JOURNAL LA SOCIALE
VOL. 01, ISSUE 06 (001-007), 2020
DOI: 10.37899/journal-la-sociale.v1i6.178

Informed Consent on Medical Action in the Beauty Sector Based on Legal
Review
Franky Sumarlie
Magister of Law, Hang Tuah University, Indonesia
Corresponding Author: Franky Sumarlie
Email: frankysumarliedr@gmail.com
Article Info
Article history:
Received 4 November 2020
Received in revised form 15
November 2020
Accepted 27 November 2020
Keywords:
Informed Consent
Aesthetic Beauty Clinic
Medical Action

Abstract
The development of medical action not only in clinics, but also in beauty
clinics, requires a standard regarding informed consent. This study used
2 problem formulations, namely: 1. The essence of Informed Consent,
2.Informed Consent in Aesthetic Beauty Actions. This study used a
Statue Approach, and a Conceptual Approach. The result of this study
was that Informed Consent should be a process from the doctor
explaining the action until the patient accepts/rejects the action, either
in oral or written form. In practice, medical action for beauty at
Aesthetic Beauty Clinic was carried out in accordance with professional
standard and standard operating procedures. The relationship that
arises between the doctor and the patient is called a therapeutic
agreement. In this agreement, an approval for a medical action that is
given by the patient appears as a form of approval for aesthetic beauty
medicine action which is initiated by an offer of the doctor.

Introduction
Hippocrates said that the relationship between the patient and the doctor as a therapeutic
transaction. This therapeutic transaction begins when the patient comes to the hospital to ask
for help with his complaints. Then there is a contract or agreement between the doctor and the
patient which is called a Contract or Engagement or a therapeutic transaction. This agreement
give raise to a Business Engagement (inspannings verbintenis) because it is based on a business
obligation, the doctor must do everything in his/her power to cure the patient. The interaction
between doctor and patient give raise to a legal relationship in the therapeutic transaction
relationship, namely the emergence of rights and obligations on each party. One form of doctor
professionalism in the framework of protecting patient rights is the existence of Informed
Consent as a patient's right to obtain medical information from the doctor/beauty clinic before
receiving certain medical actions that affect the patient (Farnan et al, 2013; Whitney et al,
2004).
Nowadays, with globalization, beauty care has now become a necessity for everyone who
wants healthy skin, especially women who want beauty. Until 2016, the growth of the beauty
care industry is estimated to have increased by 20%. This is supported by data from the
Surabaya City Health Office, as of December 31, 2017, beauty clinics that are registered in the
city of Surabaya alone, both Primary and Main Clinics, are 96 clinics. The lifestyle of women
at this time demands to pay more attention to appearance, for that skin care is very important
for everyone. Moreover, to overcome various complaints that cause skin problems that can
reduce beauty, so everyone needs the right products and care.
This proper treatment action is usually done by doctors. Not only limited to hospitals and
doctor's practice, but also these beauty actions are carried out in beauty clinics. Beauty clinics
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should prioritize quality care that has been clinically tested rather than prioritizing profit but
patients do not get maximum results. Doctors and patients both have rights and obligations,
namely a reciprocal relationship between the two parties (Giordano, 2007; Morgan, 1982). The
relationship between doctor and patient that starts from a paternalistic trust relationship in its
development includes the stages of the process in medical services, including medical services
in the aesthetic sector. Each party has rights and obligations that must be respected. The right
to receive that is owned by someone will intersect with the obligation of other parties to give,
and vice versa.
In protecting the interests of patients, every medical action in a beauty clinic should carry out
Informed Consent, so that the rights and obligations of both doctors and patients can be
fulfilled. Not only running, doctors, patients, and health workers also need to understand related
to informed consent.
Methods
This research method used 2 (two) problem approaches, namely: The first approach in this
research was the statute approach. The statute approach is a legal research that puts the statute
approach as one approach. The statute approach is carried out by examining all laws and
regulations that are related to the legal issue being handled. In this writing, the required
legislation includes BW, Medical Practice Laws, Health Law and Minister of Health
Regulation of the Republic of Indonesia Number 290/MEN.KES/PER/II/2008 concerning
Approval of Medical Action. The second approach used was the conceptual approach, which
was carried out by looking for existing theories and doctrines to be used as a reference in order
to understand views and doctrines in building a legal argument in solving the issue at hand.
Results and Discussion
Informed Consent Essence
Informed consent is the free consent given by patients for a medical action, after they have
obtained all important information about the nature and consequences of the action. Informed
consent is made based on the principles of autonomy, beneficentia and nonmaleficentia, which
are rooted in human dignity where the autonomy and personal integrity of the patient is
protected and respected. If the patient is incompetent, consent is given by the family or legal
guardian. If the family/guardian is present but not competent, the medical personnel must
decide for themselves to take certain medical actions according to the patient's situation.
Informed consent is especially required in extraordinary means. However, for critical or
emergency patients who need immediate medical action to save them, proxy consent is not
required.
The term of informed consent in our Health Law does not exist, what is listed is the approval
term, acceptance or refusal of help action after receiving and understanding information about
the action. Informed consent or approval of Medical Action based on Article 1 paragraph (1)
Permenkes No. 290/Menkes/Per/III/2008 concerning Approval of Medical Action provides the
definition of consent to medical action is consent given by a patient or closest family after
receiving a complete explanation regarding the medical/dentistry action to be performed on the
patient.
The definition of Informed Consent is the consent given by the clients or their family on the
basis of information and an explanation of the medical actions that will be taken against the
client. Informed consent is a process that shows effective communication between doctors and
patients, and the meeting of thoughts about what will and what will not be done to patients
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Figure 1. Informed Consent Processi

The word consent comes from Latin, consentio, which means permit approval, consent, or a
broader meaning is giving permission or authority to someone to do an informed consent, thus
meaning a statement of consent or permission by the patient consciously, freely and rationally
after obtaining the information that they understand from health workers/doctors about the
disease. The word "understood" must be emphasized, because the understanding of information
by a health worker or doctor is not necessarily understood by the patient. It must be
remembered that what matters most is understanding by the patient. So if it is concluded, the
patient or closest family has the right to approve or reject the medical action that will be carried
out on the patient after the patient is given an explanation regarding the medical action that the
doctor will take to the patient, and what things will happen after the medical action is carried
out. Informed Consent is an agreement regarding medical action by doctors for their patient.
This consent can be in the form of oral or written. In essence, Informed Consent is a process
of communication between doctors and patients regarding the agreement on medical actions
that the doctor will take against the patient. The signing of the Informed Consent form in
writing is only an affirmation of what has been previously agreed. The purpose of a complete
explanation is for the patienst to make their own informed decision. Therefore, patients also
have the right to refuse recommended medical action. Patients also have the right to ask for the
opinion of other doctors (second opinion), and the doctor who treated them.
The explanation that is given by the doctor to the patient or patient's family based on Article 7
paragraph (1) Permenkes Number 290/Men.Kes/Per/II/2008 includes at least: Diagnosis that
has been enforced, The nature and extent of the action to be taken, The benefits and urgency
of the action, Risks and complications that may occur than the medical action, Consequences
if the action is not carried out and are there other alternative treatment methods, and Costs
related to the medical action,
Informed Consent on Medicinal Action in Aethetic Beauty Clinic
The doctor-patient relationship begins when patients come to the doctor to ask for help with
their problems in the health sector, so that with this there is already a contract or agreement
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between the doctor and patient which is called a therapeutic transaction. A therapeutic
transaction is an agreement between a doctor and a patient, in the form of a legal relationship
that creates rights and obligations for both parties. In therapeutic transactions, it is very
different from the agreement in general, namely the difference that lies in the object of the
agreement, where the result is not the main objective of the agreement, but lies in the efforts
made to cure the patient (inspaning verbintenis). This is because a patient has characteristics
that will differ from other patients, so that no two cases will be the same, because the human
immune system factor is not the same. The legal relationship between doctor and patient is
known as a Therapeutic Agreement, which occurs in ordinary circumstances the engagement
or agreement occurs because of an agreement (Law on Medical Practice, Article 39). Medical
practice is held based on an agreement between a doctor or dentist and a patient in an effort to
maintain health, prevent disease, improve health, treat disease and restore health; in unusual
circumstances (for example: medical emergencies), then an agreement or engagement occurs
due to law, (Law on Medical Practice, Article 51 letter d). Perform emergency aid on a humane
basis, unless he/she is sure that someone else is on duty and is able to do it.
Basically an agreement as a legal relationship between patient and doctor is a therapeutic
transaction, which is a transaction between a doctor and a patient where each fulfills the legal
conditions of the agreement. In order to assess the validity of the agreement, Article 1320 BW
can be applied in transactions including: There is agreement from those who commit
themselves; There is an ability between the parties to make the engagement; A certain thing
that is allowed; and For some reason that is allowed. If the legal relationship between the doctor
and the patient does not work well, it will create imbalances between the rights and obligations
of both, which will result in legal consequences, usually the patients, in this case, feels more
aggrieved, so that they can hold the doctor accountable.
The legal relationship between doctors and patients in health services is called a "Therapeutic
Transaction", which is based on an agreement, that is, an agreement in which doctors do their
best to cure the patient from their pain. This is in accordance with article 1320 BW. In this case
what is demanded is not an agreement of results or assurance of a cure or success, but the
agreement is in the form of the best possible effort or effort from the doctors in their efforts to
heal their patient carefully and thoroughly based on proper science.ii More on the division of
this Therapeutic Transaction in medical action:
Resultaatsverbintenis
namely an engagement based on achievement or work results. Doctors can promise the results
of their work to patients, for example: a dentist who makes dentures, an orthopedist who makes
foot prostheses, a cosmetic surgeon who fixes a sharp nose or other body parts. Even in Europe
the operation which is considered easy, for which the result is promised, is included in the
resultaatsverbintenis, whereas the operation which is complicated and difficult includes the
inspanningsverbintenis. In this case, in the world of aesthetic beauty, what is included with the
Results Agreement is an action that results. For example: Enlargement of body size with the
intended size.
Inspanningsverbintenis
attempt/effort/endeavor agreement, namely an engagement based on maximum
attempt/effort/endeavor to achieve a result. The patient gives full "trust" to the doctor that the
doctor will make every effort, make every endeavor to cure the patient (fiduciary relationship,
trust, vertrouwen). So doctors do not promise or guarantee that the patient will be cured. If the
doctor can promise or guarantee the patient's recovery, then juridically inspanningsverbintenis
switches to resultaatsverbintenis
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In contrast to aesthetic services, the therapeutic transaction that occurs can be a result binding.
This is because all actions are carried out as a mere aesthetic effort, namely to add to the beauty
or shape of the organs of the body, (which results are measurable), not a treatment of organ
function and damaged body tissue. In the doctor-patient relationship, the doctor gives a certain
achievement, namely doing something in accordance with the agreement reached with the
patient. Beauty clinic services even promise results before and after actions that show a change
in the problem at hand.
Medical action is an effort to find, overcome health problems, and an effort to maintain,
improve the health status of patients. To find the cause of the patient's health problems, doctors
need to carry out a series of actions/examinations starting from an interview or what is called
anamnesa, physical examination and supporting examinations. Recovery efforts can be done
through administration of drugs or surgery. All of these efforts are medical actions, because
they relate to medical care.
According to Law Number 29 of 2004 concerning Medical Practice (hereinafter referred to as
the Medical Practice Law), there are rights and obligations of doctors. These are Doctor's
Obligations based on Law number 29 of 2004 concerning Medical Practice article 50 and 5:
Providing medical services in accordance with professional standard and standard operating
procedures as well as patient medical needs; Referring the patient to another doctors or dentists
who have better skills or abilities, if they are unable to perform an examination or treatment;
Keep everything that they know about the patient a secret, even after the patient has died;
Perform emergency aid on a humane basis, unless they are sure that someone else is on duty
and able to do so; Adding knowledge and following the development of medical science or
dentistry;
Doctor's Rights are consist of these: Obtain legal protection as long as they carry out their
duties in accordance with professional standard with standard operating procedures, Providing
medical services according to professional standard with standard operating procedures, Obtain
complete and honest information from patients or their families, Receiving fees for services.
Article 44 states that in carrying out medical practice, every doctor is obliged to follow medical
service standards. Therefore, every medical action must be based on Medical Service Standards
and Standard Operating Procedures (SOP), one of the Medical Service Standards is to carry
out the obligation to provide Informed Consent to patients. This is in accordance with the
Minister of Health Regulation.
Informed consent is something that is required based on the Regulation of the Minister of
Health of the Republic of Indonesia Number 290/MEN.KES/PER/II/2008 concerning
Approval of Medical Action (hereinafter referred to as Permenkes Number
290/Men.Kes/Per/II/2008), which is used as a guideline for doctors to communicate with
patients who will follow up. All medical actions to be performed on patients must receive
written or oral consent. This has been regulated in Article 2 Permenkes Number
290/Men.Kes/Per/II/2008. Medical action here is not limited to medical action in the hospital,
but also in beauty clinics where there are actions taken by doctors.
Informed Consent is essentially a process from the moment of the patient arrives, explains the
process to be carried out, and the final result is an agreement from the patient, whether an
agreement will be taken or refusal (Cohen, 2019; Kinnersley et al, 2013). Even though it is
only regulated in the Permenkes, but Informed Consent is the basis for the relationship between
patient and doctor before any medical action is taken(Mashdurohatun et al, 2020; Felt et al,
2009).
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There is no different in medical action in a beauty clinic, the action taken is still a medical
action. According to the Minister of Health Regulation Number 290 of 2008 concerning
Approval of Medical Actions (hereinafter abbreviated as Permenkes Number 290 of 2008) in
Article 1 paragraph (3) states that medical action is a medical action in the form of preventive,
diagnostic, therapeutic or rehabilitative action that is carried out by doctors on patients.To
understand the legal aspects of medical action, it can be examined from the elements contained
in medical action. The elements of medical action from the definition of medical action as
meant by Permenkes Number 290 of 2008 are elements of medical action consisting of:
Medical action, In the form of preventive, diagnostic, therapeutic or rehabilitative Performed
by a doctor and Towards the patient. The elements above are the same as medical action in a
beauty clinic, so that for every medical action, Informed Consent should be obtained, this not
only protects the patient's rights, but is also the doctor's obligation and prevents doctors from
malpractice.
Conclusion
Approval of medical action or what is commonly called Informed Consent must be given
before the doctor gives action and after the doctor explains at least the diagnosis and procedure
for medical action, the purpose of why the doctor gave the medical action, other alternative
actions and their risks, complications and risks that may occur. Doctors cannot be sued as long
as the doctor acts in accordance with the applicable code of ethics and has been determined by
professional organizations and based on the discipline of medicine or dentistry. If they violate,
the sanctions given can be in the form of disciplinary action, warning and recommendation to
revoke the Registration Certificate. If there is a crime aspect, it can be subject to criminal
sanctions, namely Article 351 of the Criminal Code concerning Persecution, and civil
sanctions, namely being able to file a civil law suit on the basis of Article 1365 BW concerning
acts of violating the law. In essence, the doctor's obligation to take aesthetic medicine actions
in this case to beautify/change the appearance or just to treat or rejuvenate the skin or face must
be done with great care, it must be based on Informed Consent as the basis for action (in
accordance with existing regulations, in this case Permenkes). However, there is no
standardization of regulations related to written Informed Consent. Medical action in a beauty
clinic must have clear medical objectives and indications, as well as who is doing it, whether
the doctors have competence according to their knowledge who can be accounted for in
carrying out the medical action. Medical action in a beauty clinic is the same as medical action
in general, so it must be based on Informed Consent for each action.
References
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