University of Santo Tomas

Faculty of Arts And Letters

A Study on the Awareness of Patients in theSelected Public Hospitals in Manila

regarding their Legal Rights

Submitted By:

Libiran, Jared Ruiz A.

Montemayor, Anna Carmela B.

November 6,2015

2

CHAPTER 1

The Problem and its Background

This chapter presents the introduction, objectives, theoretical framework, conceptual

framework, statement of the problem, hypothesis, significance of the study, scope and

limitations, and definition of terms.

1.1.Introduction

Beggars cannot be choosers; so are patients in the public hospitals.

The situation of the Philippine public healthcare is alarming.With the lack of public

hospitals, the poor accommodation and sub standard facilities in these hospitals add up

to the problem.

Dr. Rusty Jimenez of the Private Hospitals Association of the Philippines said that there

are only 1,800 hospitals in the country both private and government-owned with a total

bed capacity of 77,000.Jimenez added that with the population of 100 million people, the

bed to patient ratio in Philippine hospitals is at one bed for every 1,000 patients.

(Dagooc, 2014)

Increasing migration of health professionals has also largely depleted the pool of health

practitioners. Doctors and nurses are leaving the country at an ever faster rate.

Dr. Melchor Rey Santos, president of the Philippine Medical Association (PMA), reported

that of the 35,000 doctors in the PMA roster, 6,000 are now working abroad. Another

4,000 have opted to retrain and shift to the nursing profession, in preparation for an

overseas job as a nurse.(Diez, 2010).

3

In the statistics of the Philippine HRH Master Plan and Nursing Workforce Management

of the Institute of Health Policy and Development Studies, University of the Philippines

Manila-National Institutes of Health, 221,323 out of 421,467 nurses who passed the

Board were unemployed in 2012,It is also estimated that from 2001 to 2011 there were

132,943 overseas-employed nurses, and only 67,202 were locally employed.

(Ermitanio&Alviar,2014)

Despite the Department of Health’s vibrancy in promoting the selling and buying of

generic medical products, the cheapest generics are still unaffordable by many of the

average Filipinos. (Picazo, 2012)

Moreover, Philippine College of Physicians president Dr. Anthony Leachonpointed out in

their health forum last 2014 that the underprivileged in the Philippines have low health

literacy. Most of the marginalized Filipinos are not educated and inferior in terms of

understandingthe basic health information and services resulting to a higher death rate

in the country.

Lack of facilities and practitioners, high cost of medicine and hospitalization and the

inadequacy of dissemination of basic health information; these are violations of human

rights as Filipino patients are seemingly deprived of those.

The Commission on Human Rights of the Philippines defines human rights as the

supreme, inherent, inalienable rights to man as a human being and those which he may

legally inherit or acquire by title as necessary to his life, liberty, dignity and self

development, including those that may accrue to him in the course of his existence,

resulting either from the dynamic, ever-changing complexities of modern living, or those

4

bestowed upon him that make him a more revered human being of even greater stature

than before.

Clear enough, when medical treatment were not availed due to the said existing

problems, it could be considered as deprivation of the patients’ inherent right to life,

especially for those who have serious illness who are badly in need of medical

assistance.

This study is about the awareness of the patients in the selected public hospitals in

Manila regarding their legal rights. In this study, the researchers assessed the current

state of patients’ rights and its implementation in the selected public hospitals in Manila.

The researchers chose Manila as the location of the study for it is the most diverse and

populous city in the Philippines. The factors affecting the patients’ unawareness

regarding their legal rights are also determined.

1.2. Objectives of the Study

The primary objective of this study is to assess the current state of patients’ rights and its

implementation in the selected public hospitals in Manila.

1.2.1 Specific Objectives

The researchers also have the following as specific objectives:

- Find out the laws and jurisprudence establishing patients’ rights in the Philippines

- Determine the factors affecting the patients’ unawareness regarding their legal

rights in the selected public hospitals in Manila

- Assess the development and implementation of policies regarding patients’ rights

of the selected public hospitals in Manila

5

- Raise awareness in the need to address the problem regarding the patients’

unawareness of their legal rights

1.3. Theoretical Framework

1.3.1. Immanuel Kant’s Theory on Rights

According to Immanuel Kant’s Theory on Rights, human rights, within the perspective of

politics, are provided by the government. These rights guarantee the freedom of its

constituents and from that freedom, the constituents derive other rights.

The development, creation and implementation of rights are primarily dependent on the

government and its respective branches. In order for a society to be able to function

properly, the state must give and enhance fundamental rights, laws, and entitlements.

According to Kant’s teachings, these laws are founded upon 3 rational principles:

1. The liberty of every member of the society as a man

2. The equality of every member of the society with every other, as a subject

3. The independence of every member of the commonwealth as a citizen

The first principle is based upon the idea of liberty of individuals. Kant emphasizes the

importance of the liberty of individuals as the state or commonwealth is not allowed to

dictate the lives of individuals.

The second principle introduces the idea of the equality of every member of society.

Equality for each member within the state under the guidance of a ruler is important for

there to be a common basis for everyone within the state. Everyone must possess the

same rights within the state so that laws can be evaluated and be applied in the same

6

equal manner for everyone. Equality, as stated by Kant, therefore, is the basis from

which rights for every human being originate.

The last principle is the idea that every member of the state is independent as a citizen.

Rights develop from this principle because it is up to the individual to act independently if

a right or law is to be practiced. If a member of society is incapable of acting

independently without the guidance of the commonwealth, rights would not be needed.

1.3.2. Jean-JaquesRosseau’s Social Contract Theory

The Social Contract Theory is the theory in which the persons’ moral and legal

obligations are dependent upon a contract or agreement among them to form the society

in which they live.

In Rosseau’s Social Contract Theory, he further describes the theory by giving the

historical process in which man began in a “state of nature” and over time progressed

into civil society. Rosseau further explained his theory by explaining that before civil

society was formed, people lived solitary and uncomplicated lives. The abundance of

nature and the relatively small size of the population, competition were non-existent, and

men rarely see each other, much less had reason for conflict or fear. Man, therefore,

was not inclined to bring harm to one another.

However, as time passed, their population increased. The means by which people could

satisfy their needs began to change. People began living in small communities.

Discoveries and inventions have made life easier and the concept of leisure time arose.

Such leisure time inevitably led people to make comparison between themselves and

others resulting in making public values.

7

The invention of property, Rosseau further states, should be regarded as the “fall from

grace” out of the State of Nature for it had brought greed, competition, vanity, inequality

and vice.

With the introduction of property, conditions of inequality became more pronounced

which led to the development of social classes and the eventual formation of the

government.

Rosseau stated in his work that the formation of the government cements the

inequalities property has produced. He then proposed the idea that men are endowed

with freedom and equality by nature; however their nature has been corrupted by their

history. Men can overcome this corruption, however, by invoking their free will to

reconstitute themselves politically, along strongly democratic principles.

1.3.3. Abraham Maslow’s Hierarchy of Needs

According to Maslow’s Hierarchy of needs, men are motivated to achieve certain needs.

Maslow devised a hierarchy of human needs that is based on two groupings: deficiency

needs and growth needs. In the deficiency needs, each lower need must first be

satisfied in order to move to the next level. Once each of these needs have been

satisfied, and if at some future time a deficiency is detected, the individual will

immediately act to remove the deficiency. The first four levels are:

1. Physiological – hunger, thirst, bodily comforts, etc.;

2. Safety or security – security from danger;

3. Belongingness and Love – Affiliation with others, acceptance;

8

4. Esteem – to achieve, competence, gain approval, and recognition.

Maslow further explained his theory by stating that an individual is ready to act upon the

growth need when deficiency needs are met. Maslow’s initial conceptualization included

only one growth need however; Maslow later differentiated the growth need of self-

actualization. Maslow identified two of the first growth needs as part of the more general

level of self-actualization and one beyond the general level that focused on growth

beyond that oriented towards self. The following are:

5. Cognitive – the urge to know, to understand, and explore;

6. Aesthetic – appreciation for symmetry, order, and beauty;

7. Self-actualization – to find self-fulfillment and realize one’s potential; and

8. Self-transcendence – to connect to something beyond the ego or to help

others find self-fulfillment and realize their potential.

1.3.4. Principle of Autonomy

The concept of “Autonomy” is one of the four traditional pillars of Bioethics. It refers to

the capacity to think, decide and act on one’s own free initiative. In the perspective of the

medical field, physicians and family members are obligated to help the patient come to

their own decision by providing full information; they should also uphold a competent,

adult patient’s decision, even if it appears medically wrong.

9

1.4. Conceptual Framework

Theory of Rights

Principle of Autonomy

Social Contract Theory

Patients’ Rights

Hierarchy of Needs

Theory

Patients in

selectedpublic

hospitals in Manila

Laws

Hospitals

Interview Method Survey Method

Patients in the selected hospitals in Manila are not aware of their legal rights

10

According to the Theory of Rights, rights must be given or enhanced by the government

through enactment and implementation of laws in order to have a fully functioning state.

These laws gave the moral and legal obligations to hospitals and health practitioners to

promulgate the rights of patients following the social contract theory stating that rights

are acquired by agreement between the government and the people.

The patients in the selected public hospitals in Manila on the other hand, must be able to

know their legal rights by the virtue of the principle of autonomy, stating that all patients

must have knowledge about their current status so he may be able to decide for himself

without force or coercion; and the hierarchy of needs theory which demands the

satisfaction of physiological need in which health satisfaction belongs.

In this study, the researchers want to prove through interview and survey method that

patients in the selected public hospitals in Manila are not aware of their legal rights, and

determine the factors of their unawareness.

1.5 Statement of the Problem

In order to achieve the objectives and realize the significance of the study, the

researchers formulated the following problems:

1.5.1. General Problem

Whether or not patients in selected public hospitals in Manila are aware of their rights as

patients

1.5.2. Specific Problems

1. Are the laws concerning patients’ rights adequate?

11

2. What are the factors affecting the patients’ unawareness regarding their legal rights in

the selected public hospitals in Manila?

3. Is the implementation of the policies of the selected public hospitals in Manila

regarding the patients’ rights sufficient?

1.6. Hypothesis

1.6.1 Hypothesis for the General Problem

H0: The patients in the selected public hospitals in Manila are unaware of their legal

rights.

H1: The patients in the selected public hospitals in Manila are aware of their legal rights.

1.6.2 Hypotheses for the Specific Problems

1. H0: Philippine laws that govern patients’ welfare and rights are adequate.

H1: Philippine laws that govern patients’ welfare and rights are not adequate.

2. H0: The factors affecting the unawareness of patients to their legal rights are

brought about by the government and the hospital

H1:The factors affecting the unawareness of patients to their legal rights are

not brought about by the government and the hospital

H2 : The factors affecting the unawareness of patients to their legal rights are

brought about by the government only

12

H3 : The factors affecting the unawareness of patients to their legal rights are

brought about by the hospital only

3. H0: The implementation of the policies of the selected public hospitals in

Manila regarding the patients’ rights is insufficient

H1: The implementation of the policies of the selected public hospitals in

Manila regarding the patients’ rights is sufficient.

1.7. Significance of the Study

The researchers deemed that the study would prove to be significant to the following

groups and entities:

First and foremost, the study would greatly benefit patients as this study aims to improve

the lives of patients, especially the ones who are in public hospitals.

Second, this study will provide the legislative body of the Philippines the facts which

would be useful for the creation and development of policies that would genuinely benefit

patients.

Third, the study may contribute to the assessment and implementation of policies of

public hospitals that would affect the patients’ welfare and the improvement of their

accommodation and service to patients.

Fourth, the University of Santo Tomas would also benefit as the study would contribute

to its intellectual property.

Fifth, this study may serve as a reference for future researchers who wish to conduct a

study regarding patient rights in the Philippines.

13

Sixth, through this study, the researchers would to raise awareness to the general public

of their rights as patients

Lastly, the student researchers would greatly benefit as this study is essential to the

fulfillment of the requirements needed in the completion of their bachelors’ degree in

Legal Management.

1.8.Scope and Limitations

The researchers’ study aims to determine whether or not the patients in public hospitals

in the city of Manila are aware of their rights and the factors that affect their knowledge

on the matter. The study is only concerned about the patients’ rights which are given in

the Philippine jurisprudence

The rights which the researchers refer to are the rights that are stated in the bill of rights,

laws passed by congress, and regulations and ordinances of the leading medical

associations in the Philippines.

The researchers have conducted their study on patients who are not terminally ill, have

discernment and are of sound mind, and who are confined in selected public hospitals in

the city of Manila only, namely,

The researchers will use survey forms and would be conducting interviews to the

patients, medical practitioners and government agencies which are involved in the

development and implementation of policies concerning patients’ rights. No other

methods will be used.

The research was conducted from August 2015 to April 2016.

14

1.9. Definition of Terms

Autonomy is defined as a moral or ethical principle which means a patient’s right to self

determination without outside control.

Bioethics is defined as ethics concerning life.

Hierarchy of needs is a theory formulated by Abraham Maslow which states that men

are motivated by their needs. Maslow further explained his theory by formulating a

pyramid where men must satisfy the lower ranking needs in order for them to satisfy the

needs that Maslow has placed on top of his pyramid.

Hospital is an institution that devoted primarily to the maintenance and operation of

facilities for the diagnosis, treatment, and care for individuals suffering from illness,

disease, injury or deformity, or in need of obstetrical or other medical or nursing care.

Rights are privileges that individuals, by legislation or their inherent nature, are entitled

to.

Malpractice is the improper performance of professional duties; a failure to meet the

standard of care that resulted in harm to another person.

Negligence is the failure to act as an ordinary prudent person; a person is harmed as a

result of the failure to act.

Patient is defined as an individual who receives medical treatment.

Patients' rights are right enjoyed by the patient.

15

Public Hospital is defined as a hospital that is operated and maintained either partially

or wholly by the government or any other political subdivision, or by any department,

division, board or other agency thereof.

Slovin's Formula is the formula used by the researchers to determine the sample size

of a population that must be taken for a specific study.

Social Contract Theory is a theory formulated by Jean-JaquesRosseauwhich states

that the persons’ moral and legal obligations are dependent upon a contract or

agreement among them to form the society in which they live.

Survey Method is a method used in quantitative researches that uses surveys where

the respondents would answer.

Theory of Rights is a theory by Immanuel Kant which states that in order to have a fully

functioning state; the government must develop and enhance rights that their

constituents would enjoy.

16

Chapter 2

2.2.1.Health and human rights resource guide (2013). Harvard School of Public

Health- Harvard University

In a resource guide published by Harvard University, they defined patient care as the

prevention, treatment, and management of illness and the preservation of physical and

mental well-being through services offered by health professionals and those, which

even though were non-professionals, has supervision to the patients. A patient has an

access to such care whether he or she is healthy or sick.

The resource guide also cited six basic aspects of patients’ rights, which one may

exercise upon availing patient care; the right to information of their rights, right to

medical treatment, right to refuse medical treatment, right to dignity and autonomy, right

to participate in making health care decisions, right to informed consent, and right to

confidentiality and privacy. All of which are patterned to the Universal Declaration on

Bioethics and Human Rights

Moreover, the resource guide also addressed certain issues regarding these rights,

particularly in the right to information, right to confidentiality and privacy and the right to

informed consent.

In the right to information, the resource guide cited a study conducted at four hospitals in

Lithuania, where it was found out that 85% of the staff and 56% of the patients in those

hospitals said that they heard of and read about patients’ rights laws.

However, only 50% of professionals and 69% of patients thought it was necessary for

patients to have information about diagnosis, treatment results, and alternative modes of

treatment.

In addition, the resource guide cited another study in Macedonia where it was found that

82% of respondents stated that there are patient rights, but 56% did not know what their

rights were

17

The resource guide stated that the right to privacy and confidentiality are

crucialespecially for patients seeking diagnosis and treatment of sexually related

illnesses, such as HIV/AIDS, and also mental illness; for those illnesses give other

people negative presumptions regarding the patient, consequently exiling them to the

society.

The resource guide suggested that health care centresshould only allow the patients,

and other specific providers, which would value the confidentiality of the patients to

access the patient’s health information. For example, a nurse who is vaccinating a

patient may not access that individual’s private mental health records because the

information is not relevant to the treatment being provided at that current moment

Lastly, the resource guide defined Informed consent as “not mere acceptance of a

medical intervention, but a voluntary and sufficiently informed decision, protecting the

right of the patient to be involved in medical decision-making, and assigning associated

duties and obligations to health-care providers.” The right to informed consent is central

to the right to health.

Issues that arise concern the competency or legal capacity of the patient to consent,

respect for personal autonomy, the sufficiency and completeness of information, and

circumstances compelling limits on the need for informed consent, like those patients

who are in comatose and cannot give their consents.

In a study of 732 European surgical patients in obstetrics and gynecology during a six-

month period, about 46% believed that the primary function of the written consent form

was to protect the hospital, and 68% thought that the form allowed doctors to take

control, while only 41% believed consent forms expressed their own wishes for

treatment.

Derogations, or departures, from the right to informed consent are necessary at times,

but the question of when derogations may be permitted is a complicated one. When a

18

patient is unconscious, medical providers must seek consent from a legally entitled

representative. However, if there is an emergency situation where the patient’s life is in

danger, medical providers may presume that consent is given. Issues of informed

consent also arise from public health policies that require compulsory testing,

compulsory vaccinations, or mandated quarantine during epidemics.

Procedural safeguards are crucial to derogations from informed consent, to ensure that

proper circumstances are met and to provide a means to challenge the departure from

the law.

2.2.2 Protecting Patients' Rights. (2012). Retrieved from

http://www.cdc.gov/tb/education/ssmodules/module7/ss7reading2.htm

The US Center of Disease Control Prevention stated the four basic rights of patients to

protect their personal and private information relevant to their medical care. These are

the right to give or withhold authorization or disclosures, the right to maintain privacy, the

right to have autonomy, and the right to be given information. All of which are also

patterned to the Universal Declaration on Bioethics and Human Rights.

The right to withhold authorization or disclosure is the act of keeping, revealing or

distributing personal information. A patient discloses his or her personal information to

the health care worker in order to receive appropriate treatment and quality care.

To the extent possible, the patient should have control over who will receive any

personal information, what information should be released to each requestor and the

duration of the authorization.The patient generally has the right to control who has

access to confidential information except as otherwise provided by law. The patient

needs to give specific authorization or permission to allow a third party to have access to

confidential information.

19

Regarding the right to maintain privacy, the health care workers taking care of the

patients should protect information revealed during provider-health care worker

encounters, including all written or electronic records of these encounters. Only those

persons directly involved in the care of the patient's health problem should have access

to private information.

Autonomy is the right of a patient to determine what will be done with his or her body,

personal belongings, and personal information; this concept applies to any adult person

who is mentally competent. Sometimes the right to autonomy can be overridden in the

interest of protecting others who may be harmed by the patient's decisions.

Sometimes the right to autonomy can be overridden in the interest of protecting others

who may be harmed by the patient's decisions. For example, a patient who has a highly-

contagious disease cannot invoke his right of autonomy to refuse medical treatment

because his disease might infect others as well.

Lastly, the patient has a right to be given information about his or her medical diagnosis,

treatment regimen, and progress. This allows the patient to make appropriate, informed

decisions about his or her health care. 

In connection to this right, a patient also has a right to review the information in his or her

medical record. A patient may want this information, to learn more about his or her

health care or in preparation for a change of health care workers. If the record contains

errors or omissions, the patient can request a correction or amendment.

2.2.3 Mateo, I. (2014) Low health literacy level alarming, making Filipinos ‘more

sick’- doctor.GMA News online.Retrieved from:http://www.gmanetwork.com/ne

ws/story /366216 /lifestyle /healthandwellness/low-health-literacy-level-alarming-

making-filipinos-more-sick doctor#sthash.tktmpQuB.dpufhttp://www.gmanetwork.

20

In a article published by Mr. Ibarra Mateo last June 18, 2014, it was stated that the low

health literacy of Filipinos, especially the poor, is one of the key drivers causing the

ranks of unhealthy and sick Filipinos to swell at an alarming rate.

Philippine College of Physicians president Dr. Anthony Leachonsaid that when a typical

Filipino patients come toto seek medical advice, they are very sick already. He said that

this is failure of health literacy

Health literacy, as defined by the US Center for Disease Control and Prevention (CDC),

is the degree to which an individual has the capacity to obtain, communicate, process,

and understand basic health information and services to make appropriate health

decisions.

The result of low health literacy, which is a higher rate of hospitalization to Philippine

medical centers, adds up to the lack of medical facilities and other medical health care

problems faced by the Philippines today.

Leachon said grinding poverty and the accompanying low level of education among poor

Filipinos aggravate the low health literacy among them, leading further to the dismal

health situation in the Philippines.

Underpriviledge sick Filipinos, who most of the time are suffering from chronic and

terminal illnesses, could not afford the medicines that they need due to their high price.

In addition,The shortage of medical doctors and other health professionals in rural areas,

coupled with the lack of health infrastructure in the countryside, intensify the impact of

the low health literacy.

Still, the Philippines is not the only country having to deal with the problems caused by

low health literacy.In the US, for example, the National Assessment of Adult Literacy

released by the US Department of Education in 2006 revealed that only 12 percent of

American consumers have proficient health literacy skills, suggesting that nearly nine out

21

of 10 adults may lack many of the skills necessary to sufficiently manage their health.

The CDC said that low health literacy can affect a person’s ability to locate health care

providers and services, fill out health forms, share personal health information with

providers, manage chronic diseases, and engage in self-care.

About one-third of US adults have trouble reading and acting on health-related

information and that even those with higher health literacy skills want health information

that is understandable, meaningful to them, and easy to use.

In the end, Leachon suggested that the society needs to educate their children at the

very young age about health literacy. It was also stated by Leachon that the parents play

a vital role in educating their children, and it must start in educating them regarding to

what they should eat, for most of the illness is caused to what people intake to their

bodies.

2.2.4.Rajesh D.,AbhishekS., Mukul C., Gaurav S., Venkteshan M., Bhardwaj A.,

Balbir K. &Aggarwal O. (2013).Patient’s awareness, attitude, understanding and

perceptions towards legal nature of informed consent.J Indian Acad Forensic

Med: India.

This study was conducted to ascertain patient’s awareness, attitude and perceptions

towards legal nature of informed consent.

According to this study, Informed consent is an autonomous action by a subject or

patient that authorizes a professional either to involve the subject in research or to

initiate a medical plan for the patient. In simple terms, it is the fundamental mechanism

where the physician informs the patient about the options for the diagnosis and

treatment of the patient's illness.

22

Informed Consent originates from the legal and ethical rights of the patient have to direct

what happens to his body and from the ethical duty of the physician to involve the patient

in his/her health care.

The most important goal of informed consent is that the patient should have an

opportunity to be an informed participant in his health care decisions so it acts as a

safeguard to ensure the preservation of individual rights.

In this study, a structured interview to 555 patients was conducted in several Indian

hospitals from January to June 2011. The researchers of this study inferred that the

patients that they interviewed had several misconceptions regarding their giving of legal

consent.

In the results, 75% of the patients falsely believed that informed consent was a legal

requirement.They believe that without signing the informed consent, they would not be

treated anymore. In connection to this, 68.8% of the respondents thought that signing

the consent meant waving their rights to any compensation.

Meanwhile, 88 % of the patients under study thought that they had no right to change

their minds after signing the consent. 75.2% of the respondents alsobelieved that they

would be left to die had not they signed the consent. 83.8% signed the consent form so

that they can undergo required operative procedure

In the end, the study concludes that there exists a vast discrepancy between the

informed consent that perceived by patients. Current consent procedures seem

inadequate as a means for the expression of autonomous choice and their ethical

standing can be called into question.

2.2.5. Yaghobian M. ,Kaheni S. , Danesh M. &Abhar F.(2014) Association between

awareness of patient rights and patient’s education, seeing bill, and age: a cross-

sectional study.Global Journal of Health Science Vol. 6 (3).Canadian Center of

Science and Education: Canada

23

This study aims to determine the awareness ofpatients from four hospitals located Sari,

Iran regarding their legal rights in order to ascertain the effectiveness of their patients’

bill of rights.

The study population consisted of 336 patients recruited from the hospitals affiliated with

Mazandaran University of Medical Sciences in Sari, through calculating the selection

quota of each hospital. Data were collected through face-to-face interview on discharge,

using a two-section questionnaire based on the bill of patient rights and with verified

reliability and validity.

The results indicate that out of 336 individuals, 55.4% were women and 44.6% were

men. Most patients were educated below high school level (36%); 25% were illiterate

and only 4.2% had a bachelor’s degree.

63.4% of the respondents answered negatively to the question inquiring whether or not

they had seen the charter of patient rights, and only 36.6% had seen the charter.

As for the source of information on the contents of the bill, out of 36.6% who had

responded positively, 28.3% mentioned the hospital as their source and only 1.5% had

received any information from public media.

In the second part of the questionnaire, the results indicate that the awareness score

ranging from 0 to 10 had a mean value of 3.226 and a standard deviation of 3.68. Most

patients (58.9%) had poor knowledge, 12% had intermediate knowledge, and 29.1% had

good knowledge

The researchers of this study concluded that patients are not sufficiently aware of their

rights, and this problem requires comprehensive planning to be resolved.

Rights of Patients in the International Community

24

The United Nations, through the United Nations Educational, Scientific and Cultural

Organization (UNESCO), have published several documents that emphasize the

importance of the rights of patients. The Universal Declaration on the Human Genome

and Human Rights, the International Declaration on Human Genetic Data, and the

Universal Declaration on Bioethics and Human Rights all have emphasized the

importance of the importance of the patient’s dignity and rights as a patient.

Rights of Patients in the Philippines

The 1987 Constitution of the Philippines have been the cornerstone of every law and

jurisprudence in the Philippines. Article III of the 1987 Constitution provides the rights

that are exercised by a Filipino citizen. It is obvious that these rights should as well be

enjoyed by any person that is under the jurisdiction of the Philippine laws even if they

are patients.

As stated under the following sections under the Article III of the Philippine Constitution:

Section 1:

“No person shall be deprived of life, liberty or property without due

process of law, nor shall any person be denied the equal protection of the laws.”

Section 3:

“1. The privacy of communication and correspondence shall be inviolable

except upon lawful order of the court, or when public safety or order requires otherwise

as prescribed by law.

2. Any evidence obtained in violation of this or the preceding section shall

be inadmissible for any purpose in any proceeding.”

25

It is the patient’s right to give informed consent and in order for this to be observed, the

physician must inform the patient of their diagnosis, the general nature of the

contemplated procedure, the risks involved, the prospect of success, the potential

danger if the procedure is not applied, the alternative methods if there are any.

Generally, the patient is the only one who can give informed consent however; there are

conditions to be fulfilled in giving informed consent. The patient must be of legal age and

of sound mind.

If the patient is unable to give the informed consent because of his inability to fulfil the

given conditions, his spouse, children, parents or siblings may give consent in his behalf

provided that they are legal age and are of sound mind.

If the listed persons above are not able to give consent, the patient’s next of kin may

give consent or even the state, represented by the City Health Officer, the Municipal

Health Officer, or the Medical Director, if the listed persons above are absent or are

unable to give consent.

There are instances where informed consent requires more disclosure of facts. One

instance is when the procedure entails much risk. The other is when the procedure is

innovative and experimental in character.

There are also instances where a detailed disclosure of facts is not required. One

instance is when the disclosure of facts would cause emotional distress to the patients

and the other is when the medical procedure is publically known.

This right is based on the fiduciary relationship of the patient and physician, the human

being’s right to self-determination, and the contractual nature of the patient-physician

relationship.

26

This right protects the patient from unnecessary or unwarranted medical procedure

without his consent, and to protect the physician from any consequence for failure to

comply with legal requirements.

However, there are instances where the patient’s consent is not needed. In cases of

emergency, where the patient is unconscious and there is no one who can give consent

in his behalf. Another case is when the law makes it compulsory for everyone to submit

to the procedure. An example of this is the Presidential Decree 996, where it mandates a

compulsory basic immunization for infants and children who are below eight years of

age.

The patient’s right to religion is also respected by the hospital. The patient may refuse

treatment if the procedure goes against the teachings of his church. A member of the

Jehova’s Witness may refuse blood transfusions.

The patient also has the right to privacy,

Intrusion may occur in the following ways:

When the patient is expected to be alone

Publishing information about the patient which might be objectionable or

offensive to ordinary persons

Appropriating for commercial purposes some aspects of personality or

facets of the patient’s life

The right to privacy of a patient, however, may be violated for the purpose of protecting

the public. The police power of the state is far more supreme than the welfare of the

patient.

27

According to Republic Act No. 7610, The Act Providing for Stronger Deterrence and

Special Protection Against Child Abuse, Exploitation and discrimination, Providing

Penalties for its Violation, and for other Purposes, the best interests of the children

should be paramount in all actions concerning them, whether undertaken by public or

private social welfare institutions, courts of law, administrative authorities, and legislative

bodies. Therefore the patient’s right to privacy may be disregarded if it goes against the

child’s best interests.

Executive Order No. 212, a statute that amends Presidential Decree No. 169, states that

the attending physician of any hospital, medical clinic, sanitarium or other medical

establishments, or any other medical practitioner, who has treated any person for

serious or less serious physical injuries as these injuries are defined in Articles 262, 263,

264 and 265 of the Revised Penal Code shall report the fact of such treatment promptly

to the nearest government health authority.

Rule 130, Section 21(c) of the Rules of Court provides:

“A person authorized to practice medicine cannot in a civil case without the consent of

the patient cannot be examined as to any information which he may have acquired in

attending such patient.”

There are instances where the right to privacy of the patient is violated when there is a

lawsuit filed by the patient against the doctor.

The patient has the right to be treated.

According to Republic Act No. 6615, An Act requiring Government and Private Hospitals

and Clinics to Extend Medical Assistance in Emergency Cases, states that all hospitals,

whether private or public, and clinics that are duly licensed are required to render

immediate emergency medical assistance and to provide facilities and medicine within

28

its capabilities to patients in emergency cases who are in danger of dying and/or who

may have suffered serious physical injuries.

Republic Act No. 8344, An Act Penalizing the Refusal of Hospitals and Medical Clinics to

Administer Appropriate Initial Medical Treatment and Support in Emergency or Serious

Cases, Amending for the Purpose Batas Pambansa Bilang 702, states that:

In emergency or serious cases, it shall be unlawful for any proprietor, president, director,

manager or any other officer, and/or medical practitioner or employee of a hospital or

medical clinic to request, solicit, demand or accept any deposit or any other form of

advance payment as a prerequisite for confinement or medical treatment of a patient in

such hospital or medical clinic or to refuse to administer medical treatment and support

as dictated by good practice of medicine to prevent death or permanent disability:

Provided, That by reason of inadequacy of the medical capabilities of the hospital or

medical clinic, the attending physician may transfer the patient to a facility where the

appropriate care can be given, after the patient or his next of kin consents to said

transfer and after the receiving hospital or medical clinic agrees to the transfer: Provided,

however, That when the patient is unconscious, incapable of giving consent and/or

unaccompanied, the physician can transfer the patient even without his consent:

Provided, further, That such transfer shall be done only after necessary emergency

treatment and support have been administered to stabilize the patient and after it has

been established that such transfer entails less risks than the patient's continued

confinement: Provided, furthermore, That no hospital or clinic, after being informed of the

medical indications for such transfer, shall refuse to receive the patient nor demand from

the patient or his next of kin any deposit or advance payment: Provided, finally, That

strict compliance with the foregoing procedure on transfer shall not be construed as a

29

refusal made punishable by this Act.

Republic Act No.9439, an Act Prohibiting the Detention of Patients in Hospitals and

Medical Clinics on Grounds of Nonpayment of Hospital Bills or Medical Expenses,

prohibits any hospital or medical clinic in the country to detain or to otherwise cause,

directly or indirectly, the detention of patients who have fully or partially recovered or

have been adequately attended to or who may have died, for reasons of nonpayment in

part or in full of hospital bills or medical expenses.

The Hippocratic Oath

I SWEAR in the presence of the Almighty and before my family, my teachers, and my

peers that according to my ability and judgement I will keep this Oath and Stipulation.

To RECKON all who have taught me this art equally dear to me as my parents and in

same spirit and dedication to impart knowledge of the art of medicine to others. I will

continue with diligence to keep abreast of advances in medicine. I will treat without

exception al who seek my ministrations, so long as to treatment of others is not

compromised thereby, and I will seek counsel of particularly skilled physicians where

indicated for the benefit of my patient.

I WILL FOLLOW the method of treatment which according to my ability and judgement, I

will consider for the benefit of my patient and abstain from whatever is harmful or

mischievous. I will neither prescribe nor administer a lethal dose of medicine to any

patient even if asked nor counsel any such thing nor perform the utmost respect for

every human life from fertilization to natural death and reject abortion that deliberately

takes a unique human life.

30

WITH PURITY, HOLINESS AND BENEFICIENCE I will pass my life and practice my art.

Except for the prudent correction of an imminent danger, I will neither treat any patient

nor carry out any research on any human being without the valid informed consent of the

subject or the appropriate legal protector thereof, understanding that research must have

as its purpose the furtherance that research, must have its purpose the furtherance of

health of that individual. Into whatever patient setting I enter, I will go for the benefit of

the sick and will abstain from every voluntary act of mischief or corruption and further

form the seduction of any patient.

WHATEVER IN CONNECTION with my professional advice or not in connection with it

may see or hear in the lives of my patients which ought not to be spoken abroad, I will

not divulge, reckoning that all such should be kept secret.

WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life

and the practice of the art and science of medicine with the blessing of Almighty and

respected by my peers and society, but should I trespass and violate this Oath, may the

reverse by my lot.

Administrative Oath

I hereby solemnly swear that I will support and defend the constitution of the Philippines;

That I will obey the laws, legal order and decree promulgated by the duly constituted

authorities of the Republic of the Philippines; and that I impose this obligation upon

myself voluntarily, without mental reservation or purpose of evasion.

I further solemnly swear that at all times and places, I will adhere to the ethical and

professional rules generally accepted by the medical profession in the Philippines;

31

And I will faithfully discharge to the best of my ability the duties and obligations

incumbent upon a legally authorized medical practitioner.

Chapter III

Research Methods

3.0 Research Designs

The information with regards to the research methods employed in the study on

the subject of “Teenage pregnancy: A Growing Problem among the Youth of NCR” will

be thoroughly explained in this chapter. The procedure of survey through the use of

written questionnaires will be utilized in order to gather the data needed for the

accomplishment of the research. The questionnaire that was formed used questions

involving the use of Likert scale, Dichotomous questions, and Close-ended statements

as designs with the purpose of measuring the respondents’ point of view when it comes

to the continuous proliferation of teenage pregnancy in the Philippines, specifically NCR.

Those were intentionally employed in order to determine whether the factors specified,

particularly (1) social media, (2) peer pressure, (3) family and, (4) liberality, have a

significant relationship with regards to the continuous rise on the rate of pregnant

adolescents.

The survey will be conducted among the students of University of Santo Tomas,

particularly those students from the Faculty of Arts and Letters. For the fulfilment of the

course Research Methods and Proposal Writing, only twenty (20) students from the said

faculty will be the respondents to answer the data collecting instrument prepared.

32

This research is quantitative in nature. To be specific, it is correlational for the

reason that it establishes a relationship among the independent variables, particularly (1)

social media, (2) peer pressure, (3) family and, (4) liberality, and the growing problem of

teenage pregnancy among the youth of NCR which is the dependent variable of this

study. Moreover, the nature of this research is quantitative because it employed the

process of survey through the use of written questionnaires to objectively gather data.

The use of graphs, tables and charts will enable the researchers as well as the readers

to see and appreciate the results that will be gathered.

To distinguish whether or not there is a relationship between the dependent and

independent variable,Pearson Product-Moment Correlation will be employed as the main

statistical tool. Likert scale, weighted mean and the computation of percentage will also

be utilized as supplementary to support the analysis of data. Furthermore, graphs will be

applied to further demonstrate and exemplify the data gathered from the respondents

through the use of questionnaires.

3.1 Sampling Size and Sampling Design

The rise of pregnancy among the youth is rampant in the Philippines specifically

in NCR. This is the main reason why the data needed only covered the part of the

National Capital Region as in accordance with the scope and limitation which was

previously discussed in chapter 1. The National Statistics Office has recorded the

highest population of Filipinos situated in NCR, wherein it accounted 11,796,873.

Moreover, 300,820 are females aging from 15-19.

To be able to know the sample size needed, the Slovin’s Formula will be utilized.

Using the Slovin’s Formula ¿N

1+N e2 , whereNis the total population of teenage females

33

in NCR and e is the margin of error specified as 5% or 0.05, the researchers would be

able to find the n or the sample population needed as respondents. Therefore, using the

formula, the sample population will be obtained through the following computations:

n= N1+N e2

n= 300,8201+(300,820 ) (0.05 )2

n=300,820754

n=399.47 female teenagers

n=399 female teenagers

The respondents needed to participate in the performance of the survey with

regards to the research is 399 females aging from 15-19 as found using the Slovin’s

Formula.

For the accomplishment of the course Research Methods and Proposal Writing,

only twenty (20) students from the Faculty of Arts and Letters of the University of Santo

Tomas were selected as participants for the survey. The researchers will conduct

surveys on the 23rd and 24th of March 2015 wherein the participation of the said students

will provide the responses needed.

3.2 Data Collection Instrument

The researchers have constructed a data collecting instrument which will be used

in the conduct of surveys. Compared to face-face interviews, the use of written

questionnaires is more cost-effective and time saving. This is evident in such a way that

34

it can cover a large number of the respondents’ population in a short period of time and

in a relatively cost-effective way. It can also reduce the bias opinions and perceptions of

the researchers for the reason that the data collection instrument that will be used on the

surveys will be uniform and precise. Lastly, the results of the questionnaires can be

quantified quickly and easily by the researchers.

The data collection instrument was comprised of several questions which were

formulated to assess the respondents’ perception on whether or not there is a

relationship between the rising number of teenage pregnancy among the youth situated

in NCR and among the four factors which are the following: (1) Peer pressure, (2) Media,

(3) Family, and (4) Liberality.

The instrument incorporated is composed of three main parts which are as

follows: (1) questions involving the use of Likert Scale, (2) Dichotomous questions, and

(3) close-ended questions. The said instrument was comprised of 26 questions, 8 under

the Likert scale, 10 under the dichotomous test and 8 for the close-ended questions, all

related to the group’s thesis topic: Teenage Pregnancy: A Growing Problem among the

Youth of National Capital Region.

The Likert Scale was employed in order for the researchers to assign quantitative

value to qualitative data in order to make it amenable to statistical analysis. Through this

way, the respondents’ attitude towards the research will be accounted.

Dichotomous questions, on the other hand, were used in order to provide the

participants with a contingent market of choices. With this type of questions, the

researchers will be able to simplify the data coding and analysis.

The last type of questions were classified as the close-ended questions which

were useful for it is easily quantifiable. This responses that will be gathered will be easier

35

to compare with one another. Another is that the respondents are most likely to answer

sensitive questions. Lastly, this type of questioning is convenient for both the

researchers and the respondents for it is easy to be crafted and as well as to be

answered by the respondents.

Through the application of the following designs, the researchers will be able to

gather data that will be of much help in the investigation and fulfilment of the research.

3.3 Data Gathering Procedure

To know if there is a significant relationship between the continuous rise of the

rate of teenage pregnancy among the Filipino youths situated at NCR and the factors

mentioned such as (1) Peer pressure, (2) Media,(3) Family, and (4) Liberality, a survey

will be conducted.

The use of survey is preferred in this research because of its advantages. First,

surveys offer a high level of capability when it comes to representing a huge number of

respondents’ population. Second, surveys are cost-effective. The researchers only need

to prepare and provide the budget needed for the production of the copies of the data

collecting instrument. Third, surveys provide a good statistical significance. Due to the

large number of representatives that a survey can cover, the researchers can easily find

a statistically significant results compared to other data gathering methods. Lastly, the

researchers’ own biased perceptions can be eliminated due to the standardization of the

questionnaires that will be presented to the respondents. Through this, a precise result

can also be obtained (Treadwell, 2014).

The data that will be used in the research will be gathered through conducting

the process of survey using a data collecting instrument. The questionnaires were

36

created using suitable and modified questions arranged from the simple to the more

complicated questions to answer, formulated by the researchers themselves.

The copies of the data collecting instrument will be distributed randomly among

20 female students of the Faculty of Arts and Letters of the University of Santo Tomas,

regardless of their year and major. The respondents’ consciousness may affect their

honesty and effectiveness in answering the survey which is why the researchers will not

require the respondents to write down the students’ actual names. They will also

assurethe confidentiality of the respondents’ answers, using it only for academic and

classroom purposes.

3.4 Data Analysis

To scrutinize the data gathered through the conduct of surveys, the researchers

will employ the use of different statistical tools, graphs, tables and charts. These

methods will directly help the researchers in illustrating and analysing the data gathered

from the questionnaires. It will also be of much help in conveying knowledge to its

readers.

To communicate and further demonstrate a research finding, one must use a

statistical method. Statistical methods and analyses also give credibility to research

methodology and conclusion as well. The use of several statistical tools are significant to

determine the reliability and precision of the data collected with regards to the fulfilment

of the study. Furthermore, statistical analysis tools are required for a systematic and

scientifically valid analysis of the information collected through the surveys conducted.

To test and authenticatethe data gathered, five statistical analysis tools will be employed

and these are the following:

A. Pearson Product-Moment Correlation

37

Since this research aims to establish the relationship between the

proliferation of pregnant teenagers located in NCR and the factors such as (1)

Peer pressure, (2) Media,(3) Family, and (4) Liberality, the Pearson Product-

Moment Correlation will be utilized as a statistical tool. As defined by the

dictionary, Thesaurus, Pearson Product-Moment Correlation is “the most

commonly used method of computing a correlation coefficient between variables

that are linearly related”.

According to Taylor (1990), the Pearson Product-Moment Correlation can

range from - 1.00 to + 1.00. A + 1.00 correlation means that the dependent and

independent variables are perfectly related in a positive direction. This only

means that as one variable increases, the other variable also increases. A - 1.00

correlation, on the other hand, only shows that as one variable increases, the

other variable decreases. A correlation of 0 only proves that there is no

relationship or connection between the variables. These interpretation only

indicate the direction of the variables. But regardless of the direction, the stronger

the connection, the more there is a linear relationship between the variables.

The formula to be utilized in order to determine whether or not there

exists a relationship between the variables is:

r = N ∑xy−(∑x )(∑ y)√¿¿¿

Where:

N = number of pairs of scores

38

∑xy = sum of the products of paired scores

∑x = sum of x scores

∑y = sum of y scores

∑x² = sum of squared x scores

∑y² = sum of squared y scores

B. Likert Scale

Likert scale is employed to further analyse the information collected through

the questionnaires. It is defined as a psychometric scale which are commonly

used in surveys in order to measure directly the attitudes of the respondents with

regards to the topic of the study (McLeod, 2008). A four-point-scale was

assigned to obtain an accurate gage on the respondents’ outlook towards the

variables involved in the research.

The table below shows how each scale is rated:

Scale Range Interpretation

4 3.1-4.0 Strongly Agree

3 2.1-3.0 Agree

2 1.1-2.0 Disagree

1 0-1.0 Strongly Disagree

C. Weighted Mean

39

According to Manikandan (2011), mean is the most commonly used method

to measure central tendency. It is defined as the average of all the data gathered.

The computation of weighted mean is vital for the reason that in order to utilize

Likert scale, the researchers must first accomplish the calculation of the weighted

mean. It is computed by adding all the values in the data set and later on divided

by the number of observations involved.

The formula to be used for the weighted mean is:

X w=∑W i X i∑W i

Where:

X w= Weighted Mean

W i= Weight given to each Data Value or each Number of Responses

X i= Data Value/ Number of Responses

Σ= Summation

D. Percentage

To further examine the data collected through the conduct of surveys, the

researchers utilized the computation of percentage. The perspective of the

respondents’ will definitely be taken into account. Computing the percentage will

be substantial for the investigation of whether or not there is a significant

40

relationship between the variables involved in the study. The formula employed

to acquire the percentage needed is:

P=¿

Where:

P= Percentage (%)

F= Frequency

N= Total Number of Population

E. Frequency Distribution

Through the employment of written questionnaires as the instrument for the

collection of data, scores in the answers of the respondents will be efficiently

given. The use of frequency distribution is vital in the research for it is helpful in

the tabulation of data which will be effective in conveying the substantial

information acquired through the responses of the respondents concerning the

research.

Graphs were also employed to further illustrate the data gathered through the

surveys conducted beforehand. Charts and tables will be utilized as well in order

for the researchers and the readers, as well, to easily see and appreciate the

results of the survey.

The use of graphs, charts and tables are of much help in further illustrating

the data gathered according to Rodrigues (2013). First, they serve as a powerful

communication tools for they are comprehensive and they can easily impart

knowledge to the readers and the researchers as well. Second, it emphasizes

41

important information in a way that data are statistically organized which makes it

easier for the readers to locate substantial facts regarding the study. Third, it

visually presents the significant results of the data thus, making it more

understandable. Fourth, it clarifies complicated points because it is well-ordered.

And lastly, it is useful in illustrating key points about the results of the data

collected.

Three kinds of graphs will be specifically used and these are the following:

A. Scatter Plot

As defined by Gotauco (2012), scatter plot is a set of points plotted on the

horizontal and vertical axes of a graph. It shows the relationship between the two

sets of data. The researchers employed this graph because it has the capability

of showing whether or not there is an affiliation between the dependent and

independent variables present in the study.

B. Pie chart

Pie chart will be utilized because aside from the fact that it is appealing, they

display data in percentage which can be more appreciated by the readers.It also

shows significant dissimilaritiesamong groups which are included under one

variable. Pie charts are divided into different segments in which each segment

represent the relative size of each value (Gotauco, 2012).

C. Bar Graph

A bar graph displays discrete data in a separate column which makes it

easier for the researchers to compare and contrast the data gathered (Gotauco,

2012). This is the reason why the researchers find it suitable to be utilized in the

42

representation of the collected information through the use of written

questionnaires.

Graphs are preferred to be used by the researchers due to the reason that

they are more effective at helping the readers of the research visualize the data

rather than reading from the text itself. Through the illustrations created, the

researchers can easily impart the information gathered regarding the study, thus,

establishing a well-rounded research.

References

Bellosillo, J., Castro, B., Mapili, E., Rebosa, A., &Rebosa, A. (2010). Basics of

Philippine Medical Jurisprudence and Ethics (2010 Ed.). Quezon City, PH:

Central Books Supply Inc.

Bellosillo, J., Marquez, J, Mapili, E, &Basilonia-Simon, L. (2011). Introduction to Nursing

Jurisprudence, Ethics, Leadership and Management (2011 Ed.). Quezon City, PH:

Central Books Supply Inc.

Dagooc, E. (2014) Phl needs to address hospital bed shortage. The Philippine Star.

Retrieved from:http://www.philstar.com/cebu-business/2014/09/05/1365613/phl-

needs-address-hospital-bed-shortage

Ermitanio, N. and Alviar, V. (2014).A symptom of the greater problem in health system.

Philippine Daily Inquirer.Retrieved from: http://business.inquirer.net/166164/a-

symptom-of-the-greater-problem-in-health-system#ixzz3qgzcPOL5

Huitt, W. (2007).Maslow's hierarchy of needs. Educational Psychology Interactive.

43

Valdosta, GA: Valdosta State University. Retrieved

from: http://www.edpsycinteractive.org/topics/regsys/maslow.html

Mateo, I. (2014)Low health literacy level alarming, making Filipinos ‘more sick’

doctor.GMA News

online.Retrievedfrom:http://www.gmanetwork.com/news/story /366216

/lifestyle/healthandwellness/low-health-literacy-level-alarming-making-filipinos-

more-sick doctor#sthash.tktmpQuB.dpufhttp://www.gmanetwork.

com/news/story/366216/lifestyle/healthandwellness/low-health-literacy

-level-alarming-making-filipinos-more-sick-doctor

Ong, W. (2012).Top 10 health agendas of the Philippines.The Philippine Star.Retrieved

from: http://www.philstar.com/health-and-family/786108/top-10-health-agendas-

philippines

Picazo, O.(2012)Medicines still beyond reach of many. Philippine Daily Inquirer.

Retrieved from:http://opinion.inquirer.net/33107/medicines-still-beyond-reach-of-

many

Solis, P. (1980). Medical Jurisprudence (The Practice of Medicine and the Law). Quezon

City, PH: R. P. Grcia Publishing Co.

Taro, F. (1991).Human Rights, Philippine Perspective (1st Ed).Metromanila, PH:

National Bookstore Inc.