LIVE AND LET DIE: ESTABLISHING THE LEGAL STATUS OF ADVANCE DIRECTIVES FOR REFUSAL OF LIFE-SUSTAINING MEDICAL TREATMENT, THEIR ENFORCEABILITY AND LIMITATIONS

Juan Paolo Miguel B. Leido (JD'12)

ABSTRACT

Death is a fate that awaits everyone—there is no surer event in life than its end. Yet despite its certainty, there is a deep-rooted cultural aversion to the idea of death: we knock on wood when we speak of it, we grow superstitious when we are bereaved by the death of a loved one, we euphemise the very word. At most, we have a secret morbid fascination for it; sensationalist media reminds us of its actuality, and yet we engage it at arms length, and only through the framed reality of the TV screen, the computer monitor, or the printed word. Such regard for death is reflected in our laws, or rather, for purposes of this thesis, the lack of such laws, for the Philippine legal setting has not explicated any true recognition of our control over the circumstances that surround our death. Several jurisdictions outside of the Philippines have already recognized such ability to control, limited in the medical field, by capacitating a patient to determine the extent of his treatment at the end of his life through mechanisms called advance directives. Though recognized by practice in the Philippine medical setting, the lack of an explicit legal framework for advance directives in end-of-life care raises problems in the enforceability of such directives and muddles the scope of patients' rights. Read however in conjunction with the constitutionally granted rights of liberty and privacy, and the state policy of protecting and promoting the health of the citizenry, a patient nearing death may—subject to certain conditions—assert a right of self-determination in choosing his or her end-of-life care, including a right to refuse treatment ranging from the refusal of resuscitative efforts to the withdrawal of life-sustaining treatment. This thesis is about death, and the choices that people may make in their dying—the very right to die. It focuses on those circumstances—those very real and cruel situations—wherein people's lives are so deprived of the inherent and essential qualities of living, by reason of grave illness or physical incapacity, that they would rather choose to end their lives than suffer the burdens such a debilitated manner of living leaves them. In recognizing the right to die, this study aims to further expand what it means to enjoy the right to life and liberty—for one cannot be said to possess such rights if one is deprived of the control of the conditions, within the bounds of the law and under particular circumstances, on which it will end.