Achmad Shiva’ul Haq Asjach
Scholar ID, Sinta ID, Scopus ID, WoS ID
Introduction
Healthcare
services constitute a form of public service that is closely associated with
the protection of human rights, particularly the right to obtain safe,
high-quality, and humane healthcare services. In carrying out their
professional duties, medical personnel are not only bound by professional
standards and standard operating procedures, but also by professional codes of
ethics and applicable legal regulations. Consequently, issues frequently arise
in healthcare practice regarding the boundaries between ethical violations,
professional disciplinary violations, and legal violations, particularly in
cases involving alleged medical negligence.
The professional
code of ethics for medical personnel serves an essential function as a moral
and professional guideline in the provision of healthcare services to patients.
Nevertheless, the implementation of professional ethical standards in Indonesia
continues to face various challenges, including weak ethical oversight, limited
public understanding of medical risks, and the growing tendency to criminalize
medical personnel in cases of unsuccessful healthcare outcomes. In this
context, the harmonization between ethical responsibility and legal liability
becomes highly significant in ensuring patient protection while simultaneously
providing legal certainty for medical personnel.
Implementation
of the Professional Code of Ethics for Medical Personnel in Indonesia
A professional
code of ethics constitutes a set of moral norms that serves as a guideline for
the conduct of medical personnel in performing their professional duties. In
the Indonesian medical profession, these ethical guidelines are embodied in the
Indonesian Medical Code of Ethics (Kode Etik Kedokteran Indonesia/KODEKI),
which emphasizes the principles of humanity, professionalism, respect for
patients’ rights, and the obligation to maintain the quality of healthcare
services (KODEKI, 2012).
The
implementation of the professional code of ethics aims to maintain a
relationship of trust between physicians and patients. Such a relationship is
fiduciary in nature, meaning that it is founded upon the trust that medical
personnel will act in the best interests of the patient. Accordingly, medical
personnel are obligated to provide healthcare services in accordance with
professional standards, standard operating procedures, and the principle of due
care (Nasution, 2013).
In practice, the
implementation of the professional code of ethics continues to encounter
various obstacles. One of the primary issues is the weak supervision and
enforcement of professional ethical standards in an effective and transparent
manner. In many instances, ethical violations are resolved solely through
internal professional organizational mechanisms, without adequately providing a
sense of justice for patients. Furthermore, some medical personnel remain less
than optimal in implementing informed consent procedures, resulting in patients
not receiving comprehensive medical information prior to the performance of
medical treatment or procedures (Komalawati, 2002).
Harmonization
of Ethical Responsibility and Legal Liability of Medical Personnel
The responsibilities of medical personnel are fundamentally not limited to ethical obligations, but also encompass civil, criminal, and administrative legal liabilities. These three forms of responsibility are often interconnected in cases involving alleged medical negligence.
Ethical Responsibility
Ethical responsibility relates to the compliance of medical personnel with the professional code of ethics. Ethical violations may include inhumane conduct, the unauthorized disclosure of patients’ medical confidentiality, discrimination in healthcare services, and actions inconsistent with the dignity of the medical profession. Ethical violations are examined by professional ethics councils, which aim to uphold the honor of the profession and maintain the integrity of medical personnel (Soekanto, 1990).
Civil Liability
From the perspective of civil law, the relationship between physicians
and patients gives rise to a therapeutic legal relationship based on an
obligation of best efforts (inspanning verbintenis). This means that
physicians do not guarantee recovery; rather, they are obligated to undertake
their best medical efforts in accordance with professional standards
(Komalawati, 2002).
If a patient suffers losses as a result of medical negligence, the patient may file a civil lawsuit based on breach of contract or tortious conduct, as regulated under Article 1365 of the Indonesian Civil Code (Kitab Undang-Undang Hukum Perdata/KUHPerdata). In such cases, the patient must prove the existence of fault, damages, causality, and unlawful conduct on the part of the medical personnel.
Criminal Liability
Criminal liability arises when medical personnel commit gross negligence
resulting in serious injury or the death of a patient. Under Indonesian
criminal law, provisions concerning negligence are regulated in Articles 359
and 360 of the Indonesian Criminal Code (Kitab Undang-Undang Hukum Pidana/KUHP).
Nevertheless, not every medical failure may be classified as a criminal offense. The medical field inherently involves risks in the form of complications and adverse events that may occur even when medical personnel have acted in accordance with professional standards. Therefore, the establishment of proof regarding medical negligence must be conducted carefully in order to prevent the criminalization of medical personnel (Guwandi, 2004).
Administrative Liability
Administrative liability relates to violations of administrative
regulations governing healthcare services, such as practicing without a
license, breaches of service standards, or failure to fulfill the
administrative obligations imposed on hospitals and medical personnel.
Administrative sanctions may include warnings, restrictions on medical
practice, revocation of practice licenses, and other administrative penalties
in accordance with Law Number 17 of 2023 concerning Health.
Examples of
Alleged Medical Negligence Cases
One of the most
common cases occurring in Indonesia involves allegations of medical malpractice
arising from delays in patient treatment at hospitals, which ultimately result
in the patient’s death. In several instances, the patient’s family directly reports
medical personnel to the police on allegations of malpractice without first
pursuing professional ethical and disciplinary mechanisms.
This phenomenon
demonstrates that the public still finds it difficult to distinguish between
medical risks, medical complications, and medical negligence. Not every patient
death is the result of malpractice. Under certain circumstances, therapeutic
failure may occur due to the patient’s disease risk factors, medical
limitations, or unavoidable complications (Guwandi, 2004). On the other hand,
there are also actual cases in which medical personnel genuinely commit
negligence, such as administering incorrect medication, performing surgical
procedures contrary to established protocols, or delaying emergency treatment.
In such circumstances, medical personnel may be held simultaneously accountable
under both ethical and legal frameworks.
Comprehensive
Legal Solutions
In order to
create a balance between patient protection and the protection of the medical
profession, comprehensive legal solutions are required.
First, it is
necessary to strengthen medical dispute resolution mechanisms through mediation
and professional disciplinary review before cases are brought into the criminal
justice system. This approach is essential to ensure that every adverse event
is not immediately subjected to criminalization.
Second, public
education on health law should be enhanced, particularly regarding the
distinctions between medical risks, medical complications, and malpractice, so
that society may develop a more proportional understanding of medical issues.
Third, the
implementation of informed consent should be optimized as a form of legal
protection for both patients and medical personnel. Clear and transparent
consent to medical treatment will minimize the likelihood of legal disputes in
the future.
Fourth, ethical
oversight by professional organizations and the government must be strengthened
to ensure that the enforcement of professional codes of ethics is conducted
objectively, independently, and accountably.
Fifth,
healthcare legal policy reforms should prioritize a restorative justice
approach in resolving medical disputes, thereby enabling the restoration of the
relationship between patients and medical personnel without disregarding the
principle of justice.
Conclusion
The
implementation of the professional code of ethics for medical personnel in
Indonesia plays an important role in providing protection for patients while
simultaneously maintaining the professionalism of medical personnel. In
healthcare practice, ethical responsibility often intersects with civil,
criminal, and administrative legal responsibilities, particularly in cases
involving alleged medical negligence.
Harmonization
between ethical mechanisms and legal mechanisms is therefore essential to
ensure that patient protection is balanced with legal certainty for medical
personnel. Accordingly, the resolution of medical disputes should not rely
solely on a criminal law approach, but should also take into account ethical
considerations, professional disciplinary mechanisms, mediation, and
restorative justice in order to create a healthcare system that is fair,
professional, and oriented toward patient safety.
References
Guwandi. (2004).
Hukum medik (Medical law). Balai Penerbit FKUI.
Indonesian
Criminal Code (Kitab Undang-Undang Hukum Pidana).
Indonesian
Medical Code of Ethics (Kode Etik Kedokteran Indonesia). (2012).
Indonesian Medical Association (Ikatan Dokter Indonesia).
Komalawati, V.
(2002). Peranan informed consent dalam transaksi terapeutik. Citra
Aditya Bakti.
Nasution, B. J.
(2013). Hukum kesehatan: Pertanggungjawaban dokter. Rineka Cipta.
Soekanto, S.
(1990). Segi-segi hukum hak dan kewajiban pasien dalam kerangka hukum
kesehatan. Mandar Maju.
Law of the
Republic of Indonesia Number 17 of 2023 concerning Health.
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