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Protection of Conscience Project

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Service, not Servitude
Legal Commentary

Supreme Court of the Philippines

The Responsible Parenthood and Reproductive Health Act of 2012

Extracts of opinions supporting freedom of conscience

April, 2014

Introduction:

The Supreme Court of the Philippines has issued a decision concerning the controversial Responsible Parenthood and Reproductive Health Act of 2012 ( RH Law).  The ruling confirms the Protection of Conscience Project's criticism of the parts of the law that adversely affected freedom of conscience among health care workers.  Those sections have been struck down by the Court.

The Supreme Court of the Philippines consists of 15 judges.  With respect to the issue of freedom of conscience among health care workers and institutions:

  • 11 judges held that the mandatory referral provision in the law was an unconstitutional violation of freedom of conscience;
  •  10 of the 11 also ruled that forcing an objecting health care worker to provide "complete and correct information" about contraception was a violation of freedom of conscience
    • The eleventh judge held that this was not, but added that the provision could not be used to suppress the freedom of objecting health care workers to express professional or other opinions concerning contraception.

Sections of the majority and individual opinions supportive of freedom of conscience are reproduced below.  Page numbers are [highlighted] to facilitate reference to the text of the decision.

MAJORITY DECISION

Jose Catral Mendoza

Presbitero J. Velasco

Lucas P. Bersamin

Martin S. Villarama, Jr.

Jose Portugal Perez

Diosdado M. Peralta

[P. 60] Position of the Petitioners
[P. 61] 2. On Religious Accommodation and The Duty to Refer

Petitioners Imbong and Luat note that while the RH Law attempts to address religious sentiments by making provisions for a conscientious objector, the constitutional guarantee is nonetheless violated because the law also imposes upon the conscientious objector the duty to refer the patient seeking reproductive health services to another medical practitioner who would be able to provide for the patient's needs. For the petitioners, this amounts to requiring the conscientious objector to cooperate with the very thing he refuses to do without violating his/her religious beliefs.190

They further argue that even if the conscientious objector's duty to refer is recognized, the recognition is unduly limited, because although it allows a conscientious objector in Section 23 (a)(3) the option to refer a patient seeking reproductive health services and information - no escape is afforded the conscientious objector in Section 23 (a)(1) and (2), i.e. against a patient seeking reproductive health procedures. They claim that the right of other individuals to conscientiously object, such as: a) those working in public health facilities referred to in Section 7; b) public officers involved in the implementation of the law referred to in Section 23(b); and c) teachers in public schools referred to in Section 14 of the RH Law, are also not recognized.191

Petitioner Echavez and the other medical practitioners meanwhile, contend that the requirement to refer the matter to another health care service provider is still considered a compulsion on those objecting healthcare service providers. They add that compelling them to do the act against their will violates the Doctrine of Benevolent Neutrality. . .

[P. 62] Petitioner CFC also argues that the requirement for a conscientious objector to refer the person seeking reproductive health care services to another provider infringes on one's freedom of religion as it forces the objector to become an unwilling participant in the commission of a serious sin under Catholic teachings. While the right to act on one's belief may be regulated by the State, the acts prohibited by the RH Law are passive acts which produce neither harm nor injury to the public.193

Petitioner CFC adds that the RH Law does not show compelling state interest to justify regulation of religious freedom because it mentions no emergency, risk or threat that endangers state interests. It does not explain how the rights of the people (to equality, non-discrimination of rights, sustainable human development, health, education, information, choice and to make decisions according to religious convictions, ethics, cultural beliefs and the demands of responsible parenthood) are being threatened or are not being met as to justify the impairment of religious freedom.194

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The Respondents' Positions

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[P. 63] . . .With respect to the duty to refer, the respondents insist that the same does not violate the constitutional guarantee of religious freedom, it being a carefully balanced compromise between the interests of the religious objector, on one hand, who is allowed to keep silent but is required to refer - and that of the citizen who needs access to information and who has the right to expect that the health care professional in front of her will act professionally. For the respondents, the concession given by the State under Section 7 and 23(a)(3) is sufficient accommodation to the right to freely exercise one's religion without unnecessarily infringing on the rights of others.202 Whatever burden is placed on the petitioner's religious freedom is minimal as the duty to refer is limited in duration, location and impact.203

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[P. 64] The Church and The State

At the outset, it cannot be denied that we all live in a heterogeneous society. It is made up of people of diverse ethnic, cultural and religious beliefs and backgrounds. History has shown us that our government, in law and in practice, has allowed these various religious, cultural, social and racial groups to thrive in a single society together. It has embraced minority groups and is tolerant towards all - the religious people of different sects and the non-believers. The undisputed fact is that our people generally believe in a deity, whatever they conceived Him to be, and to whom they call for guidance and enlightenment in crafting our fundamental law. . .

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[P. 66] . . .the basis of the free exercise clause is the respect for the inviolability of the human conscience.207 Under this part of religious freedom guarantee, the State is prohibited from unduly interfering with the outside manifestations of one's belief and faith.208 Explaining the concept of religious freedom, the Court, in Victoriano v. Elizalde Rope Workers Union209 wrote:

The constitutional provisions not only prohibits legislation for the support of any religious tenets or the modes of worship of any sect, thus forestalling compulsion by law of the acceptance of any creed or the practice of any form of worship (U.S. Ballard, 322 U.S. 78, 88 L. ed. 1148, 1153), but also assures the free exercise of one's chosen form of religion within limits of utmost amplitude. It has been said that the religion clauses of the Constitution are all designed to protect the broadest possible liberty of conscience, to allow each man to believe as his conscience directs, to profess his beliefs, and to live as he believes he ought to live, consistent with the liberty of others and with the common good. Any legislation whose effect or purpose is to impede the observance of one or all religions, or to discriminate invidiously between the religions, is invalid, even though the burden may be characterized as being only indirect. (Sherbert v. Verner, 374 U.S. 398, 10 L.ed.2d 965, 83 S. Ct. 1970) But if the state regulates conduct by enacting, within its power, a general law which has for its purpose and effect to advance the state's secular goals, the statute is valid despite its indirect burden on religious observance, unless the state can accomplish its purpose without imposing such burden. (Braunfeld v. Brown, 366 U.S. 599, 6 Led. 2d. 563, 81 S. Ct. 144; McGowan v. Maryland, 366 U.S. 420, 444-5 and 449).

As expounded in Escritor,

The establishment and free exercise clauses were not designed to serve contradictory purposes. They have a single goal - to promote freedom of individual religious beliefs and practices. In simplest terms, the free exercise clause prohibits government from inhibiting religious beliefs with penalties for religious beliefs and practice, while the establishment clause prohibits government from inhibiting religious belief with rewards for religious beliefs and practices. In other words, the two religion clauses were intended to [P. 67] deny government the power to use either the carrot or the stick to influence individual religious beliefs and practices.210

Corollary to the guarantee of free exercise of one's religion is the principle that the guarantee of religious freedom is comprised of two parts: the freedom to believe, and the freedom to act on one's belief. The first part is absolute. As explained in Gerona v. Secretary of Education:211

The realm of belief and creed is infinite and limitless bounded only by one's imagination and thought. So is the freedom of belief, including religious belief, limitless and without bounds. One may believe in most anything, however strange, bizarre and unreasonable the same may appear to others, even heretical when weighed in the scales of orthodoxy or doctrinal standards. But between the freedom of belief and the exercise of said belief, there is quite a stretch of road to travel.212

The second part however, is limited and subject to the awesome power of the State and can be enjoyed only with proper regard to the rights of others. It is "subject to regulation where the belief is translated into external acts that affect the public welfare."213

Legislative Acts and the Free Exercise Clause

Thus, in case of conflict between the free exercise clause and the State, the Court adheres to the doctrine of benevolent neutrality. This has been clearly decided by the Court in Estrada v. Escritor, (Escritor)214 where it was stated "that benevolent neutrality-accommodation, whether mandatory or permissive, is the spirit, intent and framework underlying the Philippine Constitution."215 In the same case, it was further explained that

The benevolent neutrality theory believes that with respect to these governmental actions, accommodation of religion may be allowed, not to promote the government's favored form of religion, but to allow individuals and groups to exercise their religion without hindrance. "The purpose of accommodation is to remove a burden on, or facilitate the exercise of, a person's or institution's religion."216 "What is sought under the theory of accommodation is not a declaration of unconstitutionality of a facially neutral law, but [P. 68] an exemption from its application or its 'burdensome effect,' whether by the legislature or the courts."217

In ascertaining the limits of the exercise of religious freedom, the compelling state interest test is proper.218 Underlying the compelling state interest test is the notion that free exercise is a fundamental right and that laws burdening it should be subject to strict scrutiny.219 In Escritor, it was written:

Philippine jurisprudence articulates several tests to determine these limits. Beginning with the first case on the Free Exercise Clause, American Bible Society, the Court mentioned the "clear and present danger" test but did not employ it. Nevertheless, this test continued to be cited in subsequent cases on religious liberty. The Gerona case then pronounced that the test of permissibility of religious freedom is whether it violates the established institutions of society and law. The Victoriano case mentioned the "immediate and grave danger" test as well as the doctrine that a law of general applicability may burden religious exercise provided the law is the least restrictive means to accomplish the goal of the law. The case also used, albeit inappropriately, the "compelling state interest" test. After Victoriano, German went back to the Gerona rule. Ebralinag then employed the "grave and immediate danger" test and overruled the Gerona test. The fairly recent case of Iglesia ni Cristo went back to the "clear and present danger" test in the maiden case of American Bible Society. Not surprisingly, all the cases which employed the "clear and present danger" or "grave and immediate danger" test involved, in one form or another, religious speech as this test is often used in cases on freedom of expression. On the other hand, the Gerona and German cases set the rule that religious freedom will not prevail over established institutions of society and law. Gerona, however, which was the authority cited by German has been overruled by Ebralinag which employed the "grave and immediate danger" test. Victoriano was the only case that employed the "compelling state interest" test, but as explained previously, the use of the test was inappropriate to the facts of the case.

The case at bar does not involve speech as in American Bible Society, Ebralinag and Iglesia ni Cristo where the "clear and present danger" and "grave and immediate danger" tests were appropriate as speech has easily discernible or immediate effects. The Gerona and German doctrine, aside from having been overruled, is not congruent with the benevolent neutrality approach, thus not appropriate in this jurisdiction. Similar to Victoriano, the present case involves purely conduct arising from religious belief. The "compelling state interest" test is proper where conduct is [P. 69] involved for the whole gamut of human conduct has different effects on the state's interests: some effects may be immediate and short-term while others delayed and far-reaching. A test that would protect the interests of the state in preventing a substantive evil, whether immediate or delayed, is therefore necessary. However, not any interest of the state would suffice to prevail over the right to religious freedom as this is a fundamental right that enjoys a preferred position in the hierarchy of rights - "the most inalienable and sacred of all human rights'', in the words of Jefferson. This right is sacred for an invocation of the Free Exercise Clause is an appeal to a higher sovereignty. The entire constitutional order of limited government is premised upon an acknowledgment of such higher sovereignty, thus the Filipinos implore the "aid of Almighty God in order to build a just and humane society and establish a government." As held in Sherbert, only the gravest abuses, endangering paramount interests can limit this fundamental right. A mere balancing of interests which balances a right with just a colorable state interest is therefore not appropriate. Instead, only a compelling interest of the state can prevail over the fundamental right to religious liberty. The test requires the state to carry a heavy burden, a compelling one, for to do otherwise would allow the state to batter religion, especially the less powerful ones until they are destroyed. In determining which shall prevail between the state's interest and religious liberty, reasonableness shall be the guide. The "compelling state interest" serves the purpose of revering religious liberty while at the same time affording protection to the paramount interests of the state. This was the test used in Sherbert which involved conduct, i.e. refusal to work on Saturdays. In the end, the "compelling state interest" test, by upholding the paramount interests of the state, seeks to protect the very state, without which, religious liberty will not be preserved. [Emphases in the original. Underlining supplied.]

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[P. 71]  . . .While the Constitution prohibits abortion, laws were enacted allowing the use of contraceptives. To some medical practitioners, however, the whole idea of using contraceptives is an anathema. Consistent with the principle of benevolent neutrality, their beliefs should be respected. . .

The Free Exercise Clause and the Duty to Refer

[P. 72] While the RH Law, in espousing state policy to promote reproductive health manifestly respects diverse religious beliefs in line with the NonEstablishment Clause, the same conclusion cannot be reached with respect to Sections 7, 23 and 24 thereof. The said provisions commonly mandate that a hospital or a medical practitioner to immediately refer a person seeking health care and services under the law to another accessible healthcare provider despite their conscientious objections based on religious or ethical beliefs.

In a situation where the free exercise of religion is allegedly burdened by government legislation or practice, the compelling state interest test in line with the Court's espousal of the Doctrine of Benevolent Neutrality in Escritor, finds application. In this case, the conscientious objector's claim to religious freedom would warrant an exemption from obligations under the RH Law, unless the government succeeds in demonstrating a more compelling state interest in the accomplishment of an important secular objective. Necessarily so, the plea of conscientious objectors for exemption from the RH Law deserves no less than strict scrutiny.

In applying the test, the first inquiry is whether a conscientious objector's right to religious freedom has been burdened. As in Escritor, there is no doubt that an intense tug-of-war plagues a conscientious objector. One side coaxes him into obedience to the law and the abandonment of his religious beliefs, while the other entices him to a clean conscience yet under the pain of penalty. The scenario is an illustration of the predicament of medical practitioners whose religious beliefs are incongruent with what the RH Law promotes.

The Court is of the view that the obligation to refer imposed by the RH Law violates the religious belief and conviction of a conscientious objector. Once the medical practitioner, against his will, refers a patient seeking information on modem reproductive health products, services, procedures and methods, his conscience is immediately burdened as he has been compelled to perform an act against his beliefs. As Commissioner Joaquin A. Bernas (Commissioner Bernas) has written, "at the basis of the free exercise clause is the respect for the inviolability of the human conscience."222

Though it has been said that the act of referral is an opt-out clause, it is, however, a false compromise because it makes pro-life health providers complicit in the performance of an act that they find morally repugnant or offensive. They cannot, in conscience, do indirectly what they cannot do directly. One may not be the principal, but he is equally guilty if he abets the offensive act by indirect participation.

[P. 73] Moreover, the guarantee of religious freedom is necessarily intertwined with the right to free speech, it being an externalization of one's thought and conscience. This in tum includes the right to be silent. With the constitutional guarantee of religious freedom follows the protection that should be afforded to individuals in communicating their beliefs to others as well as the protection for simply being silent. The Bill of Rights guarantees the liberty of the individual to utter what is in his mind and the liberty not to utter what is not in his mind.223 While the RH Law seeks to provide freedom of choice through informed consent, freedom of choice guarantees the liberty of the religious conscience and prohibits any degree of compulsion or burden, whether direct or indirect, in the practice of one's religion.224

In case of conflict between the religious beliefs and moral convictions of individuals, on one hand, and the interest of the State, on the other, to provide access and information on reproductive health products, services, procedures and methods to enable the people to determine the timing, number and spacing of the birth of their children, the Court is of the strong view that the religious freedom of health providers, whether public or private, should be accorded primacy. Accordingly, a conscientious objector should be exempt from compliance with the mandates of the RH Law. If he would be compelled to act contrary to his religious belief and conviction, it would be violative of "the principle of non-coercion" enshrined in the constitutional right to free exercise of religion.

Interestingly, on April 24, 2013, Scotland's Inner House of the Court of Session, found in the case of Doogan and Wood v. NHS Greater Glasgow and Clyde Health Board,225 that the midwives claiming to be conscientious objectors under the provisions of Scotland's Abortion Act of 1967, could not be required to delegate, supervise or support staff on their labor ward who were involved in abortions.226 The Inner House stated "that if 'participation' were defined according to whether the person was taking part 'directly' or ' indirectly' this would actually mean more complexity and uncertainty."227

While the said case did not cover the act of referral, the applicable principle was the same - they could not be forced to assist abortions if it would be against their conscience or will.

[P. 74] Institutional Health Providers

The same holds true with respect to non-maternity specialty hospitals and hospitals owned and operated by a religious group and health care service providers. Considering that Section 24 of the RH Law penalizes such institutions should they fail or refuse to comply with their duty to refer under Section 7 and Section 23(a)(3), the Court deems that it must be struck down for being violative of the freedom of religion. The same applies to Section 23(a)(1) and (a)(2) in relation to Section 24, considering that in the dissemination of information regarding programs and services and in the performance of reproductive health procedures, the religious freedom of health care service providers should be respected.

In the case of Islamic Da'wah Council of the Philippines, Inc. v. Office of the Executive Secretary228 it was stressed:

Freedom of religion was accorded preferred status by the framers of our fundamental law. And this Court has consistently affirmed this preferred status, well aware that it is "designed to protect the broadest possible liberty of conscience, to allow each man to believe as his conscience directs, to profess his beliefs, and to live as he believes he ought to live, consistent with the liberty of others and with the common good." 10

The Court is not oblivious to the view that penalties provided by law endeavour to ensure compliance. Without set consequences for either an active violation or mere inaction, a law tends to be toothless and ineffectual. Nonetheless, when what is bartered for an effective implementation of a law is a constitutionally-protected right the Court firmly chooses to stamp its disapproval. The punishment of a healthcare service provider, who fails and/or refuses to refer a patient to another, or who declines to perform reproductive health procedure on a patient because incompatible religious beliefs, is a clear inhibition of a constitutional guarantee which the Court cannot allow.

The Implementing Rules and Regulation (RH-IRR)

The last paragraph of Section 5.24 of the RH-IRR reads:

Provided, That skilled health professional such as provincial, city or municipal health officers, chiefs of hospital, head nurses, [P. 75] supervising midwives, among others, who by virtue of their office are specifically charged with the duty to implement the provisions of the RPRH Act and these Rules, cannot be considered as conscientious objectors.

This is discriminatory and violative of the equal protection clause. The conscientious objection clause should be equally protective of the religious belief of public health officers. There is no perceptible distinction why they should not be considered exempt from the mandates of the law. The protection accorded to other conscientious objectors should equally apply to all medical practitioners without distinction whether they belong to the public or private sector. After all, the freedom to believe is intrinsic in every individual and the protective robe that guarantees its free exercise is not taken off even if one acquires employment in the government.

It should be stressed that intellectual liberty occupies a place inferior to none in the hierarchy of human values. The mind must be free to think what it wills, whether in the secular or religious sphere, to give expression to its beliefs by oral discourse or through the media and, thus, seek other candid views in occasions or gatherings or in more permanent aggrupation. Embraced in such concept then are freedom of religion, freedom of speech, of the press, assembly and petition, and freedom of association.229

The discriminatory provision is void not only because no such exception is stated in the RH Law itself but also because it is violative of the equal protection clause in the Constitution. Quoting respondent Lagman, if there is any conflict between the RH-IRR and the RH Law, the law must prevail.

Justice Mendoza: I'll go to another point. The RH Law .. .in your Comment- in Intervention on page 52, you mentioned RH Law is replete with provisions in upholding the freedom of religion and respecting religious convictions. Earlier, you affirmed this with qualifications. Now, you have read, I presumed you have read the IRR - Implementing Rules and Regulations of the RH Bill?

Congressman Lagman: Yes, Your Honor, I have read but I have to admit, it's a long IRR and I have not thoroughly dissected the nuances of the provisions.

Justice Mendoza: I will read to you one provision. It's Section 5.24. This I cannot find in the RH Law. But in the IRR it says: " .... skilled health [P.76] professionals such as provincial, city or municipal health officers, chief of hospitals, head nurses, supervising midwives, among others, who by virtue of their office are specifically charged with the duty to implement the provisions of the RPRH Act and these Rules, cannot be considered as conscientious objectors." Do you agree with this?

Congressman Lagman: I will have to go over again the provisions, Your Honor.

Justice Mendoza: In other words, public health officers in contrast to the private practitioners who can be conscientious objectors, skilled health professionals cannot be considered conscientious objectors. Do you agree with this? Is this not against the constitutional right to the religious belief?

Congressman Lagman: Your Honor, if there is any conflict between the IRR and the law, the law must prevail.230

Compelling State Interest

The foregoing discussion then begets the question on whether the respondents, in defense of the subject provisions, were able to:

1] demonstrate a more compelling state interest to restrain conscientious objectors in their choice of services to render; and

2] discharge the burden of proof that the obligatory character of the law is the least intrusive means to achieve the objectives of the law.

Unfortunately, a deep scrutiny of the respondents' submissions proved to be in vain. The OSG was curiously silent in the establishment of a more compelling state interest that would rationalize the curbing of a conscientious objector's right not to adhere to an action contrary to his religious convictions. During the oral arguments, the OSG maintained the same silence and evasion. The Transcripts of the Stenographic Notes disclose the following:

Justice De Castro: Let's go back to the duty of the conscientious objector to refer. ..

Senior State Solicitor Hilbay: Yes, Justice.

Justice De Castro: ... which you are discussing awhile ago with Justice Abad. [P.77] What is the compelling State interest in imposing this duty to refer to a conscientious objector which refuses to do so because of his religious belief?

Senior State Solicitor Hilbay: Ahh, Your Honor, ..

Justice De Castro: What is the compelling State interest to impose this burden?

Senior State Solicitor Hilbay: In the first place, Your Honor, I don't believe that the standard is a compelling State interest, this is an ordinary health legislation involving professionals. This is not a free speech matter or a pure free exercise matter. This is a regulation by the State of the relationship between medical doctors and their patients. 231

Resultantly, the Court finds no compelling state interest which would limit the free exercise clause of the conscientious objectors, however few in number. Only the prevention of an immediate and grave danger to the security and welfare of the community can justify the infringement of religious freedom. If the government fails to show the seriousness and immediacy of the threat, State intrusion is constitutionally unacceptable.232

Freedom of religion means more than just the freedom to believe. It also means the freedom to act or not to act according to what one believes. And this freedom is violated when one is compelled to act against one's belief or is prevented from acting according to one's belief.233

Apparently, in these cases, there is no immediate danger to the life or health of an individual in the perceived scenario of the subject provisions. After all, a couple who plans the timing, number and spacing of the birth of their children refers to a future event that is contingent on whether or not the mother decides to adopt or use the information, product, method or supply given to her or whether she even decides to become pregnant at all. On the other hand, the burden placed upon those who object to contraceptive use is immediate and occurs the moment a patient seeks consultation on reproductive health matters.

Moreover, granting that a compelling interest exists to justify the infringement of the conscientious objector's religious freedom, the respondents have failed to demonstrate "the gravest abuses, endangering paramount interests" which could limit or override a person's fundamental [P. 78] right to religious freedom. Also, the respondents have not presented any government effort exerted to show that the means it takes to achieve its legitimate state objective is the least intrusive means.234 Other than the assertion that the act of referring would only be momentary, considering that the act of referral by a conscientious objector is the very action being contested as violative of religious freedom, it behooves the respondents to demonstrate that no other means can be undertaken by the State to achieve its objective without violating the rights of the conscientious objector. The health concerns of women may still be addressed by other practitioners who may perform reproductive health-related procedures with open willingness and motivation. Suffice it to say, a person who is forced to perform an act in utter reluctance deserves the protection of the Court as the last vanguard of constitutional freedoms.

At any rate, there are other secular steps already taken by the Legislature to ensure that the right to health is protected. Considering other legislations as they stand now, R.A. No. 4 729 or the Contraceptive Act, R.A. No. 6365 or "The Population Act of the Philippines" and R.A. No. 9710, otherwise known as "The Magna Carta of Women," amply cater to the needs of women in relation to health services and programs. . . .

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[P. 80] . . . As an afterthought, Asst. Solicitor General Hilbay eventually replied that the compelling state interest was "Fifteen maternal deaths per day, hundreds of thousands of unintended pregnancies, lives changed, x x x."235 He, however, failed to substantiate this point by concrete facts and figures from reputable sources.

The undisputed fact, however, is that the World Health Organization reported that the Filipino maternal mortality rate dropped to 48 percent from 1990 to 2008,236 although there was still no RH Law at that time. Despite such revelation, the proponents still insist that such number of maternal deaths constitute a compelling state interest.

Granting that there are still deficiencies and flaws in the delivery of social healthcare programs for Filipino women, they could not be solved by a measure that puts an unwarrantable stranglehold on religious beliefs in exchange for blind conformity.

Exception: Life Threatening Cases

All this notwithstanding, the Court properly recognizes a valid exception set forth in the law. While generally healthcare service providers cannot be forced to render reproductive health care procedures if doing it would contravene their religious beliefs, an exception must be made in life-threatening cases that require the performance of emergency procedures. In these situations, the right to life of the mother should be given preference, considering that a referral by a medical practitioner would amount to a denial of service, resulting to unnecessarily placing the life of a mother in grave danger. Thus, during the oral arguments, Atty. Liban, representing CFC, manifested: "the forced referral clause that we are objecting on grounds of violation of freedom of religion does not contemplate an emergency."237

In a conflict situation between the life of the mother and the life of a [P. 81] child, the doctor is morally obliged always to try to save both lives. If, however, it is impossible, the resulting death to one should not be deliberate. Atty. Noche explained:

Principle of Double-Effect. - May we please remind the principal author of the RH Bill in the House of Representatives of the principle of double-effect wherein intentional harm on the life of either the mother of the child is never justified to bring about a "good" effect. In a conflict situation between the life of the child and the life of the mother, the doctor is morally obliged always to try to save both lives. However, he can act in favor of one (not necessarily the mother) when it is medically impossible to save both, provided that no direct harm is intended to the other. If the above principles are observed, the loss of the child's life or the mother's life is not intentional and, therefore, unavoidable. Hence, the doctor would not be guilty of abortion or murder. The mother is never pitted against the child because both their lives are equally valuable.238

Accordingly, if it is necessary to save the life of a mother, procedures endangering the life of the child may be resorted to even if is against the religious sentiments of the medical practitioner. As quoted above, whatever burden imposed upon a medical practitioner in this case would have been more than justified considering the life he would be able to save. . .

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[P.95] 8-Involuntary Servitude

The petitioners also aver that the RH Law is constitutionally infirm as it violates the constitutional prohibition against involuntary servitude. They posit that Section 17 of the assailed legislation requiring private and nongovernment health care service providers to render forty-eight ( 48) hours of pro bono reproductive health services, actually amounts to involuntary servitude because it requires medical practitioners to perform acts against their will.262

The OSG counters that the rendition of pro bono services envisioned in Section 17 can hardly be considered as forced labor analogous to slavery, as reproductive health care service providers have the discretion as to the manner and time of giving pro bono services. Moreover, the OSG points out that the imposition is within the powers of the government, the accreditation of medical practitioners with PhilHealth being a privilege and not a right.

The point of the OSG is well-taken.

It should first be mentioned that the practice of medicine is undeniably imbued with public interest that it is both a power and a duty of the State to control and regulate it in order to protect and promote the public welfare. Like the legal profession, the practice of medicine is not a right but a privileged burdened with conditions as it directly involves the very lives of the people. A fortiori, this power includes the power of Congress263 to prescribe the qualifications for the practice of professions or trades which affect the public welfare, the public health, the public morals, and the public safety; and to regulate or control such professions or trades, even to the point of revoking such right altogether.264

Moreover, as some petitioners put it, the notion of involuntary servitude connotes the presence of force, threats, intimidation or other similar means of coercion and compulsion.265 A reading of the assailed provision, however, reveals that it only encourages private and non-[P.96] government reproductive healthcare service providers to render pro bona service. Other than non-accreditation with PhilHealth, no penalty is imposed should they choose to do otherwise. Private and non-government reproductive healthcare service providers also enjoy the liberty to choose which kind of health service they wish to provide, when, where and how to provide it or whether to provide it all. Clearly, therefore, no compulsion, force or threat is made upon them to render pro bono service against their will. While the rendering of such service was made a prerequisite to accreditation with PhilHealth, the Court does not consider the same to be an unreasonable burden, but rather, a necessary incentive imposed by Congress in the furtherance of a perceived legitimate state interest.

Consistent with what the Court had earlier discussed, however, it should be emphasized that conscientious objectors are exempt from this provision as long as their religious beliefs and convictions do not allow them to render reproductive health service, pro bona or otherwise.

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[P. 103] WHEREFORE, the petitions are PARTIALLY GRANTED. Accordingly, the Court declares R.A. No. 10354 as NOT UNCONSTITUTIONAL except with respect to the following provisions which are declared UNCONSTITUTIONAL:

1] Section 7 and the corresponding provision in the RH-IRR insofar as they:

a) require private health facilities and non-maternity specialty hospitals and hospitals owned and operated by a religious group to refer patients, not in an emergency or life-threatening case, as defined under Republic Act No. 8344, to another health facility which is conveniently accessible; and

b) allow minor-parents or minors who have suffered a miscarriage access to modern methods of family planning without written consent from their parents or guardian/s;

2] Section 23(a)(1) and the corresponding provision in the RH-IRR, particularly Section 5 .24 thereof, insofar as they punish any healthcare service provider who fails and or refuses to disseminate information regarding programs and services on reproductive health regardless of his or her religious beliefs. . .

5] Section 23(a)(3) and the corresponding provision in the RH-IRR, particularly Section 5.24 thereof, insofar as they punish any healthcare service provider who fails and/or refuses to refer a patient not in an emergency or life-threatening case, as defined under Republic Act No. 8344, to another health care service provider within the same facility or one which is conveniently accessible regardless of his or her religious beliefs;

6] Section 23(b) and the corresponding provision in the RH-IRR, particularly Section 5 .24 thereof, insofar as they punish any public officer who refuses to support reproductive health programs or shall do any act that hinders the full implementation of a reproductive health program, regardless of his or her religious beliefs;

[P. 104] 7] Section 17 and the corresponding provision in the RH-IRR regarding the rendering of pro bona reproductive health service in so far as they affect the conscientious objector in securing PhilHealth accreditation; . . .


Notes

190.  Joint Memorandum, lmbong/Luat, rollo (G.R. No. 204819), p. 2615.

191.  Joint Memorandum, Imbong/Luat, rollo (G.R. No. 204819), pp. 2616-2621.

***

193.  Petition, Couples for Christ Foundation, Inc. v. Ochoa, rollo (G.R. No. 207172), pp. 20-23.

194.  Petition, Couples for Christ Foundation, Inc. v. Ochoa, rollo (G.R. No. 207 I 72), pp. 20-23 .

***

202.  Memorandum, OSG, rollo (G.R. No. 204819), p. 2677.

203.  Memorandum, OSG, rollo (G.R. No. 204819), p. 2679.

***

207.  Bernas, The 1987 Constitution, 2009 Ed., p. 330

208.  Gorospe, Constitutional Law, Vol. I, p. I 066

209.  59 SCRA 54 (1974).

210.  Escritor v. Estrada, A.M. No. P-02-1651 , June 22, 2006, 525 Phil. 110, 140- 141 (2006).

211.  106 Phil. 2 (1959).

212.  Gerona v. Secretary of Education, 106 Phil. 2, 9-10 ( 1959).

213.  Ebralinag v. Division Superintendent of Schools, 2 19 SCRA 256 ( 1993 ), March 1, 1993.

214.  525 Phil. 110 (2006).

215.  Id. at 137.

216.  Id. at 148.

217.  Id. at 149.

218.  ld. at 175.

219.  Id. at 168- 169.

***

222.  Bernas, The 1987 Constitution, 2009 Ed., p. 330.

223.  Separate Opinion, Cruz, Ebralinag v. Division Superintendent of Schools, 2 19 SCRA 256 ( 1993 ), March 1, 1993.

224.  Estrada v. Escritor, supra note 220, at 537.

225.  20 130 CSIH 36.

226.  http://www.skepticink.com/tippling/201 3/05/05/conscientious-objection-to-abortion-catholic-midwives-win-appeal/; last visited February 22, 2014

227.  http://ukhumanrightsblog.com/2013/05/03/conscientious-objection-to-abortion-catholic-midwives-win-appeal;last visited February 22, 2014

228.  453 Phil. 440 (2003).

229.  Fernando on the Philippine Constitution, 1974 ed. , p. 565; See Dissenting Opinion Makasiar, Garcia v. The Faculty Admission Committee G.R. No. L-40779, November 28, 1975.

230.  TSN, August 13, 201 3, pp. 52-54.

231. TSN, August27, 201 3, pp. 71-72

232.  Islamic Da'wah Council of the Philippines v. Office of the Executive Secretary of the Office of the President of the Philippines, supra note 228 at 450.

233.  http://fatherbemasblogs.blogspot.com/2011 _02_01_archive.html; last visited February 15, 2014.

234.  Estrada v. Escritor, supra note 2 10.

235.  TSN, August 27, 201 3, p. 130.

236.  http://www.lifenews.com/20 11 /09/01 /philippines-sees-maternal-mortality-decline-without-abortion; last visited March 9, 2014 [Researchers from the institute for Health Metrics and Evaluation of the University of Washington in Seattle examined maternal mortality rates in 181 countries and found the rate (the number of women's deaths per 100,000) dropped by 81 percent in the Philippines between 1980 and 2008. The decrease comes as the largely Catholic nation has resisted efforts to legalize abortions, even though the United Nations and pro-abortion groups claim women will supposedly die in illegal abortions and increase the maternal mortality rate if abortion is prohibited. 

The 2010 study, published in Lancet, shows the Philippines outpaced first-world nations like Germany, Russia and Israel - where abortions are legal - in cutting maternal mortality rates. Meanwhile, the National Statistical Coordination Board in the Philippines, according to Spero Forum, has shown the same results. From 1990-2010, the daily maternal mortality rate dropped 21 percent, its figures indicated. The World Health Organization also found that the Filipino maternal mortality rate dropped 48 percent from 1990 to 2008.

237.  TSN, July 23, 2013, p. 23.

238.  Memorandum, Alliance for the Family Foundation, Inc. (ALFI) v. Ochoa, rollo (G.R. No. 204934), p. 1407.

***

262.  Petition, Serve Life Cagayan De Oro City, Inc. v. Ochoa, rollo, (G.R. No. 204988), pp.16-48; Petition, Echavez v. Ochoa, rollo (G.R. No. 205478), pp. 7-9.

263.  Except the practice of law which is under the supervision of the Supreme Court.

264.  United States v. Jesus, 31 Phil. 2 18, 230 ( 191 5).

265.  Petition, Echavez v. Ochoa, rollo (G. R. No. 205478), p. 8.



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