Mercy Killing in Bioethical, Legal, and End-of-Life Care Perspectives
Main Article Content
Abstract
Mercy killing remains a highly contested issue in bioethics, medical law, and end-of-life care because it involves the deliberate ending of life under the justification of compassion. Although the term is often associated with euthanasia and assisted dying, it must be carefully distinguished from refusal of treatment, withdrawal of life-sustaining treatment, do-not-resuscitate decisions, and palliative sedation, since these practices differ in intention, causation, consent, and legal consequences. This study aims to analyze mercy killing from bioethical, legal, and end-of-life care perspectives, with particular attention to patient autonomy, human dignity, vulnerability, palliative care, professional conscience, and implications for the Indonesian health-care context. Using a normative bioethical and legal-analytical approach, this article examines the ethical tension between relieving unbearable suffering and protecting human life. The analysis shows that autonomy cannot be separated from decision-making capacity, freedom from coercion, adequate information, and access to meaningful alternatives, especially palliative care. It also emphasizes that vulnerable groups, including older persons, disabled individuals, economically disadvantaged patients, and people with mental disorders, require stronger protection against subtle social pressure. In Indonesia, where law, religion, culture, and medical ethics strongly emphasize the sanctity and protection of life, the central priority should not be the normalization of active life-ending practices, but the strengthening of palliative care, legal clarity, clinical ethics consultation, and humane communication at the end of life.
Article Details
Section

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Aggarwal, N. K., & Jain, A. (2024). Neuroethics and Neurolaw in Forensic Neuropsychiatry: A Guide for Clinicians. Behavioral Science and Law, 42(1), 11–19.
Auret, K., Pikora, T. J., & Briand, B. C. (2025). Still safe; still respectful: a mixed methods study exploring the early experiences of a rural community hospice in providing voluntary assisted dying. BMC Palliative Care, 24(1), 78. https://doi.org/10.1186/s12904-025-01713-6
Bastidas-Bilbao, H., Castle, D., Gupta, M., Stergiopoulos, V., & Hawke, L. D. (2024). Medical assistance in dying for mental illness: a complex intervention requiring a correspondingly complex evaluation approach. The British Journal of Psychiatry, 225(1), 264–267. https://doi.org/10.1192/bjp.2024.21
Chatzinikolaou, F., Vavoulidis, E., Tsiapla, T., Margioula-Siarkou, C., Dinas, K., & Petousis, S. (2025). Overkill in forensic medicine: A systematic review. Acta Psychologica, 259, 105388. https://doi.org/10.1016/j.actpsy.2025.105388
Colburn, B. (2025). Palliative care‐based arguments against assisted dying. Bioethics, 39(2), 187–194. https://doi.org/10.1111/bioe.13352
Downar, J., MacDonald, S., & Buchman, S. (2023). Medical Assistance in Dying and Palliative Care: Shared Trajectories. Journal of Palliative Medicine, 26(7), 896–899. https://doi.org/10.1089/jpm.2023.0209
Favron-Godbout, C., & Racine, E. (2023). Medical assistance in dying for people living with mental disorders: a qualitative thematic review. BMC Medical Ethics, 24(1), 86. https://doi.org/10.1186/s12910-023-00971-4
Grove, G. L., Lovell, M. R., Hughes, I., Maehler, E., & Best, M. (2025). Voluntary-assisted dying, euthanasia and physician-assisted suicide: global perspectives—systematic review. BMJ Supportive & Palliative Care, 15(4), 423–435. https://doi.org/10.1136/spcare-2024-005116
Haining, C. M., Willmott, L., & White, B. P. (2025). Institutional Responses to Voluntary Assisted Dying: An Empirical Study in Victoria and Western Australia. Journal of Bioethical Inquiry, 22(4), 863–880. https://doi.org/10.1007/s11673-024-10418-z
Isaac, S., McLachlan, A. J., & Chaar, B. (2024). Policies and cost analyses of voluntary assisted dying (VAD) laws – a mapping review & analysis. Health Economics Review, 14(1), 66. https://doi.org/10.1186/s13561-024-00547-x
Kadir, Z. K. (2025). Fear and Control: Rethinking Criminal Policy through the Lens of Moral Panic. International Journal of Law Analytics, 3(2), 201–218. https://doi.org/10.59890/ijla.v3i2.13
Kadir, Z. K. (2026a). Narrative Closure in Honor killing Cases: How Judgments Stabilise Meaning, Eliminate Ambiguity, and Produce Sentencing Certainty. Punggawa Law Review, 1(1), 1–10.
Kadir, Z. K. (2026b). Neurocriminology and the Next Generation of Criminological Theory: Integration, Limits, and Ethical Risks. Punggawa Global Research: Jurnal Multidisiplin, 1(1), 1–8.
Kadir, Z. K. (2026c). Siri’Killing dalam Masyarakat Bugis-Makassar: Konstruksi, Pola Pembunuhan, dan Respons Hukum Pidana. MUTIARA: Jurnal Ilmiah Multidisiplin Indonesia, 4(2), 158–172.
Kanamori, L. F., Xu, C., Hasan, S. S., & Doi, S. A. (2021). Quality Versus Risk-of-Bias Assessment in Clinical Research. Journal of Clinical Epidemiology, 16(6), 1–17.
Lilleker, J. (2023). Reforming Medical Manslaughter, the Scottish Way? The Journal of Criminal Law, 87(3), 161–191. https://doi.org/10.1177/00220183231174146
Loader, I., & Sparks, R. (2020). Criminology, insecurity and fear: Conceptualising the politics of unease. The British Journal of Criminology, 60(3), 725–742.
Martineau, I., Hamrouni, N., & Hébert, J. (2024). From ontological to relational: A scoping review of conceptions of dignity invoked in deliberations on medically assisted death. BMC Medical Ethics, 25(1), 96. https://doi.org/10.1186/s12910-024-01095-z
Munro, N. A. R. (2025). Should Medical Experts Giving Evidence in Criminal Trials Adhere to EFNSI Forensic Guidelines in Evaluative Reporting. Forensic Sciences, 5(1), 13. https://doi.org/10.3390/forensicsci5010013
Sallnow, L., Dorsey-Rivera, B. E., Ntizimira, C., Ahmad, N., & Kumar, S. (2025). Assisted dying, complex systems, and global equity in palliative care. The Lancet, 405(10473), 103–105. https://doi.org/10.1016/S0140-6736(24)02717-X
Stergiopoulos, V., Bastidas-Bilbao, H., Gupta, M., Buchman, D. Z., Stewart, D. E., Rajji, T., Simpson, A. I. F., van Kesteren, M. R., Cappe, V., Castle, D., Shields, R., & Hawke, L. D. (2024). Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives. BMC Psychiatry, 24(1), 120. https://doi.org/10.1186/s12888-024-05541-5
Thomas, K. J., Baumer, E. P., & Loughran, T. (2022). Structural Predictors of Choice: Testing a Multilevel Rational Choice Theory of Crime. Criminolog, 60(4), 606–636.
Thomas, R., Pesut, B., Puurveen, G., Thorne, S., Tishelman, C., & Leimbigler, B. (2023). Medical Assistance in Dying: A Review of Canadian Health Authority Policy Documents. Global Qualitative Nursing Research, 10. https://doi.org/10.1177/23333936231167309
Wittrock, J. (2025). A human right to assisted dying? Autonomy, dignity, and exceptions to the right to life. Nursing Ethics, 32(7), 2033–2043. https://doi.org/10.1177/09697330251328655
Yee, A., Tong, E., Nissim, R., Zimmermann, C., Allin, S., Gibson, J. L., Li, M., Rodin, G., & Shapiro, G. K. (2025). Health leaders’ perspectives and attitudes on medical assistance in dying and its legalization: a qualitative study. BMC Medical Ethics, 26(1), 57. https://doi.org/10.1186/s12910-025-01208-2