Introduction

In the Philippines, a Special Power of Attorney (SPA) for Healthcare (also known as a Healthcare Proxy, Medical Power of Attorney, or Advance Healthcare Directive with proxy) is a legal instrument that allows a person (the Principal) to appoint another individual (the Agent or Healthcare Proxy) to make medical and healthcare decisions on his or her behalf when the Principal becomes incapacitated and unable to express informed consent.

This document becomes operative only upon the Principal’s incapacity as determined by attending physicians. It is distinct from a general or ordinary power of attorney because it is limited exclusively to healthcare decisions.

Legal Basis

While the Philippines does not yet have a comprehensive national law specifically governing advance directives and healthcare proxies (as of December 2025), the Special Power of Attorney for Healthcare derives its validity from the following provisions of existing law:

Civil Code of the Philippines
- Articles 1868–1909 (Agency)
- Article 1883 – Special powers of attorney are required for acts of strict dominion or ownership, but medical decisions are considered acts of administration that can be validly delegated through a special power of attorney.
- Article 1892 – The agent must act within the scope of authority.
Republic Act No. 9439 (“Patients’ Rights Act of 2008”)
- Recognizes the patient’s right to informed consent and the right to appoint a surrogate decision-maker when the patient is incapacitated.
Republic Act No. 7170 (Organ Donation Act) and RA 11215 (National Integrated Cancer Control Act)
- Implicitly acknowledge the role of surrogates in life-and-death decisions.
Supreme Court decisions and DOH Administrative Orders
- The Supreme Court has repeatedly upheld the primacy of patient autonomy and the validity of surrogate decision-making when the patient is incompetent.
Senate Bill No. 1906 (Advance Medical Directive Act) and similar bills
- As of 2025, these bills remain pending in Congress. In the absence of specific legislation, the SPA for Healthcare remains the most practical and widely accepted tool.

When the SPA for Healthcare Becomes Effective

The document must explicitly state that it becomes operative only upon the Principal’s incapacity. Incapacity is usually defined as:

Coma, persistent vegetative state, terminal illness, severe dementia, or any condition where the patient cannot understand the nature and consequences of the medical decision (as certified in writing by two licensed physicians, one of whom is the attending physician).

Scope of Authority of the Healthcare Agent

A well-drafted SPA for Healthcare may authorize the agent to:

Give, withhold, or withdraw informed consent to any medical treatment, procedure, or intervention (including surgery, chemotherapy, dialysis, etc.)
Consent to or refuse life-sustaining treatment (mechanical ventilation, tube feeding, resuscitation – CPR/DNR)
Access medical records
Hire or fire healthcare providers
Admit or discharge from hospitals or hospices
Authorize autopsy or disposition of remains (if included)
Make anatomical gifts (organ donation)

The authority is limited to healthcare decisions only. It does not include financial or property matters unless expressly combined with another SPA.

Requirements for Validity

Capacity of the Principal
The Principal must be of legal age (18 years old and above) and of sound mind at the time of execution.
In Writing
The SPA must be in writing. While notarization is not strictly required by the Civil Code for the validity of the agency relationship between principal and agent, notarization is strongly recommended (and required by most hospitals) because:
- It constitutes prima facie evidence of authenticity (Section 30, Rule 132, Revised Rules on Evidence)
- Hospitals and doctors insist on notarized copies to protect themselves from liability.
Two Disinterested Witnesses
Many templates follow the practice of having at least two disinterested witnesses (similar to a Last Will and Testament) even if not strictly required by law for an SPA.
Clear Activation Trigger
The document must specify that it springs into effect only upon certification of incapacity by two physicians.
Specificity
The power granted must be clearly described. A vague SPA will be rejected by hospitals.

Recommended Structure of a Philippine SPA for Healthcare

A robust document usually contains the following parts:

Title: “SPECIAL POWER OF ATTORNEY FOR HEALTHCARE DECISIONS (Healthcare Proxy / Advance Healthcare Directive)”
Details of the Principal (full name, address, citizenship, etc.)
Appointment of Primary Agent and one or two Alternate Agents
Effective date and trigger (upon incapacity certified by two physicians)
Detailed enumeration of powers
Guidance on the Principal’s values and wishes (optional but highly recommended – this section functions as a Living Will)
Provision on life-sustaining treatment (comfort-care only, or prolong life at all costs, etc.)
Signature of Principal
Signature of two disinterested witnesses
Acknowledgment before a Notary Public
Annex: Optional separate “Living Will” or treatment preferences

Relationship with a Separate Living Will

Many Filipinos execute two separate documents:

A Living Will (personal declaration of treatment preferences when terminally ill or in persistent vegetative state)
A Healthcare SPA (appointing an agent)

They complement each other. The Living Will guides the agent; the SPA gives legal authority to enforce the wishes.

Sample Key Clauses (commonly accepted by major hospitals)

Activation Clause
“This Special Power of Attorney shall become effective only upon my incapacity to give informed consent as determined and certified in writing by two licensed physicians.”

Life-Sustaining Treatment Clause (example of comfort-care preference)
“If I am in a terminal condition or persistent vegetative state with no reasonable prospect of recovery, I direct that I be given only comfort care and pain relief, and that artificially provided nutrition and hydration and all other life-sustaining measures be withheld or withdrawn.”

DNR Clause
“My agent is authorized to execute a Do-Not-Resuscitate (DNR) order if, in the opinion of my attending physician, attempted resuscitation would be futile or excessively burdensome.”

Revocation

The Principal may revoke the SPA at any time while still competent by:

Executing a written revocation (preferably notarized)
Physical destruction of all copies
Oral revocation in the presence of witnesses (less advisable)

Acceptance by Hospitals and Doctors

Major hospitals (St. Luke’s, The Medical City, Makati Medical Center, Philippine General Hospital, Asian Hospital, Cardinal Santos, etc.) now routinely honor properly executed and notarized SPAs for Healthcare, especially after training programs conducted by the Philippine Society for Hospice & Palliative Care and the Bioethics departments of medical schools.

Practical Tips

Execute the document while still healthy.
Give copies to: your agent(s), alternate agents, family physician, and preferred hospital(s).
Review and update every 3–5 years or after major life events.
Discuss your wishes in detail with your appointed agent(s).
Have multiple original notarized copies.

Limitations and Risks

Doctors may still refuse to follow the agent’s decision if it violates their personal moral beliefs (conscientious objection), although they must refer or transfer care.
In the absence of a national registry, there is always a risk that an old revoked copy may surface.
Family members who disagree with the agent may file a court petition (rare but possible).

Conclusion

Until the Philippines enacts a dedicated Advance Medical Directives law, the notarized Special Power of Attorney for Healthcare, combined when possible with a separate Living Will, remains the most effective and legally recognized method of ensuring that your medical treatment preferences are respected when you can no longer speak for yourself.

It is a profound act of autonomy, love, and responsibility toward your family, sparing them the agony of guessing what you would have wanted during the most difficult moments of life. Consulting a lawyer experienced in estate planning and healthcare law is highly recommended to tailor the document to your specific wishes and to ensure it will be honored by Philippine healthcare institutions.