Health Facility Accountability for Terminal Patient Palliative Care Services Under Health Law

Rusman Wahyusetiawan; Adi Herisasono; Rafadi Khan Khayru; Yeni Vitrianingsih; Fayola Issalillah

Authors

Rusman Wahyusetiawan Universitas Sunan Giri Surabaya, Indonesia
Adi Herisasono Universitas Sunan Giri Surabaya, Indonesia
Rafadi Khan Khayru Universitas Sunan Giri Surabaya, Indonesia
Yeni Vitrianingsih Universitas Sunan Giri Surabaya, Indonesia
Fayola Issalillah Universitas Sunan Giri Surabaya, Indonesia

Keywords:

palliative care; terminal patients; quality of service; informed consent; medical records; pain management; facility accountability

Abstract

This article examines the construction of obligations and accountability standards for health facilities in providing palliative care for terminal patients based on national health law. A normative legal study was used to assess the relationship between patients' rights to quality services, the obligations of the implementing institutions, and the accountability mechanisms arising from medical consent, medical records, and pain management. The analysis shows that palliative obligations are rooted in the guarantee of the right to health, as reinforced by the Health Law, the Hospital Law, and the Minister of Health Regulation on palliative care. Institutional accountability standards are realized through informed consent procedures that ensure patient understanding and consent, complete and verifiable medical record documentation, and pain management that prioritizes safety and the availability of analgesics, including opioids, in accordance with narcotics regulations. Consumer protection regimes, human rights, and medical practice discipline expand the scope of compliance and open the door to administrative, civil, and professional disciplinary sanctions in the event of system negligence. This article offers operational parameters for quality audits and risk mitigation, in the form of standard procedures, documentation indicators, and pharmaceutical governance, so that end-of-life services are carried out humanely and accountably. This approach emphasizes the obligation of hospitals and primary health facilities to establish referral networks, staff training, and complaint handling mechanisms. Compliance can be assessed by tracing written evidence on consent forms, progress notes, pain assessments, and medication records. These findings are relevant for policymakers, facility managers, and health workers. The measure of palliative care quality is determined by the consistency of procedures, transparency of information, and availability of appropriate therapies.

References

Arisanti, N., Sasongko, E. P. S., Pandia, V., & Hilmanto, D. (2019). Implementation of Palliative Care for Patients with Terminal Diseases from the Viewpoint of Healthcare Personnel. BMC Research Notes, 12(1), 1-5

Bernat, J. L. (2013). Ethical Issues in End-of-Life Care. Journal of Neurology, 260(11), 2721–2727.

Berwick, D. M. (2011). Launching Accountable Care Organizations—The Proposed Rule for the Medicare Shared Savings Program. New England Journal of Medicine, 364(16), e32.

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, Health, and Cost. Health Affairs, 27(3), 759–769.

Caraceni, A., Hanks, G., Kaasa, S., Bennett, M. I., Brunelli, C., Cherny, N., … De Conno, F. (2012). Use of opioid analgesics in the treatment of cancer pain: Evidence-based recommendations from the EAPC. The Lancet Oncology, 13(2), e58–e68.

Darmawan, D., Issalillah, F., Khayru, R. K., Herdiyana, A. R. A., Putra, A. R., Mardikaningsih, R., & Sinambela, E. A. (2022). BPJS Patients Satisfaction Analysis Towards Service Quality of Public Health Center in Surabaya. Media Kesehatan Masyarakat Indonesia, 18(4), 124-131.

Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the U.S., Canada, and Europe. New England Journal of Medicine, 374(1), 79–90.

Ferrell, B. R., Temel, J. S., Temin, S., Alesi, E. R., Balboni, T. A., Basch, E. M., Firn, J. I., Paice, J. A., Peppercorn, J. M., Phillips, T., Stovall, E. L., Zimmermann, C., Smith, T. J. (2016). Integration of Palliative Care into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology, 35(1), 96–112.

Gawande, A. (2014). Being Mortal: Medicine and What Matters in the End. New York, NY: Metropolitan Books.

Gudin, J., & Fudin, J. (2013). A Narrative Pharmacological Review of Buprenorphine: A Unique Opioid for the Treatment of Chronic Pain. Pain and Therapy, 2(2), 71–83.

Harianto, A. V., Vitrianingsih, Y., Issalillah, F., & Mardikaningsih, R. (2024). Challenges and Changes Concerning National Health Development in Indonesia: Legal Perspectives, Service Access, and Infectious Disease Management. International Journal of Service Science, Management, Engineering, and Technology, 5(2), 22-26.

Hartika, Y., Saputra, R., Pakpahan, N. H., Darmawan, D., & Putra, A. R. (2023). A Study on the Falsification of Health Certificates: Perspective of Criminal Law and Professional Ethics. Journal of Social Science Studies, 3(2), 175-180.

Herisasono, A., Darmawan, D., Gautama, E. C., & Issalillah, F. (2023). Protection of Patient Rights in the Perspective of Law and Medical Ethics in Indonesia. Journal of Social Science Studies, 3(2), 195-202.

Institute of Medicine. (2012). Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: National Academies Press.

Institute of Medicine. (2015). Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: National Academies Press.

Issalillah, F., R. K. Khayru, & N. Aisyah. (2022). Parameters of Mineral Water that is Safe for Health. Bulletin of Science, Technology and Society, 1(1), 4-6.

Jha, A. K., Orav, E. J., Dobson, A., & Book, R. A. (2010). Measuring Efficiency: The Association of Hospital Costs and Quality of Care. Health Affairs, 29(5), 897–904.

Keles, S. (2019). Palliative Care Ethics: Medicine’s Duty to Help. In Pallative Care. IntechOpen

Kelley, A. S., & Morrison, R. S. (2015). Palliative Care for the Seriously Ill. New England Journal of Medicine, 373(8), 747–755.

Khayru, R. K. & F. Issalillah. (2022). Service Quality and Patient Satisfaction of Public Health Care. International Journal of Service Science, Management, Engineering, and Technology, 1(1), 20 – 23.

Khayru, R. K. & F. Issalillah. (2022). The Equal Distribution of Access to Health Services Through Telemedicine: Applications and Challenges. International Journal of Service Science, Management, Engineering, and Technology, 2(3), 24–27.

Khayru, R. K. (2022). Transforming Healthcare: The Power of Artificial Intelligence, Bulletin of Science, Technology and Society, 1(3), 15-19.

Kruse, C. S., Stein, A., Thomas, H., & Kaur, H. (2018). The Use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature. Journal of Medical Systems, 42(11), 1-16.

Kurniawan, M. F., Rizky, C., Hardyansah, R., & Haniyah, H. (2025). Implementation of the Right to Visiting Service for Inmates in Class I Correctional Institution Surabaya. AL-MIKRAJ Jurnal Studi Islam dan Humaniora (E-ISSN 2745-4584), 5(2), 625-638.

Lethy, Y. N., Issalillah, F., Vitrianingsih, Y., Darmawan, D., & Khayru, R. K. (2023). Legal Protection for Patients Against Negligence of Medical Personnel. International Journal of Service Science, Management, Engineering, and Technology, 4(2), 39-43.

Meier, D. E. (2011). Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care. Milbank Quarterly, 89(3), 343–380.

Mollaoğlu, M. C., Günay, D., & Mollaoğlu, M. (2019). Palliative Care Services from Past to Present.

Noor, A., Herisasono, A., Hardyansah, R., Darmawan, D., & Saktiawan, P. (2023). Juridical Review of the Rights of Indigent Patients in Health Services in Indonesia. Journal of Social Science Studies, 3(2), 253-258.

Paice, J. A., Portenoy, R., Lacchetti, C., Campbell, T., Cheville, A., Citron, M., Constine, L.S., Cooper, A., Glare, P., Keefe, F., Koyyalagunta, L., Levy, M., Miaskowski, C., Green, S. O., & Bruera, E. (2016). Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology, 34(27), 3325–3345.

Permenkes Republik Indonesia. (2008). Peraturan Menteri Kesehatan Nomor 269 Tahun 2008 tentang Rekam Medis. Berita Negara Republik Indonesia. Jakarta.

Permenkes Republik Indonesia. (2008). Peraturan Menteri Kesehatan Nomor 290 Tahun 2008 tentang Persetujuan Tindakan Kedokteran. Berita Negara Republik Indonesia. Jakarta

Permenkes Republik Indonesia. (2014). Peraturan Menteri Kesehatan Nomor 37 Tahun 2014 tentang Pelayanan Paliatif.

Porter, M. E. (2010). What is Value in Health Care?. New England Journal of Medicine, 363(26), 2477–2481.

Quill, T. E., & Abernethy, A. P. (2013). Generalist Plus Specialist Palliative Care—Creating a More Sustainable Model. New England Journal of Medicine, 368(13), 1173–1175.

Republik Indonesia. (1945). Undang-Undang Dasar Negara Republik Indonesia Tahun 1945

Republik Indonesia. (1999). Undang-Undang Nomor 39 Tahun 1999 tentang Hak Asasi Manusia. Lembaran Negara Republik Indonesia tahun 1999 Nomor 165. Sekretaris Negara, Jakarta.

Republik Indonesia. (1999). Undang-Undang Nomor 8 Tahun 1999 tentang Perlindungan Konsumen. Lembaran Negara Republik Indonesia Tahun 1999 Nomor 22. Sekretaris Negara, Jakarta.

Republik Indonesia. (2004). Undang-Undang Nomor 29 Tahun 2004 tentang Praktik Kedokteran. Lembaran Negara Republik Indonesia Tahun 2004 Nomor 116. Sekretariat Negara, Jakarta.

Republik Indonesia. (2004). Undang-Undang Nomor 40 Tahun 2004 tentang Sistem Jaminan Sosial Nasional. Lembaran Negara Republik Indonesia Tahun 2004 Nomor 150. Sekretaris Negara, Jakarta.

Republik Indonesia. (2009). Undang-Undang Nomor 35 Tahun 2009 tentang Narkotika. Lembaran Negara Republik Indonesia Tahun 2009 Nomor 143. Sekretariat Negara, Jakarta.

Republik Indonesia. (2009). Undang-Undang Nomor 36 Tahun 2009 tentang Kesehatan (antara lain Pasal 5 dan Pasal 32). Lembaran Negara Republik Indonesia Tahun 2009 Nomor 144. Sekretariat Negara, Jakarta.

Republik Indonesia. (2009). Undang-Undang Nomor 44 Tahun 2009 tentang Rumah Sakit. Lembaran Negara Republik Indonesia Tahun 2009 Nomor 153. Sekretariat Negara, Jakarta.

Republik Indonesia. (2011). Undang-Undang Nomor 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial. Lembaran Negara Republik Indonesia Tahun 2011 Nomor 116. Sekretariat Negara, Jakarta.

Republik Indonesia. (2014). Undang-Undang Nomor 36 Tahun 2014 tentang Tenaga Kesehatan. Lembaran Negara Republik Indonesia Tahun 2014 Nomor 298. Sekretariat Negara, Jakarta.

Republik Indonesia. (2016). Peraturan Pemerintah Nomor 47 Tahun 2016 tentang Fasilitas Pelayanan Kesehatan. Lembaran Negara Republik Indonesia Tahun 2016 Nomor 229. Sekretariat Negara, Jakarta.

Republik Indonesia. (2018). Peraturan Presiden Nomor 82 Tahun 2018 tentang Jaminan Kesehatan (beserta perubahan yang masih berlaku). Lembaran Negara Republik Indonesia Tahun 2018 Nomor 165. Sekretariat Negara, Jakarta.

Republik Indonesia. (2023). Undang-Undang Nomor 17 Tahun 2023 tentang Kesehatan. Lembaran Negara Republik Indonesia Tahun 2023 Nomor 105. Sekretariat Negara, Jakarta.

Rietjens, J. A. J. C., Deschepper, R., Pasman, H. R. W., Deliens, L., & Korfage, I. J. (2013). Medical End-of-Life Decisions: Does its Use Differ in Vulnerable Patient Groups?. Journal of Medical Ethics, 39(10), 667–671.

Rindianti, D. F., & Nugraheni, N. (2023). The Urgency of The Existence of Approval of Medical Actions in Palliative Services. Yurisdiksi: Jurnal Wacana Hukum dan Sains, 19(3), 384-395.

Rumbold, J. M. M., & Pierscionek, B. K. (2014). The Effect of the General Data Protection Regulation on Medical Research. Journal of Medical Ethics, 40(11), 719–722.

Sahidu, S., Putra, A. R., & Darmawan, D. (2023). Medical Advertising Regulations and Patient Protection as Consumers of Healthcare Services. Journal of Social Science Studies, 3(1), 331-342.

Setiawan, S., Hardyansah, R., Khayru, R. K., & Putra, A. R. (2023). Consumer Protection in the Health Sector: The Legal Responsibilities of Pharmacists. Journal of Social Science Studies, 3(2), 131-138.

Setiyadi, G. B., Negara, D. S., Khayru, R. K., Darmawan, D., & Saputra, R. (2023). Misdiagnosis and Legal Liability of Doctors: A Normative Juridical Study in the Indonesian Health System. Journal of Social Science Studies, 3(2), 215-220.

Sidi, R. (2024). Legal Responsibility for Medical Risks and Medical Negligence in the View of Health Law. Journal of General Education Science, 2(1), 104-110.

Slowther, A., McClimans, L., & Price, C. (2012). Development of Clinical Ethics Services in the UK: A National Survey. Journal of Medical Ethics, 38(4), 210–214.

Suanjaya, M. A., Sutarno, S., & Zamroni, M. (2023). Legal Protection of Cancer Patients’ Social Security Participants in Targeting Therapy Services in Hospital. JILPR Journal Indonesia Law and Policy Review, 4(3), 155-165.

Sumali, A. B., Slamet, C. M., & Siti, W. (2024). Review of Legal Ethics in Applying Palliative Care to Improving the Quality of Life of Patients. KnE Social Sciences. KnE Social Sciences, 301-309.

The Joint Commission. (2012). Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, IL: The Joint Commission.

Titko, E., Dei, M., Smalii, O., & Yuldashev, S. (2020). Impact of Palliative Care/Medicine on Realization of “Right to Life” and “Right to Dignity” in The Context of Human Rights Protection. Journal of History Culture and Art Research, 9(1), 49-68.

Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., … Wang, S. J. (2015). A Classification of Chronic Pain for ICD-11. Pain, 156(6), 1003–1007.

Truog, R. D., Campbell, M. L., Curtis, J. R., Haas, C. E., Luce, J. M., Rubenfeld, G. D., & Kaufman, D. C. (2015). Recommendations for End-of-Life Care in the Intensive Care Unit: A Consensus Statement. American Journal of Respiratory and Critical Care Medicine, 191(4), 431–439.

Vitrianingsih, Y., Issalillah, F., Mardikaningsih, R., & Halizah, S. N. (2023). Juridical Study of Medical Malpractice by Midwives Based on Law No. IX. 17 of 2023 Concerning Health. Journal of Social Science Studies, 3(2), 169-174.

Waluyo, A., Vitrianingsih, Y., Mardikaningsih, R., Issalillah, F., & Negara, D. S. (2024). Legal Regulation of Multinational Corporate Health Services and Local Legal Obligations. Journal of Social Science Studies, 4(1), 359-370.

World Health Organization. (2011). Cancer Control: Knowledge into Action—WHO Guide for Effective Programmes: Palliative Care. Geneva, Switzerland: World Health Organization.

World Health Organization. (2014). Global Atlas of Palliative Care at the End of Life. Geneva, Switzerland: World Health Organization.