FOURTEENTH CONGRESS OF THE REPUBLIC) 
First Regular Session 
OF THE PHILIPPINES 
7 y’ 
15 ’ 
*I 
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decision to have life-sustaining treatment withheld or withdrawn in instances of a terminal 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. Modem 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 primary 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be withheld or withdrawn.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.* 
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* This bill was originally filed during the Thirteenth Congress, First Regular Session. 


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I 
FOURTEENTH CONGRESS OF THE REPUBLIC) 
1 j 
OF THE PHILIPPINES 
1 
. .~ 
‘‘3 I‘I . , - 
First Regular Session 
) 
Introduced by Senator Miriam Defensor Santiago 
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TREATMENT WITHHELD OR WITHDRAWN IN INSTANCES OF A TERMINAL 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 Representatives of the Philippines in 
Congress assembled: 
SECTION 1. Title. -This Act shall be known as the “Natural Death Act of 2007.” 
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. Definition 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-snstaining 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 onlv to orolone. the tlrocess of dvine.. “Life-sustaining treatment” shall not include the 
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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. 
(G) “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. 
(11) “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 whom is the patient’s 
attending physician, and both of 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 Life-Sustaining Treatment. - 
(A) 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: 
(1) Are not related to the declarer by blood or marriage; 
(2) Would not be entitled to any portion of the estate of the declarer upon 
declarer’s decease under any will of the declarer or codicil thereto then existing or, at the 
time of the directive, by operation of law then existing; 
(3) Shall not be the attending physician; 
(4) Shall not be an employee of the attending physician or a health facility in 
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which the declarer is a patient; or 
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(5) 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. 
(B) The directive shall be duly notarized. 
(C) 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 
I 
(month, year). 
, 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 physicians, 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. 
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(b) In the absence of my ability to give directions regarding the use of 
such life-sustaining treatment, it is my intention that this directive shall be 
honored by my family and physician(s) as the 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): 
1 0  I DO want to have artificially provided nutrition and hydration. 
1 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 emotionally 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. 
(8) 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 .................... 
........................ 
.............................. 
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The declarer has been personally known to me and I believe him or her to 
be capable of making health care decisions. 
Witness. ............................. 
Witness. ............................. 
(ACKNOWLEDGMENT) 
(D) 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. 
(E) A directive executed in another political jurisdiction is valid to the extent permitted 
by Philippine law. 
SECTION 5. Revocation of Directive. - 
(A) A directive may be revoked at any time by the declarer, without regard to declarer’s 
mental state or competency, by any ofthe following methods: 
(1) 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. 
(2) By a written revocation of the declarer expressing declarer’s intent to revoke, 
signed, and dated by the declarer. Such revocation shall become effective only upon 
cominunication 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. 
(3) 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. 
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(B) There shall he 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 
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knowledge of the revocation. 
(C) 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. - 
(A) On Insurance. - 
(1) 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. 
(2) The making of a directive pursuant lo 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 modify 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 
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withholding or withdrawal of life-sustaining treatment from an insured qualified patient, 
notwithstanding any term of the policy to the contrary. 
(3) No physician, health hcility, 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. 
(B) 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. - 
(A) Any person who willfully conceals, cancels, defaces, obliterates, or damages the 
directive o€ another without such declarer’s consent is guilty of a gross misdemeanor. 
(B) 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 I I. Discharge So That Patient May Die At Home. - If a qualified patient 
capable of making 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 
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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. Effectivity Clause. - This Act shall take effect fifteen (15) days after its 
publication in at least two newspapers of general circulation. 
Approved, 
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