MEDICAL SCIENCE AND THE LAW
Atty. Edwin L. Dimatatac, MD, FPCP, MHA
CASE
Mr. Santos, a rich man, decided to donate P5M to the
unborn child of Ms. Cruz. The legal documents were
executed and the money was given to Ms. Cruz.
While Ms. Cruz was only eight months pregnant, she
went into labor. She delivered a baby girl who died
within one hour after birth. Mr. Santos, upon learning
of the death of the child, wanted to get back the P5M
he donated. If you were the lawyer consulted by Mr.
Santos, what would you advise?
WHEN IS A PERSON
CONSIDERED BORN?
Art. 40. Birth determines personality; but the conceived
child shall be considered born for all purposes that are
favorable to it, provided it be born later with the conditions
specified in the following article.
Art. 41. For civil purposes, the fetus is considered born if it
is alive at the time it is completely delivered from the
mother's womb. However, if the fetus had an intra-uterine
life of less than seven months, it is not deemed born if it
dies within twenty-four hours after its complete delivery
from the maternal womb.
WHAT IS THE INTRAUTERINE LIFE?
A conceived child shall be considered born for
all purposes favorable to it provided that:
a.Delivered alive INTRAUTERINE LIFE of 7
months or older (7m, >7m)
b.Delivered alive at less than 7 months, does
NOT die within 24 hours (<7m)
Whether an infant survives for 24 hours is a
determination made in the hospitals or by
someone who attends to a woman during
childbirth.
In very rare instance, some
newborn babies would appear dead but are
in fact still alive.
Lazarus syndrome
autoresuscitation after
failed cardiopulmonary
resuscitation
GESTATIONAL AGE
The law assumes that a baby born at 7 months
would survive.
In the Philippine General Hospital a baby
born at 27 weeks survived
In the United States A baby named Amillia
Taylor was born at 21 weeks and 6 days
weighing only 283 grams (2006)
AMILIA TAYLOR
GESTATIONAL AGE
Counted from first day of last menstruation of
mother
May also be based on early ultrasound
From first day of last menstruation
expected date of delivery will be from 38 to
42 weeks
A laborer brought his wife who was 38 weeks pregnant
to the hospital because of abdominal pain. The wife
went into labor but the child died during delivery. The
laborer claimed for a paternity leave and bereavement
leave for death of a dependent as provided for in their
collective bargaining agreement. The company
allowed him paternity leave but refused to allow the
bereavement leave.
Company claimed that the child was not born alive and
could not have acquired juridical personality. Company
claimed that a dead fetus which did not acquire juridical
personality will not entitle the laborer to a bereavement
leave allowed under the CBA for the death of a
dependent. If you were deciding the case, how will you
rule? [Continental Steel Manufacturing Corporation vs.
Montao, 603 SCRA 621(2009)]
DEFINITION
Abortion
Fetal death
infanticide
ABORTION
Medical Definition
Abortion products of conception expelled at
20 weeks or less (24 weeks)
Fetal death in utero - More than 20 weeks or
weighs 500g or more
Criminal law considers viability or capability of
independent existence
ABORTION
Aborted baby
at 15 weeks
Usual Causes
of Abortion:
infection, nutrition, anatomic abnormalities,
alcohol and tobacco, chromosomal
abnormalities of fetus
ABORTION
RPC arts. 256, 257, 258, 259
Intentional Abortion
Unintentional abortion
Abortion practiced by the woman
herself of by her parents
Abortion practiced by a physician or
midwife and dispensing of abortives
INTENTIONAL ABORTION
1. use of any violence upon the person of the
pregnant woman.
Abortion caused by trauma - as a
rule,
caused by event/trauma that
occurred
weeks before (more fatal in later stages of
pregnancy)
In later stages, a fetus might die because of
Uterine rupture, Placental Abruption
INTENTIONAL ABORTION
2. without using violence
could be drugs
ex. morning after pills not legal, alter
hormone levels to
prevent implantation
UNINTENTIONAL ABORTION
Art. 257. Unintentional abortion. xxx any person
who shall cause an abortion by violence, but
unintentionally.
Abortion practiced by a physician or midwife
taking advantage of their scientific knowledge
or skill, shall cause an abortion or assist in
causing the same.
Dispensing of abortive by pharmacist without
prescription
Ex. Cytotec (misoprostol) for
ulcer
INFANTICIDE
Art. 255. Infanticide. The penalty provided
for parricide in Article 246 and for murder in
Article 248 shall be imposed upon any person
who shall kill any child less than three days of
age. xxx
A man came home to his 6-month pregnant
wife. He then stabbed her 14 times. The
neighbors who heard the commotion went into
the house just as the man rushed out. They
saw the bloodied body of the dead wife and a
dead baby apparently delivered from the
mothers womb. What crimes were committed?
CAPACITY TO ACT
NCC, Art. 38. Minority, insanity or
imbecility, the state of being a deafmute, prodigality and civil interdiction
are mere restrictions on capacity to
act, and do not exempt the
incapacitated person from certain
obligations, as when the latter arise
from his acts or from property
relations, such as easements. (32a)
Art. 39. The following circumstances, among
others, modify
or limit
CAPACITY
TO
ACTcapacity to act: age,
insanity, imbecility, the state of being a deafmute, penalty, prodigality, family relations,
alienage, absence, insolvency and trusteeship.
The consequences of these circumstances are
governed in this Code, other codes, the Rules of
Court, and in special laws. Capacity to act is not
limited on account of religious belief or political
opinion.
A married woman, twenty-one years of age or
over, is qualified for all acts of civil life, except
in cases specified by law. (n)
SEX
SEX OF A CHILD
Genetic
Appearance
See Republic vs. Cagandahan, 565 SCRA
72(2008)
MALE OR FEMALE?
AGE
R.A. 9344, SEC. 6. Minimum Age of Criminal Responsibility. - A
child fifteen (15) years of age or under at the time of the
commission of the offense shall be exempt from criminal liability.
Sec. 7. xxx The age of a child may be determined from
the child's birth certificate, baptismal certificate or any
other pertinent documents. In the absence of these
documents, age may be based on information from the
child himself/herself, testimonies of other persons, the
physical appearance of the child and other relevant
evidence. xxx
*OLD AGE over 70 years old mitigating circumstance
DEFINITION
Imbecile
Idiot
moron
IMBECILITY
Wechsler IQ test ratings identify those
as imbeciles who suffer moderate
mental retardation.
- Idiot - 2 years old, profound Mental
Retardation IQ below 20
- Imbecile - 2-7 years old, moderate to
severe mental retardation IQ 20-49
- Moron 7-12 years old, Mild mental
retardation -- IQ 50-69
IMBECILITY
Terms used - idiot, imbecile, moron mild
retardation, moderate retardation, severe
retardation, and profound retardation intellectual
disability
Intellectual disability may be assessed by
psychologists and psychiatrists
Causes: Trauma to head, genetics (Down
Syndrome), Infections (Meningitis), Lead poisoning
or exposure to toxic substances
DEAF-MUTE
Hearing tests, Examination by an ENT
DEAF-MUTE
The absence of a qualified interpreter
in sign language and of any other
means,
whether
in
writing
or
otherwise, to inform the accused of
the charges against him denied the
accused his fundamental right to due
process of law. [People vs. Parazo,
310 SCRA 146(1999)]
DEFINE
Insanity
Lucid Interval
INSANITY
INSANITY - a person with a psychiatric
condition is considered insane, usually those
who suffer hallucinations, delusions, disordered
thinking
Lucid intervals - usually, those with a
psychiatric condition, controlled by medication,
or therapy would think clearly
Ex. Schizophrenia (medical criteria)
INSANITY
JOHN NASH
INSANITY
Schizophrenia - typically begin between adolescence
and early adulthood for males and a few years later
for females, and usually as a result of a stressful
period (such as beginning college or starting a first
full time job).
delusions and hallucinations, disorganized behavior
and/or speech, flattening or inappropriate affect
INSANITY
Bipolar I disorder
1. at least one manic episode a person must have at
least one manic episode (Mania intense high, euphoria,
feels indestructible, elevated self-esteem, talkative)
2. Depression develops as mania fades, consequences
of activities becomes apparent
Developmental disorders include autism and
mental retardation, disorders which are
typically first evident in childhood
Personality disorders are clinical syndromes
which have a more long lasting symptoms and
encompass the individual's way of interacting
with the world.
They include Paranoid,
Antisocial,
and
Borderline
Personality
Disorders.
DEFINE
Psychological Incapacity
PSYCHOLOGICAL INCAPACITY
the intention of the law to confine the
application of Article 36 to the most serious
cases of personality disorders, clearly
demonstrative of an utter insensitivity or
inability to give meaning and significance to
the marriage; that the psychological illness
that must have afflicted a party at the
inception of the marriage should be a
malady so grave and permanent as to
deprive one of awareness of the duties and
responsibilities of the matrimonial bond he
or she is about to assume. [Suazo vs. Suazo,
615 SCRA 154(2010)]
PSYCHOLOGICAL INCAPACITY
1. Pathological Lying (Magical Thinking) - Antonio
vs. Reyes, 484 SCRA 353, March 10, 2006
2. Constant nonfulfillment, senseless and
protracted refusal to have sexual intercourse
[Chi Ming Tsoi vs. Court of Appeals, 266 SCRA
324(1997)]
INSANITY MENTIONED IN LAW
Competency to stand Trial
Exempting Circumstance
Death convict who becomes insane after his
final conviction cannot be executed while in a
state of insanity
Detention by reason of insanity or imbecility is
not considered a penalty
INSANITY
Violent insanity shall be considered legal
grounds for the detention of any person
Raises penalty for rape, serious physical
injuries, if victim becomes insane; rape if victim
is insane
Ground for annulment
Capacity to give consent to contract [Unsound
Mind]
INSANITY
CRIMINAL INSANITY - individuals make-up
at the time of the offending act was such that,
with respect to criminality of his conduct, he
substantially lacked capacity to act rationally
* ignorance lack of understanding
* compulsion irresistible impulse
Legal standards for criminal insanity do not
match the psychiatric diagnostic criteria
Temporary insanity
NO TEMPORARY INSANITY
Neither are we persuaded by EDGARDOs
plea of temporary insanity. As the OSG
aptly stated, temporary insanity is not
recognized in this jurisdiction. Insanity,
under Article 12 of the Revised Penal Code,
connotes that the accused must have been
deprived completely of reason and freedom
of the will at the time of the commission of
the crime, or that he must have acted
without the least discernment. Mere
abnormality of the accuseds mental
faculties does not exclude imputability.
[People vs. Aquino, 322 SCRA 769(2000)]
BWS
R.A. 9262, Sec. 3(c)" Battered Woman
Syndrome" refers to a scientifically defined
pattern of psychological and behavioral
symptoms found in women living in battering
relationships as a result of cumulative
abuse.
Sec. 26 xxx In the determination of the state
of mind of the woman who was suffering
from battered woman syndrome at the time
of the commission of the crime, the courts
shall be assisted by expert psychiatrists/
psychologists.
Battered Woman Syndrome - three phases:
(1) the tension-building phase- minor
batterings in the form of verbal or slight
physical abuse; woman tries to pacify the
batterer through a show of kind, nurturing
behavior; or by simply staying out of his way;
(2) the acute battering incident phase characterized by brutality, destructiveness
and sometimes, death. The battered woman
realizes that she cannot reason with him and
that resistance would only exacerbate her
condition; and (3) the tranquil period, where
the couple experience a compound relief
and the batterer may show a tender and
nurturing behavior towards his partner
[People vs. Genosa, 419 SCRA 537(2004)]
DEFINE
Insanity
Unsound Mind
THE UNSOUND MIND
Insanity or Imbecility cannot give consent to a
contract
Unsound mind does not have testamentary
capacity
THE UNSOUND MIND
Civil Code, Art. 799. To be of sound mind, it is not
necessary that the testator be in full possession of
all his reasoning faculties, or that his mind be
wholly unbroken, unimpaired, or unshattered by
disease, injury or other cause.
It shall be sufficient if the testator was able at the
time of making the will to know the nature of the
estate to be disposed of, the proper objects of his
bounty, and the character of the testamentary act.
DISEASES THAT COULD AFFECT
SOUNDNESS OF MIND
Multiple sclerosis
Psychiatric Conditions: severe depression, bipolar
disorder, schizophrenia
Alzheimers disease
Stroke, cerebrovascular diseases
Metabolic disorders
Hepatic encephalopathy
Meningitis
FILIATION
Family Code, art. 164
Children conceived as a result of artificial
insemination of the wife with the sperm of the
husband or that of a donor or both are likewise
legitimate children of the husband and his wife,
provided, that both of them authorized or
ratified such insemination in a written
instrument executed and signed by them before
the birth of the child.
FILIATION
1
. Artificial Insemination sperm is placed in
reproductive tract of female
2. In vitro Fertilization test tube baby
IN VITRO FERTILIZATION
John and Marcia separated because
according to Marcia, John was unable to fulfill
her needs as a woman.
After being
separated for a year, it then came to Johns
knowledge that Marcia gave birth to a baby
boy. John wanted to impugn the legitimacy
of the child on the ground that he had been
previously diagnosed with low sperm count.
If he comes to you for help, what advice will
you give him?
FILIATION
Art. 166. Legitimacy of a child may be impugned only on
the following grounds:
(1) That it was physically impossible for the husband to
have sexual intercourse with his wife within the first 120
days of the 300 days which immediately preceded the
birth of the child because of:
(a) the physical incapacity of the husband to have sexual
intercourse with his wife;
(b) the fact that the husband and wife were living
separately in such a way that sexual intercourse was not
possible; or
(c) serious illness of the husband, which absolutely
prevented sexual intercourse;
FILIATION
Art. 166. Legitimacy of a child may be impugned only
on the following grounds:
(2) That it is proved that for biological or other scientific
reasons, the child could not have been that of the
husband, except in the instance provided in the second
paragraph of Article 164; or
(3) That in case of children conceived through artificial
insemination, the written authorization or ratification of
either parent was obtained through mistake, fraud,
violence, intimidation, or undue influence.
FILIATION
Physical causes - impotence
Serious illness diseases that prevent
a man from achieving/sustaining an
erection
Biological/Scientific Reasons DNA,
Genetics
FILIATION
DEFINE
Impotent
Sterile
Infertile
FILIATION
Impotence is the inability of a person to perform
sexual intercourse. [erectile dysfunction]
Sterility is the inability of the male to beget
children [abnormal sperm, low sperm count]
Infertility is the inability of female to bear
children
PHYSICAL CAUSES
What can cause impotence?
Erectile Dysfunction
Medication: Antidepressants and other psychiatric
medications
High blood pressure drugs
Chemotherapy
High Level Painkillers (Morphine, Fentanyl)
Recreational Drugs
SERIOUS ILLNESS
Illness:
1. high blood (because of medications)
2. diabetes (due to blood vessel and nerve
damage)
3. heart failure
BIOLOGICAL/SCIENTIFIC EVIDENCE
Rule on DNA Evidence 9(c) - DNA results that
exclude the putative parent from paternity shall
be conclusive proof of non-paternity. If the
value of the Probability of Paternity is less than
99.9%, the results of the DNA testing shall be
considered as corroborative evidence. If the
value of the Probability of Paternity is 99.9% or
higher, there shall be a disputable presumption
of paternity.
BIOLOGICAL/SCIENTIFIC EVIDENCE
DNA paternity testing probability must be
99.9% (disputable presumption satisfactory
unless contradicted by other evidence)
Blood type
a. Type O + Type O = Type O
b. Type A + Type O = Type A, O
c. Type A + Type B = Type A, B, AB, O
Physical Characteristics
FILIATION
FILIATION
MARRIAGE
Family Code Art. 45. Annulment
(2) That either party was of unsound mind, unless
such party after coming to reason, freely
cohabited with the other as husband and wife;
xxx
MARRIAGE
Family Code Art. 45. Annulment
(5) That either party was physically incapable of
consummating the marriage with the other, and
such incapacity continues and appears to be
incurable; or
(6) That either party was afflicted with a sexuallytransmissible disease found to be serious and
appears to be incurable.
MARRIAGE
Family Code Art. 46. Fraud as ground for
annulment
(2) Concealment by the wife of the fact that at
the time of the marriage, she was pregnant by
a man other than her husband;
(3) Concealment of sexually transmissible
disease, regardless of its nature, existing at the
time of the marriage; or
MARRIAGE
Family Code Art. 46. Fraud as ground for
annulment
(4) Concealment of drug addiction, habitual
alcoholism or homosexuality or lesbianism
existing at the time of the marriage.
Justin and Selena got married. After one week,
Justin consulted with you because he wanted
to file for annulment.
Apparently Selena
concealed that she was 4 months pregnant by
another man. Selena claimed that Justin knew
about the pregnancy and promised to love her
anyway. Selena said that it would have been
imposible conceal her pregnancy given its
advanced stage. What will you advise?
PREGNANCY
STD curable, incurable
INCURABLE
AIDS HIV
*Condom less risky sex
Herpes - painful,
ulcerative blisters
or sores on the
genitals in both
men and women
STD curable, incurable
CURABLE
Syphilis painless
chancre
if untreated can cause
blindness,
numbness, nerve damage
STD curable, incurable
CURABLE
Gonorrhea - burning sensation when urinating;
white, yellow, or green discharge from the
penis; increased vaginal discharge, or vaginal
bleeding between periods.
Chlamydia
ALCOHOLISM
Alcoholism it is a condition characterized by
a compulsion to drink, dependence on alcohol,
prolonged use affects the brain
Treatment- Detoxification, Control of
Withdrawal Symptoms, Psychological Support
ALCOHOLISM
Two "yes" responses
indicate that the
respondent should
be investigated
further.
The questionnaire
asks the following
questions:
ALCOHOLISM
Have you ever felt you needed to Cut
down on your drinking?
Have people Annoyed you by
criticizing your drinking?
Have you ever felt Guilty about
drinking?
Have you ever felt you needed a drink
first thing in the morning (Eye-opener)
to steady your nerves or to get rid of a
hangover?
DRUG ADDICTION
Drug Addiction severe compulsion to seek
and take drugs; has serious physical, mental
and social consequences
- detoxification, psychological treatment, social
support
THANK YOU!
