undergo capacity building, reorientation, and training to develop their ability to
deliver evidence-based, gender-sensitive, culturally-appropriate and human rights-oriented palliative
care services, with emphasis on the community and public health aspects of palliative care

Sec. 21. Capacity Building of Barangay Health Workers (BHWs). - The DOH shall be
responsible for disseminating information and providing training programs on palliative care to LGUs
The LGUs, with technical assistance from the DOH, shall be responsible for the training of BHWs and
other barangay volunteers on the promotion of palliative care. The DOH shall provide assistance to
LGUs with medical supplies and equipment needed by BHWs to carry out their functions effectively.

Sec. 22. Research and Development. - Research and development shall be undertaken, in
collaboration with academic institutions, palliative, hospice, and related associations, and non-
government organizations, to produce the information, data, and evidence necessary to formulate and
develop a culturally-relevant national palliative care program incorporating indigenous concepts and
practices related to palliative care.

High ethical standards in palliative care research shall be considered to ensure that:
(a) research is conducted only with the free and informed consent of the persons involved;

(b) researchers do not receive any privileges, compensation or remuneration in exchange for
encouraging or recruiting participants;

(©) potentially harmful or dangerous research is not undertaken; and

(@) all research is approved by an independent ethics committee, in accordance with applicable
law.

Research and development shall also be undertaken vis-i-vis non-medical, traditional or
altemative practices.

Sec. 23. National Palliative Care Registry. ~ The Department of Health in collaboration with
relevant stakeholders shall establish a national palliative care registry and monitoring system. The
registry must cover all forms of palliative care illnesses among adults and children and serve as a guide
in policy development of the National Palliative and Hospice Care Program.

CHAPTER VI
DUTIES AND RESPONSIBILITIES OF GOVERNMENT AGENCIES

10


Sec. 24. Duties and Responsibilities of the Department of Health (DOH). ~ In pursuit of the
policies and objectives declared in this Act, the DOH shall:

(a) Formulate, develop, and implement a national palliative care program. In coordination
with relevant government agencies, create a framework for Palliative Care Awareness Program to
promote elective strategies regarding palliative car, its components, and services, as well as to improve
awareness on stigmatized medical conditions,

(b) Ensure that a safe, therapeutic, and hygicnic environment with sufficient privacy exists in
all palliative care health facilities and, for this purpose, shall be responsible for the regulation, licensing,
monitoring, and assessment of all palliative care facilities;

(©) Integrate palliative care into the routine health information system and identify, collate,
routinely report and use core palliative care health data disaggregated by sex and age, and health
outcomes, including data on hospice and bereavement care, in order to improve palliative care service
delivery, and promotion strategies;

(@)_ Improve research capacity and academic collaboration on national priorities for research
in palliative care, particularly operational research with direct relevance to service. development,
implementation, and the exercise of human rights by persons with advanced life-limiting conditions,
including the establishment of centers of excellence;

(c) Ensure that all public and private palliative care health institutions uphold the right of
patients to be protected against torture or cruel, inhumane, and degrading treatment;

(9) Coordinate with the Philippine Health Insurance Corporation to ensure that insurance
packages equivalent to those covering physical disorders of comparable impact to the patient, as
neasured by Disability-Adjusted Life Year or other methodologies, are available to patients affected by
advanced life-limiting conditions;

(g) Prohibit forced or inadequately remunerated labor within palliative care health facilities,
unless such labor is justified as part of an accepted therapeutic treatment program:

(h)_ Provide support services for families and co-workers of palliative patients, palliative care
providers, specialists, workers, and other service providers;

(i) Develop altematives to institutionalization, particularly community-based approaches
aimed at receiving patients discharged from hospitals, meeting the needs expressed by persons with
‘Advanced life-limiting health conditions, and respecting their autonomy, decisions, dignity, and privacy:

{j) Ensure that all health facilities shall establish their respective intemal review boards. in
consultation with stakeholders, the DOH shall promulgate the rules and regulations necessary for the
éfiicient disposition of all proceedings, matters, and cases referred to, or reviewed by, the intemal
review board;

(&) Establish a balanced system of community-based and hospital-based palliative cart
services at all levels of the public health care system from the barangay, municipal, city, provincial,
regional to the national level;

(0). Ensure that all health workers shall undergo human rights trainings in coordination with
appropriate agencies or organizations; and

ve


(m) Ensure sufficient supply of medicines for palliative care that are available at affordable
prices. Further, the DOH shall formulate a monitoring system to check that pain medications are safe
and administered in correct dosages

Sec. 25. Duties and Responsibilities of the Commission on Human Rights (CHR). — The CHR
shall:

(a) Establish mechanisms to investigate, address, and act upon complaints of impropriety and
abuse in the treatment and care received by palliative patients, particularly when such treatment or care
is administered or implemented involuntarily;

(b)_ Inspect palliative care health facilities to ensure that palliative patients therein are not being
subjected to cruel, inhumane, or degrading conditions or treatment;

(©) Investigate all cases involving involuntary treatment, confinement, or care of palliative
patients, for the purpose of ensuring strict compfiance with domestic and intemational standards
respecting the legality, quality, and appropriateness of such treatment, confinement, or care; and

(@) Appoint focal commissioner for palliative care tasked with protecting and promoting the
rights of palliative patients and other persons utilizing palliative care services or confined in health
facilities, as well as the rights of palliative care professional, specialists and workers. The focal
commissioner shall, upon a finding that a palliative care health facility, palliative care provider,
palliative care specialist or palliative care health worker has violated any of the rights provided for in
this Act, take all necessary actions to rectify or remedy such violation, including recommending that an
administrative, civil, or criminal case be filed by the appropriate government agency.

Sec. 26. Duties and Responsibilities of the Department of Education (DepEd), Commission on
Higher Fducation (CHED), and the Technical Education and Skills Development Authority (TESDA).
— The DepEd, CHED and TESDA shall:

(a) Integrate age-appropriate content pertaining to palliative care info the curriculum at all
educational levels both in public and private institutions;

(b) Develop guidelines and standards on age-appropriate and evidenced-based palliative care
programs both in public and private institutions;

(©) Pursue strategies that promote the realization of palliative care and well-being in
educational institutions; and

(@)_ Ensure that palliative care promotions in public and private educational institutions shall
be adequately complemented with qualified mental health professionals.

Sec. 27. Duties and Responsibilities of the Department of Social Welfare and Development
(DSWD). ~The DSWD shall:

(a) Refer palliative patients to palliative care health facilities, providers, specialists, workers,
and other service providers for appropriate care;

(b) Provide or facilitate access to public or group housing facilities, counselling, therapy, and
livelihood training and other available skills development programs; and

(©) In coordination with the LGUs and the DOH, formulate, develop, and implement

psychosocial well-being training programs, including psychosocial and spiritual support services during
and after natural disasters and other calamities.

12


Sec. 28. Duties and Responsibilities of Local Government Units (LGUs). - The LGUs shall:

(a) Review, formulate, and develop the regulations and guidelines necessary to implement an
effective palliative care policy within its territorial jurisdiction, including the passage of a local
‘ordinance on the subject of palliative care, consistent with existing relevant national policies and
guidelines;

(b) Integrate palliative care services in the basic health care services, and ensure that palliative
care services are provided in primary health care facilities and hospitals, within its territorial
jurisdiction;

(©) Establish training programs necessary to enhance the capacity of palliative care service
providers at the LGU level, in coordination with appropriate national government agencies and other
stakeholders,

(4) Promote deinstitutionalization and other community-based approaches in the delivery of
palliative care services;

(©) Establish, reorient, and modemize palliative care health facilities necessary to adequately
provide palliative care services, within its territorial jurisdiction;

(Refer palliative patients to palliative care health facilities, providers, specialists, workers,
and other service providers for appropriate care; and

(g) Establish a multi-sectoral stakeholder network for the identification, management, and
prevention of advanced life-limiting health conditions.

Sec. 29. Upgrading of Local Hospitals and Health Care Facilities. - Each LGU, upon its
determination of the necessity based on well-supported data provided by its local health office, shall
establish or upgrade local hospitals and facilities with adequate and qualified personnel, equipment and
supplier to be able to provide palliative care services and to address palliative emergencies: Provided,
That people in geographically isolated and/or highly populated and depressed areas shall have the same
level of access and shall not be neglected by providing other means such as home visits or mobile health
care clinics, as needed: Provided further, That the national government shall provide additional funding
and other necessary assistance for the effective implementation of this provision, if necessary.

CHAPTER VII
ESSENTIAL MEDICINES

Sec. 30. Essential Palliative Medicines ~The DOH and other concemed government agencies
shall implement reforms supporting early access to essential palliative medicines, innovative medicines
and health technologies to ensure highest possible quality of life among all people with palliative and
hospice care needs. The reforms include facilitating easy prescribing, dispensing and access to drugs
for compassionate use and developing a more responsive system for effectively addressing urgent
needs.

‘The DOH shall ensure a sufficient supply of medicines for palliative care that are available at
affordable prices. PDEA and FDA shall create a dedicated and streamlined process for licensing,
procurement, prescription, dispensing, and monitoring of these drugs.

CHAPTER VIII
THE PHILIPPINE COUNCIL FOR PALLIATIVE CARE

Sec. 31. Mandate. - The Philippine Council for Palliative Care, herein referred to as the Council,
1s heréby established as a policy-making, planning, coordinating and advisory body on palliative care,

13


‘The Council shall be attached to the DOH to oversee the implementation of this Act particularly on the
protection of the rights and freedom of persons with palliative care, hospice care and psychosocial needs
and the delivery of a rational, unified and integrated palliative care services responsive to the needs of
the Filipino people.

See. 32. Composition of The Council. - The Council shall be composed of the following:

(a) Secretary of DOH as Chairperson;

(b). Secretary of DepEd;

(©) Secretary of DOLE;

(@) Secretary of DSWD;

(©) Secretary of the Department of the Interior and Local Govemment (DILG);

(8) President and Chief Executive Officer of PhilHealth;

(g) Chairperson of CHR;

(bh) Chairperson of CHED;

(i) One (1) representative from the academe/rescarch involved in palliative and hospice care:

(Two (2) representatives from palliative care-focused medical professional organizations;
and

(k) Three (3) representatives from palliative care-focused nongovernment organizations
(NGOs) and advocacy networks.

The members of the Council from the government may designate their permanent authorized
representatives.

Within thirty (30) days from the effectivity of this Act, the members of the Council from the
academe/research, private sector and NGOs shall be appointed by the President of the Philippines from
alist of three (3) nominees submitted by the organizations, as endorsed by the Council.

Members representing the academe/research, private sector and NGOs of the Council shall
serve fora term of three (3) years. In case a vacancy occurs in the Council, any person chosen to fill the
position vacated by a member of the Council shall only serve the unexpired term of said member.

Sec. 33. Duties and Functions. - The Council shall exercise the following duties:

(a) Develop and periodically update, in coordination with the DOH, a national multi-sectoral
strategic plan for palliative care that further operationalizes the objectives of this Act which shall
include the following:

(i) The country’s targets and strategies in protecting the rights of Filipinos with palliative
care needs and in promoting palliative care and the well-being of Filipinos, as provided in this Act;

(i) The government's plan in establishing a rational, unified and integrated service delivery

network for palliative care services including the development of health human resources and
information system for palliative care: and

14


(iii) The budgetary requirements and a corollary investment plan that shall identify the
sources of funds for its implementation;

(b) Monitor the implementation of the rules and regulations of this Act and the strategic plan
for palliative care, undertake mid-term assessments and evaluations of the impact of the
interventions in achieving the objectives of this Act;

(©) Ensure the implementation of the policies provided in this Act, and issue or cause issuance
of orders, or make recommendations to the implementing agencies as the Council considers
appropriate;

(@) Coordinate the activities and strengthen working relationships among national government
agencies, LGUs, and nongovernment agencies involved in palliative care promotion;

(©) Coordinate with foreign and intemational organizations regarding data collection, research
and treatment modalities for persons with advanced life-limiting health conditions;

(Coordinate joint planning and budgeting of relevant agencies to ensure funds for programs
and projects indicated in the strategic medium-term plan are included in the agency's annual budget;

(g) Call upon other goverment agencies and stakeholders to provide data and information in
formulating policies and programs, and to assist the Council in the performance of its functions,

(h) Establish a National Palliative Care Registry and monitoring system that cover all
advanced life-limiting conditions among adults and children and serve as guide in the policy
development of the Council; and

(i) Perform other duties and functions necessary to carry out the purposes of this Act.

Sec. 34. Creation of the DOH Palliative Care Division. — There shall be created in the DOH,
a Palliative Care Division, under the Disease Prevention and Control Bureau, staffed by qualified
palliative care specialists and support staff with permanent appointments and supported with an
adequate yearly budget, It shall implement the National Palliative Care Program and, in addition, shall
also serve as the Secretariat of the Council

CHAPTER IX
MISCELLANEOUS PROVISIONS

Sec. 35. Appropriations. — The amount needed for the initial implementation of this Act shall
be charged against the 2024 appropriations of the DOH. ‘Thereafter, such amounts necessary shall be
include in the annual appropriations of the LGUs and other implementing agencies

Sec. 36. Implementing Rules and Regulations (IRR). - The Secretary of Health, in coordination
with the CHR, DSWD, DILG, DepEd, CHED, TESDA, DOLE, CSC and together with associations or
organizations representing palliative patients and palliative care providers, specialists, workers, and
other service providers, shall issue the IRR necessary for the effective implementation of this Act within
‘one hundred twenty (120) days from the effectivity thereof.

Sec. 37. Separability Clause. — If any provision of this Act is declared unconstitutional or
invalid by a court of competent jurisdiction, the remaining provisions not affected thereby shall continue
to be in full force and effect

Sec. 38. Repealing Clause. - All laws, decrees, executive orders, department or memorandum
orders and otner aliministraiive issuances or parts thereof which are inconsistent with the provisions of
this Act are hereby modified, superseded or repealed accordingly.

15


Sec. 39. Effectivity. - This Act shall take effect fifteen (15) days after its publication in the
Official Gazette or in at least two (2) newspapers of general circulation.

Approved,

16