Presumed Consent and the Doctrine of Necessity as the Basis for Emergency Medical Treatment Without Informed Consent
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Abstract
Informed consent has been recognised as a key prerequisite for the validity of medical actions, but emergencies often force doctors to act without explicit consent. This article analyses the application of the principle of presumed consent and the doctrine of necessity as the legal basis for medical actions without informed consent in emergency situations, using a normative legal approach based on qualitative literature studies. Primary and secondary legal materials in the form of legislation, professional codes of ethics, health law literature, and bioethics writings were analysed through thematic synthesis. The results of the study show that the principle of presumed consent functions as a legal fiction that replaces actual consent when the patient is unable to make decisions and delaying action would pose a serious threat to life or health. Meanwhile, the doctrine of necessity provides justification for actions that violate the integrity of the patient's body if they are intended to prevent greater harm by fulfilling the condition of proportionality. In the Indonesian legal system, this structure is reinforced by Article 1320 of the Civil Code, Articles 48 and 50 of the Criminal Code, Article 45 paragraph (2) of the Medical Practice Law, and ethical obligations in the Indonesian Medical Code of Ethics, which place patient safety as the primary consideration. However, this study emphasises that the principle of presumed consent and the doctrine of necessity must be treated as strictly limited exceptions through the criteria of genuine emergency, patient incapacity, proportionality of action, and adequate documentation. This article recommends the formulation of detailed operational guidelines and the strengthening of legal ethics education for medical personnel, so that emergency actions without informed consent are legally protected without eroding the autonomy and dignity of patients as subjects of rights.
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