The Right to Care Ordinances: Who Decides When the Patient Cannot?
Thirteen local governments now require hospitals to recognize healthcare proxies. Their ordinances do not agree with one another — and the differences fall exactly where a hospital most needs certainty.
First of two parts. Part Two, "Can Someone Else Consent to Your Surgery?", takes up whether Philippine law permits medical consent to be delegated at all.
An elderly man is admitted to a private tertiary hospital, seriously ill. He has been separated in fact from his wife for many years; they were never annulled, and there are grown children. For the better part of two decades he has lived with another woman, and it is she who is at the bedside — who knows his medications, who has managed his care, whom the nursing staff have been briefing since admission.
Some days in, the legal wife arrives. She has not been part of his life in years, and she arrives at the point in an illness when questions of succession begin to take shape.
Two women in the corridor. One holds a marriage certificate. The other holds the patient's trust, his history, and his actual care. The patient can no longer say which of them he wants deciding for him.
Who does the attending physician listen to?
Every hospital in this country has some version of this case, and most resolve it the same way — by reaching for the marriage certificate, because it is the only document in the room. That instinct is understandable. It is also less grounded in law than the institutions relying on it believe.
The "Right to Care" ordinances now spreading across the Philippines are an attempt to answer that question in advance. They deserve serious attention from hospital counsel, and something the coverage has not given them: a candid account of what they can and cannot do.
Beginning with an uncomfortable one. Had that man lived in Quezon City, the pioneer jurisdiction, he could not have executed a Right to Care proxy at all.
Born at Pride, but no longer confined to it
On the last Saturday of June, Metro Manila Pride returned to Remedios Circle in Malate under the banner Bukas, Atin. Three years earlier, almost to the week, Quezon City had launched something quieter at the same season — a card with a QR code, given to couples whose relationships the law does not name.
The Right to Care Card was born of that grievance, and should be described honestly as a gift from the LGBTQIA+ community. But it did not stay there. The same silence in Philippine law that strands a same-sex partner also strands the common-law spouse of thirty years, the solo parent, the seafarer's household, and the widow whose children are all abroad and whose only real next of kin is the friend she has shared a house with since the nineties.
For hospitals, that shift is the whole story. This is no longer an advocacy matter arriving occasionally at the admitting desk. It is a compliance obligation in a growing list of jurisdictions.
Where the policy now stands
Quezon City moved first, launching the card in June 2023 and institutionalizing it through Ordinance No. SP-3221, S-2023 — passed on third and final reading on 2 October 2023 and approved by Mayor Josefina “Joy” Belmonte on 20 October 2023. Its title is plain: an ordinance requiring the recognition of health care proxies by all health facilities within Quezon City. San Juan City followed two years later, and Iloilo City in March 2026. Mandaluyong, Parañaque, Dasmariñas, Biñan, and Laoag City have since enacted their own, Laoag under the name Alikaka, the Ilocano word for care.
The provinces followed. Cavite legislated first; Cebu came next, but by executive order of Governor Pamela “Pam” Baricuatro rather than by ordinance; Laguna and Ilocos Sur then legislated in turn. Ilocos Sur's Provincial Ordinance No. 0337, S-2026 — enacted unanimously on 26 May 2026 and approved by Governor Jeremias C. Singson on 17 June 2026 — establishes a Right to Care and Healthcare Companion Support Program with the Provincial Health Office as lead agency and a provincial registry of principals and care partners.
Bills are pending in both chambers to make the policy national, and Northern Samar has signaled it will follow.
What is striking is the compression. Quezon City stood alone for two years. Nearly every other enactment has come in the past eight months, and the pace has not slowed. Any hospital not yet covered should assume it soon will be.
That velocity creates the problem this article is about. These ordinances are being drafted quickly, in parallel, by councils working from each other's press coverage rather than from a common statute — and the results do not line up.
Two of them are examined closely here: Quezon City, because it is the template everyone else has worked from, and Ilocos Sur, because it is among the most recent and the most fully built out. Both are read from certified copies rather than from reporting, which matters more than it should — press accounts of these ordinances conflict routinely on dates, numbering, and scope. Where the two diverge is where every other ordinance will need to be checked.
Not all of these are the same instrument
An ordinance is legislation; an executive order is not. A governor's EO binds the provincial bureaucracy and its own facilities. It cannot create obligations enforceable against a private hospital.
The reported scope of the Cebu issuance is also narrower — designating a trusted person to accompany a patient, serve as emergency contact, and assist in accessing social services. Companionship and contactability are not authority to consent to or refuse treatment. Any hospital, and any cardholder, that treats the two as interchangeable is heading for a bad afternoon.
The ordinances do not agree with each other
This is the part that matters operationally, because they diverge on the three points a hospital most needs settled.
Who may execute one, and who may serve. Quezon City confines the role of Principal to an adult who is single or legally separated, or the partner of a qualified agent who is a city resident. Ilocos Sur imposes no such limit, opening the program to any adult residing in the province. Iloilo City diverges in a third direction, setting the threshold at twenty-one rather than eighteen and requiring that the agent be a fellow resident not related to the principal — a restriction that would disqualify the very sibling or child another ordinance would prefer.
The Quezon City restriction deserves more attention than it has received. Legal separation is a judicial decree, not a state of affairs, and in a country without divorce comparatively few separated Filipinos hold one. The effect is that the person most often stranded by the existing rules — long estranged from a spouse, never judicially separated, building a life with someone else — is the person the pioneer ordinance does not cover.
Quezon City appears to have reached the same conclusion. A measure is pending before the 23rd City Council to amend SP-3221 by providing universal access to health care proxy designation and safeguards consistent with existing national laws. If enacted in those terms, the civil-status restriction goes. Until then it stands, and every ordinance drafted from the Quezon City template should be checked for the same clause.
Who is bound. Quezon City directs all health care providers within its territorial jurisdiction, and backs it with a fine of five thousand pesos or imprisonment of up to six months, together with a report to the Department of Health. Ilocos Sur mandates recognition only by public healthcare facilities; private facilities are "strongly encouraged" to do the same, and the penalty clause reaches only public healthcare personnel through civil service proceedings. A private hospital in Vigan and a private hospital in Quezon City are in entirely different legal positions.
Who wins a conflict. This is the sharpest divergence, and the ordinances fall into three groups that do not merely differ — they contradict.
The agent prevails. Quezon City provides that decisions by the health care agent shall have priority over decisions by any other person, subject only to limits in the proxy itself. Dasmariñas reproduces the formulation. Parañaque carries Quezon City's identical penalty structure, and Biñan's ordinance title tracks it almost word for word. Where this clause appears, the estranged relative in the corridor has no standing to override the designated agent, and the hospital's path is clear.
The family prevails. Cavite's provincial ordinance takes the opposite position, providing that the proxy decides on the condition that a first-degree relative is incapable or not present. That subordinates the designated agent to the family rather than elevating him above it. Same policy label, inverted rule.
Nobody decides. Ilocos Sur provides that where the care partner and another claimant disagree, the provider shall act in accordance with existing laws, court orders, and applicable medical and ethical standards. That is not a rule. It creates the conflict and hands it back to the attending physician, pointing to "existing laws" which — as the second part of this series argues — do not answer the question.
The practical consequence deserves stating plainly. Presented with the same two claimants at the same bedside, a hospital in Quezon City must follow the designated agent, a hospital in Cavite may have to look first for a first-degree relative, and a hospital in Vigan is on its own. A national policy this is not.
So the first thing to establish about any ordinance binding your facility is which of those three it contains.
A hospital group operating across several LGUs cannot write one policy off one ordinance.
What immunity clauses can and cannot do
Several ordinances grant immunity to providers acting in good faith, and risk managers reading news coverage have understandably concluded the exposure is closed.
It is not — and the Quezon City text says so itself, if read closely. Section 9 provides that the City shall hold health care providers, their agents and employees free from liability for honoring in good faith a decision made under the ordinance. The City. Not the courts, and not the aggrieved relative who was never a party to any of it.
Civil liability for medical negligence arises under Articles 19 to 21 and 2176 of the Civil Code, and for institutions under the corporate negligence and apparent authority principles our Supreme Court worked through in Professional Services, Inc. v. Agana (G.R. No. 126297). No local government can abrogate any of it. What these clauses supply is real but narrower: forbearance by the LGU, and evidence of good faith and conformity to a recognized local standard should a relative sue. That is a shield worth having. It is not immunity.
The territorial limit compounds this, and one drafting response shows how partial the fix is. Quezon City recognizes proxies executed in other local government units — but that provision runs inbound only. It tells Quezon City providers to honor a Cavite proxy. It does nothing for a Quezon City card presented in Taguig, and it works only where the other jurisdiction reciprocates. Emergencies do not respect boundaries, and neither do referrals, transfers, and traffic.
What a hospital should do now
Waiting for a national law is understandable and wrong. The obligations in the covered LGUs already exist and, in at least one case, the implementing rules do not yet. Facilities there are bound today and unguided today. Five things are worth doing:
Build a verification and escalation pathway, so a presented card reaches someone with authority to evaluate it rather than being accepted or refused at the counter. Quezon City charges a provider merely presented with a card — or who finds one on the patient's person — with due knowledge of the proxy, and requires the linked instrument to be placed in the medical record.
Pull the ordinance that binds each of your facilities, and read four clauses. Who may execute a proxy; whether private facilities are mandated or merely encouraged; what happens when the agent and a relative disagree; and what the penalty clause actually reaches. Those four answers differ by jurisdiction, and a group policy written off one ordinance will be wrong somewhere. Work from the certified copy — press reporting on these measures is unreliable on scope.
Distinguish, in writing, the decisions an agent may make from those requiring elevated review. Ilocos Sur expressly extends the agent's authority to ventilators and intubation. No ordinance in force squarely addresses withdrawal of treatment already begun.
Document the capacity determination. In every design the agent's authority is contingent on it, and Ilocos Sur specifies what the record must contain: the factual and medical basis, the date and time, and the name and designation of the professional who made it.
Train admitting and emergency staff on what the card is — evidence of a notarized agency, not a municipal license, and not a substitute for clinical judgment.
Policies should be drafted against the specific ordinances binding each facility, and reviewed with counsel. That is not a formality. The institution is being asked to choose between two claimants, on contested authority, in minutes, with Agana in the background.
The question underneath
All of this assumes the cards work — that a person may validly appoint someone to consent to treatment on their behalf. That assumption is less secure than it looks, and no ordinance can secure it. Part Two of this series, "Can Someone Else Consent to Your Surgery?", takes up that question.
For now, the corridor. Nothing in our statutes tells the attending physician which of those two women speaks for the patient. The ordinances are an attempt to ensure that, next time, the patient will have spoken for himself — though in the city where the movement began, a man in his position could not have spoken at all.
This article is general information, not legal advice. For a specific situation, consult counsel.
