Ethics and the Right to Palliative Care for Marginalized Communities in Indonesia

Abstract

This study examines the ethical and moral dimensions of fulfilling the right to palliative care for marginalized communities in Indonesia, an issue that has largely been addressed as a technical-administrative concern rather than as a matter of social justice. The study addresses two questions: how ethical and moral principles conceptualize the right of marginalized communities to adequate and dignified palliative care, and which structural factors most significantly shape inequalities in access to such care within the Indonesian health system. To address these questions, the study employs a normative-ethical review approach combined with a thematic synthesis of six primary documents, including systematic reviews, normative legal studies, and bioethics articles, supplemented by supporting literature. The sources were analyzed according to the two research questions. The synthesis indicates that the right to palliative care has a strong constitutional and legislative foundation and emphasizes patient autonomy; however, its implementation is constrained by the ambiguous legal status of technical guidelines and the dominance of family decision-making over individual autonomy. Inequalities in access are shaped by the concentration of facilities in major cities, limited availability of trained health professionals, a national financing scheme that does not explicitly cover palliative care services, and low public awareness, as reflected in Indonesia’s relatively low position in global quality-of-death rankings. The findings also reveal that existing legal and ethical literature rarely explicitly incorporates socioeconomic vulnerability as an analytical variable. These findings underscore the need for a contextual ethical framework that integrates distributive justice into national palliative care policies in order to strengthen the protection of health rights among vulnerable groups.