THE CONCEPT OF AMÂNAH IN INFORMED CONSENT

The Concept of Amânah in Informed Consent. The Appeal Decision of the Supreme Court of the Republic of Indonesia Number 365K/Pid/2012 granted the appeal request of Public Prosecutor of Manado State Public Prosecutor’s Office. The Supreme Court annulled the Manado State Court Decision that imposed 10 (ten) months criminal imprisonment to each defendant. The Indonesian Doctors Association argued that the contract between doctor and patient is a contract of process, not a contract of result. At the very least, this Appeal Decision provided an opportunity for legal experts to test and evaluate the concept of informed consent both philosophically and juridically. This paper argues that informed consent should be built on the framework of amânah which is an important concept in Islamic law.

Further the Supreme Court judged by itself and decided that the first defendant, second defendant, and third defendant has been proven legitimately and conclusively guilty of the criminal charge due to action caused by negligence which resulted in the death of others as well as convicting the defendants with imprisonment for 10 (ten) months each. 4 e Appeal Decision of the Supreme Court examined several legal facts, one of which could still be debated philosophically and juridically which is informed consent.
Indonesian Doctor Association (Ikatan Dokter PN.MDO. 4 See Putusan Kasasi Mahkamah Agung Republik Indonesia Nomor 365K/Pid/2012. Indonesia/IDI) argued that the Supreme Court verdict is a criminalization of doctor's profession. 5 As such, IDI has urged doctors to demonstrate against the verdict. 6 IDI further argued that the contract between doctor and patient is a contract of process not a contract of result. 7 IDI regretted the use of KUHP (Kitab Undangundang Hukum Pidana, Criminal Law Sourcebook/ Indonesian Penal Code) to judge cases arising out of medical treatments. 8 is development has provided an impetus to review the Law of Doctor's Practice (Undang-Undang Praktik Kedokteran) as doctors need the sense of security when performing their profession to prevent criminalization against them. 9 Doctor's nationwide demonstration has caused a drastic reduction of public health service and a consequent tension in the relationship between doctors and patients. 10 is saga has provided the impetus for much needed evaluation of Indonesian health law, such that it could provide more elegantly and unbiased legal certainty between doctors and patients. e concept of state's role in public health begins with the theory of protection where the state is obligated to protect the public by provided health services. 11 is concept then develops into the theory of right where the public as citizens have the rights to obtain health services. 12 ese reasons caused the amendment of the 1945 Republic of Indonesia Constitution (Undang-Undang Dasar Republik Indonesia Tahun 1945, UUD 1945, in which principally the guarantee of health insurance is regulated under Article 28H Clause (1) 13 5 Sindonews.com, "Demo Dokter", in http://daerah.sindonews. com, accessed on 2nd October 2013. 6 Tribunnews.com, "Dokter Mogok Nasional", in http://www. tribunnews.com/kesehatan, accessed on 2nd October 2013. 7 Zainal Abidin, "Bisakah Dokter Dipenjarakan?", in Indonesia Lawyer Club Talk Show TVOne, Tuesday, 8th October 2013. 8 Anonim, "IDI Sesalkan Penggunaan KUHP pada Kasus Tindakan Medis Dokter", in http://health.okezone.com, accessed on 2nd October 2013. 9 Republika Online, "Politikus Minta Kriminalisasi Dokter Disikapi secara Arif ", in http://www.republika.co.id/berita/nasional/ hukum, accessed on 2nd October 2013. 10 Tempo.com, "Menyoal Demonstrasi Dokter", Friday, in http:// www.tempo.co/read/kolom, accessed on 3th October 2013. 11 e function of government to protect all individuals, as long as it is faithful to this pledge, the government cannot be denied its power but when it ceases to do it, its laws have no validity and the government may be overthrown. Hari Chand, Modern Jurisprudence, (Kuala Lumpur: International Law Book Services: 1994), p. 45. 12 Without the health law the legal branch of health law will not be complete when we take the right of health and life as the goal. Wu Chongqi, Law, Health Law and Science of Health Law, in World Association for Medical Law, August-December 2012, Vol. 4, p. 5. 13 Article 28H clause (1) UUD 1945 states that "Each person has a right to a life of well-being in body and mind, to a place to dwell, to enjoy a good and healthy environment and to receive medical care". and Article 34 Clause (3) 14 of UUD 1945. Based on this foundational constitution 15 , public health service provision is arranged further under lower-level regulations. 16 e Constitution of the World Health Organisation (WHO) 17 stated that " e enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being...". 18 e issue of health law has been developing for a long time, along with the development of consumer protection law. 19 However, officially the development of health law in the world at large started since the First Congress of World Association for Medical Law in 1967 to guarantee public health rights. Berna Arda elaborated that human rights concept has three stages: (1) One contains mostly personal rights, such as equality, freedom, personal 14 Article 34 clause (3) states that " e state has the responsibility to provide proper medical and public service facilities". 15 e terms constitution and foundational law (Undang-Undang Dasar) are often debated among legal experts, whether it is derived from constitution (English), grondwet (Dutch) and gerundgesetz (German). In general constitution is defined broader than foundational law as constitution covers written and unwritten aspects. Moh. Mahfud Md, Perdebatan Hukum Tata Negara Pasca Amandemen Konstitusi, (Jakarta: LP3ES, 2007), p. xi-xii. Jimly elaborated that constitution in general rests on three consensual elements, which are: (1) e consensus of common purpose or aspiration (the general goals of society or general acceptance of the same philosophy of government). (2) e consensus of rule of law as the foundation of government and management of state (the basis of government security, political rights and owner's right. (2) Stage human rights can be characterized as economical, social and cultural rights. (3) Stage of human rights arised at the second half of the 20th century. And human rights such as peace, living in a healthy environment, patient's rights and consumer rights are part of third stage rights. Because of the collective feature of these third stage human rights these also named as solidarity rights. 20 Agreeing with the above idea, Yutaka Arai-Takahashi elaborated the right to health is conceptually or practically interwoven with other economic, social and cultural rights, such as the right to work, food, clothing, housing, education and social security. at the protective scope of the right to education can be extended to an individual entitlement to education on nutrition prenatal or post natal care suggests that other stand-alone economic and social rights have considerable bearing on health. 21 e idea of health law provides guarantee to the public that they would obtain the necessary health service. In health law informed consent is an important factor of doctor and patient relationship. e verdict of the Supreme Court is closely related to this idea. 22 What is the real foundation of informed consent philosophy? How is informed consent implemented? How is informed consent related to the concept of amânah? e answers to this question would be viewed from the perspective of health law and consumer protection law which would be discussed in this paper.
is paper aims to elucidate the concept of amânah in relation to informed consent with regards to doctor and patient relationship viewed from the perspective of health law and consumer protection law. Islamic law as one of the sources of law in Indonesia could be utilized to examine doctor and patient relationship especially issues related to informed consent where the concept of amânah in Islamic law is the philosophical foundation for all human activities, as all contracts (al-'aqd) is begun with the concept of amânah.
Using juridical normative methodology with statutes approach presented under qualitative methodology, this study analyzed legal foundations and legal norms of informed consent from the perspective of health law and consumer protection law. Foundations, norms and doctrines contained in the Alquran, Hadith, Islamic law and other laws such as legal norm contained in state regulations were analyzed. Statutes approach is conducted through the analysis of state regulations related to informed consent which is the 1945 In addition of these verses, many other Alquran verses presented the messages and values of amânah. e word amânah originates from the Arabic word amina-ya'manu and also âmana-yu'minu which means trustworthy (shiddîq) and îmân means believing, submitting and obeying what God has decreed. While amânah means trustworthy, its antonym being khiyânah (traitorous). 23 Amânah does indeed possess a similarity of meaning with "trust" but between "amânah" and "trust" there is a philosophical difference. To implement amânah is a reflection of human servitude as God's creature as mentioned in the above verses. While to implement trust is a reflection of the concept benefit which ultimately has it source in materialism and utilitarianism as could be seen in the definition of trust in Blacks Law Dictionary, " e right, enforceable solely in equity, to the beneficial enjoyment of property to which another person holds the legal title; a property interest held by one person (the trustee) at the request of another (the settlor) for the benefit of third party (the beneficiary)." 24 Ibn 'Arabî defined amânah as the entirety of action protected from fraud and its derivatives as well as action that must be fulfilled to the giver of amânah. 25 Dawam Rahardjo opined that everything that is related to duty, obligation, right and responsibility could be referred to the concept of amânah as foundational value, 26 hence amânah is an intention which must be paid attention to in all human activities.
Amânah is the entirety of responsibility accepted by someone given trust to perform an action as it should be 27 as such the concept of amânah possess 3 (three) elements, such as: Amânah giver, Amânah receiver and Amânah performed. e concept of amânah possesses a wide scope which could be classified into four aspects, which are: (1) e concept of amânah to God. 28 (2) e concept of amânah to self. 29 (3) e concept of amânah to others. 30 and (4) e concept of amânah to the environment. 31 Amânah actually begins from the creation of humans on earth (khalîfah fî al-ardh). 32 Humans are given amânah to maintain the universe responsibly to create prosperity (mashlahat) 33 for all of mankind. 26 Dawam Rahardjo, Ensiklopedia Alquran;Tafsir Sosial Berdasarkan Konsep-Konsep Kunci, (Jakarta: Paramadina, 1996), p. 204. 27 Amânah is something entrusted (deposited) to others. Pusat Bahasa Departemen Pendidikan Nasional, Kamus Besar Bahasa Indonesia, (Jakarta: Balai Pustaka, 2005), p. 35. 28 All the amânah which is obligated on human comes in the form of God's rights towards its slaves, such as prayer, alms, fast, expiation (kafârat) and vow (nadzar), all of which are amânah entrusted without monitoring. 'Abd Allâh ibn Muhammad ibn 'Abd al-Rahmân ibn Ishâq al-Syaykhî, Tafsîr  e Prophet Muhammad when giving amânah to his companions always considers their ability to fulfill the amânah. ere is a tradition that Abû Dzar once came to see the Prophet for a public position but was denied by the Prophet as he was considered weak. 34 is proves that the Prophet consider the ability of amânah receiver. Another story, this time in the Alquran, would be when the Prophet Yûsuf requested the position of state treasurer to the king. In fact, the Prophet Yûsuf has considered that he is able to fulfill the amânah that he requested. 35 Such was the case for the speech of Abû Bakr when he was appointed caliph: "O People. I was entrusted as your ruler although I am not better than any one of you. Support me as long as you see me following the right path and correct me when you see me going astray. Obey me as long as I observe God in your affairs. If I disobey Him, you owe me no obedience. e weak among you are powerful (in my eyes) until I get them their due. e powerful you are weak (in my eyes) until I take away from them what is due to others. I say that and seek God's forgiveness for myself and for you". 36 Abû Bakr's speech contains a very deep concept of amânah that he only wanted to be obeyed as long as he was considered to be in the right path and corrected and left behind when he strayed from the right path.
is indicates that the amânah receiver could deviate at any given moment from the right path. erefore a correction mechanism to maintain the fulfillment of amânah is needed.

The Legal Relationship between Doctor and Patient
Daldiyono pointed that doctor and patient relationship possess several evolving natures. First, religious nature where disease is considered to originate from the anger of Gods in which patient comes to Religious Leader for cure through religious means. In this case the Religious Leader is viewed also as a doctor.
Second, paternalistic nature in subsequent generation specialization and division of labor occur. People with expertise to treat patient (who could be considered the first generation doctors), no longer use religious means. As the lay public does not understand the healing process an asymmetric relationship arises between doctor and patient. e dependency of patient to doctor is reinforced as doctor's orders must be obeyed by patient as only the doctor understand the science of healing. is model of relationship occurs since the 5th century before the common era to the modern century before the development of information technology.
ird, service and consumption nature. e development of technology and information changes the relationship theory between doctor and patient from paternalistic to service provider and consumer relationship where the public becomes aware of its rights and able to evaluate doctor's work. However, this era of provider and consumer relationship resulted in a psychological distance between doctor and patient laden with business aspects. As such patient easily sue and doctor responds by providing medical service defensively.
Fourth, partnership and joint effort nature. is relationship format is very ideal where the doctor and patient must value and trust each other. is kind of partnership could be developed like familial relationship when the patient is aware and independent while the doctor is wise and acts virtuously. 37 Such is also the explanation of Mason and Smith, very early medicine was, a matter of mystery there being no apparent natural reason why disease struck one person rather than another. e answer had to be round in the supernatural and supernatural powers being sparingly distributed, healing became a prerogative of a few whose power depended largely on the ignorance of others. At its inception, the medical profession was elitist and it is easy to imagine the transference of healing powers from the isolated tribal witch doctor to the priest of organised religion. 38 Further, medical profession is a "common calling" to 37  protect the public. After the development of contract law, the principle of doctor's responsibility to protect the public is replaced with contractual relationship, starting from the request of patient for medical care and the fulfillment of the request by doctor to provide medical care. In the last decade the legal relationship between doctor and patient is dominated by tort of negligence which develops concurrently with the development of hospital industry not a few doctors have been judged based on this negligence principle. 39 Duty of care which is imposed upon law on the doctor arises when the doctor agrees to treat the patients be the medical care requested explicitly or implicitly. As long as this relationship exists the doctor is obligated to treat the patient as long as necessary in medical practice. When this relationship is terminated, the doctor must agree to avoid the charge of abandoning the patient. e point of legal relationship between doctor and patient is both have freedom of choice except in emergency cases. In emergency cases, doctor has legal obligation to provide emergency care to anyone eventhough they are not his patients. In health law this is called the principle of duty to provide emergency services. 40 As such Michael Davies pointed that medical law is concerned with the responsibility of members of the medical profession for their actions. It is also about human rights, moral viewpoints, ethical concepts, economic demands on society and duties owed. 41

The Perspective of Health and Consumer Protection Law on Informed Consent
In health law, the right of patient consent after provision of information (informed consent) is the foundation of relationship between patient and doctor. In Indonesia, the case of Muchjidin in Sukabumi in 1984 is the milestone of informed consent doctrine. 42 Informed consent was born due to the therapeutic 39 In relationship with patient, doctor does not guarantee the health of patient and does not guarantee that the patient would be cured but must guarantee that the implementation of medical treatment follows the proper procedure. e lack of clarity of this concept could be used as a trap against doctor as any unsatisfied patient could sue the doctor. Law provides protection for doctor in such event unless the doctor do promise health and cure or conduct medical treatment out of procedure. Ellen I. Picard 42 In the case of Muchjidin, he gave his signature as a sign of consent without being given adequate information of the risk of the medical treatment. In this case the judge could annul the medical consent by relationship between medical personnel and patient 43 in which every party possess rights and responsibilities which must be respected.
If related with KUHPerdata (Kitab Undang-Undang Hukum Perdata, Civil Code), there are 4 (four) requirements which must be fulfilled in informed consent: (1) Agreement between those who bind themselves.
(2) Competence to enter into an agreement.
(3) A certain definite problem. (4) A cause that is not forbidden. 44 However, the category of informed consent agreement in the relationship is inspanningsverbintenis agreement which is agreement based on effort not resultaatsverbintenis agreement which is agreement based on result. 45 e informed consent doctrine is of course in opposition with paternalist doctrine where the doctor impose upon themselves the obligation to cure patient and the patient must accept and fulfill obligation requested by the doctor. In this doctrine only the doctor understands medical care and thus the doctor can do no wrong. is argumentation potentially does much harm to patient whose consent is not needed for any medical treatment by the doctor. However, there are exceptions such as in cases emergency, natural disaster and disease when the doctor's treatment could be performed without informed consent. 46 Related to development from paternalistic to informed consent doctrine, Ellen and Gerald pointed that law in Canada give patient the right to decide whether to undergo treatment or not. 47 47 Physical contact with the patient is essential in virtually all medical treatment. e doctor may need to palpate the abdomen, use a tongue depressor or attach the electrodes of an electrocardiograph.
In these examples, the patient may have given more than mere passive consent and actually have requested the examination or procedure and so it may seem that bodily contact in medical situations differs little from that in the social or sporting context. But there is an important difference in that the parties are not in an equal position because the doctor is far more knowledgeable than the patient about the latter's condition and the available treatment. In the past, when doctors and Gerald stated that, the form of consent 48 is divided into express consent and implied consent. Consent must possess several elements, which are: (1) Given voluntarily. (2) Given by a patient who has capacity. (3) Referable both to the treatment and to the person who is to administer that treatment. (4) Given by a patient who is informed. 49 Informed consent emerges out of ethical principles in medical treatment. e principle of autonomy stated that every person is an end in herself and deserves to be treated as an end in herself. Every person is to be treated as a separate person able to govern herself. As such the principle of autonomy is considered as a freedom to act which is only valuable when people respect each other's autonomy. In the field of health law the idea of autonomy principle becomes very important as it is the foundation or acknowledgement of patient's rights of his or her own self. 50 As such, Peggy Foster stated by citing Ian Kennedy, that "Consent in the context of modem medicine is... an ethical doctrine about respect for persons and about power." 51 A further elaboration of autonomy which is very fundamental in health law as stated by Judge Cardozo in Schloendorff v. Society of New York Hospital (1914) 105 N.E.92 is "Every person being of adult years and sound mind has a right to determine what shall be done with his own body." 52 is elaboration of autonomy is very closely related to the concept of ownership as the basis of the principle of autonomy is ownership which is ownership of the patient's body to undergo medical treatment. 53 As such medical ethics rest on patient autonomy or patient acceptance of health care. However, the lack of medical knowledge and fear of occupied more of a paternal role there were fewer problems with consent because most patients expected and accepted the doctor's direction. While some modem patients continue to accept this traditional model of the doctor-patient relationship, many do not and want to know more about the medical treatment or procedure involved including the possible risks and available alternatives. As we shall see, this right to a thorough disclosure of information about proposed treatment is now firmly entrenched in Canadian law, as is the patient's right ultimately to decide whether or not to undergo that treatment. Ellen I. Picard  illness where patient is not equal morally to doctor who has more knowledge, thus patient needs encouragement and respect as an individual to be treated. 54 In later development, the principle of autonomy which has roots in the principle of ownership evolves into the principle of "beneficence". Devereux stated that: e countervailing principle to autonomy is often beneficence. e moral duty of beneficence requires medical practitioners to act so as to produce the best medical result for their patient.
at is to say they must act so as to promote the wellbeing of the patient. Beneficence may also involve the prevention of harm, the removal of harm, benevolence or compassion. e idea of beneficence is trained to treat, to attempt to cure the patient. 55 Further Catherine stated: e principle of beneficence obliges a doctor to abstain from injuring others and to help others further their legitimate interests by preventing or removing possible harms. It is the responsibility of the medical profession to do good to patients and the public. Beneficence includes efforts to improve the health of a community. 56 e principle of "beneficence" is reinforced with the principle of "non maleficence". As stated by Catherine non maleficence is the duty to do no harm, an obligation not to inflict harm intentionally. Obligations of beneficence and non maleficence are both expressed in the Hippocratic Oath: "I will follow that system of regimen which according to my ability and judgement, I consider for the benefit of my patients and abstain from whatever is deleterious and mischievous." 57 e principle of autonomy, beneficence and non maleficence becomes the philosophical foundation of informed consent regime in medical practice. In Indonesia informed consent is formulated in Article 45 Law Number 29 Year 2004 on Medical Practice. Briefly, the article formulates that every medical treatment being performed by a doctor to a patient must be with patient's consent after the patient being given comprehensive information which at least includes: (1) Diagnosis and medical procedure. (2) e purpose of medical procedure. (3) Other alternatives and accompanying risks. (4) Risk and complication which might occur. (5) Prognosis on the medical treatment performed. is consent could be given in writing or verbally however medical treatments which carry with it high risk must 54  be performed after written consent signed by those with rights to give consent.
In the perspective of consumer protection law the relationship between doctor and patient could be construed in terms of relationship between health providers and health receivers. 58 Business English Dictionary define consumer as "A person or company which buys and uses goods and service". 59 According to Black's Law Dictionary a consumer is "A person who buys goods or service for personal, family or household use with no intention or resale; a natural person who use products for personal rather than business purpose". 60 While in the Textbook on Consumer Law, a consumer is "One who purchases goods or service". 61 Law Number 8 Year 1999 on Consumer Protection defines a consumer "Anyone who utilizes goods and/or services available in society, be it for personal, family, other people or creature benefit in which the goods and/or services are not resold". 62 If a consumer could be defined as above, a patient would be health receiver of goods and/or services (such as medical treatment) while a doctor would be health providers of goods and/or services (again, such as medical treatment). So the health receiver is consumer while the health provider is producer. However, according to Daldiono, eventhough the relationship between a patient and a doctor could be likened to a consumer and a producer as it is permeated with business aspects, 63 principles contained in consumer protection law also apply to guarantee 64 patient's rights. 65 e speech of John F. Kennedy on 15 March 1962 in front of the United States Congress on consumer protection was marked as a new era for consumer protection.
is speech obtained much support evidenced by the formation of consumer protection law in the United States a move which was followed by 58 Dokter, Consumer protection is all effort which guarantees legal certainty to provide protection to consumer. e right to be informed. (4) e right to be heard. 67 ese universal consumer rights could be construed as the rights of patients (health receivers) to obtain medical treatment from doctors (health providers) with the following explanation. First, the right to be heard which is the right of patient to be heard concerning the complaints the patient is suffering from such that the doctor can diagnose the patient and determine the medical treatment to be performed.
Second, the right to be informed after presenting complaint of the illness being suffered based on the right to be heard, the patient has the right to obtain information on the diagnosis, medical treatment, treatment alternatives, risk, complication as well as prognosis on the illness being suffered. e right to be informed is one of the foundations of informed consent for the patient from the perspective of consumer protection law. the patient has rights upon himself or herself based on the principle of ownership such that the patient has the freedom of choice to accept or reject the medical treatment, acceptance or rejection being the patient prerogative right. It must be understood that the foundation of the right to be informed is the freedom of choice that the patient could make to determine his or her decision. is right determines whether relationship based on informed consent occurs or not.
Fourth, the right to safety which is the final result desired by both patient and doctor. However, it must be emphasized that the bond between patient and doctor is inspanningsverbintenis bond, a bond based on maximum effort to cure patient not resultaatsverbintenis bond, a bond based on result which could guarantee patient's health. e right to safety could be connected with the principle of beneficence and the principle of non maleficence. e idea of beneficence is to attempt to cure the patient while non maleficence is the duty to do no harm, an obligation not to inflict harm intentionally.
One of the argumentations of Inosentius Samsul on the importance of government intervention for consumer protection is the relationship between consumer and producer is asymmetrical. 68 is argumentation also supports the idea that the relationship between patient and doctor must be symmetrical in the form of partnership as elaborated by Daldiono previously. Dunggan stated that consumer protection law rest on welfare consideration 69 as is protection to patient who desires benefit (maslahat) to patient.
Based on the above explanation, the principles of autonomy, beneficence and non maleficence contained in health law or universal rights contained in consumer protection law, which are: (1) e right to safety. (2) e right to choose.
(3) e right to be informed. (4) e right to be heard all support the doctrine of informed consent on the relationship between patient and doctor. consent. In the Supreme Court decision there are several legal facts related to informed consent, which are: (1) at the Defendants before performing cito secsio sesaria operation on the victim had not conveyed to the victim's family the possibility of event which could befell the victim.
(2) at the victim signature contained in the consent form is spurious signature according to the analysis result of Criminal Laboratory NO.LAB: 509/ DTF/2011. 70 Both facts are sufficient to prove that the implementation of informed consent is closely related to the concept of amânah.
Amânah in Islamic law is very closely related to justice 71 and justice is indeed one of the criteria of success to fulfill amânah. Majid Khadduri stated: In the Alquran there are over two hundred admonitions against injustice expressed in such word as zhulm, itsm, dhalâl and others, and no less than almost a hundred expressions embodying the notion of justice, either directly in such word as 'adl, qisth, mîzan and others as noted before or in variety of indirect expression." 72 Amânah which must be fulfilled by human as khalîfah fî al-ardh to safeguard the universe is quite burdensome, such that there is dialogue between angel and God, in which the angels question the ability of human to fulfill the amânah. Even the heavens, the earth, and the mountains are reluctant to fulfill the amânah as they are afraid of not fulfilling it. 73 e burden of amânah which must be fulfilled by humans is supported by the human mind which is also part of the amânah of God to be safeguarded.. 74 Related to the philosophy of human creation, this means all parts of humans physically, spiritually or mentally are amânah of God including the task of doctor to provide medical treatment to patients and the need of patients to get cure for their disease. As such the concept of amânah must be internalized and crystallized in every human movement as a reflection of slavehood to God. us doctor and patient based on informed consent is also part of the relationship build on the framework of amânah. As informed consent is agreement (amânah) given by patient to doctor after obtaining information from the doctor. 75 Based on this explanation, several levels of the concept of amânah could be elaborated in informed consent, which are: (1) at God gives amânah to doctor to apply maximum effort to cure patients not to guarantee the patient's health, as guarantee of health belongs to God's domain.
(2) On the other hand, God has given amânah to patients to maintain their health and life not to surrender their health and life to be guaranteed by doctor's treatment, as the guarantee of health and life belongs to God's domain.
(3) In the next level the patient wishes to cure their illness by presenting their complain and requesting help from God who are considered more knowledgeable in medicine compared to himself or herself, the doctor then provide explanation (information) to patient on the diagnosis, medical treatment, treatment alternatives, risk, complication and prognosis 76 of the illness being suffered. If the patient agrees 77 on the medical treatment to be performed, informed consent has been given as amânah to the doctor. is explanation could be defined as the trilogy of amânah concept in informed consent as could be depicted in the following diagram: Hence the question arise, can someone guarantee that he or she would always be consistent in fulfilling amânah that is his duty? Can a doctor always fulfill the amânah given to him in providing medical treatment to patient? As such, could someone's fulfillment of amânah be controlled? ese questions are difficult to answer 75  precisely but could be elaborated in stages.
e Supreme Court Decision of dr. Dewa Ayu Sasiary Prawani, dr. Hendry Simanjuntak and dr. Hendy Siagian in fact is derived from the understanding and implementation of the concept of amânah in informed consent. Performing cito secsio sesaria operation on the victim without conveying to the family the possibility of events which could befell the victim is not fulfilling amânah. Such is the case for faking signature, an act that does not fulfill amânah. 78 Except chosen people such as Prophets, not a single person could guarantee the consistency of fulfilling amânah in their course of duty. Abû Bakr who obtained the title al-Shiddîq in his "inauguration speech" requested to be corrected if he goes in the wrong direction. 79 e Prophet refused to give any position to Abû Dzar as he is deemed weak 80 in fulfilling amânah which is an indication that academic ability does not necessarily correlate with ability to fulfill amânah. Daldiono elaborated that a wise doctor is a smart and kind doctor. 81 Kind behavior that fulfills amânah needs to be controlled such that the consistency is maintained, as the behavior of fulfilling amânah could change depending on the condition and situation when amânah is being fulfilled. e trilogy of amânah concept in informed consent could be a lens to view the practice of medicine in Indonesia, such as follows: first, Article 2 of Law on Medical Practice stated that " e practice of medicine is carried out based on Pancasila and the values on science, benefit, justice, humanity, balance and protection and patient's safety." 82 Implicitly, the terms of this article has contained the value of amânah as it has been based by Pancasila as the values of humanity, protection, benefit and justice are implicit in Pancasila. However, explicitly the value of amânah is not included in this article, a regrettable fact since this article is hoped to be the spirit of the regulation of relationship between doctor and patient.
Second, every doctor which performs medical practice in Indonesia must have practice license issued by local medical authority in the regency/city where the practice is located and the doctor practice license 78 (1) states "Practice License (Surat Izin Praktik/SIP) of a doctor or dentist is given at most to 3 (three) practice locations, be it in medical service infrastructure of the government, private or individual practice." 84 Further in Article 4 clause (3) it is stated "SIP of 3 (three) practice locations as mentioned in clause (1) could be located in 1 (one) District/City or other District/City be it in the same Province or other Province." 85 If this philosophical foundation is welfare and benefit for doctors, this regulation is appropriate as it limits the location of doctor's practice. However, if amânah is used as the philosophical foundation of this regulation hence it is not fully appropriate. A doctor who practices in three different provinces would have to travel a long distance to reach his or her practice place. In a situation where the patient being treated is in emergency condition but the doctor is practicing in a different province could amânah be performed according to informed consent. Could doctor refer his or her patients to other doctor because he is then practicing in other province while he or she is still competent to treat the patient? 86 Isn't that against the amânah which has been given by the patient based on informed consent? In the perspective of amânah a doctor must be able to gauge his or her ability to fulfill amânah related to practice location. As such, in the perspective of amânah the regulation for location of doctor's practice (not the number of doctor's practice) should be reviewed by considering distance, condition and situation where in major cities there exists a great number of traffic jams. is review is important to be done based on the philosophy of amânah being given to the doctor by the patient based on informed consent. Year 2004 on Medical Practice which stipulates "Doctor or dentist when practicing medicine has the obligation to refer a patient to another doctor or dentist who has more expertise or ability when they could not perform a treatment or provide medication." obtain legal protection when performing duty based on professional standard and according to standard operational procedure. (2) To give medical treatment based on professional standard and according to standard operational procedure. (3) To obtain complete and honest information from the patient or his or her family. (4) To receive pay." 87 e ambiguity in this article could be found in the order of doctor's rights where the stipulation of "To obtain legal protection when performing duty based on professional standard and according to standard operational procedure" is placed as the first right while the amânah given to him or her has not been fulfilled. is stipulation was born out of the defensive attitude of doctor when treating patient, not from his or her offensive attitude in which doctors and patients are both in partnership to fulfill amânah. e stipulation of the legal right should be placed after the stipulation of right "To obtain complete and honest information from the patient or his or her family".

Closing Remarks
Health is an obligation of every citizen who must be protected by the state. In obtaining their legal rights of health patient has a legal relationship with doctor based on informed consent. e principle of autonomy, beneficence and non maleficence in the perspective of health law as well as the right to safety, the right to choose, the right to be informed and the right to be heard in the perspective of consumer protection law supports and becomes the philosophical foundation of informed consent doctrine in the relationship of doctor and patient. Medical treatment given to the patient based on informed consent must be implemented fulfilling amânah based on the trilogy of amânah concept. []