[Pinoy Criminology] Protecting the old and sickly from prolonged trial detention

There are moments when a legal system must pause and ask itself a basic, uncomfortable question: At what point does detention stop being justice and start becoming a slow death sentence?

That question hovered over the recently concluded Jail and Prison Decongestion Summit organized by the Philippine Supreme Court from January 21 to 23, 2026, at the Manila Hotel. Amid discussions of clogged dockets, delayed hearings, and overworked judges, one proposal stood out for its moral clarity and practical urgency: medical recognizance.

Medical recognizance is disarmingly simple. It allows the provisional release of a person deprived of liberty whose health has deteriorated to the point that continued detention will aggravate illness or result in death. It is not acquittal. It is not absolution. It is a recognition that the State’s power to detain does not include the power to let people die needlessly while waiting for their day in court.

This proposal arises from a reality too grim to ignore. Philippine jails, particularly those under the Bureau of Jail Management and Penology (BJMP), operate at an average congestion rate of 286 percent nationwide, placing the country among the most congested jail systems in the world. Cells built for 20 people routinely hold three or four times that number. In extreme cases documented in recent years, facilities designed for a handful of detainees have held hundreds. These are not outliers; they are symptoms of a system stretched far beyond humane limits.

Congestion would already be intolerable if detention were brief. But it is not. Criminal cases in the Philippines take an average of 528 days to be resolved. That is a year and a half of waiting — for a hearing, for a witness, for a reset, for another postponement. For healthy detainees, this is punishment by delay. For the sick, the elderly, and the disabled, it is often a countdown.

The numbers tell their own story. In Metro Manila alone, at least 40 detainees die every month, many from preventable illnesses, such as tuberculosis, pneumonia, hypertension, and other chronic conditions. These deaths are not caused by crime; they are caused by confinement in spaces where air is scarce, sanitation is inadequate, and medical care is limited or absent. Detention becomes less a holding measure and more a medical risk factor.

The Supreme Court has, to its credit, recognized that health and age matter. In the landmark decision granting bail to Juan Ponce Enrile, the Court acknowledged that frail health and advanced age constitute humanitarian grounds for release. The logic was sound: justice must be tempered with compassion when detention itself becomes cruel.

But therein lies the problem. That compassion has never been systematized. There is no clear, uniform mechanism for ordinary detainees — those without power, prestige, or a battalion of lawyers — to seek the same consideration. Humanitarian release has remained an exception enjoyed by the few, rather than a right accessible to all who meet objective criteria.

Medical recognizance seeks to correct this imbalance, not by lowering standards but by clarifying them.

Under the proposed mechanism, a detainee may petition the court for release on medical grounds when three conditions are present:

• The detainee suffers from a chronic, debilitating, or life-threatening illness.
• Continued detention will aggravate the condition or endanger life.
• The jail facility lacks the capacity to provide adequate treatment.

These are not speculative claims. They must be supported by medical evidence.

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The process begins with certification from the jail’s medical officer, detailing the diagnosis, the detainee’s condition, the risks of continued detention, and the facility’s limitations. For serious cases, this is followed by a mandatory independent medical evaluation by a Department of Health–accredited physician or medical panel. This two-tier system protects against abuse while ensuring credibility.

The proposal is precise about what constitutes medical urgency. It includes conditions such as active tuberculosis, severe cardiac or respiratory failure, cancer requiring chemotherapy or palliative care, signs of organ failure, recurrent hospitalization, rapid weight loss, post-surgical conditions requiring rehabilitation, severe mental health disorders, and advanced age accompanied by comorbidities.

Judicial action is time-bound. Courts are required to act on petitions within five judicial days, recognizing that medical emergencies do not wait for procedural convenience. Where imminent danger exists, provisional release may be ordered pending completion of documentation. Release may take the form of recognizance, hospital arrest, or house arrest, with conditions imposed to ensure continued court jurisdiction.

Crucially, medical recognizance does not extinguish criminal liability. The case proceeds. The accused remains under the authority of the court. Reporting requirements, medical updates, and travel restrictions may be imposed. Any misrepresentation by the accused or false certification by medical personnel carries penalties, including revocation of release and administrative or criminal sanctions.

In a system where approximately 75 percent of detainees are awaiting trial, detention often reflects poverty rather than guilt. Monetary bail punishes the indigent and spares the affluent. Medical recognizance disrupts this logic by shifting the focus from money to medicine, from ability to pay to risk to life.

There is a deeper question beneath all this: What is the purpose of detention? If it is to ensure appearance in court, medical recognizance can achieve that through conditions. If it is to protect public safety, releasing a terminally ill or severely incapacitated detainee under supervision hardly undermines that goal. If it is punishment, then we must ask whether death by neglect is a sentence our laws actually authorize.

Medical recognizance does not solve jail congestion. It does not cure court delay. It does not fix a broken bail system overnight. What it does is narrower — and more urgent. It prevents detention from becoming a form of quiet execution for those who are old, sick, and still legally innocent.

A justice system reveals its character not in how it treats the powerful, but in how it treats the powerless. Medical recognizance asks the State to remember a simple truth: custody does not cancel humanity. And compassion, when structured and accountable, is not the enemy of justice — it is its final proof. – Rappler.com

Raymund E. Narag, PhD, is an associate professor in criminology and criminal justice at the School of Justice and Public Safety, Southern Illinois University, Carbondale.