Legal Boundaries Between Palliative Care and Euthanasia in Indonesia: Reassessing End-of-Life Decisions Under Law No. 17 of 2023 on Health and Article 461 of the New Criminal Code

This article examines the legal boundaries between palliative care, treatment limitation, and euthanasia in Indonesia after the enactment of Law No. 17 of 2023 on Health and Minister of Health Decree No. HK.01.07/Menkes/2180/2023 on Palliative Care Services. Using normative legal research, the study combines statutory, conceptual, and comparative approaches. It argues that Indonesian law does not decriminalize active euthanasia. Article 461 of Law No. 1 of 2023 concerning the Criminal Code continues to criminalize intentionally taking another person’s life at that person’s serious request. At the same time, Indonesian health law recognizes palliative care and permits clinically appropriate end-of-life decisions, including withholding or withdrawing medically futile treatment, where the purpose is to avoid disproportionate intervention and relieve suffering rather than to cause death. The absence of detailed procedural safeguards creates uncertainty for patients, families, hospitals, and healthcare professionals. The article distinguishes euthanasia from treatment refusal, limitation of futile treatment, and palliative sedation by examining intention, causation, medical indication, proportionality, and procedural accountability. Comparative lessons from the Netherlands, Belgium, and Victoria, Australia are used not to recommend automatic legalization of euthanasia, but to identify safeguards that can improve Indonesian end-of-life governance. The article proposes a rights-based framework consisting of capacity assessment, written informed consent, independent medical review, multidisciplinary consultation, ethics oversight, documentation, dispute resolution, and good-faith legal protection for professionals. This framework preserves the criminal-law prohibition on intentional life-ending acts while strengthening dignity, autonomy, and legal certainty in terminal care.

euthanasia; palliative care; end-of-life decision-making; informed consent; criminal law; Indonesia.

1. Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press. [Google Scholar] [Crossref]

2. Council of Europe. (1997). Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine (Oviedo Convention). https://rm.coe.int/168007cf98 [Google Scholar] [Crossref]

3. Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2018). Comparison of the expression and granting of requests for euthanasia in Belgium. Palliative Medicine, 32(1), 114–122. [Google Scholar] [Crossref]

4. Dworkin, R. (1993). Life's dominion: An argument about abortion, euthanasia, and individual freedom. Alfred A. Knopf. [Google Scholar] [Crossref]

5. European Association for Palliative Care. (2016). Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliative Medicine, 30(2), 104–116. [Google Scholar] [Crossref]

6. Furlan, T. J. (2024). James Rachels and the morality of euthanasia. Theoretical Medicine and Bioethics, 45, 69–97. [Google Scholar] [Crossref]

7. Gamester, N., & Van den Eynden, B. (2009). Palliative care and legalized euthanasia in Belgium. Journal of Palliative Medicine, 12(7), 589–591. [Google Scholar] [Crossref]

8. General Medical Council. (2020). Treatment and care towards the end of life: Good practice in decision making. [Google Scholar] [Crossref]

9. Indonesia. Constitution of the Republic of Indonesia of 1945. [Google Scholar] [Crossref]

10. Indonesia. Law No. 1 of 2023 concerning the Criminal Code. [Google Scholar] [Crossref]

11. Indonesia. Law No. 17 of 2023 concerning Health. [Google Scholar] [Crossref]

12. Kementerian Kesehatan Republik Indonesia. (2023). Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/Menkes/2180/2023 tentang Pedoman Penyelenggaraan Pelayanan Paliatif. [Google Scholar] [Crossref]

13. Materstvedt, L. J., Clark, D., Ellershaw, J., et al. (2003). Euthanasia and physician-assisted suicide: A view from an EAPC Ethics Task Force. Palliative Medicine, 17(2), 97–101. [Google Scholar] [Crossref]

14. Mroz, S., Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2021). Assisted dying around the world: A status quaestionis. Annals of Palliative Medicine, 10(3), 3540–3553. [Google Scholar] [Crossref]

15. National Health Service. (2023). End of life care. [Google Scholar] [Crossref]

16. Pope, T. M. (2019). Medical futility and potentially inappropriate treatment. Journal of Clinical Ethics, 30(2), 115–126. [Google Scholar] [Crossref]

17. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. (1983). Deciding to forego life-sustaining treatment. U.S. Government Printing Office. [Google Scholar] [Crossref]

18. Radbruch, G. (2006). Statutory lawlessness and supra-statutory law (B. Litschewski Paulson & S. L. Paulson, Trans.). Oxford Journal of Legal Studies, 26(1), 1–11. (Original work published 1946) [Google Scholar] [Crossref]

19. Rachels, J. (1975). Active and passive euthanasia. The New England Journal of Medicine, 292(2), 78–80. [Google Scholar] [Crossref]

20. Sulmasy, D. P., & Mueller, P. S. (2017). Ethics and the legalization of physician-assisted suicide. Annals of Internal Medicine, 167(8), 576–578. [Google Scholar] [Crossref]

21. The Royal Australian College of General Practitioners. (2022). End-of-life care clinical guidelines. [Google Scholar] [Crossref]

22. Victoria State Government. (2017). Voluntary Assisted Dying Act 2017 (Vic). [Google Scholar] [Crossref]

23. World Health Organization. (2020). Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care [Google Scholar] [Crossref]

24. World Health Organization. (2023). Integrating palliative care and symptom relief into primary health care. [Google Scholar] [Crossref]

25. Yale School of Medicine. (2022). Palliative care principles and practice. [Google Scholar] [Crossref]

26. Youngner, S. J., & Arnold, R. M. (2001). The challenge of euthanasia and physician-assisted suicide. Journal of Clinical Ethics, 12(2), 89–96. [Google Scholar] [Crossref]

27. Quill, T. E., Lo, B., & Brock, D. W. (1997). Palliative options of last resort. JAMA, 278(23), 2099–2104. [Google Scholar] [Crossref]

28. Singer, P. (2011). Practical ethics (3rd ed.). Cambridge University Press. [Google Scholar] [Crossref]

29. Australian Government Department of Health. (2023). National Palliative Care Strategy 2018. [Google Scholar] [Crossref]

30. Canadian Medical Association. (2021). Medical Assistance in Dying (MAID): CMA Policy. [Google Scholar] [Crossref]

31. World Medical Association. (2022). Declaration on Euthanasia and Physician-Assisted Suicide. [Google Scholar] [Crossref]

32. American Medical Association. (2023). Code of Medical Ethics Opinion 5.7: Physician-Assisted Suicide. [Google Scholar] [Crossref]

33. General Medical Council. (2024). Decision making and consent. [Google Scholar] [Crossref]

34. Beauchamp, T. L. (2020). Standing on principles: Collected essays. Oxford University Press. [Google Scholar] [Crossref]

35. Childress, J. F. (2020). Public bioethics: Reflections on ethics and public policy. Oxford University Press. [Google Scholar] [Crossref]

36. Veatch, R. M. (2016). The basics of bioethics (3rd ed.). Routledge. [Google Scholar] [Crossref]

37. Pellegrino, E. D., & Thomasma, D. C. (1993). The virtues in medical practice. Oxford University Press. [Google Scholar] [Crossref]

• Occupational Culture in Relation to Job Satisfaction and Work Performance among Police
• Inmates' Character Reformation and Recidivism in Nigeria: A Study of Okaka Correctional Facility, Yenagoa, Bayelsa State.
• Life World of Former Female Basic Internal Security Operations Course (BISOC) Trainees
• Efficacy of Fingerprint and Facial Recognition in Enhancing National Security in Kenya
• No More Catcalling: Awareness of College of Criminal Justice Education Students on Republic Act 11313 Also Known as Safe Spaces Act