VI.

INTRODUCTION

A. BACKGROUND

Euthanasia or mercy killing is derived from the Greek words eu (meaning good)
and thanatos (meaning death), which combined means good death or dying well. It is
defined as inducing the painless death of a person who is severely debilitated for reasons
assumed to be merciful and as the intentional termination of the life of a person with the purpose
of relieving him from suffering and pain. 1
In the Philippines, euthanasia, whatever its kind is generally a violation of existing
criminal laws. In instances of voluntary euthanasia, where the subject causes or helps to bring
about his own death, the law of suicide, as well as the law of homicide is applicable.2
Euthanasia is divided into different types, voluntary, involuntary, non-voluntary, active
and passive. Voluntary euthanasia is mercy killing administered upon request or at least with the
consent of the deceased. This is usually applied to those persons who are in their right minds like
the incurably diseased patients. Involuntary euthanasia or "destruction of life not worth living" is
used to describe not the patient's own attitude towards life but his objective uselessness to the

1 Model United Nations of Lbeck, 2014

2 Amado Tolentino, Jr., Is there a right to die? A study of the law of euthanasia, PLJ Volume 49 Number
4-02, 1974, page 446
1

community. This is the distraction of idiots, the old aged, the insane, the monstrosities and the
defective, in the early stages of life3. Involuntary euthanasia shall not be discussed in this
writing. Non-voluntary euthanasia means that an appropriate person has to decide about the
further medical treatment of the patient because the latter is not able to ask directly for
euthanasia due to illness. This occurs when the person who is killed made no request and gave no
consent.4Active euthanasia involves causing the death of a person through a direct action, in
response to a request from that person. Passive euthanasia is hastening the death of a person by
altering some form of support and letting nature take its which includes turning off respirators,
halting medications, discontinuing food and water so as to allowing a person to dehydrate or
starve to death, or failure to resuscitate5. Physician-assisted euthanasia occurs when a person
self-administers a lethal substance prescribed by a physician.
The legal status of euthanasia differs from one country to another. There are several
countries in the world which considers euthanasia to be legal. In these countries, they have
considered the right to die as a right under their laws. Colombia's Constitutional Court ruled in
1997 that "no person can be held criminally responsible for taking the life of a terminally ill
patient who has given clear authorization to do so. In 1990, the Florida Supreme Court decided
in Guardianship of Estelle Browning that Browning had "the constitutional right to choose or
refuse medical treatment, and that right extends to all relevant decisions concerning one's
health.6 The European Convention on Human Rights gives a person the right to die. The
American Civil Liberties Union believes that the right of a competent terminally ill person to
3 Ibid
4 Http://euthanasia.com/definitions Last accessed on October 24, 2015
5 http://legal-dictionary.thefreedictionary.com/euthanasia Last accessed on October 24, 2015
2

avoid excruciating pain and embrace a timely and dignified death bears the sanction of history
and is implicit in the concept of ordered liberty. Netherlands, Belgium, and Luxembourg have
legalized euthanasia. 7 In these jurisdictions where euthanasia has been legal, safeguards, criteria,
and procedures were put in place to control the practices, to ensure societal oversight, and to
prevent from being abused or misused. Some criteria and procedures are common across the
jurisdictions; others vary from country to country. The extent to which these controls and
safeguards have been able to control the practices and to avoid abuse merits closer inspection,
particularly by jurisdictions contemplating the legalization of euthanasia.8
The Philippine Senate considered a controversial proposal known as Senate Bill No.
1887 or the Natural Death Act which was filed by Senator Miriam Defensor-Santiago. The bill
seeks to recognize the fundamental right of adult persons to decide their own health care.
However, the bill met contradictions from the Catholic Church. The church has been seen as a
hindrance to health policy-makers and medical workers in many cases over the years. 9 The
Catholic church based its opposition on the Fifth Commandment- You shall not kill. The Vatican
announced "Human life is sacred because from its beginning it involves the creative action of
God and it remains forever in a special relationship with the Creator, who is its sole end. God
alone is the Lord of life from its beginning until its end: no one can under any circumstance

6Id.
7 Deliens L, van der Wal G., The euthanasia law in Belgium and the Netherlands, Lancet 2003 and
Watson R. Luxembourg is to allow euthanasia. BMJ 2009
8 J. Pereira, Current Oncology Volume 18, Number 2
9 BMJ VOLUME 314 7 JUNE 1997
3

claim for himself the right directly to destroy an innocent human being." 10 Therefore, it is still
considered illegal in our country.

B. THESIS STATEMENT

Any act of euthanasia is not legal in the Philippines and punishable under the law such as
the Revised Penal Code. The legislation shall pass a law which would make it legal for patients
who request to undergo Passive Euthanasia, Active Euthanasia and Physician Assisted Suicide
and to safeguard family members who decide on behalf of the patient provided it is within the
safeguards and regulations of the law. The patient must fall under the definition of Uniform
Determination of Death Act.

C. BRIEF DISCUSSION OF FINDINGS

10 http://www.vatican.va/archive/ccc_css/archive/catechism/p3s2c2a5.htm

In Matter of Welfare of Colyer,11 the United States Supreme Court has identified a right
of privacy emanating from the penumbra of the specific guarantees of the Bill of Rights and from
the language of the First, Fourth, Fifth, Ninth, Fourteenth Amendments.
The decision by the incurably ill to forego medical treatment and allow the natural
processes of death to follow their inevitable course is so manifestly fundamental decision in their
lives, that it is inconceivable that the would not apply to it.12

D. CONCLUSION AND RECOMMENDATION

The writer thinks it is time to pass a law which would make it legal for patients who
request to undergo Passive Euthanasia, Active Euthanasia and Physician Assisted Suicide and to
safeguard family members who decide on behalf of the patient provided it is within the
safeguards and regulations of the law. At present, physicians who help a patient die can be
charged with malpractice since it violates the Hippocratic Oath which states that physicians must
11Matter of Welfare of Colyer, 660 P. 2d 738, 740 (Wash., 1983)
12 Ibid
5

value the life of their patient and never suggest anyone a way towards suicide. Medical
practitioners are also subject to criminal liability under the Revised Penal Code such as parricide,
murder, homicide, giving assistance to suicide depending on the circumstances of every case.
The Department of Justice said in the 2010 Resolution regarding the Laurel case that Euthanasia
in the Philippines as in the instant case is still murder and any physician who assists a person in
taking his/her own life is liable for the crime of assisting a person to commit suicide under the
Revised Penal Code. The 1987 Constitution, in Article II provides:
Section 11. The State values the dignity of every human person and guarantees
full respect for human rights.
However , in the case of Carter v Canada13 (Attorney General), the Canadian Supreme
Court has unanimously overturned the prohibition on assisted suicide and voluntary euthanasia
contained in the Canadian Criminal Code. The Court found that the Code provisions infringe on
the rights to life, liberty and security of the person, rights which are protected by the Canadian
Charter of Rights and Freedoms.
There must be a respect for individual freedom and rights. An individual should have the
liberty to choose the time of death which would result in shortening the period of suffering and
financial burdens of the person and family. The lack of law prolongs the dying process of a
gravely ill patient at the cost of immense physical and emotional suffering and expense. There is
a great importance to consider the right of a dying person to take full control over the body in
choosing when to fight for life and when to allow death. It will be beneficial to patients who
have incurable diseases or under extreme or unbearable physical pain. Death is a private matter,
13 Carter v Canada (Attorney General), 2015 SCC 5, 6 February 2015
6

human beings must have the right to die when and how they want to. The right of an individual
to choose should be paramount. So long as the patient is lucid and his or her intent is beyond
doubt, there need be no further questions14. Euthanasia cannot be considered without reference to
human rights, but all relevant rights should be included such as the rights of every person to their
life and to the standards of health care appropriate to their illness and to protect the equal rights
of all the sick.
The writer thinks it is most appropriate for a legislation to make it legal for terminally ill
patients who request to undergo Passive Euthanasia, Active Euthanasia and Physician Assisted
Suicide and to safeguard family members who decide on behalf of the patient provided it is
within the safeguards and regulations of the law. There is a need for a law which would provide
the proper guidelines to qualify the act as legal based on international standards. In order for a
patient to avail of euthanasia, patients illness must be considered under the Uniform
Determination of Death which provides "An individual who has sustained either (1) irreversible
cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of
the entire brain, including the brain stem, is dead. A determination of death must be made in
accordance with accepted medical standards."
. These must be provided in writing by a physician but must be validated by another
physician. The request for voluntary euthanasia, passive euthanasia or PAS has to be voluntary
and the requesting person must provide explicit written consent and must be competent at the
time the request is made. There should be a mandatory reporting and conducted only by

14 The Independent, March 2002

7

physicians. These universal standards of euthanasia shall be applied to meet the requirements of
safeguards of euthanasia.

E. METHODOLOGY

The writer researched on foreign and local journals, magazines, foreign jurisprudence.

F. SCOPE AND LIMITATIONS

The study only covers active euthanasia, passive euthanasia and Physician Assisted
euthanasia.

G. SIGNIFICANCE OF THE STUDY

The study affects the people for all shall benefit from the advantages of active euthanasia,
passive euthanasia and Physician Assisted Suicide. Those who are suffering from terminal illness
which such sickness, injury or disease adversely affect the quality of life of such patients can
choose to continue medication or withdraw medical procedures to avail of the exercise of
euthanasia. Another advantage is for economical benefit of the patient. Medical practitioners

shall not be held criminally or administratively liable and other persons shall not be held
criminally liable in exercising acts of euthanasia, whatever its kind except for involuntary
euthanasia.
Proponents of euthanasia and PAS identify three main benefits to legalization: realizing
individual autonomy, reducing needless pain and suffering, and providing psychological
reassurance to dying patients.15

VII. DISCUSSION

A. DOJ RESOLUTION IN LAUREL CASE

In the case of Mary Ann Laurel and Patrick Laurel, the Department of Justice in 2010
through a resolution ordered the filing of parricide charges because of the findings that the
proximate cause of the death of Mario Laurel, husband of Mary Ann Laurel and father of Patrick
15 Ezekiel J. Emanuel, Ethics, Vol. 109, No. 3. Apr., 1999, pp. 629-642.
9

Laurel, is the removal of the life support system and the withholding of medical treatment upon
instructions of respondents.
The Department of Justice in its Resolution in 2010 in the case of Mary Ann Laurel, a
thorough examination of the record failed to mention any particular physician who rendered a
categorical declaration from the scientific point of view that Mario was clinically dead nor a
recovery from the coma is nil. Taking the foregoing into account, it is apparent that although in a
coma at the time, Mario was alive, scientifically and biologically. He expired due to cardiac
arrest and multiple organ failure when the mechanical ventilator attached to him was turned off.
16

In such resolution, it was explained, In this legal jurisdiction, it is not for any person to
decide when a man or a woman is ripe for the taking or killing while he or she is in a coma.
Euthanasia in the Philippines as in the instant case is still murder A good motive is not
incompatible with an unlawful intent. One may be convicted of a crime whether his motive
appears to be good or bad or even though no motive is proven. A good motive does not prevent
an act from being a crime.17

B. LEGAL DEFINITION OF DEATH

16 2010 Department Of Justice Resolution

17 Ibid
10

Death has been defined as irreversible cessation of circulatory and respiratory functions
and of all functions of the entire brain, including the brain stem18.
In Bennett v Peattie19, the Ontario Court of Appeal stated that "From the standpoint of
judicial inquiry, I am inclined to the view that in cases where there has been no resuscitation,
death should be regarded as having taken place at the moment when respiration and pulsation
ceased without entering into the inquiry that troubles biologists as to the exact line between life
and death in the individual."
Justice MacKenzie explained in Re Rosebush 20 "A person will be considered dead if in
the announced opinion of a physician, based on ordinary standards of medical practice in the
community, there is the irreversible cessation of spontaneous respiratory and circulatory
functions. If artificial means of support preclude a determination that these functions have
ceased, a person will be considered dead if in the announced opinion of a physician, based on
ordinary standards of medical practice in the community, there is the irreversible cessation of
spontaneous brain functions. Death will have occurred at the time when the relevant functions
ceased."

18 http://www.duhaime.org/LegalDictionary/D/Death.aspx Last accessed on December 29, 2015

19 Bennett v Peattie, (1925) 57 OLR 233

20 In re Rosebush, 491 NW 2d 633

11

C. UNIFORM DETERMINATION OF DEATH ACT

The American National Conference of Commissioners on Uniform Laws proposed, in

1980, a Uniform Determination of Death Act which has been adopted by, amongst others,
Kansas, as statute 77-202 as follows:
"An individual who has sustained either (1) irreversible cessation of circulatory and
respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including
the brain stem, is dead. A determination of death must be made in accordance with accepted
medical standards."21
Brain death is defined as the irreversible loss of all functions of the brain, including the
brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes,
and apnoea. An evaluation for brain death should be considered in patients who have suffered a
massive, irreversible brain injury of identifiable cause. A patient determined to be brain dead is
legally and clinically dead22.
D. FACTUAL AND HISTORICAL BACKGROUND

21 National Conference of Commissioners on Uniform Laws website at

nccusl.orgnccusl.org/Update/uniformact_factsheets/uniformacts-fs-udda.asp Last accessed
on December 18, 2015

22 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772257/ Last accessed on

December 27, 2015
12

1. KNOWN CASES

a. KAREN ANN QUINLAN

On April 15, 1975, Quinlan attended a friend's birthday party at a local in New Jersey. An
ambulance was called and mouth-to-mouth resuscitation was attempted after finding out she was
not breathing but she did not regain consciousness. Quinlan was admitted to Newton Memorial
Hospital in New Jersey in a coma. She remained there for nine days in an unresponsive condition
before being transferred to Saint Clare's Hospital, a larger facility. Quinlan had suffered
irreversible brain damage after experiencing an extended period of respiratory failure. No precise
cause of her respiratory failure has been given. Her brain was damaged to the extent that she
entered a persistent vegetative state, a state of completely altered consciousness. Over the next
few months she remained in the hospital and her condition gradually deteriorated. She was given
nasogastric feeding and a ventilator to help her breathe.
The court ruled that although the Constitution does not explicitly mention a right of
privacy, Supreme Court decisions have recognized that a right of personal privacy exists and that
certain areas of privacy are guaranteed under the Constitution. The Court has interdicted judicial
intrusion into many aspects of personal decision, sometimes basing this restraint upon the

13

conception of a limitation of judicial interest and responsibility, such as with regard to

contraception and its relationship to family life and decision.23
The claimed interests of the State in this case are essentially
the preservation and sanctity of human life and defense of the right of
the physician to administer medical treatment according to his best
judgment. In this case the doctors say that removing Karen from the
respirator will conflict with their professional judgment. The plaintiff
answers that Karen's present treatment serves only a maintenance
function; that the respirator cannot cure or improve her condition but
at best can only prolong her inevitable slow deterioration and death;
and that the interests of the patient, as seen by her surrogate, the
guardian, must be evaluated by the court as predominant, even in the
face of an opinion contra by the present attending physicians.
Plaintiff's distinction is significant. The nature of Karen's care and the
realistic chances of her recovery are quite unlike those of the patients
discussed in many of the cases where treatments were ordered. In
many of those cases the medical procedure required (usually a
transfusion) constituted a minimal bodily invasion and the chances of
recovery and return to functioning life were very good. We think that
the State's interest contra weakens and the individual's right to
privacy grows as the degree of bodily invasion increases and the
prognosis dims. Ultimately, there comes a point at which the
individual's rights overcome the State interest. It is for that reason
that we believe Karen's choice, if she were competent to make it,
would be vindicated by the law. Her prognosis is extremely poor, -she will never resume cognitive life. And the bodily invasion is very
great, -- she requires 24 hour intensive nursing care, antibiotics, the
assistance of a respirator, a catheter and feeding tube.24
Our affirmation of Karen's independent right of choice,
however, would ordinarily be based upon her competency to assert it.
The sad truth, however, is that she is grossly incompetent and we
cannot discern her supposed choice based on the testimony of her
previous conversations with friends, where such testimony is without
sufficient probative weight. Nevertheless we have concluded that
Karen's right of privacy may be asserted on her behalf by her
guardian under the peculiar circumstances here present.25

23 Matter of Quinlan, 355 A.2d 647, 662-666, (N.J. 1976)

24 Id.
14

If a putative decision by Karen to permit this non-cognitive,

vegetative existence to terminate by natural forces is regarded as a
valuable incident of her right of privacy, as we believe it to be, then it
should not be discarded solely on the basis that her condition prevents
her conscious exercise of the choice. The only practical way to
prevent destruction of the right is to permit the guardian and family
of Karen to render their best judgment, subject to the qualifications
hereinafter stated, as to whether she would exercise it in these
circumstances. If their conclusion is in the affirmative this decision
should be accepted by a society the overwhelming majority of whose
members would, we think, in similar circumstances, exercise such a
choice in the same way for themselves or for those closest to them. It
is for this reason that we determine that Karen's right of privacy may
be asserted in her behalf, in this respect, by her guardian and family
under the particular circumstances presented by this record.26
The court balanced the degree of bodily invasion against the State's interest in
preserving life. For Karen Quinlan, the degree of bodily invasion was great, since she required a
respirator, an intravenous feeding apparatus, a catheter, and intensive nursing care. The court
concluded that Karen's privacy right outweighed the State's interest.27

b. ESTELLE BROWNING

25 Id.
26 Id.
27 Id.
15

In In Re: Guardianship of Estelle M. Browning, State of Florida, vs. Herbert 28, on

November 19, 1985, a competent Estelle Browning executed a declaration stating of her desire to
withheld or withdraw procedures when the application of such procedures would serve only to
prolong artificially the process of dying due to terminal condition, there is no recovery and death
is imminent. Mrs. Browning has also expressed her desire not to have nutrition and hydration
(food and water) provided by gastric tube or intravenously. Mrs. Browning was admitted to the
hospital after suffering from stroke. She has undergone operation and was discharged and
transferred in a nursing home where she had experienced physical difficulties. Her guardian,
Mrs. Herbert filed a petition in circuit court to terminate the nasogastric feeding based upon Mrs.
Browning's living will. Her friends testified regarding the desire of Mrs. Browning.
The Court has decided and held that the right of privacy which is Mrs. Browning's, as a
competent person, fundamental right of self-determination controls in this case. The Court
further held,
Because the word "privacy" generally has been used in
common parlance in its informational or disclosural sense, its broader
meaning has been somewhat ignored. However, the concept of
privacy encompasses much more than the right to control the
disclosure of information about oneself. "Privacy" has been used
interchangeably with the common understanding of the notion of
"liberty," and both imply a fundamental right of self- determination
subject only to the state's compelling and overriding interest. For
example, privacy has been defined as an individual's "control over or
the autonomy of the intimacies of personal identity,"; or as a
"physical and psychological zone within which an individual has the
right to be free from intrusion or coercion, whether by government or
by society at large.29

28 In Re: Guardianship of Estelle M. Browning, State of Florida, vs. Doris F. Herbert, etc., No. 74, 174, September
13, 1990

29 Id
16

These components of privacy are the same as those encompassed in

the concept of freedom, and, as recognized in In re T.W., 551 So.2d
1186 (Fla. 1989), are deeply rooted in our nation's philosophical and
political heritage. In Florida, we have recognized that this
fundamental right of privacy has been expressly enumerated in article
I, section 23 of the Florida Constitution, which provides "an explicit
textual foundation for those privacy interests inherent in the concept
of liberty.30
Therefore, the Court ruled that everyone has a fundamental right to the sole control of his or her
person. A competent person, such as Mrs. Browning, has the constitutional right to choose or
refuse medical treatment which right extends to all relevant decisions concerning one's health31.
A competent and incompetent person has been constitutionally protected right to choose
or reject medical treatment, in the case of the latter, another person may exercise the
incompetents right to forego medical treatment. Such rigt is not lost by the mere fact that
a person has been on vegetative state. Indeed, the right of privacy would be an empty
right were it not to extend to competent and incompetent persons alike. The right
involved here is one of self- determination that cannot be qualified by the condition of the
patient32
In the decision of the Court, it ruled that due to Mrs. Brownings incapacity due to her
condition to exercise the right granted to her, the guardian may do so.

c. BERTHA COLYER
30 Id
31 Id
32 Id
17

On March 8, 1982, 69 year old Bertha Colyer, sustained a cardiopulmonary arrest

which caused for her heart to stop breathing. Her body lost oxygen for 10 minutes
resulting to massive brain damage. She was brought to St. Lukes Hospital in Bellingham
wherein she was in persistent vegetative state and there were findings by two medical
doctors that her recovery is small. Her husband applied for guardianship and petitioned
for the removal of life support system which was favorably decided by the Court.33
The Court has ruled that,
Sufficient state action exists to invoke the constitutional right
of privacy if the nexus between the State and the challenged action of
the regulated activity is so close that the action of the latter may fairly
be treated as the action of the State itself.34
An adult who is incurably and terminally ill may choose to
withhold or withdraw treatment that serves only to prolong the dying
process. This right, based on the constitutional right of privacy and
the right to be free from bodily invasion, is not absolute but must be
balanced against the State's interests in preserving life, protecting
interests of third parties, preventing suicide, and maintaining the
ethical integrity of the medical profession.35
When a patient whose life is sustained by artificial support systems
has family members familiar with his character and his beliefs held
during his competency, a decision to withdraw the life sustaining
treatment does not require judicial intervention.
A guardian of an individual whose life is sustained by
artificial support systems has authority to exercise the individual's
personal right to withhold or withdraw life sustaining treatment. The
guardian uses his best judgment and bases his decision on his
familiarity with the individual's character, personality, and general
33 In the Matter of Welfare of Bertha Colyer, No. 48521-6, March 10, 1983
34 Ibid
35 Ibid
18

attitude toward medical treatment. Prior statements by the individual

regarding the refusal of life sustaining treatment may also be
probative depending upon his age and maturity, the context of the
statements, and their relation to the illness.36
In the proceeding to appoint a guardian for a patient kept alive
by support systems, the guardian ad litem represents the patient's best
interests by providing the court with a written evaluation of the
proposed guardian focusing on the relationship between him and the
patient and any evidence of improper motives. Should judicial
intervention be required subsequent to the appointment of the
guardian, the guardian ad litem investigates and gathers for the court
all the facts relevant to the termination of the support systems.37
The withdrawal of life sustaining treatment from an incurably ill
patient does not constitute homicide if it is accomplished in good
faith compliance with judicially imposed safeguards.38
Similar intrusive care applied to the case of Karen Quinlan was required for Bertha
Colyer. Therefore, applying the balancing test in Quinlans case, the Court concluded that Bertha
Colyer's privacy right was greater than the State's interest in preserving her life.

d. NANCY CRUZAN

Nancy Cruzan, a recently married thirty year- old employee of the State of Missouri, was
involved in a one-car accident in Jasper County, Missouri on January 11, 1983 at about 1:00 a.m.
Nancy Cruzan was not conscious when she was taken to the hospital. The hospital did a series of
36 Id.
37 Id.
38 Id.
19

tests which revealed lacerations of her liver but no significant brain abnormality. She was
provided with treatment for all of her physical ailments, although she remained unconscious.39
A gastrostomy tube, a feeding tube, was placed into her stomach. Although she was able
to take nutrition orally, it was placed in order to assist her recovery and to ease the feeding
process. Nancy Cruzan has not improved even after several rehabilitation experts worked with
her.40
Seven years later and Nancy Cruzan is thirty-six years old, she stays in a nursing home in
Missouri. The trial court made seven findings of fact, based on the consensus opinions of her
doctors, about her and her prospects for life. First, she can breathe on her own, and she will
continue to breathe on her own. Second, she is oblivious to her environment. Third, what used to
be her brain, or at least the cerebral cortex, has atrophied and that area within the skull is now
filling with spinal fluid. Her brain deterioration is "irreversible, permanent, progressive, and
ongoing." Fourth, her highest cognitive brain function is exhibited by grimacing, perhaps in
response to pain and sound. Fifth, she is a spastic quadriplegic. Sixth, her arms and legs are
contracted as a consequence of the absence of brain activity. There is irreversible damage to the
muscles and tendons in her arms and legs. Seventh, she lacks the cognitive and reflexive ability
to chew and swallow all that she needs to sustain herself. In sum, she is in a persistent vegetative
state.41
Before her accident, competent Nancy Cruzan told her friends that she didn't want to live
unless she could live what she called a "halfway normal" life. Her parents believed that
39 Cruzan V. Harmon, 497 U.S. 261, June 25, 1990
40 Ibid
41 Ibid
20

their daughter would want the tube removed and that it is appropriate and consistent with the
maintenance of her dignity for the tube to be removed. If the tube is removed, she will die.
Nancy's parents, who are also her legal guardians, have asked the Mt. Vernon State Hospital to
remove the tube which was refused without a court order.
The case went to trial in a trial court in Missouri, which heard arguments on behalf of the Cruzan
family to have the tube removed from their daughter's stomach. They also heard arguments from
the state, arguing otherwise.
The Supreme Court of Missouri ruled that Cruzan was neither dead nor terminally ill
although she was in a persistent vegetative state, her right to refuse treatment emanating from
right of privacy or common-law right did not outweigh Missouris strong policy favoring the
preservation of life, her conversation with her housemates were unreliable for the purpose of
detemining her intent and insufficient for her parents to exercise substituted udgment and in the
absence of a living will or clear and convincing evidence, a peson could not assume the choice of
medical treatment for a incompetent person. This was upheld by United States Supreme Court. It
ruled that due process was not violated by the Missouri requirement that here must be a clear and
convincing evidence of her wishes which was fulfilled by additional witnesses. The tubes were
removed in December 1990 and Nancy Cruzan died after two weeks.

E. REVISED PENAL CODE LIABILITY

21

Generally, it can be said that euthanasia, whether voluntary or involuntary, and whether
by affirmative act or by omission, is a violation of existing criminal laws. In instances of
voluntary euthanasia, where the subject causes or helps to bring about his own death, the law of
suicide, as well as the law of homicide is applicable.42
A careful examination of Philippine law on the subject will reveal that mercy killing is
murder, homicide, parricide or assistance to suicide. Mercy as a motive is not even a mitigating
circumstances43.

F. CONTRADICTIONS OF THE CATHOLIC CHURCH

Pope Pius XII was the first to explicate clearly the moral problem and provide guidance on
euthanasia44. "Human life is an inviolable gift from God. Our love of God and His creation
should cause us to shun any thought of violating this great gift through suicide or euthanasia. 45
42 PLJ Volume 49 No. 4-02 by Amado S. Tolentino, Jr.
43 Ibid
44 What Is the Church's Teaching on Euthanasia? by Fr. William Saunders,
http://www.catholicculture.org/culture/library/view Last accessed on October 24, 2015

45 "A Catholic Guide to End-of-Life Decisions: An Explanation of Church Teaching on Advance

Directives, Euthanasia, and Physician Assisted Suicide", National Catholic Bioethics Center (NCBC),
22

Direct euthanasia is morally unacceptable whatever its motives and means because it consists in
putting an end to the lives of handicapped, sick, or dying persons46.
The acceptance by human society of murderous famines, without efforts to remedy them, is a
scandalous injustice and a grave offense. Those whose usurious and avaricious dealings lead to
the hunger and death of their brethren in the human family indirectly commit homicide, which is
imputable to them.47
Intentional euthanasia, whatever its forms or motives, is murder. It is gravely contrary to the
dignity of the human person and to the respect due to the living God, his Creator48.

G. LAW IN FOREIGN COUNTRIES

Euthanasia has been legal in Belgium since 2002, Netherlands since 2001 and Luxembourg since
February 19, 200949. In the United States, the states of Oregon and Washington legalized PAS in

www.ncbcenter.org
46 http://www.vatican.va/archive/ccc_ccs/archive/catechism/p3s2c2a5.htm Last accessed on October 24,
2015
47 Ibid
48 Ibid
23

1997 and 1999 respectively, but euthanasia remains illegal. 50 Most of the countries still consider
euthanasia as illegal such as Australia which has previously legalized in the Northern Territory in
1995 but overturned in 1997, Canada, Germany, Israel, India, Italy, Russia, Spain, Switzerland,
United Kingdom.51
Physician-assisted suicide is now legal in a number of states in the United States, including
Oregon and Washington State, as well as in Switzerland and in the Netherlands. The data from
these places show that the implementation of physician-assisted suicide, when it is accompanied
by certain safeguards (including comprehensive screening and informed consent processes), does
not lead to uncontrolled expansion or abuse. In Switzerland, the number of assisted suicides has
risen steadily over the past decade, but the total number of suicides has declined. The data from
Oregon and Washington show that the majority of persons who request physician-assisted
suicide are white, educated men not a population that would be considered particularly
vulnerable. Also, only a minority of persons who inquire about suicide assistance actually
complete the process; this indicates that the option is perceived as a choice that can be
abandoned.52

49 http://www.nationalreview.com/article/398521/europes-increasing-acceptance-euthanasia-and-assisted-suicidesydney-leach Last accessed on October 24, 2015

50J. Pereira, Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls, Current
Oncology, Volume 18, Number 2, page 1
51 http://euthanasia.procon.org/view.resource.php?resourceID=000136 Last accessed on October 24, 2015
52 Physician-Assisted Suicide, Nikola Biller-Andorno, M.D., Ph.D,
http://www.nejm.org/doi/full/10.1056/NEJMclde1302615, Last accessed December 28, 2015

24

H. RIGHT OF PRIVACY

In the case of Ople v. Torres 53, find that the right of privacy is recognized and enshrined
in several provisions of our Constitution. Other facets of the right to privacy are protected in
various provisions of the Bill of Right. The right to privacy is one of the most threatened rights
of man living in a mass society. The threats emanate from various sources governments,
journalists, employers, social scientists, etc.
In the case of Gamboa vs. Chan, the court said, The right to privacy as such is accorded
recognition independently of its identification with liberty; in itself, it is fully deserving of
constitutional protection. The language of Prof. Emerson is particularly apt: The concept of
limited government has always included the idea that governmental powers stop short of certain
intrusions into the personal life of the citizen. This is indeed one of the basic distinctions between
absolute and limited government. Ultimate and pervasive control of the individual, in all aspects
of his life, is the hallmark of the absolute state. In contrast, a system of limited government,
safeguards a private sector, which belongs to the individual, firmly distinguishing it from the
public sector, which the state can control. Protection of this private sector protection, in other
words, of the dignity and integrity of the individual has become increasingly important as
modern society has developed. All the forces of a technological age industrialization,
urbanization, and organization operate to narrow the area of privacy and facilitate intrusion

53 Ople v. Torres, G.R. No.127685, July 23, 1998

25

into it. In modern terms, the capacity to maintain and support this enclave of private life marks
the difference between a democratic and a totalitarian society.54
In the 1965 case of Griswold v. Connecticut55, the United States Supreme Court gave more
substance to the right of privacy when it ruled that the right has a constitutional foundation. It
held that there is a right of privacy which can be found within the penumbras of the First, Third,
Fourth, Fifth and Ninth Amendments, viz:
Specific guarantees in the Bill of Rights have penumbras
formed by emanations from these guarantees that help give them life
and substance . . . Various guarantees create zones of privacy. The
right of association contained in the penumbra of the First
Amendment is one, as we have seen. The Third Amendment in its
prohibition against the quartering of soldiers 'in any house' in time of
peace without the consent of the owner is another facet of that
privacy. The Fourth Amendment explicitly affirms the 'right of the
people to be secure in their persons, houses, papers, and effects,
against unreasonable searches and seizures.' The Fifth Amendment in
its Self-Incrimination Clause enables the citizen to create a zone of
privacy which government may not force him to surrender to his
detriment. The Ninth Amendment provides: 'The enumeration in
the Constitution, of certain rights, shall not be construed to deny or
disparage others retained by the people.
In 1976, the New Jersey Supreme Court decided and held In re Quinlan 56, an
alleged incompetent that the right of privacy is broad enough to encompass a patient's
decision to decline medical treatment under certain circumstances, in much the same
way as it is broad enough to encompass a woman's decision to terminate pregnancy
54 Gamboa v. P/SSUPT. Chan G.R. No. 193636, July 24, 2012
55 Griswold v. Connecticut 381 U.S. 479 (1965)
56 In re matter of Quinlan, 70 N.J. 10, 355 A.2d 647, cert. denied, 429 U.S. 922 (1976).
26

under certain conditions. Thus, for the first time in the United States, a court authorized
the withdrawal of life-support systems. The court noted that the patient, Karen Ann
Quinlan, was not brain dead, but was in a vegetative state from which she was very
unlikely to recover.
After such decision of the Court in Quinlan case, a patient in vegetative state
could exercise his or her right to refuse medical treatment because the decision to refuse
medical treatment was protected by the right of privacy.
The Court has interdicted judicial intrusion into many aspects of personal decision,
sometimes basing this restraint upon the conception of a limitation of judicial interest and
responsibility, such as with regard to contraception and its relationship to family life and
decision.
Although the Constitution does not explicitly mention a right of privacy, Supreme Court
decisions have recognized that a right of personal privacy exists and that certain areas of privacy
are guaranteed under the Constitution. The Court has interdicted judicial intrusion into many
aspects of personal decision, sometimes basing this restraint upon the conception of a limitation
of judicial interest and responsibility, such as with regard to contraception and its relationship to
family life and decision.57
Ultimately there comes a point at which the individual's rights overcome the State
interest, stated in Matter of Quinlan.58

57 In re matter of Quinlan, 70 N.J. 10, 355 A.2d 647, cert. denied, 429 U.S. 922 (1976).
58 Ibid
27

In Bouvia v. Supreme Court59, Elizabeth Bouvia was a competent twenty-eight-year-old

woman suffering from severe cerebral palsy and degenerative arthritis. Who was confined to a
hospital bed where she was completely dependent on the hospital staff. Bouvia required spoon
feeding, but was physically unable to swallow much food. Against her will, and contrary to her
express written instructions, the doctors inserted a nasogastric feeding which led Bouvia in
instituting a civil suit, and sought an injunction ordering the physicians to remove the tube. In
1983, Bouvia had checked herself into a Riverside County public hospital, where she expressed
her desire to starve herself to death while receiving treatment to ameliorate the accompanying
discomfort. In a well-publicized decision, the Riverside County Superior Court held that Bouvia
must either submit to treatment, meaning either to eat or to be fed, or leave the hospital.
Therefore, the doctors, the hospital and the court faced the question of whether a competent adult
has an absolute right to refuse life-sustaining treatment. The court found that the right to refuse
medical treatment is recognized as part of the right of privacy, which is protected by both the
federal and state constitutions.
According to the decision of the court, the right to refuse medical treatment is to be given
the same respect as the right to privacy. "Exercise of the right to refuse medical treatment
requires no one's approval. It is not merely one vote subject to being overridden by medical
opinion."
From the decision of the court, it has been held that it is absolute to refuse medical
treatment, Bouvias wishes are paramount because she was competent and was able to make a
decision regarding the treatment to be done to her in which she was entitled to.

59 Bouvia v. Supreme Court, 225 Cal. Rptr. 297, June 5, 1986

28

I. RIGHT TO BE FREE FROM BODILY INVASION

The common law right to be free from bodily invasion is an

alternative basis for the right to refuse life sustaining treatment.
Historically, an operation without authorization constituted an
assault and battery, as well as malpractice.60
This right to be free from nonconsensual invasions of one's
bodily integrity is the basis for the doctrine of informed consent
which requires physicians to disclose to a patient all material facts
and risks concerning the patient's condition, thus enabling the patient
to make an informed choice regarding the proposed treatment. Such
information must include the possibility of alternative treatment or
no treatment at all. Thus, freedom of choice with respect to medical
treatment encompasses the right to refuse life sustaining treatment in
certain circumstances.61

J. STATE INTERESTS AS AN EXCEPTION

This right to refuse treatment, be it founded on constitutional

or common law precepts, is not absolute, for the state has an interest
in protecting the sanctity of the lives of its citizens. This state interest
has been identified in four areas: (1) the preservation of life; (2) the
protection of interests of innocent third parties; (3) the prevention of

60 Matter of Welfare of Colyer, 660 P. 2d 738, 740 (Wash., 1983)

61 Ibid
29

suicide; and (4) maintenance of the ethical integrity of the medical

profession. 62
The most significant state interest, the preservation of life, has
prevailed to require liesaving treatment for nonconsenting patients.
This interest weakens, however, in situations where continued
treatment serves only to prolong a life inflicted with an incurable
condition. 63
The other identified state interests do not mandate a different
conclusion. Bertha Colyer had no children and her immediate family,
consisting of her sisters, joined in her husband's request to remove the
life sustaining mechanisms. Hence, no third party interests needed to
be protected. Nor was prevention of suicide a pertinent consideration
here. A death which occurs after the removal of life sustaining
systems is from natural causes, neither set in motion nor intended by
the patient. 64
Finally, the State's interest in the maintenance of the ethical
integrity of the medical profession is not at odds with this result.
The prevailing ethical practice seems to be to recognize that
the dying are more often in need of comfort than treatment.
Recognition of the right to refuse necessary treatment in appropriate
circumstances is consistent with existing medical mores; such a
doctrine does not threaten either the integrity of the medical
profession, the proper role of hospitals in caring for such patients or
the State's interest in protecting the same. It is not necessary to deny a
right of self-determination to a patient in order to recognize the
interests of doctors, hospitals, and medical personnel in attendance on
the patient.65

62 Id.
63 Id.
64 Id.
65 Id.
30

Thus, we conclude there were no compelling state interests

opposing the removal of life sustaining mechanisms from Bertha
Colyer that outweighed her right to refuse such treatment.66

VIII. CONCLUSIONS AND RECOMMENDATIONS

As shown in this thesis, the performance of euthanasia, whatever kind such as voluntary,
involuntary, active, passive, is not legal in the Philippines. One may be faced with criminal
charges under the Revised Penal Code or in violation of the Hippocratic Oath for medical
practitioners. However, it has been discussed that there is a right of privacy granted to all. In
such right, one may choose the healthcare he wants over his body subject to State interest. Such
right extends to both competent and incompetent persons, in which a guardian may do so in the
latter case.
In the Philippines, it is otherwise. Therefore, there is a need for the legislation to make a
law to legalize active euthanasia, passive euthanasia and physician assisted suicide in our country
and to safeguard family members who decide on behalf of the patient provided it is within the
safeguards and regulations of the law. In a law which shall be passed, safeguards must be
thoroughly considered to make sure that the exercise of euthanasia will not be exposed to abuse.

66 Id.
31

A competent person, at least 18 years of age, may make express his wish through
a notarized directive, witnessed by at least three competent witnesses, that in case of a diagnosis
by two medical doctors that the condition falls under the definition of death based on Uniform
Determination Death Act which provides provides "An individual who has sustained either (1)
irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all
functions of the entire brain, including the brain stem, is dead. A determination of death must be
made in accordance with accepted medical standards."
Should a competent person becomes incompetent such as being in a coma due to illness,
sickness or injury, a guardian whom the patient has chosen or if none, the nearest member of the
family, of legal age, may make the decision in behalf of the patient.

VII. BIBILIOGRAPHY

LAW
Section 11, Article II, 1987 Constitution of the Philippines

LOCAL CASE
Gamboa v. P/SSUPT. Chan G.R. No. 193636, July 24, 2012
Ople v. Torres, G.R. No.127685, July 23, 1998

FOREIGN CASES
Carter v Canada (Attorney General), 2015 SCC 5, 6 February 2015
32

In Re: Guardianship of Estelle M. Browning, State of Florida, vs. Doris F. Herbert, etc., No. 74,
174, September 13, 1990
Cruzan V. Harmon, 497 U.S. 261, June 25, 1990
Bouvia v. Supreme Court, 225 Cal. Rptr. 297, June 5, 1986
In the Matter of Welfare of Bertha Colyer, No. 48521-6, March 10, 1983
Matter of Quinlan, 355 A.2d 647, 662-666, (N.J. 1976)

In re matter of Quinlan, 70 N.J. 10, 355 A.2d 647, cert. denied, 429 U.S. 922 (1976)
Griswold v. Connecticut 381 U.S. 479 (1965)
Bennett v Peattie, (1925) 57 OLR 233
In re Rosebush, 491 NW 2d 633

JOURNALS
Model United Nations of Lbeck, 2014
Deliens L, van der Wal G., The euthanasia law in Belgium and the Netherlands, Lancet 2003
Watson R. Luxembourg is to allow euthanasia. BMJ 2009
The Independent, March 2002
BMJ VOLUME 314 7 JUNE 1997
Ezekiel J. Emanuel, Ethics, Vol. 109, No. 3. Apr., 1999, pp. 629-642
J. Pereira, Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls,
Current Oncology, Volume 18, Number 2, page 1
Amado Tolentino, Jr., Is there a right to die? A study of the law of euthanasia, PLJ Volume 49
Number 4-02, 1974, page 444

33

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