PHYSICIAN-PATIENT

CONTRACTUAL
RELATIONSHIP

ATTY. JUDY ANNE YUKI YULO, RN, MD

PHYSICIAN – PATIENT CONTRACTUAL RELATIONSHIP

LEGAL

PHYSICIAN
PROFESSIONAL PATIENT MORAL
RELATIONSHIP

HUMANITARIAN
 THE PHYSICIAN - PATIENT
CONTRACTUAL RELATIONSHIP
• THE PHYSICIAN – PATIENT RELATIONSHIP IS A
CONTRACT.

• IT IS A RELATIONSHIP THAT IS BOTH

CONSENSUAL AND FIDUCIARY.

• A PATIENT WHO ENTRUSTS HIMSELF TO A

PHYSICIAN’S CARE CREATES NOT ONLY
ETHICAL OBLIGATIONS BUT ALSO LEGAL
OBLIGATIONS THAT ARE DEFINITE AND
WEIGHTY.
NATURE OF THE PHYSICIAN-PATIENT
CONTRACTUAL RELATIONSHIP
THE PRESENCE OF A CONTRACTUAL RELATIONSHIP IS THE PRIMORDIAL BASIS OF ANY
NEGLIGENCE CASES.
CONTRACT
• NCC ART. 1305 – A CONTRACT IS A MEETING OF
THE MINDS BETWEEN 2 PERSONS WHEREBY ONE
BINDS HIMSELF WITH RESPECT TO ANOTHER TO
GIVE SOMETHING OR TO RENDER SOME SERVICE.
A. CONSENSUAL
• BASED ON MUTUAL CONSENT
• MEETING OF THE MINDS

B. FIDUCIARY
• BASED ON MUTUAL TRUST AND CONFIDENCE
• THE PATIENT MUST BE ABLE TO COMMUNICATE ALL
RELEVANT INFORMATION ABOUT THE ILLNESS OR
INJURY IN ORDER FOR THE PHYSICIAN TO MAKE
ACCURATE DIAGNOSIS AND PROViDE TREATMENT
RECOMMENDATION.
INNOMINATE CONTRACT OF
FACIO UT DES

´ LATIN TERM WHICH MEANS ”I DO AND YOU GIVE”

´ PRINCIPLE OF UNJUST ENRICHMENT
´THAT NO ONE SHALL UNJUSTLY ENRICH HIMSELF
AT THE EXPENSE OF OTHERS.
 PARTIES TO A PHYSICIAN – PATIENT
CONTRACTUAL RELATIONSHIP
THE PHYSICIAN
WHO RENDERS THE MEDICAL
SERVICES IN EXCHANGE FOR
THE PAYMENT IN THE FORM
OF PROFESSIONAL FEE.
THE PATIENT
WHO RECEIVES THE MEDICAL
SERVICES AND IN TURN PAYS
THE PROFESSIONAL FEE TO
THE PHYSICIAN.
 ESSENTIAL REQUISITES OF
CONTRACTUAL RELATIONSHIP
A. CONSENT
GIVEN BY THE PATIENT HIMSELF OR SOMEONE AUTHORIZED
BY LAW TO GIVE CONSENT
NCC: ELEMENTS:
1. MUST BE MANIFESTED BY THE CONCURRENCE OF THE OFFER AND THE ACCEPTANCE
2. THE CONTRACTING PARTY MUST POSSESS THE NECESSARY LEGAL CAPACITY
18 YEARS OF AGE
THE FOLLOWING CANNOT GIVE CONSENT TO A CONTRACT: ART 1327 NCC
UNEMANCIPATED MINORS
INSANE (EXCEPT DURING LUCID INTERVAL 1328 NCC) OR DEMENTED PERSONS
DEAF-MUTES WHO DON’T KNOW HOW TO READ OR WRITE

3. THE CONSENT MUST BE INTELLIGENT, FREE, SPONTANEOUS, AND REAL

5 VICES OF CONSENT: (NCC 1330)
1. MISTAKE
2. VIOLENCE
3. INTIMIDATION
4. UNDUE INFLUENCE
5. FRAUD
 ESSENTIAL REQUISITES OF
CONTRACTUAL RELATIONSHIP
B. OBJECT/SUBJECT MATTER
- TO RENDER MEDICAL SERVICE
- MUST NOT BE OUTSIDE THE COMMERCE OF MAN
- MUST BE LEGAL AND NOT CONTRARY TO LAW, MORALS,
GOOD CUSTOMS, PUBLIC ORDER, OR PUBLIC POLICY

GARCIA-RUEDA VS PASCASIO GR 118141 SEPTEMBER 5, 1997

IN ACCEPTING A CASE, A PHYSICIAN IN EFFECT REPRESENTS THAT,
HAVING THE MEDICAL TRAINING AND SKILL POSSESSED BY
PHYSICIANS AND SURGEONS PRACTICING IN THE SAME FIELD, HE
WILL EMPLOY SUCH TRAINING, CARE, AND SKILL IN THE
TREATMENT OF HIS PATIENTS. HE IS THEREFORE HAS THE DUTY TO
USE AT LEAST THE SAME LEVEL OF CARE THAT ANY OTHER
REASONABLE, COMPETENT PHYSICIAN WOULD USE TO TREAT A
CONDITION UNDER THE SAME CIRCUMSTANCES.
 ESSENTIAL REQUISITES OF
CONTRACTUAL RELATIONSHIP
C. CAUSE/CONSIDERATION (ART 1322)
1. ONEROUS
FROM THE STANDPOINT OF A PATIENT
PATIENTS PAY FOR THE MEDICAL SERVICES RENDERED.

2. REMUNERATORY
FROM THE STANDPOINT OF A PHYSICIAN
PHYSICIANS ARE PAID FOR THE MEDICAL SERVICES RENDERED.

3. GRATUITOUS
”GRATIS ET AMORE”
FREE
PURE LIBERALITY OF THE BENEFACTOR
(DONATION)
FORMS OF CONTRACTUAL
RELATIONSHIP

´ 1. EXPRESSED
THROUGH VERBAL ACTS / ORAL OR WRITTEN
CONSENT FORM

´ 2. IMPLIED
NON VERBAL ACTS BUT THERE IS A CLEAR INDICATION
THAT BOTH PARTIES AGREE

QUASI-CONTRACTS
 COMMENCEMENT OF PHYSICIAN-PATIENT
CONTRACTUAL RELATIONSHIP

´ FROM THE TIME THE PATIENT ASKS THE PHYSICIAN

FOR MEDICAL SERVICE AND THE LATTER AGREED
AND THE ACCEPTANCE OF THE PHYSICIAN IS
KNOWN TO THE PATIENT.

DOCTRINE OF MANIFESTATION
DOCTRINE OF COGNITION
FREEDOM TO CONTRACT MEDICAL
SERVICES AND LIMITATIONS
The contracting parties are free to establish such stipulations, clauses,
terms and conditions as they may deem convenient, provided they are
not contrary to law, morals, good customs, public order, or public policy.
This is the PRINCIPLE OF AUTONOMY OF CONTRACTS

´ LIMITATIONS: MUST NOT BE CONTRARY TO:

´ 1. LAW
´ 2. MORALS
´ 3. GOOD CUSTOMS
´ 4. PUBLIC ORDER
´ 5. PUBLIC POLICY
CASES WHEN THERE IS NO PHYSICIAN-
PATIENT CONTRACTUAL RELATIONSHIP

´ 1. PRE EMPLOYMENT PHYSICAL EXAMINATION

´ 2. ELIGIBILITY FOR INSURANCE PHYSICAL EXAMINATION
´ 3. PSYCHIATRIC EVALUATION OF THE ACCUSED
´ 4. AUTOPSY
´ 5. CASUAL QUESTIONS IN CASUAL SETTINGS
NOT PART OF PHYSICIAN-PATIENT
CONTRACT
´ Cruz v. CA G.R. No. 122445. November 18, 1997
´ 1. DOCTORS ARE NOT GUARANTORS OF CARE.
´ 2. DOCTORS DO NOT WARRANT GOOD RESULTS.
´ 3. DOCTORS ARE NOT INSURERS AGAINST MISHAP OR
UNUSUAL CONSEQUENCES
´ 4. DOCTORS ARE NOT LIABLE FOR HONEST MISTAKE OF
JUDGMENT
ARTICLE II
THE PHYSICIAN AND THE PATIENT
SECTION 1
´ A physician should attend to his
patients faithfully and conscientiously.
He should secure for them all possible
benefits that may depend upon his
professional skill and care. As the sole
tribunal to adjudge the physician's
failure to fulfill his obligation to his
patients is, in most cases, his own
conscience, and violation of this rule
on his part is discreditable and
inexcusable.
SECTION 2
´ A physician is free to choose whom
he will serve. He may refuse calls, or
other medical services for reasons
satisfactory to his professional
conscience. He should, however,
always respond to any request for his
assistance in an emergency. Once
he undertakes a case, he should not
abandon nor neglect it. If for any
reason he wants to be released from
it, he should announce his desire
previously, giving sufficient time or
opportunity for the patient or his
family to secure services of another
physician.
SECTION 3
´ In cases of emergency,
when immediate action is
necessary, a physician
should administer at least
first aid treatment and then
refer the patient to a more
qualified and competent
physician if the case does
not fall within his particular
field of practice. He shall not
abandon his or her patient
until such time that his
patient has become stable.
SECTION 4
´ In serious or difficult
cases which are
difficult to diagnose
and treat, or when the
circumstances of the
patient or the family so
demand or justify, the
attending physician
should seek the
assistance of his or her
colleagues.
 SECTION 5
´ A physician must exercise honesty and
good faith in expressing his or her opinion as
to the diagnosis, prognosis, and treatment
of the case under his care. Timely notice of
the seriousness of the disease should be
given to the patient or, if unconscious or if
the information will tend to endanger his
condition, the information must be given to
his family. It is highly unprofessional to
conceal or exaggerate the condition of the
patient, or to pretend to cure or alleviate a
disease for the purpose of persuading the
patient to take or continue the course of
treatment, knowing that such assurance is
without accepted scientific basis.
SECTION 6
´ The medical practitioner should guard as a
sacred trust anything that is confidential or
private in nature that he or she may discover
or that may be communicated to him or her
in the professional relationship with his or her
patients, even after death. He or she should
never divulge this confidential information, or
anything that may reflect upon the moral
character of the person involved, except
when it is required in the interest of justice,
public health, or public safety. A medical
practitioner shall at all times respect the rights
of his patient except only in cases or
situations when the law, justice and/or the
public welfare will require.
 SECTION 7
´ The medical profession not being a
business and service is its primary
concern, a physician should not
charge exorbitant or excessive fees.
In determining the amount of
professional fees, he or she should
always consider the financial status
of the patient, the nature of the
case, the time consumed, his/her
professional standing and skill, and
the average fees charged by
physicians of the same standing in
the same locality.
SECTION 8
´ A physician shall not enter into
any relationship with his or her
patient that is conflict with his or
her position as physician of the
patient. He or she shall not, for
purposes of gain or lust, take
advantage of his or her moral
ascendancy over his or her
patient. A physician shall gain
his or her patient's trust only for
purposes of obtaining good
rapport with his or her patient
and with the intention of
obtaining successful treatment
of his or her patient's illness. [1]
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