The Noodtoestand Doctrine and the Limits of Physicians' Criminal Liability in Remote Emergency Medical Services
DOI:
https://doi.org/10.38035/jlph.v6i4.3387Keywords:
criminal liability, emergency medical services, health law, noodtoestand, physiciansAbstract
This article examines the limits of physicians' criminal liability when emergency medical services are provided in remote areas with limited facilities, personnel, referral access, and diagnostic support. It uses normative legal research with statutory, conceptual, and comparative approaches. The analysis connects Indonesian criminal law, health law, medical practice regulation, medical ethics, and recent literature on emergency care, patient safety, rural health services, and the necessity defense. The article argues that noodtoestand cannot operate as blanket immunity. It must be tested through imminent danger, absence of reasonable alternatives, proportionality, good faith, professional competence, and accountable documentation. The article proposes conditional legal protection through professional review before criminal prosecution. This model protects physicians who act reasonably under constrained emergency conditions while preserving patient rights and medical accountability.
References
Abang Anton, Beny Satria, & Yasmirah Mandasari Saragih. (2024). Criminal liability of medical personnel in Law Number 17 of 2023 concerning Health. International Journal of Law, Crime and Justice, 1(2), 36–50. https://doi.org/10.62951/ijlcj.v1i2.50
Al Ghifari, M. A., Risdawati, I., & Sahlepi, M. A. (2026). Implementation of Law No. 17 of 2023 on dispute resolution between patients and health workers in complications of eye surgery. Journal Evidence of Law, 5(1), 550–557. https://doi.org/10.59066/jel.v5i1.2490
Alexander, L. (2005). Lesser evils: A closer look at the paradigmatic justification. Law and Philosophy, 24(6), 611–643. https://doi.org/10.1007/s10982-005-0844-9
Appelbaum, P. S. (2007). Assessment of patients’ competence to consent to treatment. New England Journal of Medicine, 357(18), 1834–1840. https://doi.org/10.1056/NEJMcp074045
Arnolds, E. B., & Garland, N. F. (1974). The defense of necessity in criminal law: The right to choose the lesser evil. The Journal of Criminal Law and Criminology (1973-), 65(3), 289. https://doi.org/10.2307/1142600
Awangga, A. (2025). Settlement of medical disputes after Law No. 17 of 2023 concerning Health. JILPR Journal Indonesia Law and Policy Review, 6(2), 264–269. https://doi.org/10.56371/jirpl.v6i2.371
Baungaard, N., Skovvang, P. L., Assing Hvidt, E., Gerbild, H., Kirstine Andersen, M., & Lykkegaard, J. (2022). How defensive medicine is defined in European medical literature: a systematic review. BMJ Open, 12(1), e057169. https://doi.org/10.1136/bmjopen-2021-057169
Brennan, T. A., Leape, L. L., Laird, N. M., Hebert, L., Localio, A. R., Lawthers, A. G., Newhouse, J. P., Weiler, P. C., & Hiatt, H. H. (1991). Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I. New England Journal of Medicine, 324(6), 370–376. https://doi.org/10.1056/NEJM199102073240604
Castro-Delgado, R., Panta Bhandari, M., & Subedi Acharya, R. (2025). Emergency medical services and primary health care linkage: A potential solution for effective emergency response in rural areas: The case of Ukraine. Frontiers in Public Health, 13, 1691361. https://doi.org/10.3389/fpubh.2025.1691361
Chiong, W., Kim, A. S., Huang, I. A., Farahany, N. A., & Josephson, S. A. (2014). Testing the presumption of consent to emergency treatment for acute ischemic stroke. JAMA, 311(16), 1689. https://doi.org/10.1001/jama.2014.3302
Colvin, E. (1990). Exculpatory defences in criminal law. Oxford Journal of Legal Studies, 10(3), 381–407. https://doi.org/10.1093/ojls/10.3.381
Damayanti, T., Putra, H. D., & Anggraeni, H. Y. (2024). Informed consent pada kasus kegawatdaruratan di rumah sakit berdasarkan Undang-Undang No. 17 Tahun 2023. UNES Law Review, 7(1), 246–254. https://doi.org/10.31933/unesrev.v7i1.2260
Dennis, I. H. (2009). On necessity as a defence to crime: Possibilities, problems and the limits of justification and excuse. Criminal Law and Philosophy, 3(1), 29–49. https://doi.org/10.1007/s11572-008-9062-5
Dwi Atmoko. (2022). Settlement of medical disputes through the forum of the Indonesian Medical Discipline Honory Assembly (MKDKI) based on the provisions of Article 66 of Law Number 29 of 2004 concerning Medical Practice. Awang Long Law Review, 4(2), 432–440. https://doi.org/10.56301/awl.v4i2.467
Gearty, C. (1989). Necessity: A necessary defence in criminal law? The Cambridge Law Journal, 48(3), 357–359. https://doi.org/10.1017/S0008197300109572
Gettel, C. J., Kitchen, C., Rothenberg, C., Song, Y., Koski-Vacirca, R., Schaffer, K., Janke, A. T., Mohr, N. M., Greenwood-Ericksen, M., & Venkatesh, A. K. (2025). Emergency department visits among rural and urban older adults: disparities in ambulatory and emergency care sensitive conditions. BMC Health Services Research, 25(1), 975. https://doi.org/10.1186/s12913-025-13161-2
Ginting, J. D., Yanto, O., & Suminar, S. R. (2025). Risks of increased defensive medicine due to the medical world digitalization and the legal implications based on Indonesian health laws. Sinergi International Journal of Law, 4(1), 1–14. https://doi.org/10.61194/law.v4i1.809
Gladys Haryanto, Erna Ambarwati, & Lany, A. (2025). Legal protection for medical personnel in BPJS affiliated hospitals based on Law Number 17 of 2023. Research Horizon, 5(4), 1513–1522. https://doi.org/10.54518/rh.5.4.2025.705
Hely Ramadhini Harahap, H. R. H., & Ahmad Ma’mun Fikri, A. M. F. (2025). Criminal policy reform for medical personnel in Indonesia’s new Criminal Code: Legal protection and implementation challenges. Research Horizon, 5(6), 2923–2934. https://doi.org/10.54518/rh.5.6.2025.910
Iong, M. T. (2024). Ethical healthcare during public health emergencies: A focus on non-COVID-19 patients. Risk Management and Healthcare Policy, Volume 17, 2803–2810. https://doi.org/10.2147/RMHP.S485356
Kakemam, E., Arab-Zozani, M., Raeissi, P., & Albelbeisi, A. H. (2022). The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review. BMC Health Services Research, 22(1), 800. https://doi.org/10.1186/s12913-022-08194-w
Keristian, H. R., & Triana, Y. (2025). Medical negligence by doctors resulting in criminal law charges: Case study on the decision of the Supreme Court of the Republic of Indonesia No. 590 K/PID/2012. Journal of Community Health Provision, 5(2), 61–69. https://doi.org/10.55885/jchp.v5i2.598
Kompanje, E. J. O., van Dijck, J. T. J. M., Chalos, V., van den Berg, S. A., Janssen, P. M., Nederkoorn, P. J., van der Jagt, M., Citerio, G., Stocchetti, N., Dippel, D. W. J., & Peul, W. C. (2020). Informed consent procedures for emergency interventional research in patients with traumatic brain injury and ischaemic stroke. The Lancet Neurology, 19(12), 1033–1042. https://doi.org/10.1016/S1474-4422(20)30276-3
Marzuki, M. F. S., Wildan, R., & Rijal, S. (2023). Penelusuran Epistemologi Kekadiman Alam dalam Tahafut Al-Falasifah dan Tahafut Al-Tahafut. Jurnal Pemikiran Islam, 3(2), 192–216. https://doi.org/10.22373/jpi.v3i2.22541
Mohr, N. M., Okoro, U., Harland, K. K., Fuller, B. M., Campbell, K., Swanson, M. B., Wymore, C., Faine, B., Zepeski, A., Parker, E. A., Mack, L., Bell, A., DeJong, K., Mueller, K., Chrischilles, E., Carpenter, C. R., Wallace, K., Jones, M. P., & Ward, M. M. (2023). Outcomes associated with rural emergency department provider-to-provider telehealth for sepsis care: A multicenter cohort study. Annals of Emergency Medicine, 81(1), 1–13. https://doi.org/10.1016/j.annemergmed.2022.07.024
Naurah, G., Simarmata, M., Risdawati, I., Sumarno, S., & Zarzani, T. R. (2025). Analysis of hospital legal responsibility in cases of refusal of emergency patients based on Law No. 17 of 2023 concerning Health. Legal Brief, 14(3), 495–505. https://doi.org/10.35335/legal.v14i3.1350
Ni Luh Gede Astariyani, & Julio de Araujo da Silva. (2025). Legal protection of doctors in the handling of medical emergencies. Contrarius, 1(3), 214–231. https://doi.org/10.53955/contrarius.v1i3.215
Nurchasanah, N., Sakti, M., & Nugroho, A. A. (2025). Juridical analysis of Law Number 17 of 2023 concerning Health on legal protection for medical and health personnel. Asian Journal of Social and Humanities, 4(2), 2348–2356. https://doi.org/10.59888/8jaz9g54
Panagioti, M., Khan, K., Keers, R. N., Abuzour, A., Phipps, D., Kontopantelis, E., Bower, P., Campbell, S., Haneef, R., Avery, A. J., & Ashcroft, D. M. (2019). Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ, 366, l4185. https://doi.org/10.1136/bmj.l4185
Putri, J., Bihar, S., & Jamaludin, A. (2025). Legal aspects of informed consent for patients requiring emergency treatment. Research Horizon, 5(4), 1599–1610. https://doi.org/10.54518/rh.5.4.2025.747
Ritonga, W. H. S., Ravena, D., & Rahim, A. H. (2025). Responsibility of medical personnel in performing emergency actions related to the legal interests of legal subjects. Interdental Jurnal Kedokteran Gigi (IJKG), 21(2), 232–241. https://doi.org/10.46862/interdental.v21i2.12171
Sakinatunnisa, S., & Alawiya, N. (2025). Legal responsibility of healthcare facilities in the management of medical emergencies. Jurnal Hukum In Concreto, 4(2), 257–270. https://doi.org/10.35960/inconcreto.v4i2.1933
Schaffer, A. C., Jena, A. B., Seabury, S. A., Singh, H., Chalasani, V., & Kachalia, A. (2017). Rates and characteristics of paid malpractice claims among US physicians by specialty, 1992--2014. JAMA Internal Medicine, 177(5), 710. https://doi.org/10.1001/jamainternmed.2017.0311
Setiadi, A. S., Sanusi, S., Koharudin, M., & Gunarto, A. (2023). Rights, obligations, and authorities of medical and health personnel in primary health services post Law Number 17 of 2023 concerning Health. Asian Journal of Engineering, Social and Health, 2(12), 1601–1611. https://doi.org/10.46799/ajesh.v2i12.186
Shojania, K. G., & Dixon-Woods, M. (2017). Estimating deaths due to medical error: the ongoing controversy and why it matters. BMJ Quality & Safety, 26(5), 423–428. https://doi.org/10.1136/bmjqs-2016-006144
Silva, L. de M., Mainardes, E. W., & Sepulcri, L. M. C. B. (2026). The communication skills of public sector leaders and their effects on public servants. International Journal of Public Leadership, 1–24. https://doi.org/10.1108/IJPL-03-2025-0059
Situngkir, A. H., Mulyantika, D. A., Hasibuan, H., Muliadi, M., Saragih, S. N., & Zarzani, T. R. (2024). Review of Law No. 17 of 2023 concerning Health Chapter VI (Health Service Facilities). International Journal of Synergy in Law, Criminal, and Justice, 1(1), 26–28. https://doi.org/10.70321/ijslcj.v1i1.5
Sreeram, A., Nair, R., & Rahman, M. A. (2024). Efficacy of educational interventions on improving medical emergency readiness of rural healthcare providers: a scoping review. BMC Health Services Research, 24(1), 843. https://doi.org/10.1186/s12913-024-11116-7
Studdert, D. M. (2005). Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA, 293(21), 2609. https://doi.org/10.1001/jama.293.21.2609
Studdert, D. M., Mello, M. M., Gawande, A. A., Gandhi, T. K., Kachalia, A., Yoon, C., Puopolo, A. L., & Brennan, T. A. (2006). Claims, errors, and compensation payments in medical malpractice litigation. New England Journal of Medicine, 354(19), 2024–2033. https://doi.org/10.1056/NEJMsa054479
Suwadi, P., Ayuningtyas, P. W., Septiningrum, S. Y., & Manthovani, R. (2024). Legal comparison of the use of telemedicine between Indonesia and the United States. International Journal of Human Rights in Healthcare, 17(3), 315–329. https://doi.org/10.1108/IJHRH-04-2022-0032
Tamon, O., Setiawan, E. W., & Sapsudin, A. (2025). Legal protection for doctors under Law Number 17 of 2023 concerning Health. Research Horizon, 5(4), 1281–1292. https://doi.org/10.54518/rh.5.4.2025.720
Tsou, C., Robinson, S., Boyd, J., Jamieson, A., Blakeman, R., Yeung, J., McDonnell, J., Waters, S., Bosich, K., & Hendrie, D. (2021). Effectiveness of telehealth in rural and remote emergency departments: Systematic review. Journal of Medical Internet Research, 23(11), e30632. https://doi.org/10.2196/30632
Viranda, J., & Zulfiko, R. (2026). Analysis of legal responsibility for forged informed consent in emergency medical procedures: A comparative study of Indonesian court verdicts. Healthy Tadulako Journal (Jurnal Kesehatan Tadulako), 12(1), 167–174. https://doi.org/10.22487/htj.v12i1.1819
Zhang, Z. (2024). Survey and analysis on the resource situation of primary health care institutions in rural China. Frontiers in Public Health, 12, 1394527. https://doi.org/10.3389/fpubh.2024.1394527
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Matthew Antonio Ariellmaury Rajagukguk Rajagukguk, Nathalina Naibaho

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish their manuscripts in this journal agree to the following conditions:
- The copyright on each article belongs to the author(s).
- The author acknowledges that the Journal of Law, Poliitic and Humanities (JLPH) has the right to be the first to publish with a Creative Commons Attribution 4.0 International license (Attribution 4.0 International (CC BY 4.0).
- Authors can submit articles separately, arrange for the non-exclusive distribution of manuscripts that have been published in this journal into other versions (e.g., sent to the author's institutional repository, publication into books, etc.), by acknowledging that the manuscript has been published for the first time in the Journal of Law, Poliitic and Humanities (JLPH).
























