MEDTECH LAWS & BIOETHICS

LECTURE 1: RA 10173 DATA PRIVACY ACT OF 2012

CHRISTIAN JOHN E.VILLAHERMOSA, RMT
April 15, 2021
For updates and corrections → @mar4rii on Twitter

- In the laboratory, we allow or require patients to fill out a

OUTLINE form which we intend to collect their personal
information which we need, for us to release the result.
I. Declaration of policy VI. Rights of the data - We have to make sure that the patient is aware why are
we getting this information from them.
II. National Privacy Commission subject
- Lab testing is part of the protected means of gathering
i. Privacy commissioner VII. Prohibited acts and acquiring information.
ii. Deputy privacy VIII. Other information LEGITIMATE PURPOSE
commissioner IX. Pamet code of ethics - compatible with a declared and specified purpose.
III. Data privacy principles - As to personal information, all our intentions and
IV. What is personal information? purposes must be legitimate.
V. Sensitive personal information - In the laboratory, if we ask them for personal information
that is somehow tantamount to a legitimate purpose in
(SPI)
the provision of testing as well as the release of result.
PROPORTIONALITY
- adequate, relevant, suitable, necessary, and not
excessive in relation to a declared and specified
purpose
RA 10173 DATA PRIVACY ACT OF 2012 - dapat equal lang; we need your personal information for
I. DECLARATION OF POLICY this reason.
- to protect the fundamental human right of privacy, of - Any other extraneous reasons for acquiring personal
communication while ensuring free flow of information to information are FORBIDDEN.
promote innovation and growth. IV. WHAT IS PERSONAL INFORMATION?
- to ensure that personal information in information and - any information whether recorded in a material form or
communications systems in the government and in the not, from which the identity of an individual is
private sector are secured and protected. apparent or can be reasonably and directly
▪ In the laboratory, we have to make sure all ascertained by the entity holding the information, or
forms of information shared to us by our when put together with other information would directly
patients are kept private, confidential, secured and certainly identify an individual.
and protected and must ONLY be used in the - In the lab, personal information that is used are: Name,
manner which the patient gave his/her consent. Age, Sex, Address, Birthday (some labs require), Phone
II. NATIONAL PRIVACY COMMISSION number and, etc.
- administers and implements the provisions of this Act - These are shared freely for contact tracing. However, it
- monitors and ensures compliance of the country with should not be a reason for them to be disclosed
international standards set for data protection. inappropriately.
- attached to the Department of Information and - Must be kept at all times and securely and must only be
Communications Technology (DICT) used to their intended purpose (contact tracing, testing
▪ basically because of more pressing concerns and, etc.)
on privacy are done through the information V. SENSITIVE PERSONAL INFORMATION (SPI)
highway or online manner. - an individual’s race, ethnic origin, marital status, age,
- headed by a Privacy Commissioner (also acts as the color, and religious, philosophical or political
Chairman) affiliations
- Assisted by 2 Deputy Privacy Commissioners (1 for - an individual’s health, education, genetic or sexual
Data Processing Systems, 1 for Policies and Planning) life, or to any proceeding for any offense committed or
i. PRIVACY COMMISSIONER alleged to have been committed by such person, the
- at least thirty-five (35) years of age; disposal of such proceedings, or the sentence of any
- good moral character, unquestionable integrity and court in such proceedings
known probity - social security numbers, previous or current health
- recognized expert in the field of information technology records, licenses or its denials, suspension or
and data privacy revocation, and tax returns
- Term: 3 years, may be reappointed for another 3 years - Sexual preference and orientation, genetic
- Same rank with a Department Secretary information
ii. DEPUTY PRIVACY COMMISSIONER - More private and more personal information.
- must be recognized experts in the field of information - These are still considered as personal information
and communications technology and data privacy because they are possessed by a person but they are
- Term: 3 years, may be reappointed for another 3 years sensitive because any form of disclosure of this
- Same rank with a Department Undersecretary information may have a damaging effect to the
III. DATA PRIVACY PRINCIPLES individual.
TRANSPARENCY - Should NOT be disclosed freely, consent is required.
- data subject must be aware of the nature, purpose, and - NOT shared often as they will be prone to any form of
extent of the processing of his or her personal data. maltreatment.
1
 - Mas protected than personal information.
VI. RIGHTS OF THE DATA SUBJECT
- Be informed
- Reasonable access (to the means of data gathering)
- Dispute the inaccuracy or error in the personal
information
- Suspend, withdraw or order the blocking, removal or
destruction of his or her personal information from the
personal information controller’s filing system
- Be indemnified for any damages sustained
▪ If the data that the patient or person has
shared was used in any other means, other
than what was specified as the legitimate
purpose.
▪ Pede sha maghabol duon sa nag patakag
gamit and can be paid or indemnify for the
damage sustained.
- Transmissibility
- Data portability
VII. PROHIBITED ACTS
- Unauthorized Processing of Personal Information and
Sensitive Personal Information
- Accessing Personal Information and Sensitive Personal
Information Due to Negligence
o If u left a folder containing lots of information of
different people, it is a negligent act and you
are now liable for damages.
- Improper Disposal of Personal Information and
Sensitive Personal Information.
o It is recommended that if you will dispose
papers, it should be shred prior.
- Processing of Personal Information and Sensitive
Personal Information for Unauthorized Purposes
- Unauthorized Access or Intentional Breach
- Concealment of Security Breaches Involving Sensitive
Personal Information
- Malicious Disclosure
o You disclosed the information with the intention
of embarrassing or humiliating a certain
individual.
- Unauthorized Disclosure
VIII. OTHER INFORMATION
•Approved on August 15, 2012 by BenignoAquino III
THE MEDICAL TECHNOLOGIST CODE OF ETHICS
CODE OF ETHICS
- ethical benchmarks for professionals
- a set of good and bad behavior
- a form of legislation that binds a specific profession.
o If you are found guilty of doing something that
is forbidden, either directly or indirectly by the
code of ethics, you will be subjected to
sanctions.
- violations: sanctions
- checklist of what should be done and should not be
done.
IX. PAMET CODE OF ETHICS
- As I enter into the practice of medical technology, I
shall:
Accept the responsibilities inherent to being a professional'
- Professionalism
o implies quality of workmanship or service.
o working to defined standards and principles
o tips:
▪ be on time
▪ don't be grumpy
▪ dress appropriately
▪ watch your mouth
▪ don't lie
'Uphold the law and shall not participate in
Illegal work'
- illegal activities in the laboratories include releasing
fraudulent results.
- If you did something wrong during testing, admit and try
to correct the wrong that has been done.
‘Act in a spirit of fairness to all and in a spirit
Of brotherhood toward other members of the
Profession’
- nurses, pharmacists, radiologic technologists,
physicians, other medical technologists, etc.
'Accept employment from more than one employer only when
there is no conflict of interest’
- conflict of interest: a situation that has the potential to
undermine the impartiality of a person/clash between
self-interest and professional interest.
- You cannot work full time in two laboratories at the
same time.
‘Perform my task with full confidence, absolute
Reliability, and accuracy’
- proper procedure
- double checks
- Case: Garcia v. Salvador (G.R. 168512)PAMET CODE
OF ETHICS
'Share my knowledge and expertise with
My colleagues’
- mutual sharing of information (innate or acquired
through trainings and seminars).
- In the workplace, you are all equal.
‘Contribute to the advancement of professional organization and
other allied health organizations’
- PAMET
'Restrict my praises, criticisms, view and opinions within
constructive limits'
- use the Feedback Sandwich Method (Positive-
ImprovePositive)
- specify and focus on the situation, not the person
- give your recommendations
- when assessing person na namali, make sure na dili
sha I criticize harshly. You focus on the situation and not
on the person and give your recommendation after.
'Treat any information i acquired in the course of my work as
strictly confidential'
- breach of confidentiality: when a patient's private
information is made available to a third party without
his/her consent
- examples: drug testing, HIV testing
PAMET CODE OF ETHICS
'Uphold the dignity and respect of my profession and conduct
myself a reputation of reliability, honesty and integrity'
- reliability: consistency of actions
- honesty: the quality of being fair and truthful
- integrity: moral uprightness
Be dedicated to the use of clinical laboratory science to promote
life and benefit mankind'
- help in the diagnosis of diseases
- help quell epidemics and outbreaks
' Report any violations of the above principles of the professional
conduct to authorized agency and to the ethics committee of the
organization'
- Section 24 of RA 5527
- 2 Board members plus a legal officer.
▪ If u did something wrong then you may be
investigated.
'To these principles, i hereby subscribe and
Pledge to conduct myself at all times in a
Manner befitting the dignity of my profession.
2
 MEDTECH LAWS & BIOETHICS

LECTURE 4: RA 7170 Organ Donation Act of 1991

CHRISTIAN VILLAHERMOSA, RMT
March 24, 2021
For updates and corrections → @mar4rii on Twitter

- Ang mga kamag-anak ng patay decided to donate the

OUTLINE body parts or the organs of the dead person to another
person.
I. Important details VIII. Amendment or - Donee (recipient of donation)
II. Definition of terms revocation of - The decision to donate is on the family members of the
III. How death is determined? legacy/donation dead person—in this case, the dead person did not
IV. Execution of legacy IX. Rights and duties post- intend to mention that he wanted to donate his body
V. All organ donations mortem parts after his death.
VI. Legatees/donees X. Hope - Ang patay is NOT the donor but is just the decedent,
VII. Delivery of the document of XI. Current issues whereas the donor is ang tao na nagdecide to give the
legacy/donation organs to another person.
PART
- includes transplantable organs, tissues, eyes, bones,
arteries, blood, other fluids, and other portions of the
human body.
RA 7170: ORGAN DONATION ACT OF 1991
III. HOW DEATH IS DETERMINED? (in hospitals)
I. IMPORTANT DETAILS
May patay dapat na mauna bago kumuha ng organs.
- Date of Approval: January 7, 1992
Two ways to fully determined a person is already dead.
- Approved by: Corazon C. Aquino
- In the opinion of the attending physician:
- Total Number of Sections: 19
▪ Absence of natural respiratory and cardiac
- Purpose: 'to authorize the legacy or donation of all or functions
part of ▪ Resuscitation attempts would not be
- a human body after death for specified purposes' successful.
- the major limitation of this act is only on donations or on - In the opinion of the consulting physician:
giving of organs after the death of the person. ▪ Irreversible cessation of all brain functions
- The policy regarding the giving of organs while the ▪ Resuscitation attempts would not be
person is still alive is NOT present in this act. successful.
- Organ donation is not very common in the Philippines - Three (3) functions and determine: respiratory, cardiac,
unlike blood donation—due to religious beliefs or and brain function. – if all three are not present and any
preservation. attempt to revive these functions would not be
- Kidneys are commonly donated. successful then death will be declared.
II. DEFINITION OF TERMS IV. EXECUTION OF LEGACY
ORGAN BANK STORAGE FACILITY - Who may execute a legacy?
- licensed, accredited, and approved to store human ▪ Any individual:
bodies and/or human body parts. o at least 18 years old
- Human body—some people tend to give their whole o of sound mind
body to science or medicine for research and anatomy - How to execute a legacy?
classes. ▪ Last will and testament
- NKTI—major organ bank storage facility. ▪ Organ donor card
DECEDENT - Legacy may be made through:
- a deceased individual (includes a stillborn infant or ▪ a specified legatee (recipient of the legacy) or
fetus) without specifying a legatee.
- any dead person. - The testator may designate surgeons/physicians to
TESTATOR perform the procedure—you have the freedom to select
- an individual who makes a legacy of all or part of his kung sinong surgeon ang magkuha ng organs.
body. - The legacy document should be signed by the testator
- A living person who decided to donate his organs to in the presence of two witnesses.
another person once he dies. ▪ Witnesses are important because they can
- May incorporate his/her wishes or either he can avail an testify you created your legacy without
organ donor card which will entitle the hospital to coercion.
harvest his organs once he dies—he is making a - What if the specified legatee is not around during the
legacy. death of the testator?
- Harvesting of organs will only happen after the death of ▪ The attending physician/surgeon will serve as
the testator. the temporary legatee
- LEGACY- his expression of his desire to donate his - What if the testator did not specify a legatee?
body parts by incorporating in the last will and testament ▪ the attending physician/surgeon will serve as
or avail an organ donor card. the legatee—they have the power to select
- legatee (recipient of legacy). who will be the recipient of the organ.
DONOR - A legacy becomes effective after the death of the
- an individual authorized to donate all or part of the body testator.
of the decedent. - Who may execute a donation?

1
 ▪ Legal spouse
▪ Son or daughter of legal age
▪ Either parent
▪ Brother or sister of legal age
▪ Guardian of the decedent at the time of his
death
- What if the nearest kin is absent? Who will execute the
donation?
▪ the attending physician
▪ the head of the hospital
▪ designated officer of the hospital
▪ BUT FIRST... the family of the deceased
should be located within 48 hours.
V. IN ALL ORGAN DONATIONS:
▪ Diagnosis of death should be made separately
by two qualified physicians
- these physicians should NOT BE:
▪ A member of the medical team who will
remove the organ
▪ The attending physician of the recipient of the
organ
▪ The head of the hospital/designated officer
authorizing the removal of the organ
o these three people have conflict of interest
with regards to organs. They may just
declare its death.
- Examination of human body or body parts
▪ Necessary to ensure medical acceptability
▪ Only trained/qualified personnel shall
remove/transplant organs
▪ In case of medico-legal cases:
o Perform autopsy to determine suitable
organs
VI. LEGATEES/DONEES
- Any hospital, physician, or surgeon
- Any accredited medical or dental school, college, or
university
- Any organ bank storage facility
- Any specified individual
VII. DELIVERY OF THE DOCUMENT OF LEGACY/DONATION
If the legacy/donation is made to a specified legatee:
- the legacy/donation documents (will/card/donation
document) should be delivered to the legatee/donee
- the documents could also be stored in an organ bank
storage facility for safekeeping
VIII. AMENDMENT OR REVOCATION OF
LEGACY/DONATION
If the will/card/document was delivered:
- Signed statement
o Stating your change of mind or heart.
- Oral statement with 2 witnesses (sent to legatee)
- Dying declaration (physician to legatee)
- Signed card/document found on the person
o Ex: Tattoo or document
if the will/card/document was not delivered:
- (Conditions mentioned above)
- Destruction, cancellation, or mutilation of the documents
- Revocation of wills
IX. RIGHTS AND DUTIES POST-MORTEM
- legatee may accept/reject the legacy
- removal of organs without MUTILATION
o kung ano lang gi wish or gi intend na ibigay
yung lang din ang kunin.
- international sharing of organs or tissues:
RECIPROCITY
o if country A asked for an organ from country
B, that is okay as long as country A will also
give organs to Country B
X. HOPE
Human Organ Preservation Effort (HOPE)
- established in 1983
- NKTI program that coordinates organ donation
- retrieval, preservation, and allocation of organs and
tissues for clinical transplantation
- waiting list
XI. CURRENT ISSUES
R. A 9208
- Anti-trafficking in person act
o -people in poor communities tend to sell their
organs to mostly other countries who are in
need.
Case: G.R. 175540
- Dr. Filoteo Alano v. Zenaida Magud-Logmao
- Issue: to set aside the CA ruling adjudging the petitioner
liable for damages
Facts:
- March 1, 1988: Arnelito Logmao, then eighteen (18)
years old, was brought to the East Avenue Medical
Center (EAMC) in Quezon City by two sidewalk
vendors, who allegedly saw the former fall from the
overpass near the Farmers’ Market in Cubao, Quezon
City
- Patient’s data sheet identified the patient as Angelito
Lugmoso of Boni Avenue, Mandaluyong
- March 2: Logmao was transferred to NKTIAlano v.
Magud-Logmao
- At NKTI, the name Angelito [Logmao] was recorded as
Angelito Lugmoso.
- Dr. Enrique T. Ona, Chairman of the Department of
Surgery, observed that the severity of the brain injury of
Lugmoso manifested symptoms of brain death
o should Lugmoso expire despite the
necessary medical care and management
and he would be found to be a suitable
organ donor and his family would consent to
organ donation, the organs thus donated
could be detached and transplanted
promptly to any compatible beneficiary
- Certifications were issued by Channel 4, ABS-CBN and
GMA attesting that the request made by the NKTI on
March 2, 1988 to air its appeal to locate the family and
relatives of Angelito Lugmoso of Boni Avenue,
Mandaluyong was accommodated
- March 3: Angelito was pronounced dead and then a
team of doctors removed the heart, kidneys, pancreas,
liver and spleen of Lugmoso; kidneys and pancreas
were transplanted immediately to 2 patients
- March 11: NKTI issued a press release announcing its
successful double organ transplantation
o a cousin of plaintiff, heard the news aired on
television that the donor was an eighteen
(18) year old boy whose remains were at La
Funeraria Oro in Quezon City; the cousin
informed Zenaida who went to the funeral
home and saw Angelito’s cadaver
- April 29: Zenaida filed a complaint for damages and
alleged that defendants conspired to remove the
organs of Arnelito while the latter was still alive and that
they concealed his true identity.
SC VERDICT
- Petitioner instructed his subordinates to "make certain"
that "all reasonable efforts" are exerted to locate the
patient's next of kin, even enumerating ways in which to
ensure that notices of the death of the patient would
reach said relatives.
- The doctors and personnel of NKTI disseminated
notices of the death of respondent's son to the media
and sought the assistance of the appropriate police
authorities as early as March 2, 1988
- It should be emphasized that the internal organs of the
deceased were removed only after he had been
declared brain dead; thus, the emotional pain suffered
by respondent due to the death of her son cannot in
any way be attributed to petitioner. Neither can the
2
Court find evidence on record to show that
respondent's emotional suffering at the sight of the
pitiful state in which she found her son's lifeless body
be categorically attributed to petitioner's conduct.

3
 MEDTECH LAWS & BIOETHICS

LECTURE 4: Philippine Clean Water Act of 2004 (RA 9275)

CHRISTIAN VILLAHERMOSA, RMT
March 19, 2021
For updates and corrections → @mar4rii on Twitter

▪ Analyst
OUTLINE o Appropriate bachelor's degree
I. Rules and regulations for drinking IV. Technical o 2 years experience in water testing
water analysis requirements o Chemist/chemical technician (water
II. Drinking water V. Analytical methods chemistry)
III. Water testing laboratories o Medicaltechnologist/microbiologist/othe
r allied health professionals (water
bacteriology)
▪ Laboratory Aide
I. RULES AND REGULATIONS FOR DRINKING WATER ANALYSIS
o 6 months experience on clerical support
RA 9275
and sampling
- Philippine Clean Water Act of 2004
o 2 years of college
- Approved: March 22, 2004 by GMA
- Equipment, Instruments, Reagents, and Supplies
- 'protection, preservation, and revival of the quality of our
▪ Incubator
fresh, brackish, and marine waters'
▪ Drying oven
- Since our water come from natural resources, they have to
▪ Autoclave
undergone treatment and testing first prior to the
▪ Optical counting equipment
distribution to our home to make sure that they are safe.
▪ and others
II. DRINKING WATER
V. ANALYTICAL METHODS
- Clear
- Testing for coliform bacteria
- Colorless
▪ present in the digestive tracts of animals and also
- Free from objectionable taste
found in wastes, and plant/soil material
- And odor
▪ water pollution by coliform has disease potential
- Must not contain: any substances/organisms, chemicals,
- Total coliform: includes bacteria in soil, surface water, and
radioactive materials
human/animal waste
- Contamination comes from: sewage, human or animal
▪ Wherein we determine ALL types coli forms.
excrement, other wastes.
- Fecal coliform (specific counting for fecal coli form): present
III. WATER TESTING LABORATORIES
in gut and feces, more accurate Indication.
- Classification based on service capability
- Escherichia coli: best indicator, major species
▪ Bacteriological Analysis
Presumptive phase:
▪ Biological Analysis
- Lauryl Tryptose Broth (gas formation within 24-48 hours and
▪ Physical Analysis
observe for turbidity)—Turbid: Positive result. If mag positive
▪ Chemical Analysis
proceed to next step (confirmed phase). If NOT, STOP.
▪ Radiological Analysis (only performed by Philippine
Nuclear Research Institute)
▪ Our concern as a medical technologist, we perform
bacteriological analysis of water.
- Certificate of Accreditation: valid for 3 years (BHFS: first
issuance, CHD: renewal)
IV. TECHNICAL REQUIREMENTS
- Physical Plant
▪ Permanent building
▪ Water/power supply
▪ Drainage
▪ System/ventilation
Confirmed phase:
▪ 20 sq.m. Workplace
- Brilliant Green Bile Lactose Broth (gas formation within 24-48
▪ Safety and disposal
hours)—Turbid: POSITIVE. If positve, proceed to completed
▪ Separation between neighboring activities
phase.
o The activities of water testing lab must
be separated with the other activities IF
the lab is located in a complex of
facilities, especially if it’s renting an area.
- Personnel
▪ Head of the laboratory
o With management training
o With a prc license
o At least 3 years of experience in water
testing

1
Completed phase:
▪ Single strength Lauryl Tryptose Broth: gas
formation
▪ LES Endo/MacConkey: Gram staining
▪ Best indicator culturing a water sample into a
culture media. One of the media that would be
used is Endo/MacConkey agar which can detect the
presence of E. coli.
▪ Pink colonies indicates a POSITIVE result and
indicates the presence of lactose fermenting coli
form bacteria hence, there is a contamination in
the water supply.

QUALITY/TECHNICAL MANUAL
- types of analysis
- handling/acceptance of specimens
o Sterilized glass bottles (clear, 120 mL)
o Fill the bottle with 100 ml of water
o If from lakes, rivers, dug wells: submerge bottle to
a depth of one foot below the surface.
SPECIMEN COLLECTION
- Clean the tap, flush for 1-2 minutes
- Sterilize the tap
▪ flaming with ignited cotton swab
▪ swab soaked with chlorox or 100 mg/L sodium
hypochlorite solution
- Flush the tap for 1-2 minutes
- Open sampling bottle and fill with water
- Cap the bottle and label (date/time of collection, water
sampling code, name of collector)
- Store and transport the bottle within 6 hours: cooler with ice
within 24 hours
LAB REPORTS
- results, name of head of the lab and analyst, testing facility
LAB RECORDS (retain for a minimum of 5 years)
- personnel records and analytical records
QUALITY MANAGEMENT
- internal quality audit every 6 months
PROFICIENCY TESTING
- NRL: EAM

2
 MEDTECH LAWS & BIOETHICS

LECTURE 4: Intro to Bioethics

CHRISTIAN JOHN E.VILLAHERMOSA, RMT
May 5, 2021
For updates and corrections → @mar4rii on Twitter

OUTLINE MEDICAL ETHICS

I. . OVERVIEW OF ETHICS VII. PROBLEMS IN MEDICAL - Ethics in medicine/medical practice
AND BIOETHICS ETHICS ETHICS ▪ concerned with the obligations of the doctors and
II. BIOETHICS VIII. IGNORANCE the hospital to the patient along with other health
III. ETHICAL SYSTEMS IX. NEGLIGENCE professionals and society.
IV. THE HEALTHCARE FOUR MAJOR ETHICAL PRINCIPLES
PROFESSION - Autonomy
V. MEDICAL ETHICS - Beneficence
VI. FOUR MAJOR ETHICAL - Non-maleficence
PRINCIPLES - Justice
AUTONOMY
I. OVERVIEW OF ETHICS AND BIOETHICS - The act of respecting the decisions of others
ETHICS - The basis of informed consent: patient must Understand the
- the systematic philosophical study of morality procedure and its likelihood of success
▪ An inquiry into what is right and what is wrong - Free from coercion
▪ Looks into different moral or normative codes in - The patient has the final say on what should be done to his or
society her body.
▪ Concerned with studying and/or building up a - We should not force medical procedures; we should NOT
coherent set of ‘rules’ or principles by which people force treatment of patients without their consent.
ought to live BENEFICENCE
▪ Guide for individuals on what we should do and not - doing an action that benefits others
do. ▪ Intention of doing good for the patient
▪ Subjective- there is certain actions or certain codes ▪ chief objective of health professionals: to
that are allowed in one society and is not allowed help
upon another society. - in contrast with autonomy however, autonomy ang mag
II. BIOETHICS supersede kay autonomy ang mas nangingibabaw.
- ethics focused on moral issues in the field of health care - We can only suggest but we cannot actually force the
III. ETHICAL SYSTEMS procedure to patients.
Deontological ethics NON-MALEFICENCE
- focused on adherence to independent moral rules or duties - The ‘do no harm’ principle
- when you follow your duty, you are behaving morally; when ▪ avoidance of doing harm to others through
you fail to follow your duty, you are behaving immorally. commission or omission
- If a certain action is declared as wrong then it is wrong in all - iniiwasan mo lang na makagawa ng masama to our patients.
forms. JUSTICE
- ‘Give to each that which is his due’
- Treat all patients equally.
Teleological ethics PROBLEMS IN MEDICAL ETHICS
- focused on the consequences which any action might have; - IGNORANCE
ends justifying the means. - NEGLIGENCE
- A certain action becomes right if it benefited other people. ▪ Medical Negligence/Medical MalpracticeI
- The end justifies the means (ex: Case of Robin Hood). IGNORANCE
Virtue ethics - lack of technical or theoretical knowledge in the act of doing
- focus on helping people develop good character traits, such work
as kindness and generosity, which allow a person to make the - examples: incompetent, no experience, no knowledge of
correct decisions later in life. consequence, failure of job execution
- Middle ground between teleological and Deontological ethics. - may nagawa kang mali kasi hindi mo alam kung ano ang
- They do not ascribe a certain action as right or wrong but it mali.
gives freedom to other interpretation. - More forgivable.
THE HEALTHCARE PROFESSION NEGLIGENCE
“Professional practice is defined as practice that reflects the - the failure to observe, for the protection of the interests of
commitment to caring relationships with patients and families and another person, that degree of care, precaution, and
strong ethical values; utilization of specialized knowledge, critical vigilance which the circumstances justly demand, whereby
inquiry, and evidence-informed decision making; continuous such other person suffers injury
development of self and others; accountability and responsibility for - failed to take an action that a reasonable person would do
insightful competent practice; demonstration of a spirit of - did something that a reasonable person would not do
collaboration and flexibility to optimize service.” - alam mo ang ginagawa mo pero may nagawa kang mali.
▪ MEDICAL MALPRACTICE
1
 ▪ ’a particular form of negligence which
consists in the failure of a physician or
surgeon to apply to his practice of
medicine that degree of care and skill
which is ordinarily employed by the
profession generally, under similar
conditions, and in like surrounding
circumstances’ (Reyes vs. Sisters of Mercy
Hospital)
ELEMENTS OF NEGLIGENCE
- a duty was owed
▪ mag create muna ang isang
physician-patient relationship if wala, the
other elements would not hold water.
- the duty was not met: breach
- injury or harm was done
- failure to meet the duty owed resulted to the injury:
proximate cause
DUTY
- There must be a professional relationship between the
patient and the physician
▪ created when the patient engages the
services of the doctor and the doctor
agrees to provide care to the patient
- may be implied from the physician's affirmative action to
diagnose and/or treat a patient, or in his participation in such
diagnosis and/or treatment
- even if injury, breach and proximate cause created, if there is
no duty, wala ding kaso.
JARCIA V. PEOPLE
- A patient was hit by a taxi and was sent to a hospital
- 2 doctors ordered an x-ray which showed no fracture
▪ Told the mother that there is no need to
examine the whole leg because only the
ankle was hit
Patient developed fever, swelling of the
right leg, and misalignment of the right
foot: had mid-tibial fracture
- Doctors’ arguments: they were just passing by the ER for
lunch
- These doctors ordered and x-ray, gave medication and
recommended care to the patient is already and implied
physician-patient relationship.
- Hindi kailangan na siya talag ang attending physician.
BREACH
- breach of the standard of care/improper performance
expected of other similarly trained medical professionals
acting under the same circumstances
- may mali kang ginawa na other doctors would not do given
the same set of circumstances.
BORROMEO V. FAMILY CARE HOSPITAL
- Borromeo’s wife was sent to the hospital for acute
appendicitis
- Post-op, patient had low blood pressure and was
unresponsive to blood transfusion and IV infusion
- Patient became restless and pale and then died (hemorrhage
due to disseminated intravascular coagulation is the COD)
▪ DIC- a certain disorder wherein naubos
ang clotting factors sa katawan.
▪ Initiated by infection or sepsis.
- Issue: Is there negligence?
- SC verdict: NO MEDICAL MALPRACTICE (the death was due to
a medical disorder)
▪ no proof that the doctor fell short of the
expected standard required under the
circumstances
INJURY
- direct result of the doctor’s breach
- testimony of an expert witness
- Doctrine of res ipsa loquitur (‘the thing speaks for itself’): if
availed, the need for expert witnesses is dispensed with
▪ Obvious na may injury.
- It REQUIRES a testimony form expert witness.
EXPERT WITNESS TESTIMONY
- special knowledge experience and practical training that
qualify him/her to explain highly technical medical matters to
the Court.
▪ It is very important na magtungma ang
expert witness sa kaso.
- Ramos v. CA: the expert witness, who is a pulmonologist, not
qualified to testify on the field of anesthesiology
- Cereno v. CA: The Court excluded the testimony of an expert
witness whose specialty was anesthesiology, and concluded
that an anesthesiologist cannot be considered an expert in
the field of surgery or even in surgical practices and
diagnosis.
- The court tends to favor witnesses with long work experience
(ex. OB for 30 years).
RES IPSA LOQUITUR
- allows the mere existence of an injury to justify a
presumption of negligence on the part of the person who
controls the instrument causing the injury
- no need for an expert witness. Pagtingin mo palang sa case
alam mo na may nangyari ng mali.
Elements
1. The accident is of a kind which ordinarily does not
occur in the absence of someone’s negligence;
2. It is caused by an instrumentality within the
exclusive control of the defendant or defendants;
3. The possibility of contributing conduct would make
the plaintiff responsible is eliminated.
CANTRE V. GO
- Injury in left arm of a woman after giving birth
- Wound was caused by constant taking of blood pressure:
forgot to deflate the BP cuff after use
- Wound is not an ordinary occurrence after childbirth
- Sphygmomanometer is under the supervision of the
physician
- Wound was outside the control of the mother
BATIQUIN V. CA
- A piece of a rubber glove was left on the patient’s uterus
after giving birth
- Patient became feverish, pale, and breathing fast plus with
an infection in the abdominal cavity
- After another surgery, the ovaries were infected and had to
be removed
PROXIMATE CAUSE
- ‘the cause which produces the injury and without which the
result would not have occurred’
- The breach committed by the physician is the direct cause of
your injury.
- Bataclan v. Medina
▪ Bus overturned on a ditch and 4
passengers were trapped
▪ Rescuers, carrying a light torch, arrived
and immediately, a fierce fire started
burning the bus and the passengers
burned to death
▪ Issue: Whether the proximate cause of
the deaths was the overturning of the
bus or the fire that burned the bus
▪ The proximate cause is the overturning.
Dili man mangadto ang mga rescuers
carrying a light torch kung wala nag
overturn ang bus in the first place.
2
CASUMPANG V. CORTEJO
- Mrs. Cortejo brought her son to the hospital because of
difficulty in breathing, chest pain, stomach pain, and fever
- Doctors diagnosed the child with bronchopneumonia: the
mother had doubts
- After episodes of vomiting blood, the boy was diagnosed
with dengue hemorrhagic Fever
- The boy was transferred to the ICU of another hospital where
he was diagnosed with DHF stage IV and died soon after
- Dr. Casumpang was liable of negligence in diagnosis
▪ selectively appreciated some, and not all of the
symptoms; worse, he casually ignored the pieces of
information that could have been material in
detecting dengue fever.
- The SC clarified that a wrong diagnosis is not by itself
medical malpractice
▪ But: when the physician's erroneous diagnosis was
the result of negligent conduct (e.g., neglect of
medical history, failure to order the appropriate
tests, failure to recognize symptoms), it becomes
an evidence of medical malpractice.
- Proximate cause: the SC considered expert testimony stating
that with correct and timely diagnosis and proper medical
management, dengue fever is not a life-threatening disease
and could easily be cured
- Dr. Casumpang's failure to timely diagnose the boy with
dengue, the latter was not immediately given the proper
treatment.
CAPTAIN OF THE SHIP DOCTRINE
- the operating surgeon is the person in complete charge of
the surgery room and all personnel connected with the
operation.
PROFESSIONAL SERVICES INC. V. AGANA
- patient was rushed to the hospital wherein a doctor
diagnosed her to be suffering from cancer of the sigmoid and
the cancer has spread to the ovary
- Surgeon performed anterior resection and hysterectomy
▪ decided to close the incision despite the fact that
the attending nurses informed him that there were
missing gauzes
- Patient complained of pain in the anal region and 2 pieces of
gauze were extracted from her vagina
- The surgeon was held liable
CONSENT
- An act of voluntary agreement between two parties
- IMPLIED CONSENT
- INFORMED CONSENT
THE DOCTRINE OF INFORMED CONSENT
- ‘Every human being of adult years and sound mind has a
right to determine what shall be done with his own body;
and a surgeon who performs an operation without the
patient's consent commits an assault, for which he is liable
in damages. This is true, except in cases of medical
emergency, where the patient is unconscious, and where it
is necessary to operate before consent can be obtained.’
(Schloendorff vs. Society of New York Hospitals)
- “the patient's right of self-decision can only be effectively
exercised if the patient possesses adequate information to
enable him in making an intelligent choice” (Li v. Spouses
Soliman)
- “the scope of disclosure is premised on the fact that patients
ordinarily are persons unlearned in the medical sciences”
(Li v. Spouses Soliman)
- Must be phrased in layman’s terms.
COMPONENTS OF INFORMED CONSENT
Disclosure
- refers to the communication of relevant information by the
clinician and its comprehension by the patient.
Capacity
- refers to the patient’s ability to understand the information
and to appreciate those consequences of his or her decision
that might reasonably be foreseen.
Voluntariness
- refers to the patient’s right to come to a decision freely,
without force, coercion, or manipulation.
WHAT SHOULD BE EXPLAINED TO PATIENTS?
- Nature of the procedure
- Risk/s of the procedure
- Alternative/s to the procedure
- Expected benefits of the procedure
- Potential consequences of not doing anything
LI V. SPOUSES SOLIMAN
- Issue: Whether Dr. Li can be held liable for failure to fully
disclose serious side effects to the parents of the patient?
- SC ruled in favor of Dr. Li
▪ There was adequate disclosure of material risks
inherent in the chemotherapy procedure
performed with the consent of Angelica's parents
▪ Px’s immune system was already weak on the
account of the tumor
▪ Each patient's reaction to the chemical agents even
with pre-treatment laboratory tests cannot be
precisely determined by the physician
IN CASE THE PATIENT IS INCAPABLE OF GIVING CONSENT…
- Spouse
- Son or daughter of legal age
- Either parent
- Brother or sister of legal age
- Guardian
INTENTIONAL NONDISCLOSURE
Intentionally not disclosing information to a patient or surrogate
is legal in situations of emergency or when patients waive their right to
be informed
- if physicians believe “divulging the information would
potentially harm a depressed, emotionally drained, or
unstable patient”
- use of placebos when used properly during experimental
research
- if the research is relatively risk-free to the participants and
when the nature of the research is behavioral or
psychological and disclosure might seriously skew the
outcomes of the research
HOME AGAINST MEDICAL ADVICE (HAMA)
- Autonomy vs. beneficence
- A prudent and reasonable physician will not leave the
patient at the mercy of a layman’s decision (provide
medication plans and follow-up visits)
- ‘…if a patient leaves the hospital contrary to instructions, the
physician is not liable for subsequent events’ (Runez vs.
Jurado)
- ‘There is no expectation from doctors that they track down
each patient who apparently missed their appointments or
force them to comply with their directives. After all, a person
is still the master of his own body.’
- Where a patient wants to be discharged even if the doctor
believes na dili pa ready ang patient to be discharged.
- Pede pa ulion ang patients but medication and treatment
must be provided.
PATIENT DETENTION
- only allowed in cases if ang patient is prisoner.
- Detained or convicted prisoner; with a very contagious
disease; mentally-ill
- ‘…if the patient cannot pay the hospital or physicians bill, the
law provides a remedy for them to pursue, that is, by filing
3
 the necessary suit in court for the recovery of such fee or
bill’
- ‘…if the patient is prevented from leaving the hospital for
his inability to pay the bill, any person who can act on his
behalf can apply in court for the issuance of the writ of
habeas corpus’ (MDH vs. Chua)
RA 9439
- Prohibits patient detention on the grounds of non-payment
of hospital bills
- Requires execution of a promissory note covering the unpaid
obligation
- HOWEVER…patients in private rooms are NOT covered by
this act
PATIENT CONFIDENTIALITY
- The patient has the right to privacy and protection from
unwarranted publicity.
- Disclosure of confidential information
▪ Patient condition is in controversy in a court
litigation
▪ When public health or safety demands
▪ With patient consent
▪ Patient’s condition is discussed in a scientific
forum
RIGHT TO INFORMATION
- Result of the evaluation of the nature and extent of the
disease, administration of treatment and procedures
- Itemized bill of the hospital and medical services
- Continuing health care requirements following discharge
- Medical record
RIGHT TO EXPRESS GRIEVANCES
- Express complaints and grievances without fear of
discrimination
RIGHT TO RELIGIOUS BELIEF
- Right to refuse medical treatment or procedures which may
be contrary to religious beliefs
RIGHT TO QUALITY CARE AND HUMANE TREATMENT
- No discrimination
- Good quality of service
CIVIL CODE PROVISIONS
- Art. 19. “Every person must, in the exercise of his rights and
in the performance of his duties, act with justice, give
everyone his due and observe honesty and good faith.”
- Art. 20. “Every person who, contrary to law, willfully or
negligently causes damage to another, shall indemnify the
latter for the same.”
- Art. 21. “Any person who willfully causes loss or injury to
another in manner that is contrary to morals, good customs
or public policy shall compensate the latter for the damage.

4
 MEDTECH LAWS & BIOETHICS
LECTURE 1: Bioethical issues (from past to present)
CHRISTIAN JOHN E.VILLAHERMOSA, RMT
May 17, 2021
For updates and corrections → @mar4rii on Twitter
OUTLINE
I. HUMAN SUBJECTS OF
RESEARCH/HUMAN
EXPERIMENTATION
II. INTERNATIONAL CODES
III. ABORTION
IV. ABORTION IN THE PHILIPPINES
EUTHANASIA
V. BIOPROSPECTING/BIOPIRACY
VI. And many more XD
HUMAN SUBJECTS OF RESEARCH/HUMAN EXPERIMENTATION
Tuskegee syphilis study
- 600 African American men from Macon County, Alabama
were enlisted to partake in a scientific experiment on syphilis
- subjects were unaware of this and were simply told they
were receiving treatment for bad blood
- 'scientific racism'
- Testing on humans is actually allowed but this procedure is
governed by certain rules and regulations.
- You have to be able to present the nature of your study to
your human subjects before you can start.
- Human subjects must have the capacity to understand what
you will perform on them and as well as they should be able
to sign voluntarily.
- Tuskegee syphilis study: if they give their consent, they will be
treated but the subjects were deceived in a way. In the actual
conduct of the study, there was no drug that was given to
them.
- Actually, the study was just to observe the national
progression of UNTREATED syphilis.
- These men still died but the public health service still gave
them money for the burial.
- PROBLEM: concept of informed consent. Proper disclosure
must be present before the subject can consent to the study.
INTERNATIONAL CODES
Concern human experimentation. It has already been
established that you cannot perform experiments on human beings
easily. You must be governed by international codes and regulations
which supports the civil rights and humans rights of all human beings
which will become potentially subjects of your experiments.
Nuremberg Code
- 10 standards to which physicians must conform when
carrying out experiments on human subjects
- enunciates the requirement of voluntary informed consent
- doctors may perform experiment on human subjects but it
has to be satisfactorily complied with the requirement of the
Nuremberg code.
Declaration of Helsinki
- states that potential subjects should only give consent after
being fully informed of the study's setup, goals, and sources
of funding; potential conflicts of interest; researcher
affiliation(s); risks and benefits; and their right to withdraw
- parang improvement sa Nuremberg code.
These two (2) international codes govern all international researches
which may be conducted on human beings. Dapat mapasa mo to
(Nuremberg and Helsinki) before you will be given the ethical clearance
to start your study.
ABORTION
- a medical or surgical procedure that deliberately ends a
pregnancy before an embryo or fetus is born
- Pro: it is a woman's right to have access to safe, legal
abortions. —it should be regulated kay para shang murder
so it should be forbidden.
- Against: religious or ethical reasons
- Roe v. Wade: ruled that the Constitution protects a woman's
right to an abortion through the end of the first trimester;
introduced regulations for the second trimester and to ban
abortion after the fetus has reached viability except in cases
where the mother's health is endangered.
▪ Okay lang ang abortion up to first three (3) months
of pregnancy. From four (4) months to the 9th
months hindi na sha allowed.
- Introduced regulations for any abortion during the second
trimester.
- Okay sa first trimester na ma abort. Sa second trimester
onwards, I regulate na. Either if it endangers the life of the
mother and if the pregnancy is a product of rape or incest.
ABORTION IN THE PHILIPPINES
- remains illegal under all circumstances and is highly
stigmatized
- 27 abortions per 1,000 women of reproductive age in 2000
▪ Inability to afford the cost of raising a child or an
additional child
▪ Pregnancy would endanger their health
▪ their partner or another family member did not
want or support the pregnancy
▪ result of forced sex.
- In 2008, an estimated 1,000 maternal deaths in the
Philippines were attributable to abortion complications.
- Why do some women have abortion? They do it illegally. It is
done secretly and therefore unregulated.
EUTHANASIA
- the practice of ending the life of a patient to limit the
patient's suffering—the patient is not yet dead pero pinatay
or hinayaang mamatay to end the suffering.
- Active: killing a patient by, for example, injecting a patient
with a lethal dose of a drug
- Passive: intentionally letting a patient die by withholding
artificial life support such as a ventilator or feeding tube.
- Pro: patients should have the right to do what they want
with their own lives; patients who are in vegetative states
with no prospect of recovery, letting them die prevents
future needless and futile treatment efforts
- Against: killing is always wrong; violates an obligation to do
no harm—violation of non-maleficence.
BIOPROSPECTING/BIOPIRACY
- Bioprospecting
▪ the exploration of biodiversity for new biological
resources of social and economic value.
▪ One country will go to another country to scout for
plants or products which could be utilized for
1
 medications. Especially if a plant is only growing or
endemic only in one country or in one specific
region of a country.
▪ Allowed.
- Biopiracy
▪ making use of local medicinal knowledge without
acknowledging that it is indigenous intellectual
property.
▪ Ipinagbabawal kasi you are pirating the knowledge
of the local tribes and passing them as your own.
▪ 'historically rooted in colonialism' –most countries
nan aga perform ng biopiracy are colonizers.
- Rio Declaration
▪ clarified the rights of indigenous people and local
communities to control the use of intellectual
property and to establish equitable benefit sharing
▪ regulates bio prospective.
▪ If you were able to accrue or accumulate riches
because of our information then you have to give
back to us and you have to recognize that our role
as the first people to have identified the properties
that you are selling.
THE NEEM TREE CASE
- U.S. multinational corporation W.R. Grace's 1994 patent for a
neem tree seed extract used in their antifungal spray,
Neemex
- neem extracts had been used by rural farmers in India for
more than 2,000 years in insect repellants, soaps and
contraceptives.
- Walang benefit sharing na nangyari.
- Na revoke and patent ni W.R. Grace.
CRYONICS
- an effort to save lives by using cold temperatures to preserve
the dead for decades or centuries until a future medical
technology can restore that person to full health
- Aim: to keep bodies in a stable, preserved state until the
necessary medical technology arrives
- Not a guarantee: "like an ambulance ride to a future hospital
that may or may not exist".
- Once namatay ang isang tao, ilalagay sha isang stable
preserve state na very very cold temperature until they will
be “resurrected” by a future technology.
HOW DOES CRYONICS WORK
- Once na the person died, ma pronounce na legally dead, I
stabilize yung kaniyang body to supply the brain with enough
oxygen and blood to preserve minimal function
- I susubject through cooling; the body is packed in ice and
injekan (xD) yung patient ng heparin to prevent his or her
blood from clotting.
- Heparin: I remove yung water sa body ng decedent and I
replace ng isang anti-freeze para hindi mag freeze and body.
- I co-cool ang body sa dry ice until it reaches the -130 degree
Celsius
- The body will be placed in a large metal tank filled with liquid
nitrogen na naka preserve around -196 degrees Celsius
- Naka upside down ang paglagay ng body sa tank kasi if ever
may leak the brain will still be immersed in the freezing liquid.
EUGENICS
- a movement that is aimed at improving the genetic
composition of humanity
- advocated selective breeding to achieve these goals
- technologies that make it possible to more directly alter the
genetic composition of an individual
- American eugenicists focused on efforts to stop the
transmission of negative or "undesirable" traits from
generation to generation.
- Goal: to preserve the most desirable quality in man and
tatanggalin and undesirable.
HELA CELLS
- Cancer cells from Henrietta Lacks which became the first
human "cell line"
▪ Cell line- parang collection of cells which are used in
various experiments.
▪ These cells have the capacity to multiply
uncontrollably—faster than cancer cells.
- Her surgeon took a tissue biopsy of her cancerous womb
without her knowledge or consent and was passed to cancer
researchers in the same hospital who were astonished by the
ability of the cells to replicate in laboratory culture
- some 70,000 studies have been published involving the use
of HeLa cells
▪ Including the creation of the first polio vaccine, the
identification of HIV, and the link between human
papilloma virus and cervical cancer
THE GREAT APE PROJECT
- an appeal of scientists aiming at the legal equalization of the
non-human great apes (chimpanzees, gorillas and
orangutans) with man – they are used first prior to human
experimentations.
- securing three basic rights for all great apes:
▪ The Right of Life
▪ The Protection of Individual Liberty
▪ The Prohibition of Torture
POLITICAL ABUSE OF PSYCHIATRY
- the misuse of psychiatric diagnosis, treatment and detention
for the purposes of obstructing the fundamental human
rights of certain individuals and groups in society
- abuses of the human rights of those politically opposed to
the state are often hidden under the guise of psychiatric
treatment
- Sending people to a psychiatric institution is particularly
practical
- declaring a person mentally ill provides a perfect opportunity
not to respond to their political or religious convictions
- if certain people published articles that are critical of the
government or spearheading movement which are against
the government. The government response is to make use of
the psychiatrist at the governments disposal to declare those
people as insane or mentally ill therefore they need to be
detained in a psychiatric hospital.
- Abuse of human rights of those politically opposed to the
state.
PAP IN THE USSR (Union of Soviet Socialist Republics)
- development of the concept of 'sluggish schizophrenia' by Dr
Andrei Snezhnevsky, the director of the Institute of
Psychiatry for the Soviet Union
- Also developed 'reformist delusions', which was a form
ofparanoid schizophrenia
2
 - Main hospital: Serbski Institute for Forensic Psychiatry in
Moscow
CASES OF PAP
Pyotr Chaadayev
- was imprisoned by Tsar Nicholas I after publishing an article
criticizing the backwardness of Russian society
- first person to be incarcerated in the psychiatric institution
because he was a critique of the backwardness of the Russian
society under the rule of Tsar Nicholas I.
- before USSR
Vasily Mikaelovich Stetsik
- editor of the journal that contained articles critical of the
authorities, was beaten, jailed, and then sent to a psychiatric
hospital. Childhood immunization schedule
Sergei Ablamsky - given to children.
- a lawyer who accused a local prosecutor of corruption, was - BCG and Hep B—given directly after birth.
taken in handcuffs to a psychiatric institution where he was
detained for 4 weeks.
Marina Kalashnikova
- a journalist who published articles critical of the Russian
Government, was forcibly incarcerated in a psychiatric clinic
for 35 days and was poisoned with mercury.
In all these cases, the diagnosis of a psychiatric disease or disorder was
done in order to stop these people from continuing their campaign for
reform and to stop them criticizing their govt. further.
PAP IN CONTEXT
- Psychiatry is particularly unique among the specialties of the
medical profession in that it has the power to remove liberty
- all mental health professionals and those of the future must
have an awareness of how these abuses can happen and an
unwillingness to become part of a system that is oppressive Dengvaxia was a good vaccine for children who had never infected with
- Political abuse of psychiatry can occur in more democratic dengue. It becomes a problem if meron ka ng prior exposure ng dengue
systems, but such abuse can be ameliorated and weakened tas nag pa vaccine.
by a strong active and aware professional body of mental
health professionals. VACCINE HESITANCY IN THE PHILIPPINES
- Common in countries na authoritarian and can also occur in - London School of Hygiene and Tropical Medicine vaccine
democratic systems. confidence project report
HAWAII DECLARATION ▪ the respondents' views that vaccines are
- Issued by the World Psychiatric Association important decreased from 93% (2015) to 32%
- "The Psychiatrist must never use his professional possibilities (2018); safe and effective from 82% (2015) down
to violate the dignity or human rights of any individual or to 21% (2018) and vaccine confidence dropped
group and should never let inappropriate personal desires or from 93 (2015) to 32% (2018)
feelings prejudices or beliefs interfere with the treatment. • Measles and polio outbreak in 2019
The psychiatrist must on no account utilize the tools of his ADDRESSING VACCINE HESITANCY
profession once the absence of psychiatric illness has been - Start early
established. If a patient or some third-party demand contrary - Present vaccination as the default approach
to scientific knowledge or ethical principle, the psychiatrist - Focus on protection for the child and community
must refuse to cooperate." - Build trust with parents Tell stories in addition to providing
- Regulates the PAP scientific facts
VACCINE HESITANCY - Be honest about side effects when asked, and reassure
- refers to the delay in acceptance or refusal of vaccines parents of a robust vaccine safety system
despite availability of vaccination services
Reasons: Hehe my bad karon lang na upload. GL guys 😉. Godbless sa exam
- lack of confidence (in effectiveness, safety, the system, or tom.
policy makers)
- complacency (perceived low risk of acquiring VPDs)
- lack of convenience (in the availability, accessibility, and
appeal of immunization services, including time, place,
language, and cultural contexts)

- media reports highlight a rare occurrence of an adverse

reaction to a vaccine, or associating certain disorders to
vaccines or their components