G.R. No. 184535 - Separate Opinion

G.R. No. 184535, September 3, 2019,
♦ Resolution, Per Curiam
♦ Separate Opinion, Peralta, [J]
♦ Separate Opinion, Leonen, [J]
♦ Separate Opinion, Jardeleza, [J]
♦ Separate Opinion, Caguioa, [J]
♦ Separate Opinion, Reyes, [J]

SISTER PILAR VERSOZA, PETITIONER, VS. PEOPLE OF THE PHILIPPINES, MICHELINA S. AGUIRRE-OLONDRIZ, PEDRO AGUIRRE, AND DR. MARISSA PASCUAL, RESPONDENTS.

While there were doctrinal points that this Court unanimously agreed upon, I feel that we could have gone further. There are points that should have been discussed.

Parents and legal guardians have a duty to enable their children or their wards. Legal guardians commit to take care of their wards as if they were their own. They are to love and to sacrifice always in the child's best interest. They have no prerogative to deprive them of any of their faculties. Parents and legal guardians have no right to decide on the reproductive rights of their children or wards.

Society has the general duty to protect its children. The Constitution declares the State to be the ultimate defender of a child's right to a full, decent, and dignified life.3 This role is of even greater importance in this case. Apart from being a child, Laureano "Larry" Aguirre (Larry) has a cognitive disability that rendered him incapable of fully comprehending the repercussions of a vasectomy. At the time of the procedure, he was chronologically a 24-year-old man with a mental age of an 8-year-old. It would have been impossible for him to consent to the procedure. Undergoing bilateral vasectomy requires personal reflection as it involves one's reproductive health.

This Court was confronted with a novel issue of whether the bilateral vasectomy conducted on Larry constitutes child abuse. Cases involving child abuse are public matters in which the State is necessarily involved.4 This case is of unique importance because it deals with the rights of a child with disability, who is under the People of the Philippines' special mantle of protection no less.5

Child abuse is often committed in the confines of a home, in secret and away from public notice. The child suffers silently, powerless against the abusive parent or guardian, and will most likely frame a world that justifies the despicable acts done to him or her. In the same vein, the child's self-esteem suffers, and he or she will grow to believe that all adults will be like their parent or guardian.

Indeed, child abuse is a crime with among the greatest propensities to remain hidden but causes the most damage.

Our traditional concept for the prosecution of crimes is that it should be initiated by a private offended party or by a law enforcer. But, definitely in this case, Larry could not have done so. Chances are, no social worker or law enforcer would have noticed the procedure done on him. The crime's novelty as a potential form of abuse conspire with the act itself having no visible consequences to ensure that the act remains hidden.

Vasectomy, in general, refers to a sterilization procedure for men6 where a segment of the vans deferens is cut to obstruct the flow of spermatozoa.7

Medical practitioners use various techniques in performing vasectomy.8 The transection of the vans deferens can be done through a conventional vasectomy, where the vas deferens "usually is grasped with a towel clip or an Allis forceps."9 A more recent method is the no-scalpel vasectomy, which uses a minimally invasive technique. Both types are done by making a midline incision or bilateral scrotal incisions using a scalpel.10

The most common type of vasectomy, which was conducted on Larry, is called bilateral vasectomy11 or bilateral partial vasectomy. In this procedure, the vas deferens in both scrotums are cut and removed or obstructed.12

There is a common misconception that vasectomy is a permanent method of birth control. On the contrary, it is medically possible to restore fertility through vasectomy reversal,13 where the cut ends of the vas deferens are reattached through microsurgery. The most common procedures are vasovasostomy and vasoepididymostomy.14 Reversal may even happen accidentally as a result of other medical procedures.15

The success of vasectomy reversal, however, depends on several factors. Patient evaluation is important. Factors such as the surgical skill, the patient's medical history, and antibodies may influence its success rate.16

The gravity of the procedure conducted on Larry presents before this Court important questions on the extent of the right to a full and dignified life of a child with cognitive disability vis-a-vis parental authority as contemplated by law.

Therefore, it is necessary to determine, for the guidance of the bench, the bar, and the public, whether the bilateral vasectomy conducted on Larry is a form of child abuse. In the 17 years17 that have passed since his unconsented vasectomy, Larry's cognition may have developed enough for him to become more aware of the procedure's ramifications.

Vital for discussion are the following: (1) whether Larry qualifies as a child under the law; (2) how abuse, neglect, and cruelty are defined in jurisprudence; and (3) whether the vasectomy made on Larry constitutes abuse, cruelty, neglect, or exploitation, or is prejudicial to his development.

Child abuse, as contemplated in Republic Act No. 7610,18 is a general concept consisting of several punishable acts. Section 3(b) of Republic Act No. 7610 provides its definition:

The acts constituting child abuse are amplified in the succeeding provisions of Republic Act No. 7610. Sections 5 and 6 deal with child prostitution and other forms of sexual abuse; Sections 7 and 8 cover child trafficking; Section 9 punishes obscene publications and indecent shows that involve a child.

To provide further protection to children, Republic Act No. 7610 expands the concept of child abuse to cover other acts of abuse.19 Section 10(a) of Republic Act No. 7610 states:

SECTION 10. Other Acts of Neglect, Abuse, Cruelty or Exploitation and Other Conditions Prejudicial to the Child's Development.

Section 10(a) punishes four (4) distinct acts in addition to those already covered by Article 59 of Presidential Decree No. 603, as amended, namely: (1) other acts of child abuse; (2) cruelty; (3) exploitation; and (4) being responsible for conditions prejudicial to the child's development.20 These offenses are independent of the child abuse acts specified in Republic Act No. 7610.21

For the acts in Section 10(a) to be punishable, the following elements must be accounted for: (1) the victim must be a child under the law; (2) the act committed is either abusive, cruel, or exploitative of the child, or is prejudicial to the child's development; and (3) the accused committed or is responsible for the act.22

Recognizing an individual with cognitive disability as a child is nothing new in this jurisdiction. In People v. Spouses Ybañez,23 the accused were convicted of qualified trafficking of persons. Among the three (3) victims was a girl who was more than 18 years old but was found to be "functioning within a mildly retarded level[.]"24 She was deemed a child under Republic Act No. 9208:

Section 3(a) of Republic Act No. 7610 defines a child as a "person below eighteen (18) years of age or those over but are unable to fully take care of themselves or protect themselves from abuse, neglect, cruelty, exploitation or discrimination because of a physical or mental disability or condition[.]" Recognizing the concept of mental age, the law deems that a person with cognitive disability is a child regardless of his or her chronological age. He or she would still be under the protection of the law.

In People v. Quintos,26 where a person with intellectual disability was raped, this Court defined "twelve (12) years of age" under Article 266-A(1)(d) of the Revised Penal Code as either the chronological age of a child or the mental age if a person has intellectual disability. We held:

Though Larry was chronologically 24 years old when the procedure was conducted on him, he actually had a mental age of an 8-year-old. He also has a mild mental deficiency, which rendered him unfit to decide on matters on his own. Larry is, therefore, a child under the law.

Notably, psychiatrist Marissa B. Pascual (Dr. Pascual) reported that Larry's disability "could be associated with possible perinatal insults[.]"28 While no explanation was provided in Dr. Pascual's psychiatric report, medical journals have discussed "perinatal insults" as having the effect of altering brain development.29

Perinatal brain injury commonly manifests with neonatal encephalopathy or brain malfunctions, including seizures.30 It is usually brought about by "cerebral ischemia, cerebral hemorrhage, or an ascending intrauterine infection."31 The most severe forms of perinatal brain damage lead to cerebral palsy, while a less severe damage may result in subtle changes in the child's neurodevelopment.32 Children "who suffer from perinatal brain injury often deal with dramatic consequences of this misfortune for the rest of their lives."33

Through no fault of his own, Larry's cognitive development has been severely hampered. Rather than the unfounded judgment that he would be incapable of making his own choices eventually as an adult, Pedro and Lourdes Aguirre (the Aguirre Spouses) should have extended their understanding and guidance to Larry as one would to a child, for however long it takes, to prepare him for the life to which he was entitled.

The Aguirre Spouses may have the authority to substitute Larry's . decision with their own, but they must make one that is always in favor of Larry's best interests. Their failure to do so allows the State to intervene, especially if the act is tantamount to abuse, neglect, cruelty, or one that prejudices Larry's development.

Section 10(a) of Republic Act No. 7610 is unique in that it was designed to protect children from any and all forms of abuse. It broadened the definition and scope of child abuse to supply inadequacies in our existing laws, thus strengthening the State's policy on the protection of "the most vulnerable members of the population, the Filipino children[.]"34

Araneta v. People35 laid the rule that Section 10(a) punishes four (4) separate and distinct acts, thus:

The important element in determining if there was a violation of Section 10(a) of Republic Act No. 7610 is whether the act is or can be prejudicial to a child's development. This should be read together with Section 3(b). A fundamental rule of statutory construction is that courts should not distinguish where the law does not distinguish—"ubi lex non distinguit, nee nos distinguire debemus."37

It should be remembered that the Philippines is a signatory38 to the Convention on the Rights of Persons with Disabilities. Its salient provisions state:

This commitment to uphold everyone's fundamental right to human dignity is echoed in our very own Constitution. Article XIII, Section 1 states:

To this end and in relation to family and reproductive rights, laws have been enacted with no less than the express recognition of equality and non-discrimination. The Responsible Parenthood and Reproductive Health Act of 2012,39 for one, declares as state policy the eradication of "discriminatory practices, laws and policies that infringe on a person's exercise of reproductive health rights."40 The reproductive concerns of men are also recognized as part of male responsibility.41 An entire section devoted on programs for persons with disabilities was included:

For guidance, the Implementing Rules and Regulations of Republic Act No. 761042 defines "child abuse," "cruelty," "neglect," and "exploitation" as:

The infliction of physical injury as abuse is not difficult to comprehend. In Torres v. People43 this Court deemed the act of whipping a child thrice with a wet t-shirt as child abuse:

Unlike physical abuse, which ordinarily requires overt acts, neglect is committed by omission. It pertains to the withholding of a child's needs to fully participate in society, such as access to food, education, shelter, and care, all of which children are legally entitled to in recognition of their right to grow into adulthood under the best circumstances.45

Neglect may be typified as: (1) physical; (2) educational; (3) emotional; and (4) medical.46

Physical neglect refers to the failure to provide a child's basic needs, which consists of food, clothing, and shelter. Educational neglect consists in the failure to ensure that the child receives proper and adequate education. Emotional neglect is the failure to nurture by, among others, ignoring or isolating the child. Medical neglect pertains to the failure to provide proper healthcare to a child, as when, for instance, one ignores medical recommendations.47

Neglect has also been expanded to recognize environmental neglect and supervisory neglect.48 Environmental neglect pertains to a situation where a child is left in a hazardous or unclean location. Supervisory neglect refers to a situation where a child is abandoned or left under the custody of an inappropriate substitute.49

Cruelty, on the other hand, is a much broader term as it includes acts done by word or deed. In any case, the act targets the child's intrinsic worth and dignity without regard to his or her humanity.

What comprises abuse depends on the circumstances of each case. For instance, this Court held in Bongalon v. People50 that not every physical harm done on the child is child abuse:

Although the intent of Republic Act No. 7610 was recognized in Amanquiton v. People,52 this Court cautioned that:

In reconciling the guidelines, courts should carefully examine the particular act that is alleged to constitute child abuse with due regard to the child's intrinsic worth and dignity. The ultimate determination depends on whether the act done on the child debilitates or debases his fundamental integrity, harming his or her future growth and development.

The vasectomy conducted on Larry violates his fundamental right to life and liberty.

Article III, Section 1 of the Constitution states that "[n]o 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." In Rubi v. The Provincial Board of Mindoro,54 Associate Justice George Malcolm elaborated on the right to liberty:

Granted, this liberty is not impenetrable from interference. As early as 1910, this Court has recognized in U.S. v. Toribio56 that "the State may interfere wherever the public interests demand it, and in this particular a large discretion is necessarily vested in the legislature to determine, not only what the interests of the public require, but what measures are necessary for the protection of such interests."57

However, when public interest is not under threat, neither the State nor any individual may forcibly interfere with the life and choices of another.

There will always be a sphere of autonomy within an individual's life with which the State cannot interfere. This pertains to the exercise of his or her basic human rights. The protection of the inherent dignity of every individual is guaranteed by no less than the Constitution.58 The State is obliged to ensure that every individual can make choices free from personal restraint, especially if what is at stake is a fundamental human right.

This is relevant in reproductive health rights. The area of freedom where decisions surrounding one's right to procreate are made is sacrosanct, the protection further bolstered by one's right to privacy.

Although the right to privacy is intertwined with the right to liberty, it is a distinct right that is equally entitled to protection under the Constitution.59 Article III, Section 3(1) states that "[t]he privacy of communication and correspondence shall be inviolable except upon lawful order of the court, or when public safety or order requires otherwise as prescribed by law."

The right to privacy, however, not only pertains to privacy of one's communication and correspondence. It has many dimensions, referred to as "zones of privacy," which are embedded in other constitutionally guaranteed freedoms. In Morfe v. Mutuc:60

Apart from the Constitution, our laws also recognize the zones of privacy. In Ople v. Torres:62

In his speech, "The Common Right to Privacy," retired Chief Justice Reynato S. Puno distinguished among three (3) different aspects or "strands" of the right to privacy, namely: (1) locational privacy; (2) informational privacy; and (3) decisional privacy.64

Locational privacy, also known as situational privacy, pertains to privacy that is felt in a physical space. It may be violated through an act of trespass or through an unlawful search.65 Meanwhile, informational privacy refers to one's right to control "the processing—i.e., acquisition, disclosure, and use—of personal information."66

Decisional privacy, regarded as the most controversial among the three, refers to one's right "to make certain kinds of fundamental choices with respect to their personal and reproductive autonomy."67 It finds relevance in matters that involve one's reproductive health.

Several provisions in our Constitution, though not in express terms, are essentially related to reproductive health:

SECTION 12. The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception. The natural and primary right and duty of parents in the rearing of the youth for civic efficiency and the development of moral character shall receive the support of the Government.

SECTION 1. The State recognizes the Filipino family as the foundation of the nation. Accordingly, it shall strengthen its solidarity and actively promote its total development.

(1) The right of spouses to found a family in accordance with their religious convictions and the demands of responsible parenthood[.]

One's autonomy over his or her life and body, therefore, is inextricably linked with the right to privacy.68

Reproductive health rights, being within the sphere of autonomy, are protected from interference by private individuals, including parents and guardians. At most, they can only provide guidance and education. Larry will still grow, and his mental capacity will be beyond 18 at some point. In their premature judgment that Larry would be incapable of becoming a responsible adult, the Aguirre Spouses curtailed his liberty and violated his decisional privacy.

Ignorance and fear have infantilized persons with intellectual disability, broadly categorizing them as asexual juveniles. As a result, their display of affection and sexual behaviors are dismissed as less acceptable.69

Historically, this led to practices of "selective breeding" through surgical sterilization, which prevented persons with intellectual disability from fully realizing their sexual rights.70

At present, there are available therapies and interventions that target and minimize the impairment level and improve the functionality of one with such disability.71 Intellectual disability does not disqualify an individual from becoming a parent.72 With adequate support and education, those with intellectual disability may have a healthy, appropriate expression of sexuality, and eventually, parenting skills and capacity to raise their own children.73

The possibility of Larry understanding his right to reproduce in the future should not be disregarded simply because his development is medically considered "slow." As a child in need of greater care and consideration, respondents should have acted more humanely and responsibly.

Moreover, Larry's ability to exercise his right to procreate goes beyond a mere invocation of his reproductive health rights. It seeps into his capacity to form relationships, to start a family, to be a responsible parent, and to live his life as fully and as meaningfully as possible. Taking away his ability to sire children effectively debilitates him as a child and a human being. While Larry is not barred from engaging in a relationship or sexual relations that could lead to having a child, the vasectomy has severely limited his options to start a family of his own. The decision to undergo vasectomy, whether reversible or not, involves an act that is part of private rights. The right to reproduce forms part of how humans define themselves. The choice of whether to reproduce should be respected, even if the person has cognitive disability.

Thus, the vasectomy on someone with cognitive disability, without his' or her consent, is both an act of cruelty and an act prejudicial to the person's' development.

Cruelty refers to something that debases, degrades, or demeans the intrinsic value of a child.74 This may be seen in two (2) ways. On one hand, it can refer to an act and the manner by which it was done. On the other hand, it can also refer to the result of an act.

The unconsented vasectomy on Larry is clearly a case of cruelty, not so much for the manner it was done, but because of the circumstances surrounding its commission and the resulting limitations to the way Larry will be able to live the rest of his life.

The vasectomy was a decision made by respondents despite the medical finding that Larry, at that time, was unable to comprehend the procedure's long-term ramifications. While parents are capable of exercising authority over their children, this authority is by no means unlimited. Parental authority is both a right and an obligation, granted by law under the presumption that it will be exercised for the full development of a child's mind, heart, and senses.75 Under no circumstances is it allowed to be exercised in a way that is violative of human dignity or will diminish another's intrinsic worth. Santos, Sr. v. Court of Appeals76 describes the nature of parental authority as a "sum of duties":

[Parental authority] is a mass of rights and obligations which the law grants to parents for the purpose of the children's physical preservation and development, as well as the cultivation of their intellect and the education of their heart and senses.ℒαwρhi৷ As regards parental authority, "there is no power, but a task; no complex of rights, but a sum of duties; no sovereignty but a sacred trust for the welfare of the minor."77

The mark of a good parent is not measured by his or her material wealth or mental faculties. Rather, a good parent is one who exhibits the patience, love, and ability to sacrifice so that the child discovers what it is to be nurtured, protected, and resilient.

Being cognitively disabled is not a barrier to parenthood. A person's disability has no direct correlation to being a good parent:78

It is important to separate personality from disability, to acknowledge that cognitive limitation is only about how people learn. Rarely is it the most If significant factor in deciding whether someone can parent adequately.

A parent's disability, in itself, does not necessarily determine whether a parent will be a "good enough" parent. While the individual characteristics of the parent are important, the characteristics of the supports available have a lot of influence over whether parents will succeed.79

Under the philosophy of supported parenting, persons who are cognitively disabled are fully capable of being parents themselves if given wholehearted support by both their family and community.80 This requires that their needs be identified, including "the parent's individual learning style; the parent's current knowledge, behavior, attitudes, beliefs, values; available support systems, and available resources."81

Yet, Larry's legal guardians, instead of acting only for his best interests, substituted his consent with their own under the guise of "protection."82 There were other options for Larry who, in time, could have children of his own. But this was taken away from him by the people who should have acted in Larry's best interest. To deprive him of all the options his life had to offer is an act of cruelty. It was an act borne out of selfishness, not love. It was not for them to conclude that Larry cannot become a parent or care for someone other than himself.

The State's responsibility to protect children with disabilities is both an international and constitutional commitment. When no one else is willing to take up the cudgels for Larry, the State must not renege on its duty to ensure the protection of his human dignity simply on the ground of procedural infirmity. The State must not allow the violation of a child's right made even in the misguided concept of parental authority.

ACCORDINGLY, I vote that the bilateral vasectomy conducted on Larry be considered as child abuse and a violation of Republic Act No. 7610.