Crimes Affecting Nursing Final Module PDF

CRIMES AFFECTING NURSING PROFESSION RELATED TERMINOLOGIES Felony - is defined as any act or omission punishable by law (delitos). Felonies are committed not only by means of deceit (dolo) but also by means of fault (culpa). There is deceit when the act is performed with deliberate intent, and there...

CRIMES AFFECTING NURSING PROFESSION RELATED TERMINOLOGIES Felony - is defined as any act or omission punishable by law (delitos). Felonies are committed not only by means of deceit (dolo) but also by means of fault (culpa). There is deceit when the act is performed with deliberate intent, and there is a fault when the wrongful act results from imprudence, negligence, lack of foresight, or lack of skill. Felonies usually include all crimes punishable under the Revised Penal Code (murder, rape, homicide). Offense - refers to crimes punishable under special laws (Dangerous Drugs Act, Law on Anti-Violence on Women and Children). Misdemeanor - is a minor infraction of the law. It involves crimes that carry a less severe punishment than a felony like violation of a city ordinance. Tort - is an act or omission that gives rise to injury or harm to another, and amounts to a civil wrong for which courts impose liability. In the context of torts, "injury" describes the invasion of any legal right, whereas "harm" describes a loss or detriment in fact that an individual suffers. It is also defined as a civil wrong that causes a claimant to suffer loss or harm, resulting in legal liability for the person who commits a tortious act. It can include the intentional infliction of emotional distress, negligence, financial losses, injuries, invasion of privacy, and many other things. CLASSIFICATIONS OF FELONIES According to the manner of commission 1. Dolo or Deceit - There is deceit when the act is performed with deliberate intent. 2. Culpa or Fault - There is fault when the wrongful act results from imprudence, negligence, lack of foresight, or lack of skill 4 According to the stages of execution 1. Consummated - A felony is consummated when all the elements necessary for its execution and accomplishment are present. 2. Frustrated - It is frustrated when the offender performs all the acts of execution which would produce the felony as a consequence but which, nevertheless, do not produce it by reason of causes independent of the will of the perpetrator. 3. Attempted - There is an attempt when the offender commences the commission of a felony directly by overt acts According to the gravity of offense 1. Grave felony - are those to which the law attaches the capital punishment or penalties which in any of their periods are afflictive in accordance with Article 25 of the Revised Penal Code. 2. Less grave felony - are those which the law punishes with penalties which in their maximum period are correctional, in accordance with the above-mentioned article. 3. Light felony - are those infractions of law for the commission of which the penalty of arresto menor or a fine not exceeding 200 pesos or both is provided. 46 According to the degree of participation 1. Principal Those who take a direct part in the execution of the act; Those who directly force or induce others to commit it;  Those who cooperate in the commission of the offense by another act without which it would not have been accomplished. 2. Accomplice An accomplice is one, who has direct participation or cooperation, but such participation or cooperation is not vital nor indispensable to consummating act. Crime is committed either before or simultaneous with the principal act. 3. Accessory Accessories are those who, having knowledge of the commission of the crime, and without having participated therein, either as principals or accomplices, take part subsequent to its commission in any of the following manners: By profiting themselves or assisting the offender to profit by the effects of the crime. By concealing or destroying the body of the crime, or the effects or instruments thereof, in order to prevent its discovery. By harboring, concealing, or assisting in the escape of the principal of the crime, provided the accessory acts with abuse of his public functions or whenever the author of the crime is guilty of treason, parricide, murder, or an attempt to take the life of the Chief Executive, or is known to be habitually guilty of some other crime. Penalties that may be imposed upon conviction are as follows: Scale Principal Penalties: Capital punishment: Death. (amended by R.A. 9346) Afflictive penalties: Reclusion perpetua, Reclusion temporal, Perpetual or temporary absolute disqualification, Perpetual or temporary special disqualification, Prision mayor. Correctional penalties: Prision correccional, Arresto mayor, Suspension, Destierro. Light penalties: Arresto menor, Public censure. Penalties common to the three preceding classes: Fine, and Bond to keep the peace. Accessory Penalties Perpetual or temporary absolute disqualification, Perpetual or temporary special disqualification, Suspension from public office, the right to vote and be voted for, the profession or calling, Civil interdiction, Indemnification,  Forfeiture or confiscation of instruments and proceeds of the offense, Payment of costs. Fine - When afflictive, correctional, or light penalty - A fine, Whether imposed as a single or as an alternative penalty, shall be considered an afflictive penalty, if it exceeds 6,000 pesos; a correctional penalty, if it does not exceed 6,000 pesos but is not less than 200 pesos; and a light penalty if it be less than 200 pesos. CIRCUMSTANCES AFFECTING CRIMINAL LIABILITIES Justifying Circumstances The act causing injury or death to another person is justified, hence, no one shall be criminally liable. The following do not incur any criminal liability: 1. Anyone who acts in defense of his/her person or rights, provided that the following circumstances concur: First. Unlawful aggression; Second. Reasonable necessity of the means employed to prevent or repel it; Third. Lack of sufficient provocation on the part of the person defending himself. (This provision is about Self-Defense.) 2. Anyone who acts in defense of the person or rights of his/her spouse, ascendants, descendants, or legitimate, natural or adopted brothers or sisters, or of his/her relatives by affinity in the same degrees, and those by consanguinity within the fourth civil degree, provided that the first and second requisites prescribed in the next preceding circumstance are present, and the further requisite, in case the provocation was given by the person attacked, that the one making defense had no part therein. (This provision is about Defense of Relatives.) 3. Anyone who acts in defense of the person or rights of a stranger, provided that the first and second requisites mentioned in the first circumstance of this article are present and that the person defending be not induced by revenge, resentment, or other evil motive. (This provision is about Defense of a Stranger.) 4. Any person who, in order to avoid an evil or injury, does an act which causes damage to another, provided that the following requisites are present; First. That the evil sought to be avoided actual exists; Second. That the injury feared be greater than that done to avoid it; Third. That there be no other practical and less harmful means of preventing it. 5. Any person who acts in the fulfillment of a duty or in the lawful exercise of a right or office. 6. Any person who acts in obedience to an order issued by a superior for some lawful purpose. Exempting Circumstances Although there was really a crime committed, no liability will be attached due to reason of public policy. The person committing the crime shall be exempted from any liability under the following circumstances: 1. An imbecile or an insane person, unless the latter has acted during a lucid interval. When the imbecile or an insane person has committed an act which the law defines as a felony (delito), the court shall order his confinement in one of the hospitals or asylums established for persons thus afflicted, which he/she shall not be permitted to leave without first obtaining the permission of the same court. 2. A person under nine years of age. 3. A person over nine years of age and under fifteen, unless he has acted with discernment, in which case, such minor shall be proceeded against in accordance with the provisions of article 80 of this Code. When such minor is adjudged to be criminally irresponsible, the court, in conformity with the provisions of this and the preceding paragraph, shall commit him/ her to the care and custody of his/her family who shall be charged with his surveillance and education; otherwise, he shall be committed to the care of some institution or person mentioned in said article 80. 4. Any person who, while performing a lawful act with due care, causes an injury by mere accident without fault or intention of causing it. 5. Any person who acts under the compulsion of irresistible force. 6. Any person who acts under the impulse of an uncontrollable fear of an equal or greater injury. 7. Any person who fails to perform an act required by law, when prevented by some lawful insuperable cause. Mitigating Circumstances Those acts, although resulting in criminal liability, will reduce or lessen the penalties imposable. The following are mitigating circumstances: 1. Those mentioned in the preceding chapter, when all the requisites necessary to justify the act or to exempt from criminal liability in the respective cases are not attendant. (This provision pertains to incomplete self-defense.) 2. That the offender is under eighteen years of age or over seventy years. In the case of the minor, he shall be proceeded against in accordance with the provisions of article 80. 3. That the offender had no intention to commit so grave a wrong as that committed. 4. That sufficient provocation or threat on the part of the offended party immediately preceded the act. 5. That the act was committed in the immediate vindication of a grave offense to the one committing the felony (delito) his spouse, ascendants, descendants, legitimate, natural or adopted brothers or sisters or relatives by affinity within the same degrees. 6. That of having acted upon an impulse so powerful as naturally to have produced passion or obfuscation. 7. That the offender had voluntarily surrendered him- or herself to a person in authority or his/her agents, or that he/she had voluntarily confessed his guilt before the court prior to the presentation of the evidence for the prosecution. 8. That the offender is deaf and dumb, blind or otherwise suffering some physical defect which thus restricts his/her means of action, defense, or communication with his/her fellow beings. 9. Such illness of the offender as would diminish the exercise of the will-power of the offender without however depriving him/her of consciousness of his/her acts. 10. And, finally, any other circumstance of a similar nature and analogous to those above mentioned. Aggravating Circumstances Those circumstances that cause an increase in the penalty imposable: 1. That advantage be taken by the offender of his/her public position. 2. That the crime be committed in contempt of or with insult to the public authorities. 3. That the act be committed with insult or in disregard of the respect due to the offended party on account of his/her rank, age, or sex, or that it be committed in the dwelling of the offended party, if the latter has not given provocation. 4. That the act be committed with abuse of confidence or obvious ungratefulness.  5. That the crime be committed in the palace of the Chief Executive, or in his/her presence, or where public authorities are engaged in the discharge of their duties, or in a place dedicated to religious worship. 6. That the crime be committed in the nighttime, or in an uninhabited place, or by a band, whenever such circumstances may facilitate the commission of the offense. Whenever more than three armed malefactors shall have acted together i n the commission of an offense, it shall be deemed to have been committed by a band. 7. That the crime be committed on the occasion of a conflagration, shipwreck, earthquake, epidemic, or other calamity or misfortune. 8. That the crime be committed with the aid of armed men or persons who insure or afford impunity. 9. That the accused is a recidivist. A recidivist is one who, at the time of his trial for one crime, shall have been previously convicted by final judgment of another crime embraced in the same title of this Code. 10. That the offender has been previously punished for an offense to which the law attaches an equal or greater penalty or for two or more crimes to which it attaches a lighter penalty. 11. That the crime be committed in consideration of a price, reward, or promise. 12. That the crime be committed by means of inundation, fire, poison, explosion, stranding of a vessel or intentional damage thereto, derailment of a locomotive, or by the use of any other artifice involving great waste and ruin. 13. That the act be committed with evident premeditation. 14. That craft, fraud, or disguise be employed. 15. That advantage be taken of superior strength, or means be employed to weaken the defense. 16. That the act be committed with treachery (alevosia). There is treachery when the offender commits any of the crimes against the person, employing means, methods, or forms in the execution thereof which tend directly and specially to insure its execution, without risk to himself arising from the defense which the offended party might make. 17. That means be employed or circumstances brought about which add ignominy to the natural effects of the act. 18. That the crime be committed after an unlawful entry. There is an unlawful entry when an entrance is effected by a way not intended for the purpose. 19. That as a means to the commission of a crime a wall, roof, floor, door, or window be broken. 20. That the crime be committed with the aid of persons under fifteen years of age or by means of motor vehicles, motorized watercraft, airships, or other similar means. (As amended by Rep. Act No. 5438, approved September 9,1968) 21. That the wrong done in the commission of the crime be deliberately augmented by causing other wrong not necessary for its commission.52 Alternative Circumstances Alternative circumstances are those, which must be taken into consideration as aggravating or mitigating according to the nature and effects of the crime and the other conditions attending its commission. They are the relationship, intoxication and the degree of instruction and education of the offender. The alternative circumstance of relationship shall be taken into consideration when the offended party is the spouse, ascendant, descendant, legitimate, natural, or adopted brother or sister, or relative by affinity in the same degrees of the offender. The intoxication of the offender shall be taken into consideration as a mitigating circumstance when the offender has committed a felony in a state of intoxication, if the same is not habitual or subsequent to the plan to commit said felony; but when the intoxication is habitual or intentional, it shall be considered as an aggravating circumstance. APPLICABLE CRIMES UNDER THE REVISED PENAL CODE ART. 147. Illegal associations The penalty of prision correccional in its minimum and medium periods and a fine not exceeding 1,000 pesos shall be imposed upon the founders, directors, and presidents of associations totally or partially organized for the purpose of committing any of the crimes punishable under this Code or for some purpose contrary to public morals. Mere members of said associations shall suffer the penalty of arresto mayor. (This article punishes any group of people who will form an association intended for committing any acts punishable under the Revised Penal Code). ART. 172. Falsification by private individual and use of falsified documents Falsifying documents is a criminal offense that involves the altering, changing, modifying, passing or possessing of a document for an unlawful purpose. The penalty of prision correccional in its medium and maximum periods and a fine of not more than Pº5,000 pesos shall be imposed upon: 1. Any private individual who shall commit any of the falsifications in any public or official document or letter of exchange or any other kind of commercial document; and 2. Any person who, to the damage of a third party, or with the intent to cause such damage, shall in any private document commit any of the acts of falsification enumerated in the next preceding article. ART. 174. False medical certificates, false certificates of merits or service, etc. The penalties of arresto mayor in its maximum period to prision correccional in its minimum period and a fine not to exceed P1,000 shall be imposed upon: 1. Any physician or surgeon who, in connection, with the practice of his profession, shall issue a false certificate; and 2. Any public officer who shall issue a false certificate of merit of service, good conduct or similar circumstances. ART. 175. Using false certificates The penalty of arresto menor shall be imposed upon any one who shall knowingly use any of the false certificates mentioned in the next preceding article. ART. 180. False testimony against a defendant Any person who shall give false testimony against the defendant in any criminal case shall suffer: 1. The penalty of reclusion temporal, if the defendant in said case shall have been sentenced to death; 2. The penalty of prision mayor, if the defendant shall have been sentenced to reclusion temporal or reclusion perpetua; 3. The penalty of prision correccional, if the defendant shall have been sentenced to any other afflictive penalty; and 4. The penalty of arresto mayor, if the defendant shall have been sentenced to a correctional penalty or a fine, or shall have been acquitted.  In cases provided in subdivisions 3 and 4 of this article the offender shall further suffer a fine not to exceed 1,000 pesos. (This article punishes the act of giving falsified testimony against a defendant in a criminal case). ART. 181. False testimony favorable to the defendants Any person who shall give false testimony in favor of the defendant in a criminal case, shall suffer the penalties of arresto mayor in its maximum period to prision correccional in its minimum period a fine not to exceed 1,000 pesos, if the prosecution is for a felony punishable by an afflictive penalty, and the penalty of arresto mayor in any other case. (This article punish the act of giving falsified oral testimony in favor of a defendant in a criminal case). ART. 182. False testimony in civil cases Any person found guilty of false testimony in a civil case shall suffer the penalty of prision correccional in its minimum period and a fine not to exceed 6,000 pesos, if the amount in controversy shall exceed 5,000 pesos, and the penalty of arresto mayor in its maximum period to prision correccional in its minimum period and a fine not to exceed 1,000 pesos, if the amount in controversy shall not exceed said amount or cannot be estimated. (This article punishes the act of giving falsified testimony in a civil action). ART. 183. False testimony in other cases and perjury in solemn affirmation The penalty of arresto mayor in its maximum period to prision correccional in its minimum period shall be imposed upon any person, who knowingly makes untruthful statements and not being included in the provisions of the next preceding articles, shall testify under oath, or make an affidavit, upon any material matter before a competent person authorized to administer an oath in cases in which the law so requires. Any person who, in case of a solemn affirmation made in lieu of an oath, shall commit any of the falsehoods mentioned in this and the three preceding articles of this section, shall suffer the respective penalties provided therein. (Also called as perjury, this article punishes the act of giving falsified testimony while under oath or solemn affirmation). ART. 184. Offering false testimony in evidence Any person who shall knowingly offer in evidence a false witness or testimony in any judicial or official proceeding, shall be punished as guilty of false testimony and shall suffer the respective penalties provided in this section. ART. 210. Direct bribery In summary, direct bribery is committed by a public officer who accepts an offer or promise or receives a gift or present, by himself or through another, with a view to committing a crime, or in consideration of the execution of an act that does not constitute a crime but is unjust, or to refrain from doing something that it is his official duty to do. Any public officer who shall agree to perform an act constituting a crime, in connection with the performance of this official duties, in consideration of any offer, promise, gift or present received by such officer, personally or through the mediation of another, shall suffer the penalty of prision mayor in its medium and maximum periods and a fine [of not less than the value of the gift and] not less than three times the value of the gift in addition to the penalty corresponding to the crime agreed upon, if the same shall have been committed. If the gift was accepted by the officer in consideration of the execution of an act which does not constitute a crime, and the officer executed said act, he shall suffer the same penalty provided in the preceding paragraph; and if said act shall not have been accomplished, the officer shall suffer the penalties of prision correccional, in its medium period and a fine of not less than twice the value of such gift. If the object for which the gift was received or promised was to make the public officer refrain from doing something which it was his official duty to do, he shall suffer the penalties of prision correccional in its maximum period and a fine [of not less than the value of the gift and] not less than three times the value of such gift. In addition to the penalties provided in the preceding paragraphs, the culprit shall suffer the penalty of special temporary disqualification. The provisions contained in the preceding paragraphs shall be made applicable to assessors, arbitrators, appraisal and claim commissioners, experts or any other persons performing public duties. (As amended by Batas Pambansa Blg. 872, June 10, 1985). ART. 211. Indirect bribery Indirect bribery is committed by a public officer who accepts a gift offered to him by reason of his office. The penalties of prision correccional in its medium and maximum periods, and public censure shall be imposed upon any public officer who shall accept gifts offered to him by reason of his office. (As amended by Batas Pambansa Big. 872, June 10, 1985). ART. 212. Corruption of public officials The same penalties imposed upon the officer corrupted, except those of disqualification and suspension, shall be imposed upon any person who shall have made the offers or promises or given the gifts or presents as described in the preceding articles. ART. 217. Malversation of public funds or property;Presumption of malversation In malversation of public funds, the offender misappropriates public funds for his own personal use or allows any other person to take such public funds for the latter's personal use. Any public officer who, by reason of the duties of his office, is accountable for public funds or property, shall appropriate the same or shall take or misappropriate or shall consent, through abandonment or negligence, shall permit any other person to take such public funds, or property, wholly or partially, or shall otherwise be guilty of the misappropriation or malversation of such funds or property, shall suffer: 1. The penalty of prision correccional in its medium and maximum periods, if the amount involved in the misappropriation or malversation does not exceed two hundred pesos. 2. The penalty of prision mayor in its minimum and medium periods, if the amount involved is more than two hundred pesos but does not exceed six thousand pesos. 3. The penalty of prision mayor in its maximum period to reclusion temporal in its minimum period, if the amount involved is more than six thousand pesos but is less than twelve thousand pesos. 4. The penalty of reclusion temporal, in its medium and maximum periods, if the amount involved is more than twelve thousand pesos but is less than twenty-two thousand pesos. If the amount exceeds the latter, the penalty shall be reclusion temporal in its maximum period to reclusion perpetua. In all cases, persons guilty of malversation shall also suffer the penalty of perpetual special disqualification and a fine equal to the amount of the funds malversed or equal to the total value of the property embezzled. The failure of a public officer to have duly forthcoming any public funds or property with which he is chargeable, upon demand by any duly authorized officer, shall be prima facie evidence that he has put such missing funds or property to personal use. (As amended by R.A. 1060). (A public health nurse who receives public funds for purchase of health equipment and misappropriate for personal use is an example of malversation). ART. 246. Parricide Any person who shall kill his father, mother, or child, whether legitimate or illegitimate, or any of his ascendants, or descendants, or his spouse, shall be guilty of parricide and shall be punished by the penalty of reclusion perpetua to death. ART. 248. Murder Any person who, not falling within the provisions of Article 246 shall kill another, shall be guilty of murder and shall be punished by reclusion temporal in its maximum period to death, if committed with any of the following attendant circumstances: 1. With treachery, taking advantage of superior strength, with the aid of armed men, or employing means to weaken the defense or of means or persons to insure or afford impunity. 2. In consideration of a price, reward, or promise. 3. By means of inundation, fire, poison, explosion, shipwreck, stranding of a vessel, derailment or assault upon a street car or locomotive, fall of an airship, by means of motor vehicles, or with the use of any other means involving great waste and ruin. 4. On occasion of any of the calamities enumerated in the preceding paragraph, or of an earthquake, eruption of a volcano, destructive cyclone, epidemic or other public calamity. 5. With evident premeditation. 6. With cruelty, by deliberately and inhumanly augmenting the suffering of the victim, or outraging or scoffing at his person or corpse. (The crime shall be murder if the killing is committed under any one of the above-stated circumstances.) ART. 249. Homicide Any person who, not falling within the provisions of Article 246, shall kill another without the attendance of any of the circumstances enumerated in the next preceding article, shall be deemed guilty of homicide and be punished by reclusion temporal. ART. 253. Giving assistance to suicide Any person who shall assist another to commit suicide shall suffer the penalty of prision mayor; if such person leads his assistance to another to the extent of doing the killing himself, he shall suffer the penalty of reclusion temporal. However, if the suicide is not consummated, the penalty of arresto mayor in its medium and maximum periods, shall be imposed. ART. 255. Infanticide The penalty provided for parricide in Article 246 and for murder in Article 248 shall be imposed upon any person who shall kill any child less than three days of age. If the crime penalized in this article be committed by the mother of the child for the purpose of concealing her dishonor, she shall suffer the penalty of prision correccional in its medium and maximum periods, and if said crime be committed for the same purpose by the maternal grandparents or either of them, the penalty shall be prision mayor. ART. 256. Intentional abortion Any person who shall intentionally cause an abortion shall suffer:  1. The penalty of reclusion temporal, if he shall use any violence upon the person of the pregnant woman. 2. The penalty of prision mayor if, without using violence, he shall act without the consent of the woman. 3. The penalty of prision correccional in its medium and maximum periods, if the woman shall have consented. (A nurse who improperly uses her nursing skills to induce abortion to a pregnant woman by administering abortive substance is punishable under this article). ART. 257. Unintentional abortion The penalty of prision correccional in its minimum and medium period shall be imposed upon any person who shall cause an abortion by violence, but unintentionally. (A stranger who inflicted physical harm to a woman, unknowing that she is 6-month pregnant resulting to unintentional abortion shall be punishable under this article). ART. 258. Abortion practiced by the woman herself of by her parents The penalty of prision correccional in its medium and maximum periods shall be imposed upon a woman who shall practice abortion upon herself or shall consent that any other person should do so. Any woman who shall commit this offense to conceal her dishonor, shall suffer the penalty of prision correccional in its minimum and medium periods. If this crime be committed by the parents of the pregnant woman or either of them, and they act with the consent of said woman for the purpose of concealing her dishonor, the offenders shall suffer the penalty of prision correccional in its medium and maximum periods. (A pregnant woman who takes abortive substance to induce abortion shall be liable under this article). ART. 259. Abortion practiced by a physician or midwife and dispensing of abortives The penalties provided in Article 256 shall be imposed in its maximum period, respectively, upon any physician or midwife who, taking advantage of their scientific knowledge or skill, shall cause an abortion or assist in causing the same. Any pharmacist who, without the proper prescription from a physician, shall dispense any abortive shall suffer arresto mayor and a fine not exceeding 1,000 pesos. ART. 262. Mutilation The penalty of reclusion temporal to reclusion perpetua shall be imposed upon any person who shall intentionally mutilate another by depriving him, either totally or partially, or some essential organ of reproduction. Any other intentional mutilation shall be punished by prision mayor in its medium and maximum periods. ART. 263. Serious physical injuries Any person who shall wound, beat, or assault another, shall be guilty of the crime of serious physical injuries and shall suffer: 1. The penalty of prision mayor, if in consequence of the physical injuries inflicted, the injured person shall become insane, imbecile, impotent, or blind; 2. The penalty of prison correccional in its medium and maximum periods, if in consequence of the physical injuries inflicted, the person injured shall have lost the use of speech or the power to hear or to smell, or shall have lost an eye, a hand, a foot, an arm, or a leg or shall  have lost the use of any such member, or shall have become incapacitated for the work in which he was therefore habitually engaged; 3. The penalty of prision correccional in its minimum and medium periods, if in consequence of the physical injuries inflicted, the person injured shall have become deformed, or shall have lost any other part of his body, or shall have lost the use thereof, or shall have been ill or incapacitated for the performance of the work in which he as habitually engaged for a period of more than ninety days; 4. The penalty of arresto mayor in its maximum period to prision correccional in its minimum period, if the physical injuries inflicted shall have caused the illness or incapacity for labor of the injured person for more than thirty days. (Anyone who shall commit physical harm to another person, resulting to permanent disability is liable under this article). ART. 264. Administering injurious substances or beverages The penalties established by the next preceding article shall be applicable in the respective case to any person who, without intent to kill, shall inflict upon another any serious, physical injury, by knowingly administering to him any injurious substance or beverages or by taking advantage of his weakness of mind or credulity. ART. 265. Less serious physical injuries Any person who shall inflict upon another physical injuries not described in the preceding articles, but which shall incapacitate the offended party for labor for ten days or more, or shall require medical assistance for the same period, shall be guilty of less serious physical injuries and shall suffer the penalty of arresto mayor. Whenever less serious physical injuries shall have been inflicted with the manifest intent to kill or offend the injured person, or under circumstances adding ignominy to the offense in addition to the penalty of arresto mayor, a fine not exceeding 500 pesos shall be imposed. Any less serious physical injuries inflicted upon the offender's parents, ascendants, guardians, curators, teachers, or persons of rank, or persons in authority, shall be punished by prision correccional in its minimum and medium periods, provided that, in the case of persons in authority, the deed does not constitute the crime of assault upon such person. (Anyone who shall commit physical harm to another person, resulting to hospitalization for ten (10) days or more is liable under this article). ART. 266. Slight physical injuries and maltreatment The crime of slight physical injuries shall be punished: 1. By arresto menor when the offender has inflicted physical injuries which shall incapacitate the offended party for labor from one to nine days, or shall require medical attendance during the same period. 2. By arresto menor or a fine not exceeding 20 pesos and censure when the offender has caused physical injuries which do not prevent the offended party from engaging in his habitual work nor require medical assistance. 3. By arresto menor in its minimum period or a fine not exceeding 50 pesos when the offender shall ill-treat another by deed without causing any injury. (Anyone who shall commit physical harm to another person, resulting to hospitalization of 1-9 days shall be liable under this article). ART. 267. Kidnapping and serious illegal detention Any private individual who shall kidnap or detain another, or in any other manner deprive him of his liberty, shall suffer the penalty of reclusion perpetua to death:  1. If the kidnapping or detention shall have lasted more than five days. 2. If it shall have been committed simulating public authority. 3. It any serious physical injuries setill have been inflicted upon the person kidnapped or detained; or if threats to kill him shall have been made. 4. It the person kidnapped or detained shall be a minor, female or a public officer. The penalty shall be death where the kidnapping or detention was committed for the purpose of extorting ransom from the victim or any other person, even if none of the circumstances above- mentioned were present in the commission of the offense. ART. 268. Slight illegal detention The penalty of reclusion temporal shall be imposed upon any private individual who shall commit the crimes described in the next preceding article without the attendance of any of circumstances enumerated therein. The same penalty shall be incurred by anyone who shall furnish the place for the perpetration of the crime. If the offender shall voluntarily release the person so kidnapped or detained within three days from the commencement of the detention, without having attained the purpose intended, and before the institution of criminal proceedings against him, the penalty shall be prision mayor in its minimum and medium periods and a fine not exceeding seven hundred pesos. ART. 275. Abandonment of person in danger and abandonment of one's own victim The penalty of arresto mayor shall be imposed upon: 1. Any one who shall fail to render assistance to any person whom he shall find in an uninhabited place wounded of in danger of dying, when he can render such assistance without detriment to himself, unless such omission shall constitute a more serious offense. 2. Anyone who shall fail to help or render assistance to another whom he has accidentally wounded or injured. 3. Anyone who, having found an abandoned child under seven years of age, shall fail to deliver said child to the authorities or to his family, or shall fail to take him to a safe place. (After a vehicular accident, a driver abandons his victim on roadside without giving any assistance shall be liable under his article. ART. 276. Abandoning a minor The penalty of arresto mayor and a fine not exceeding 500 pesos shall be imposed upon any one who shall abandon a child under seven years of age, the custody of which is incumbent upon him. When the death of the minor shall result from :such abandonment, the culprit shall be punished by prision correccional in its medium and maximum periods; but if the life of the minor shall have been in danger only, the penalty shall be prision correccional in its minimum and medium periods. The provisions contained in the two preceding paragraphs shall not prevent the imposition of the penalty provided for the act committed, when the same shall constitute a more serious offense. ART. 277. Abandonment of minor by person entrusted with his custody; indifference of parents The penalty of arresto mayor and a fine not exceeding 500 pesos shall be imposed upon anyone who, having charge of the rearing or education of a minor, shall deliver said minor to a public institution or other persons, without the consent of the one who entrusted such child to his care or in the absence of the latter, without the consent of the proper authorities. The same penalty shall be imposed upon the parents who shall neglect their children by not giving them the education which their station in life require and financial conditions permit.  ART. 278. Exploitation of minors The penalty of prision correccional in its minimum and medium periods and a fine not exceeding 500 pesos shall be imposed upon: 1. Any person who shall cause any boy or girl under sixteen years of age to perform any dangerous feat of balancing, physical strength, or contortion. 2. Any person who, being an acrobat, gymnast, rope-walker, diver, wild-animal tamer or circus manager or engaged in a similar calling, shall employ in exhibitions of these kinds children under sixteen years of age who are not his children or descendants. 3. Any person engaged in any of the callings enumerated in the next paragraph preceding who shall employ any descendant of his under twelve years of age in such dangerous exhibitions. 4. Any ascendant, guardian, teacher or person entrusted in any capacity with the care of a child under sixteen years of age, who shall deliver such child gratuitously to any person following any of the callings enumerated in paragraph 2 hereof, or to any habitual vagrant or beggar. If the delivery shall have been made in consideration of any price, compensation, or promise, the penalty shall in every case be imposed in its maximum period. In either case, the guardian or curator convicted shall also be removed from office as guardian or curator; and in the case of the parents of the child, they may be deprived, temporarily or perpetually, in the discretion of the court, of their parental authority. 5. Any person who shall induce any child under sixteen years of age to abandon the home of its ascendants, guardians, curators, or teachers to follow any person engaged in any of the callings mentioned in paragraph 2 hereof, or to accompany any habitual vagrant or beggar. ART. 285. Light threats The penalty of arresto menor in its minimum period or a fine not exceeding 200 pesos shall be imposed upon: 1. Any person who, without being included in the provisions of the next preceding article, shall threaten another with a weapon or draw such weapon in a quarrel, unless it be in lawful self-defense. 2. Any person who, in the heat of anger, shall orally threaten another with some harm not constituting a crime, and who by subsequent acts show that he did not persist in the idea involved in his threat, provided that the circumstances of the offense shall not bring it within the provisions of Article 282 of this Code. 3. Any person who shall orally threaten to do another any harm not constituting a felony. ART. 287. Unjust Vexation Any person who commits a course of conduct directed at a specific person that causes substantial emotional distress in such a person and serves no legitimate purpose shall suffer the penalty of arresto mayor in its minimum period or a fine ranging from 500 pesos to 5,000 pesos, or both. ART. 335. Rape is committed e following circunowledge of a woman under any of the following circumstances: 1. By using force or intimidation; 2. When the woman is deprived of reason or otherwise unconscious; and 3. When the woman is under twelve years of age, even though neither of the circumstances mentioned in the two next preceding paragraphs shall be present. The crime of rape shall be punished by reclusion perpetua.  Whenever the crime of rape is committed with the use of a deadly weapon or by two or more persons, the penalty shall be reclusion perpetua to death. When by reason or on the occasion of the rape, the victim has become insane, the penalty shall be death. When rape is attempted or frustrated and a homicide is committed by reason or on the occasion thereof, the penalty shall be likewise death. When by reason or on the occasion of the rape, a homicide is committed, the penalty shall be death. (As amended by R.A. 2632, approved June 18, 1960, and R.A. 4111, approved June 20, 1964). ART. 336. Acts of lasciviousness Any person who shall commit any act of lasciviousness upon other persons of either sex, under any of the circumstances mentioned in the preceding article, shall be punished by prision correccional. ART. 347. Simulation of births, substitution of one child for another and concealment or abandonment of a legitimate child The simulation of births and the substitution of one child for another shall be punished by prision mayor and a fine of not exceeding 1,000 pesos. The same penalties shall be imposed upon any person who shall conceal or abandon any legitimate child with intent to cause such child to lose its civil status. Any physician or surgeon or public officer who, in violation of the duties of his profession or office, shall cooperate in the execution of any of the crimes mentioned in the two next preceding paragraphs, shall suffer the penalties therein prescribed and also the penalty of temporary special disqualification. ART. 353. Libel A libel is public and malicious imputation of a crime, or of a vice or defect, real or imaginary, or any act, omission, condition, status, or circumstance tending to cause the dishonor, discredit, or contempt of a natural or juridical person, or to blacken the memory of one who is dead. ART. 355. Libel means by writings or similar means A libel committed by means of writing, printing, lithography, engraving, radio, phonograph, painting, theatrical exhibition, cinematographic exhibition, or any similar means, shall be punished by prision correccional in its minimum and medium periods or a fine ranging from 200 to 6,000 pesos, or both, in addition to the civil action which may be brought by the offended party. ART. 356. Threatening to publish and offer to present such publication for a compensation The penalty of arresto mayor or a fine from 200 to 2,000 pesos, or both, shall be imposed upon any person who threatens another to publish a libel concerning him or the parents, spouse, child, or other members of the family of the latter or upon anyone who shall offer to prevent the publication of such libel for a compensation or money consideration. ART. 358. Slander Oral defamation shall be punished by arresto mayor in its maximum period to prision correccional in its minimum period if it is of a serious and insulting nature; otherwise the penalty shall be arresto menor or a fine not exceeding 200 pesos. (A nurse who shall utter insult against her patient shall be liable under this article). ART. 365. Imprudence and negligence  Any person who, by reckless imprudence, shall commit any act which, had it been intentional, would constitute a grave felony, shall suffer the penalty of arresto mayor in its maximum period to prision correccional in its medium period; if it would have constituted a less grave felony, the penalty of arresto mayor in its minimum and medium periods shall be imposed; if it would have constituted a light felony, the penalty of arresto menor in its maximum period shall be imposed. Any person who, by simple imprudence or negligence, shall commit an act which would otherwise constitute a grave felony, shall suffer the penalty of arresto mayor in its medium and maximum periods; if it would have constituted a less serious felony, the penalty of arresto mayor in its minimum period shall be imposed. When the execution of the act covered by this article shall have only resulted in damage to the property of another, the offender shall be punished by a fine ranging from an amount equal to the value of said damages to three times such value, but which shall in no case be less than twenty-five pesos. A fine not exceeding two hundred pesos and censure shall be imposed upon any person who, by simple imprudence or negligence, shall cause some wrong which, if done maliciously, would have constituted a light felony. In the imposition of these penalties, the court shall exercise their sound discretion, without regard to the rules prescribed in Article sixty-four. The provisions contained in this article shall not be applicable: 1. When the penalty provided for the offense is equal to or lower than those provided in the first two paragraphs of this article, in which case the court shall impose the penalty next lower in degree than that which should be imposed in the period which they may deem proper to apply. 2. When, by imprudence or negligence and with violation of the Automobile Law, to death of a person shall be caused, in which case the defendant shall be punished by prision correccional in its medium and maximum periods. Reckless imprudence consists in voluntary, but without malice, doing or falling to do an act from which material damage results by reason of inexcusable lack of precaution on the part of the person performing of failing to perform such act, taking into consideration his employment or occupation, degree of intelligence, physical condition and other circumstances regarding persons, time and place. Simple imprudence consists in the lack of precaution displayed in those cases in which the damage impending to be caused is not immediate nor the danger clearly manifest. The penalty next higher in degree to those provided for in this article shall be imposed upon the offender who fails to lend on the spot to the injured parties such help as may be in this hand to give. (As amended by R.A. 1790, approved June 21, 1957). DISCUSSION ON NEGLIGENCE AND MALPRACTICE IN NURSING PROFESSION Negligence (Latin: negligentia) is a failure to exercise appropriate and or ethical ruled care expected to be exercise among specified circumstances. To determine the presence of negligence, there must be the concurrence of four (4) elements of negligence, which were derived from jurisprudence adjudged by foreign courts. Said elements are as follows: Duty Breach of duty Resulting in injury, harm, or death Causal relations between the breach of duty and resulting harm Similarly, cases involving malpractice that have been adjudicated here and abroad suggested that there be a concurrence of all elements to support a patient's legal cause of action based on nursing negligence. Considering that a malpractice case is similar to a tort case, negligence as a basis for conviction must first be determined by the existence of all elements. Lacking any or all elements may deny the claims of any aggrieved patient for retribution of damages on the said ground. Furthermore, in criminal cases involving nurses charged with malpractice, the indispensability of proving all elements is vital. Failure to prove warrants an acquittal of the nurse as said circumstance tantamount to a failure to prove one's guilt beyond reasonable doubt. All elements are discussed hereinafter: a. Duty - This involves the application of reasonable nursing skills and competencies in administering care for the safety and holistic care to patients utilizing the best practice available. Proving the initial element is commenced by adducing evidence that a nurse-patient relationship exists as the establishment of such relationship shall presumptively concludes the duty to provide professional care does exist. In proving the nurse-patient relationship comes the two theories in asserting the patient's claim. Some authorities suggested that the nurse-patient relationship should be an expressed act, while others espoused the idea that it may also be implied by factual circumstances. The theory that it must be by express contract is consistent with the current hospital policies that documents or consent forms should be signed by the patient before undergoing a particular care, treatment, or procedure. Together with such agreement is a consideration given by the patient as a form of compensation or fees. But the absence of any compensation should not discount the liability of a nurses committing malpractice. On the other hand, the relationship can also be implied when a patient seeks care and treatment for his her illnesses, asks for an available procedure or even demands health teachings, and the nurse accepts such responsibilities whether for a fee or gratuitously. As compared to an ordinary commercial relationship that financial consideration is a pre-requisite for its perfection, nurse-patient relationship can well be established even if professional services were rendered gratuitously. Gratuitous consideration of professional services happens during medical missions, caring for indigent clients, or even providing emergency medical treatment, or roadside rage for free. b. Breach of Duty - This element exists if the nurse fails to employ the professional services within the acceptable professional standards applied by nurses of similar professional practice. It may also be defined that breach of duty is the omission of the nurse to apply the degree of care, skills, and diligence that ordinarily applied by professional nurses as a reasonable degree of merit among nurses under the same line of practice or specialization. Standards of care may be defined as the degree of professional care in which a reasonable nurse, applying one's professional competencies would do or ought not to do. Since the practice of nursing involves highly technical skills and professional competency, which is not known to ordinary laypeople, it is a general rule that courts rely on testimonies adduced by an expert witness.The knowledge and testimony of an expert witnesses is required in malpractice claims in exploring technical terms and procedure, which may not be easily understood by ordinary minds before the courts of law. The objective of utilizing the testimony of expert witness is not to enter a verdict of conviction against an alleged unscrupulous practitioner based on mere conjectures or speculations.To qualify as an expert witness, it must be shown in court that he acquired special studies and practical experience accredited by a recognized body that gives him the authority to perform such professional function in which he testifies and is being called for. In medical malpractice litigation, expert witness testimony is often needed to tell the court whether such misconduct is a violation of standards of the medical profession or not. Nevertheless, some jurisdiction has relaxed the indispensability of expert witness if the complainant-patient has availed the principle of "res ipsa loquitor" (a latin term translated as "the thing speaks for itself") as the basis for a judgment of conviction. In the absence of expert testimony, the court may rely on the totality of the circumstances that lead to the injury of the patient, particularly when the negligence is so apparent. This principle makes inference on related or circumstantial evidence showing the commission of negligence in the absence of specific direct proof. c. Resulting Injury, Harm, or Death - This pertains to the damage sustained by the patient arising from the negligent conduct committed by the erring nurse. It is the duty of the claimant-victim to establish whether the professional lapse has resulted in physical infirmity arising from said misconduct. The patient, thru the prosecution, must prove the existence of legally recognizable harm in the form of physical injury to a patient and other incidental injuries arising therefrom. Hence, any similar investigation may take reference the injury sustained by the patient based on the observable danger that resulted due to negligence of the nurse or by the amount calculated by testimonies made by an expert witness. In some cases, it may be difficult for the court or even an expert witness to calculate actual losses when the true damage manifest later with the patient as to fully provide pecuniary reparation. Hence, it is crystal clear that the injury contemplated by law and jurisprudence to be compensable should primarily involve bodily harm or even death to patients. d. Causation - To be able to prove negligence committed by the nurse, it is essential that the claimant- victim should prove that the resulting injury, harm, or death suffered by an aggrieved patient has a logical relation with the professional breach committed by the nurse. Again, such causal relationship may be proven by an actual assessment by investigation based on material facts and evidence or by expert testimonies. It is necessary that the nurse' negligence is the proximate cause of the harm or death sustained by the patient. Proximate cause is that cause, which, in a natural and continuous sequence, unbroken by any efficient intervening cause, produces the injury, and without which the result would not have occurred. And more comprehensively, the proximate legal cause is that acting first and producing the injury, either immediately or by setting other events in motion, all constituting a natural and continuous chain of events, each having a close causal connection with its immediate predecessor, the final event in the chain immediately effecting the injury as a natural and probable result of the cause which first acted, under such circumstances that the person responsible for the first event should, as an ordinary, prudent, and intelligent person, have reasonable ground to expect at the moment of his act or default that an injury to some person might probably result therefrom. Commission of negligence can be called Nonfeasance, which is the failure to act where the action is required or the absence of care to be rendered. Misfeasance is the willful inappropriate action or intentional incorrect action or advice. Malfeasance is the willful and intentional action that injures a party. Other Related Crimes Assault - in some jurisdictions assault is defined as the threat of bodily harm that reasonably causes fear of harm in the victim. If the victim has not actually been touched, but only threatened (or someone attempted to touch them), then the crime is assault. A nurse who orally threatens a patient shall be liable for assault. Battery - is the actual physical impact on another person. If the victim has been touched in a painful, harmful, violent, or offensive way by the person committing the crime, this might be battery. Even a minor touching can qualify as battery provided it is painful, harmful, or offensive to the victim. A nurse who intentionally hit a patient is liable for battery. Fraud - is the intentional use of deceit, a trick, or some dishonest means to deprive another of his/her money, property, or a legal right. A party who has lost something due to fraud is entitled to file a lawsuit for damages against the party acting fraudulently, and the damages may include punitive damages as a punishment or public example due to the malicious nature of the fraud. Misleading a patient with wrong health information is liable for fraud. LEGAL ASPECTS IN NURSING CONTRACTS AND OBLIGATIONS A contract is an agreement through the meeting of the minds between two persons whereby one binds him-or herself, with respect to the other, to give something or to render some service. It has the force of law between the parties and should be complied with in good faith. The term force of law in the definition refers to the legal aspect of an agreement as a contract. This means that you can go to court and ask for civil redress in case of non-compliance with the contract. Sometimes, it can also qualify as a criminal case if fraud and deceit are present. An agreement without the "force of law" is not contract but merely personal or social agreements. The term in good faith denotes fairness and honesty of intention in the performance of the contract, so as to not destroy or injure the right of one of the parties. It would not be in good faith, for instance, when one party has exempted himself from the contract while the other is still bound to it. A contract is one of the sources of obligation. An obligation is a juridical necessity that results when a contract is completed or perfected. There can be no contract if there is no obligation, though not all obligations arise from contracts. The obligation that arises from contracts is called conventional obligation. To be valid, a contract must be binding to both contracting parties. Validity of contracts cannot be left to the decision of any one of them but by mutual decisions. Each party may stipulate any words, terms, and conditions deemed convenient, provided that they are not essentially against or contrary to law, public policy, and good morals. An agreement where the policies are left to the discretion of one party only is called as a contract of adhesion. An agreement between a nurse and a relative of a patient to inject a harmful substance to cause instant death to a patient is an example of an illegal contract. A contract has the following essential elements: Consent - a meeting of the minds between parties with respect to the object and cause; there is a certain offer by one party and there is an absolute acceptance by another party (Ex: consent to perform a surgical procedure by the patient and the concurrence of the surgeon to perform the procedure). Object - the thing, right, or service to be provided or performed under the contract (Ex: the treatment or surgery). Consideration - the essential purpose or reason for the parties to enter into such contract (the medical services to be received by the patient and the professional fee for the physician). An example of a contract is an employment agreement between a nurse and a hospital. The consent is the agreement to be employed as a nurse in a hospital. The consideration is the salary of the nurse and the services to be rendered by the nurse to patients in behalf of the hospital. While the object pertains to the employment contract or agreement entered between the parties. Types of Contracts In Express Contracts, the parties state the terms, either orally or in writing, at the time of its formation. There is a definite written or oral offer that is accepted by the offeree (i.e., the person to whom the offer is made) in a manner that explicitly demonstrates consent to its terms. (Ex: Hospital consent form)  Implied Contracts are implied in fact and contracts implied in law. A true implied contract consists of obligations arising from a mutual agreement and intent to comply, which have not been expressed in words. This agreement need not be expressed in any written documents, but may be inferred through the actions and behaviors of parties assenting on the said agreement (Example: An implied contract between a physician in providing treatment to a patient even without any written contract). Executed Contracts are those in which nothing remains to be done by either party. The phrase is, to a certain extent, a misnomer because the completion of performances by the parties signifies that a contract no longer exists. Executory Contracts are those in which some future act or obligation remains to be performed according to its terms (Example: An agreement that a surgeon will perform a surgical procedure once the patient submit his/her medical clearance from the laboratory is an example of this agreement). Bilateral Contracts are those contracts in which an exchange of mutual, reciprocal promises between parties that entails the performance of an act, or forbearance from the performance of an act, with respect to each party are stated. Unilateral Contracts involves a promise that is made by only one party. Adhesion Contracts are those that are drafted by the party who has the greater bargaining advantage, providing the weaker party with only the opportunity to adhere to (i.e, to accept) the contract or to reject it. (Example: a printed hospital admission form containing pre-determined terms and conditions for patients to sign and consent for admission). Aleatory Contracts is a mutual agreement, the effects of which are triggered by the occurrence of an uncertain event. In this type of contract, one or both parties assume risk. Voidable Contracts is a legally enforceable agreement, but it may be treated as never having been binding on a party who was suffering from some legal disability or who was a victim of fraud at the time of its execution. Void Contracts imposes no legal rights or obligations upon the parties and is not enforceable by a court. It is, in effect, no contract at all (Example: An agreement between the nurse and relative of a patient to administer a poisonous substance to the latter is void and illegal per se). Informed Consent Informed consent to medical treatment is fundamental in both ethics and law. It is one of the precepts of autonomy. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care. Successful communication in the patient-physician relationship fosters trust and supports shared decision-making. The components of informed consent include the person's knowledgeable consent to a treatment or procedure after they have been given, and understand, complete, unbiased information about: The proposed treatment or procedure. Who will perform the treatment or procedure. The purpose of the proposed treatment or procedure. The expected outcomes of the proposed treatment or procedure. The benefits of the proposed treatment or procedure. The possible risks associated with the proposed treatment or procedure. The alternatives to the particular treatment or procedure. The benefits and risks associated with alternatives to the proposed treatment or procedure. The client's right to withdraw after consent is given. The client's right to refuse a proposed treatment or procedure. Clients have the legal right to autonomy and self-determination to accept or reject all treatments, procedures, and interventions without any coercion or the undue influence of others.  The physician or other licensed care providers, like nurses and the client have roles and responsibilities in terms of informed consent. The nurse is responsible and accountable for the verification of and witnessing that the patient or the legal representative has signed the consent document in their presence and that the patient, or the legal representative, is of legal age and competent to provide consent. They also confirm that the patient has sufficient knowledge to make a knowledgeable decision. The physician or surgeon provides the client with complete information about the treatment or procedure, the potential risks including pain and complications, the benefits of the treatment or procedure, who will perform the planned treatment or procedure, and any possible alternatives to the treatment or procedure including their benefits and risks. The patient or their legal representative must give consent voluntarily and without any coercion by others. They must also ask questions and clarify things until they are certain about the procedure, the benefits, the risks, and possible alternatives. The process of informed consent occurs when communication between a patient and physician results in the patient's authorization or agreement to undergo a specific medical intervention. In seeking a patient's informed consent (or the consent of the patient's surrogate if the patient lacks decision- making capacity or declines to participate in making decisions), physicians should: (a) Assess the patient's ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision. (b) Present relevant information accurately and sensitively, in keeping with the patient's preferences for receiving medical information. The physician should include information about: ⁃ The diagnosis (when known); ⁃ The nature and purpose of recommended interventions; ⁃ The burdens, risks, and expected benefits of all options, including foregoing treatment. (c) Document the informed consent conversation and the patient's (or surrogate's) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record. In emergencies, when a decision must be made urgently, the patient is not able to participate in decision-making, and the patient's surrogate is not available, physicians may initiate treatment without prior informed consent. In such situations, the physician should inform the patient/surrogate at the earliest opportunity and obtain consent for ongoing treatment in keeping with these guidelines. Under Philippine setting, the Department of Health issued a regulation as regards obtaining patients consent in conformity with the universal declaration of patients rights. The said rule states; That the patient will not be subjected to any procedure without his written informed consent, except in the following cases: a. in emergency cases, when the patient is at imminent risk of physical injury or death if treatment is withheld or postponed. In such cases, the physician can perform any diagnostic or treatment procedure as good practice of medicine dictates without such consent; b. when the health of the population is dependent on the adoption of a mass health program to control epidemic; c. when the law makes it compulsory for everyone to submit a procedure; d. when the patient is either a minor or legally incompetent, in which case, a third party consent is required;  e. when disclosure of material information to the patient will jeopardize the success of treatment, in which case, third party disclosure and consent shall be in order; f. when the patient waives his right in writing. Informed consent shall be obtained from the patient concerned if he/she is of legal age and sound mind. In case the patient is incapable of giving consent and a third party consent is required. The following persons, in the order of priority stated hereunder, may give consent: i. spouse; ii. son or daughter of legal age; iii. either parent; iv. brother or sister of legal age, or v. guardian If a patient is a minor, consent shall be obtained from his parents or legal guardian. If next of kin, parents or legal guardians refuse to give consent to a medical or surgical procedure necessary to save the life or limb of a minor or a patient incapable of giving consent, courts, upon the petition of the physician or any person interested in the welfare of the patient, in a summary proceeding, may issue an order giving consent. 60 Advance Directives A legal document signed by a competent person to provide guidance for health care, medical or surgical and decisions (such as the removal of life support or decision for an organ donation) in situations that patient becomes incompetent to make such decisions. The two types of advance directives are living will and durable power of attorney. Living will is a legal document used to provide certain future health decisions only when a person becomes unable to decide and or choose options on their own. The living will is only used at the end of life if a person is terminally ill or permanently unconscious. The living will describes the type of medical treatment the person would want or not want to receive in these situations. It can state under what circumstances that is necessary to prolong one's lite should be started or stopped. This applies to treatments including, but not limited to breathing machines, dialysis, assistive feedings, or actual life support (such as the use of respirator) Before a health care team can resort to a patient's living will to guide certain health care decisions, the attending physician must confirm that the patient is unable to make his/her own medical decisions. The patient must also be under a medical condition that is specified by existing regulations as terminal illness or permanent unconsciousness. There are many things to consider when writing a living will. These include: ⁃ If the patient wants the use of equipment such as dialysis machines or ventilators to help keep you alive. ⁃ Do Not Resuscitate (DNR) orders (instructions not to use CPR if breathing or heartbeat stops). ⁃ If the patient would prefer for fluid or liquid (usually by IV) and/or food (tube feeding into your stomach) if he/she is unable to eat or drink. ⁃ If the patient opts for treatment for his/her pain, nausea, or other symptoms, even if he/she can't make other decisions (this may be called comfort care or palliative care).  ⁃ If the patient consents to donate his/her organs or other body tissues after death. 62 Durable power of attorney (DPA) for health care, also known as medical power of attorney, is a legal document in which the patient names a person to be a proxy (agent) to make all health care decisions if the patient became unable to do so. Before a medical power of attorney can be used to guide medical decisions, a person's physician must certify that the person is unable to make their own medical decisions. If the patient becomes unable to make your own health care decisions, the designated proxy or agent can speak with the health care team and other caregivers on his/her behalf and make decisions according to the wishes or directions earlier stated or consented by the patient. If certain situations are not known or previously assented by the patient, the designated proxy or agent will make a decision based on what he/she thinks is best for the client. If the patient regains his/her consciousness and able to make his/her own medical decisions, the appointed proxy (agent) shall lose his/her capacity to make medical decisions on the patient's behalf. The person who can be designated as a proxy or substitute should be someone the patient knows well and that he/she can trust to carry out personal or medical wishes decisions. The appointed proxy or substitute should understand how the patient would make decisions as if the patient is conscious or able, and should be comfortable asking questions and advocating the health care team on the patient's behalf. It is suggested that the patient discusses his/her decisions and wishes in detail with the proxy for proper execution when the time comes. The patient may also choose two or more names as backup proxies in case the first choice becomes unable or unwilling to perform his/her designated duties in behalf of the patient. "Do Not Resuscitate" (DNR) Order A Do-Not-Resuscitate order or DNR order is a medical order written by a doctor and consented to by the patient or relatives. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. A DR order is created or set up before an emergency occurs. A DR order allows you to choose whether or not you want CPR in an emergency. It is specific about CPR. It does not have instructions for other treatments, such as pain medicine, dialysis, other medicines, or nutrition. The doctor writes the order only after talking about it with the patient (if possible), the proxy, or the patient's family. Nursing care is directed toward meeting the comprehensive needs of patients and their families across the continuum of care. This is particularly vital in the care of patients and families at the end of life to prevent and relieve appalling symptoms and suffering that are commonly associated with dying. Nurses are leaders and vigilant advocates for the delivery of dignified and humane care. Nurses actively participate in assessing and assuring responsible and appropriate use of interventions in order to minimize unwarranted or unwanted treatment and patient suffering even at the edge of death. The DR decision should reflect what the informed patient wants or would have wanted. This demands that communication about end-of-life wishes occur among all involved parties (patient, health care providers, and family) and that appropriate DNR orders be written before a life-threatening crisis occurs. If the patients wishes are unknown, the patient's best interest is the prime consideration. The choices and values of the competent patient should always be given the highest priority, even when these wishes conflict with those of the health care team and family. An exception to this is when one or more physicians determine that CPR attempts would be medically ineffective or if the decision of the patient/ surrogate is in conflict with the informed opinion of the agency/ provider as to what constitutes beneficent care of the patient. 65  Nurses need to be aware of and have an active role in developing DR policies within the institutions where they work. In health care organizations, clear DR policies should be in place that will enable nurses to effectively participate in this crucial aspect of patient care. The appropriate use of DNR orders, together with adequate palliative end-of-life care, can prevent suffering for many dying patients who experience cardiopulmonary arrest. As primary continuous health care professionals in health care facilities, nurses must be involved in the planning as well as the implementation of resuscitation decisions. The American Nurses Association recommends that: 1. Clinical nurses actively participate in timely and frequent discussions on changing goals of care and initiate DNR discussions with patients and their families and significant others. 2. Clinical nurses ensure that DR orders are clearly documented, reviewed, and updated periodically to reflect changes in the patient's condition. 3. Nurse administrators ensure support for the clinical nurse to initiate DR discussions. 4. Nursing service administrators should develop mechanisms whereby the DNR form accompanies all inter-organizational transfers. 5. Nurse administrators have an obligation to assure palliative care support for all patients. 6. Nurse educators teach that there should be no implied or actual withdrawal of other types of care for patients with DR orders. DNR does not mean "do not treat." Attention to language is paramount to indicate the absence or presence of a DNR order should be strictly avoided. 7. Nurse educators develop and provide specialized education for nurses, physicians, and other members of the interdisciplinary health care team related to DNR. 8. Nurse researchers explore all facets of the DNR process to build a foundation for evidence- based practice. 9. All nurses ensure that whenever possible, the DR decision is a subject of explicit discussion between the health care team, patient, and family (or designated surrogate), and that actions taken are in accordance with the patient's wishes. 10. All nurses facilitate and participate in interdisciplinary mechanisms for the resolution of disputes between patients, families, and clinicians' NR orders. 11. All nurses actively participate in developing DNR policies within the institutions where they work. Specifically, policies should address, consider, or clarify the following: a. Guidance to health care professionals who have evidence that a patient does not want CPR attempted but for whom a DR order has not been written; b. Required documentation to accompany the DNR order, such as a progress note in the medical record indicating how the decision was made; c. The role of various healthcare practitioners in communicating with patients and families about DNR orders; d. Effective communication of DNR orders when transferring patients within or between facilities; e. Effective communication of DNR orders among staff that protects against patient stigmatization or confidentiality breaches; f. Guidance to practitioners on specific circumstances that may require reconsideration of the DNR order (e.g., patients undergoing surgery or invasive procedures); g. The needs of special populations (e.g., pediatrics, terminally-ill, and geriatrics). Organ Donation Organ donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient). Transplantation is necessary because the recipient's organ has failed or has been damaged by disease or injury.  Organ transplantation is one of the great advances in modern medicine. Unfortunately, the need for organ donors is much greater than the number of people who actually donate. Organs and tissues that can be transplanted include: ◦ Liver ◦ Kidney ◦ Pancreas ◦ Heart ◦ Lung ◦ Intestine ◦ Heart valves ◦ Cornea ◦ Middle ear ◦ Skin ◦ Bone ◦ Bone marrow ◦ Connective tissue ◦ Vascularized composite allografts(transplant of several structures that may include skin, bone, muscles, blood vessels, nerves, and connective tissue) In the Philippines, the passage of Republic Act No. 7170, otherwise known as the Organ Donation Act of 1991, as amended by Republic Act No. 7885, organ and tissue donations from donors who have been declared brain dead has been allowed. Under the legislation, each individual can donate all or any part of his/her body by way of legacy or will. The members of the family may also authorize such a donation in the absence of contrary intention by the decedent. Donations are only valid when made for therapy, research, or medical education. International sharing of organs is recognized but subject to approval by the Department of Health. The Department of Health (DOH) is encouraging families to consider organ donation of deceased relatives, including those who have been declared legally and medically brain dead, to help others in need of transplantation. Human transplantable organs in the Philippines only include the kidneys, liver, lungs, heart, intestines, and pancreas, in addition to human tissues such as eye tissues (corneas, sclera, etc.), bones, skin, and blood vessels. Through organ donation, one deceased human being can potentially save and dramatically improve the quality of life of eight or more individuals. The DOH also discourages incentivized organ donations, where living organ donors not related to the recipient are motivated by financial rewards. This system creates a risk for both the donor and the recipient, exposing them to further injury. World Health Organization (WHO) data from 2017 show that deaths caused by various end- stage organ diseases involved up to 230,000 Filipinos. This may have been prevented by organ transplantation. Unfortunately, organ donation from brain dead patients remains dismally low in the Philippines.  To heighten Filipino consciousness on the benefits of organ sharing, a presidential proclamation was proposed designating the month of September of every year as "National Organ and Tissue Donation Awareness Month." With the campaign slogan "Dugtong Buhay: Ako, Kabahagi Mo!" the program underscores the Filipino spirit of "bayanihan" where those extending help do not expect anything in return. The DOH, through the Philippine Organ Donation and Transplantation Program and the Philippine Network for Organ Sharing, continues to sustain advocacy and educational campaigns on deceased organ donation. The DOH recognizes the noble and altruistic act of saving a life through committing one's organs or tissues upon one's death. This can be done by signing up as organ donor cardholders and providing consent to organ donation. Indeed, organ donors are heroes of our times. 68 Last Will and Testament Basic terminologies: Last will and testament or simply a "will," is an act whereby a person is permitted, with the formalities prescribed by law, to control to a certain degree the disposition of his estate. It is a document whereby a person, called the "testator," disposes of his/ her properties or "estate," to take effect upon his/her death. The testator is the deceased person who made a last will and testament. The person who is given personal property through a will is technically called the "legatee," while the person who is given real property in a will is called the "devisee." The person named in the will who is entrusted to implement its provisions is called the "executor." If the "executor" is female, she is formally known as the "executrix". There are two kinds of wills, holographic and notarial. A holographic will must be entirely written, dated, and signed by the hand of the testator himself/herself. It is subject to no other form, and may be made in or out of the Philippines, and need not be witnessed (See Article 810, New Civil Code). On other hand, a notarial will is governed by the following provision of the Civil Code that states that: ART. 805. Every will, other than a holographic will, must be subscribed at the end thereof by the testator himself/herself or by the testator's name written by some other person in his/her presence, and by his/her express direction, and attested and subscribed by three or more credible witnesses in the presence of the testator and of one another. The testator, or the person requested by him/her to write his/her name and the instrumental witnesses of the will, shall also sign, as aforesaid, each and every page thereof, except the last, on the left margin, and all the pages shall be numbered correlatively in letters placed on the upper part of each page. The attestation shall state the number of pages used upon which the will is written, and the fact that the testator signed the will and every page thereof, or caused some other person to write his/her name, under his/her express direction, in the presence of the instrumental witnesses, and that the latter witnessed and signed the will and all the pages thereof in the presence of the testator and of one another. If the attestation clause is in a language not known to the witnesses, it shall be interpreted to them. ART. 806. Every will must be acknowledged before a notary public by the testator and the witnesses. The notary public shall not be required to retain a copy of the will, or file another with the office of the Clerk of Court. Regardless of the form required by law, the purpose of a last will and testament is to dispose or convey real and personal properties of a patient through a legal document that will be effective at the time of his death. Nurses may be required as Witnesses during the signing of a will, if they are not the designated heir/s to avoid conflict of interest. Delegation Delegation is defined as the transfer of the nurse's responsibility for the performance of a task to another nursing staff member while retaining accountability for its outcome. Responsibility can be delegated but not accountability. The "Five Rights of Delegation" that must be used when assigning care to others are: 1. The "right" person; 2. The "right" task; 3. The "right" circumstances; 4. The "right" directions and communication; and 5. The "right" supervision and evaluation. Principles for Delegation The following principles provide guidance and inform nurse's decision-making about delegation: ⁃ The nursing profession determines the scope and standards of nursing practice. ⁃ The nurse takes responsibility and accountability for the provision of nursing practice. ⁃ The nurse directs care and determines the appropriate utilization of resources when providing care. ⁃ The nurse may delegate tasks or elements of care but does not delegate the nursing process itself. ⁃ The nurse considers procedures and the knowledge and skills, training, cultural awareness, and experience of any individual to whom the nurse may delegate elements of care. ⁃ The decision to delegate is based upon the nurse judgment concerning the care complexity of the patient, the availability and competence of the individual accepting the delegation, and the type and intensity of supervision required. ⁃ The nurse acknowledges that delegation involves the relational concept of mutual respect. ⁃ Nurse leaders are accountable for establishing systems to assess, monitor, verify, and communicate ongoing competence requirements in areas related to delegation. ⁃ The institution is accountable to provide sufficient resources to enable appropriate delegation. ⁃ The institution is accountable under "respondeat superior" for problems arising from delegated tasks. ⁃ Organizational/agency policies on delegation are developed with the active participation of registered nurses. If delegation is needed for patients' care, the following measures are recommended: ⁃ Determine the baseline status and data of the patient. ⁃ Determine the standard and unchanging tasks, which can be delegated to nurse assistants. ⁃ The proper reporting among the nurse assistants if the baseline status is changed ⁃ Proper documentation of expectations as appropriate ⁃ Tasks are still within the nurse's scope of practice and what may be delegated. ⁃ Staff competencies to perform the delegated task ⁃ The requirement for supervision among those delegated  ⁃ Monitor implementation of the delegated task and determine continuity of plan of care. ⁃ Implement proper evaluation of overall condition and patients response to the delegated task. 290 ⁃ Evaluate the assistant's skills and performance of tasks. ⁃ Provide proper feedback mechanism for improvement and continuous supervision. Pointers on Delegation a. Tasks that cannot be delegated by the nurse to subordinate nursing personnel. - Teaching - Assessment - Planning - Evaluating - Decision-making b. Tasks that can be delegated to a nursing assistant ⁃ Ambulating ⁃ Turning ⁃ Bathing ⁃ Intake and output ⁃ Mouth care ⁃ Toileting ⁃ Linen changes ⁃ Feeding ⁃ Vital signs (but not to patient unstable RN needs to do) ⁃ Weights\ ⁃ Does not perform medications or invasive procedures (tube feeding, foley catheters etc.) ⁃ Does not delegate tasks for unstable patients