The Liberal Medical Dilemma: Rights of Mentally-Challenged Patients A rights-based approach to the legal issues of mental health nursing

necessitates a conceptual discussion of the very idea of rights, in general, and rights of mentally-challenged patients, in particular. This is so since it is important to highlight how their status as contemplated by the law relates to those of their healthy counterparts. In what follows two things will be discussed: (1) the liberal foundation of a rights-based approach, and (2) the concept of civil personality in Philippine law as it relates to mentallychallenged patients. Liberal Rights Model and Mental Health Nursing. The philosophical framework of the idea of rights is the liberal view of man, that is, he is rational and is able tend for himself. As such, it is but appropriate to vest him with rights for him to express himself in relation to others in society, with the ultimate end that he will find self-fulfillment. From this alone, the applicability of a rights-based framework on mentallychallenged persons, particularly those in need of health care becomes problematic. This is so since the very premise of the framework, i.e. man is rational, is at issue. Civil Personality of Mentally-Challenged Patients. A person, in a legal sense, is one who possesses civil personality. Civil personality has two components: (a) juridical capacity, or simply, personality, and (b) capacity to act. The Civil Code of the Philippines defines both concepts thus:
Juridical capacity, which is the fitness to be the subject of legal relations, is inherent in every natural 1 person...Capacity to act, which is the power to do acts with legal effect, is acquired and may be lost.

Thereafter, the Civil Code elucidates how these components of civil personality works. It is important to note the following: 1. Birth determines personality. In other words, one becomes a person, that is, fit to be the subject of legal relations, once he is born. This means that mentally-challenged patients are persons having at least the first component of civil personality, i.e. juridical capacity, in the contemplation of the law. 2. Insanity and imbecility, at least as defined by law, are characterized as (a) mere limitations, and (b) modifications or restrictions to capacity to act. If it be supposed that the class of insane and imbecile persons as defined by law is roughly equivalent to the class of mentally-challenged patients, then it will be accurate to say that said patients have limited or restricted capacity to act, i.e. to act with legal effect. This is important to note since it implies that they do have capacity to act but the same is restricted or limited. Given these frameworks, it becomes clear that mentally-challenged patients are placed in a different class than those of their healthy counterparts. This class is apparently one which occupies a lower plane. The perusal of this fact yields a two-pronged discussion: (1) in relation to the principle of equal protection of laws provided by no less than the Constitution, and (2) in relation to principles of fairness. The former is descriptive in that it describes the current state of our law; the latter is prescriptive in that it describes what the law can and should be in relation to mental health nursing.
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Art. 37, Civil Code of the Philippines. Art. 40, Civil Code of the Philippines. 3 Art. 38, Civil Code of the Philippines. 4 Art. 39, Civil Code of the Philippines.

The Constitution provides that No person shall be deprived of life, liberty, or property without due process of law, nor shall any person be denied the equal protection of the laws. Highlighting the mandate that no person shall be denied the equal protection of the laws, why does the law treats mentally-challenged persons, in general, and patients, in particular, differently as compared to their healthy counterparts? Jurisprudence in the Philippines have been unanimous in stating that equal protection of the laws does not mean that all persons should be treated equally; it only means that differential treatment or classification should be based on substantial distinctions. As such, children have lesser rights than adults. This state called minority is similar to insanity in that it is also a modification to capacity to act. In other words then, in the contemplation of the law, the difference in treatment of and ascription of rights to the mentally-challenged patients is based on a valid and substantial distinction. Simply put, they are different from their healthy counterparts. In what way or ways exactly, one cannot sweepingly declare given the diverse health conditions of said patients. This brings us to the next prong of the critique: is this an acceptable and a morally justifiable manner to treat mentally-challenged patients? Again, a sweeping answer cannot be given since there are many types of mental deficiencies that afflict patients. As such, the acceptability of respecting their preferences in terms of what health services to avail or not to avail also varies. This is due to the fact that their very capacity for rational decision is at issue. Whether or not the current state of our law is satisfactory in their treatment of mentally-challenged patients as a class depends on the stock of knowledge that informs and sustains the establishment of the said classification. Consequently, when our understanding of mental deficiencies increase, the basis for the classification will either be sustained or abandoned. Ultimately, while it is a truism that each person should be treated equally, the case of mentallychallenged patients is problematic. This is not to say that they are not to be regarded as persons, since the law itself treats them as such. What is to be pointed out, however, is the very premise of their having and therefore exercising of rights is questioned. Also, in order to provide a rule to be used in the treatment of said patients, our understanding on the forms of mental deficiencies needs to be clear so as to determine the extent of the capacity of those afflicted for rational decision.
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Sec. 1, Art. III, 1987 Constitution of the Philippines.