Bioethics in the Philippines: a Retrospective

A s i a n B i o e t h i c s R e v i e w D e c e m b e r 2 0 0 9 Vo l u m e 1 , I s s u e 4 426 Bioethics in the Philippines: a Retrospective L E O N A R D O D E C A S T R O A N D S A R A H J A N E T O L E D A N O It has been almost 20 years since the Hastings Center Report published an article on bioethics in the Philippines that referred to the emergence of a public awakening. That awakening has led to widespread awareness and public debate, though one cannot fully be confident that bioethics thinking and reasoning have truly matured. In this paper, we review developments in the period since the publication of that article. The presentation covers policies and mechanisms for bioethics review and decision-making. It also refers to issues and controversies that have come to public attention through various mass media. Additionally, it attempts an analysis of some issues in relation to tension points and concepts that have provided a framework for debate and disagreement among various sectors. Influence of Catholicism and Christianity Many aspects of Filipino culture are heavily influenced by Catholicism and Christianity. Any effort to understand developments in bioethics in the context of the Philippines has to take this point into account. 83 per cent of Filipinos declare affiliation with the Catholic Church and the Christian majority makes up about 90 per cent of the total population. Muslims or other religious groups make up the remaining ten per cent. The influence of the Catholic Church has been widely felt in matters of healthcare policy, especially those that have to do with abortion, the promotion of contraceptive use, family planning, and other reproductive health issues. Thus, public debate often takes a form that is at least partly defined by religious orientation. This characterisation was already apparent when a Constitutional Commission was formed in 1986 to rewrite the Philippines’ basic law as various R E T R O S P E C T I V E 426–444 Asian Bioethics Review December 2009 Volume 1, Issue 4 427 lobby groups sought to have nominees with their preferred religious leaning appointed to that body. Indeed, one side was perceived to have taken the upper hand as the 1987 Constitution emerged with a provision to protect “the life of the unborn from the moment of conception” (Article II, Section 12). This provision reflects a position that has repeatedly been affirmed by the Catholic hierarchy. However, actual compliance by ordinary Catholics has been less than enthusiastic. A report prepared for the Guttmacher Institute1 confirms an increasing number of induced abortions in the country, a situation that the Catholic leadership has obviously found worrying. The authors estimate the number of induced abortions in 2000 at 473,000 out of 3.1 million pregnancies. They further estimate that in the same year, 27 out of every 1,000 pregnancies occurring in the country ended up in clandestine and unsafe abortions.2 About 800 women die annually from these unsafe abortions. In addition, the study shows that: ■ One-third of women who experience an unintended pregnancy end it in an abortion. ■ Women who experience abortion come from all segments of society. They resemble average Filipino women in that the majority are married, Catholic and poor. ■ As reason for seeking an abortion, 72% of women cite the economic cost of raising a child; 54% say they have enough children already; and 57% report that the pregnancy occurred too soon after their last one. ■ 33% of women who eventually complete an abortion rely on a husband, partner, relative, friend or neighbour, or take steps to end the pregnancy themselves; 15% consult a pharmacist; and 15% consult either a traditional healer or a street vendor. Only 29% of women obtain an abortion from a doctor. The findings tell us that even if the Philippines is a predominantly Christian country with severe anti-abortion laws, the concerns of women about their reproductive health do not lean heavily...