Malpractice cases in Indonesia have risen sharply throughout 2025. Over the past three years, the Ministry of Health (Kemenkes) has recorded 51 cases of malpractice, with 24 resulting in death. The highest number of deaths occurred in 2025, reaching 13 cases.
Minister of Health Budi Gunadi considers the issue of malpractice in Indonesia to be highly complex. Citing Tempo, he explained that there are patients whose rights may have been neglected, while on the other hand, doctors also face the risk of jail time.
This concerning situation prompted Dr. dr. Siti Soekiswati, M.H., S.H. to examine the implementation of standard operating procedures (SOP) in hospitals. The lecturer at the Faculty of Medicine (FK) Universitas Muhammadiyah Surakarta (UMS) places particular emphasis on informed consent, a crucial pillar of communication between doctors and patients.
Informed consent is a written consent document containing detailed information provided by the doctor to the patient before any medical procedure is carried out. The legal basis for informed consent is outlined in Law Number 17 of 2023 and the Minister of Health Regulation Number 290/MENKES/PER/III/2008 concerning Medical Procedures Consent.
“I feel concerned seeing the way informed consent is often administered in Indonesia, many are issued by nurses,” Siti said in an online interview, Monday 8/12/2025.
During her research, Siti intentionally concealed her identity as both a researcher and a doctor. The goal was to obtain the most honest answers from her informants (nurses, medical record staff, and patients). She said the study would not be sufficient if it relied solely on normative responses.
The results showed that several clinics did provide informed consent, but many were incomplete. Some nurses were even noticeably uninformative. Important details that should have been communicated to patients before a procedure simply disappeared.
“Sometimes nurses just say, ‘Sir/Ma’am, please sign this, you can have your surgery tomorrow,’” she said, imitating a nurse on duty at a private Class D hospital in Central Java.
The importance of informed consent should be a shared concern. Both doctors and patients may be harmed if the matter of informed consent is not properly addressed from the outset.
Doctors, Siti noted, can end up behind bars if proven guilty and causing harm to a patient. Meanwhile, patients may not receive clear information about their illness, the procedure, or the costs they will incur.
Even general consent, the general information sheet given during registration, is not sufficient to replace the role of informed consent. The level is entirely different, there is a wide range of information and approvals that general consent simply does not cover.
“It can be used for IV procedures, inserting a DC (dower catheter), using a nebulizer, injections, and so on. But for surgery, it’s not enough, because treatment risks are not included in general consent,” she explained.
Siti believed that its application is actually quite simple. However, its implementation remains patchy. Factors such as working hours and the high mobility of doctors hinder the thorough execution of informed consent.
This becomes even more challenging when looking at communication patterns between doctors and patients, particularly in rural areas. Rural communities still tend to adopt a paternalistic relationship between doctor and patient.
In a paternalistic relationship, patients simply surrender and comply with any medical procedure performed by the doctor. They never question the purpose of the procedure. “In Indonesia, it’s still very paternalistic,” Siti revealed.
The relationship that should be hold between doctor and patient is a contractual relationship. This model emphasizes equality, there is no overpowering hierarchy or excessive dominance on the doctor’s side.
“Ideally, it should be equal. A contractual relationship is supposed to be on equal footing, just like the relationship between a seller and a buyer,” Siti added.
Siti refuses to let Indonesia’s healthcare system remain trapped in the same recurring issues. She has therefore introduced the concept of video-based informed consent to be implemented in every hospital.
“The patient enters a designated room, where the informed consent is explained through a recorded video from the doctor who will be handling them,” she explained.
With this method, Siti hopes patients will fully understand all the information provided, from the explanation of the surgical procedure and its risks to the costs involved. “When they leave the room, the patient already understands everything. They just need to sign the informed consent,” said the bioethics lecturer at the Master of Hospital Administration (MARS) UMS program.
According to her, this approach is the most efficient way to address the root problems in hospitals. She believed that delivering informed consent will become far easier, while reducing the potential for miscommunication. A true win-win solution.
Siti’s idea is now halfway through its development. She hoped it will soon receive an official patent. “I’ve submitted it to the Directorate General of Higher Education, but it hasn’t been approved yet because a prototype is required,” she said.
Not stopping there, Siti planned to collaborate with researchers from Uzbekistan to refine the patent. They will compare existing conditions in both Indonesia and Uzbekistan, potentially allowing her innovation to be adopted in the former Soviet nation.
While waiting for her innovation to move forward, Siti continues to emphasize the importance of informed consent to her students in the Medical Education and MARS UMS programs. In her role as a lecturer, she holds a strategic position in shaping the character of future doctors and hospital leaders.
Her wish is simple, to produce doctors who are not only competent, but also ethical. “The relationship with patients is extremely important from a legal standpoint,” she concluded.
