Supreme Court of the Philippines
The Responsible Parenthood and Reproductive Health Act of 2012
Opinions supporting freedom of conscience
In April, 2014, the Protection of Conscience Project's critique of the Responsible Parenthood and Reproductive Health Act of 2012
(RH Act) was confirmed by a ruling of the Supreme Court of the Philippines.
With respect to the issue of freedom of conscience among health care workers and institutions, of the fifteen Supreme Court judges:
- 11 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 (Del Castillo, J.) held that a requirement to provide complete and correct information was not unconstitutional, as long as it was not used to suppress the freedom of
objecting health care workers to express professional or other
opinions concerning contraception.
Estala M. Perlas-Bernabe
Marvic Mario Victor F. Leonen
Bienvenido L. Reyes
Maria Lourdes P.A. Sereno
Position of the Petitioners [P.60]
2. On Religious Accommodation and The Duty to Refer [P.61]
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
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
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
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
The Respondents' Positions
[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
[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. . .
[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
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
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
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
German went back to the Gerona rule. Ebralinag then employed the
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
has been overruled by Ebralinag which employed the "grave and immediate
danger" test. Victoriano was the only case that employed the
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
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.
[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,
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
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
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
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
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
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
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
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:
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
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
Compelling State Interest
The foregoing discussion then begets the question on whether the
respondents, in defense of the subject provisions, were able to:
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
Senior State Solicitor Hilbay: Ahh, Your Honor, ..
Justice De Castro: What is the compelling State interest to impose
Senior State Solicitor Hilbay: In the first place, Your Honor,
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.
Resultantly, the Court finds no compelling state interest
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
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
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
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. . . .
[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
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
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. . .
8-Involuntary Servitude [P.95]
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
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.
[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:
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
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
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; . . .
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.
208. Gorospe, Constitutional Law, Vol. I, p. I
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.
last visited February 22, 2014
visited February 22, 2014
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
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.
http://fatherbemasblogs.blogspot.com/2011 _02_01_archive.html; last
visited February 15, 2014.
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.