kdb rumpun ilmu kes ui 2015

8/18/2019 Kdb Rumpun Ilmu Kes Ui 2015

1/78

TEORI ETIKA &

KAIDAH DASAR BIOETIKA

Agus Purwadianto.

Jakarta, 2015


2/78

3 Masa Depan Dr (ERA PRA-J!"#PJ$%

Makin &ak&ur ' spesiaisasi )*asa+' utting

iniians" interensi/ ' &onopoistik" *unga*er*unga ' ino&e $pJP ' terkaaDAR PRA4E!A $AJA di Jkt Rp.1M"se*uan !E44 6666

#iasa-*iasa sa7a ' )ukup &akan inikura nor&a ter*anak666

Makin terpuruk ' 4DA 8MPE449 (:

di7au+i pasien e unpro/essionais&% apaagi; $ $8?E4 R$8 turunreputasi @ /inansia pasa gugat"tuntut+uku&


3/78

Masa depan dokter gigi

Pe&iik **rp R$

$pesiais 8rt+odonti ; pe&iik **rp

kinik gigi onsutan industri produk &uut @ gigi

Mana7er R$

Praktisi ; dosen Pengusa+a &is ' pe&iik stasiun 4 #intang /i& d


4/78

Persoaan dunia &edik $ua&i &inta Dr &eakukan eut+anasia t+d istrina

g )ko&a o&isi Etik R$?M +rs &en7awa* Apa @ *agai&ana 7awa*an g *enar

Pasien puang paksa *enar "saa+

Dapatkan s*g *a+an pe&*ea7aran sensitiitas etik &+sw9

Dr peneiti &e&*awa irus B5!1 ke

negara @ &asarakat )tak ikut diuntungkan

8atau tdk


5/78

Persoaan Denta

Drg non spesiais &e&*u7uk re&a7a )kurang PD utk pasang *e+e

M+sw 9= &e&inta toong )tukanggigi &e&*uatkan prosto

Drg penderita B &s+ ngotot praktek

Drg $pes #M dikonsu trau&a wa7a+ o"dokter spes kuit


6/78

Persoaan 9ar&asi

etergantungan *a+an *aku o*at 8*at &a+a @ pasu

Renda+na &inat apoteker ko&unitas gdukung sainti/ikasi 7a&u

on/ik etikoega industri D! -

o&isi ke Dr

kepatu+an pd MeCio ?itPrinipes Penguasaan akes @ *ioogias < Prinipes


7/78

Persoaan !ers

Disparitas ko&petensi @ su*sistensi interna 8rientasi kurati/ Bak pengo*atan

seder+ana >> !o.3"201F @ deegasi

tindkan &edik ttp a*ai paradig&a se+at(inkonsisten dg /ioso/i keperawatan%

Peru 7a*aran kek+asan asu+an" tindakan

keperawatan #eu& adokator pasien


8/78

Persoaan es&as

G0 ta+un &erdeka era 4 @ 9E4P *eu& adasiste& tanggu+ insidens @ preaensi utk 1 7enis penakit Pro&otor kese+atan tergusur #uku i&u kes utk $D"$M> (-% Puskes&as *ergeser ke R$

AP#! H 5I waau kini era $J$!"J! Makanan anak sekoa+ tere&ar >$ tergusur


9/78

Survey Ranking Professionals

on Level of

Moral Confidence & Trust

10 P+ar&aist ?erg

9ire/ig+ter 4ea+er Police Dotor Dentist Aountant $tok #roker


10/78

Medis atauetis

4E!$ E$MA$ "E4ER$EDAA! A$!% sE4A E$MA$

dik i


11/78

-

KeputusanMedis

Keputusanetis

Pilar Keputusan Klinis sehari2#io&edik

n/o-&edik

ndikasi&edik

pii+an pasien

kuaitas +idup/itur kontekstua

Mindset non &edis$truktur Psiko-

$osio-*udaa


12/78

Ja&u :


13/78

Physician’s competence

Valid evidencePatient’s valuesPA4E!4$ PRE9ERE!?E

9R8M $4>DE$

JAM> DPAA @ #ERMA!9AA

(Riskesdas 2010%

EDE!?E #A$ED MED?!E &odi/ikasi $udigdo $

B8


14/78


15/78

Bioetika = abstrak ?


16/78

Dr $igap @ 4ergopo+-gopo+ spt ini, *enar atau tidak


17/78

aau ang ini 1 dari ratusankor*an tsuna&i, u&pur panas (di uar R$ LL%

8!4E$ '#E!AR"$A


18/78

4+e patients -onteCts /or pri&a /a-ies -+oi-e(Agus Purwadianto, 200F%

Justi-e!on

&ae/i-en-e

Autono&#ene/i-en-e

Time

General benefi t

result, mo s t of

people,

Elect iv e, educ at ed,

bread-winner, ma ture

person

Vulnerables,

emergency, lif e

sav ing, mino r

> 1 p erson, others

similari ty, community /

social ’s rights

1 BENEFICIENCE : SIKAP/BERBUAT


19/78

onteks ' tertu7u pd pi+ak (indiidu pasien%pada u&u&na, g sta*i (tidak gawatdarurat, tidak rentan% untuk kepentinganpasienna

>ta&akan atruis&e

Men7a&in niai pokok +arkat @ &arta*at&anusia )apa sa7a ang ada, pantas (eok% kita*ersikap *aik ter+adapna (apaagi ada

ang +idup%

Buku& ' ke&asa+atan u&u& L dp ge7oaksosia, ke*e*asan *erpendapat"pers L otoriter

1.BENEFICIENCE : SIKAP/BERBUATBAIK

(1)

1 BENEFICIENCE : SIKAP BERBUAT


20/78

1.BENEFICIENCE : SIKAP BERBUATBAIK

(2)

Me&andang pasien"keuarga"sesuatuang tak +ana se7au+ &enguntungkandokter

Maksi&aisasi aki*at *aikL*uruk Mini&aisasi aki*at *uruk

#anak dianut di 4i&ur (ter&asuk R%,

paternais&e nata dan prinsip&usawara+ &u/akat

1 BENEFICIENCE : SIKAP/BERBUAT


21/78

1.BENEFICIENCE : SIKAP/BERBUATBAIK

(3)

=enera *ene/iene ' *er*uat *aik kepadasiapapun ter&asuk )ang tidak kita kena ( )*e*as dari ..... : i&partiait%, &erupakan etikanor&atie

)keran7ang sa&pa+ niai apapun $pei/i *ene/iene ' *er&ora *ia tindakan

*aik ditu7ukan kepada pi+ak k+usus )ang kitakena (% ' pasien, anak-anak, te&an-te&an.Ba ini &eni&*ukan kewa7i*an )&utak pro/esi,

k+ususna seara psikoogis.


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2.NON MALEFICENCE : TIDAK MERUIKAN(1)

onteks ' tertu7u pada pi+ak (pasien%kesakitan"&enderita, gawat darurat, &en7eangaat, distress, rentan, tidak"*ukan otono&

seperti uur, ter7epi tanpa pii+an, &iskin, *odo+. $isi PE!E=>BA! !E=A$ awan *ene/iene ' Jangan &e&*unu+, *uat inkapasitas, d

Primum non nocere (perta&a 7angan &enakiti%

4A MEM#>A4 MA! disparitas (;%,E#ERPBAA! $


23/78

!on Mae/iene 4epo siro (toerasi e&patik% utk tak kai& +ak di

depan penderitaan " kekurangan orang ain"kien Ja&in )tak &a+a +ati s*g sikap otentik pro/esi

4idak &eng-o*ek-kan kien (sekedar &en7adikanna )aat, *ukan tu7uan - ant

LH +a *uruk terprediksi tak kor*ankan tu7uang )kepentingan &orana se*anding ($inger%


24/78

!.AUTONOM" : SELF DETERMINATION(1)

onteks ' ditu7ukan pada pi+ak (apa*eperson : indiidu pasien g dewasa, se+at,*e*as (puna rentang +ak pii+ atas keputusan

dirina, seperti kondisi pro operasi eekti/%,se7a7ar dengan dokterna.

Meng+endaki, &enetu7ui, &e&*enarkan,&endukung, &e&*ea, &e&*iarkan pasiende&i dirina sendiri (se*agai &ak+uk*er&arta*at%

Buku& ' #e*as utk ...., ke+endak *e*as,

+ak @ kewa7i*an (rig+t *ased approa+%


25/78

3.#USTICE : KEADILAN(1)

onteks ' tertu7u pada pi+ak ketiga seainindiidu pasien"kien, waki"kusterpopuasi"ko&unitasN pi+ak penandangdana"ikut penanggung 7awa*, pi+ak *erpotensi

dirugikan"paing kurang diuntungkan. Me&*eri perakuan sa&a kepada pasien untuk

ke*a+agiaan pasien @ u&at &anusia akni' Me&*eri su&*angan reati/ sa&a dengan ke*utu+an

&ereka (kesa&aan su&*angan sesuai ke*utu+an

pasien% Menuntut pengor*anan &ereka seara reati/ sa&a

dengan ke&a&puan &ereka (kesa&aan *e*an sesuaidengan ke&a&puan pasien%


26/78

?+ek ist (8*seration $+eets%

#ene/iene ?riterion es !o

Pro&oting atruis&

=uaranteeing +u&an dignit

iewing patient"/a&i not as pro/ito*7ets

MaCi&ie agregat net *ene/it

?o&passionate paternais&

=uaranteeing &ini&a i/e o/ patient

Restriting )goa *ased approa+

MaCi&ie patient satis/ation

4utors na&e=roup !o.


27/78


#ene/iene ?riterion (2% es !o

MaCi&ie oera +ig+est +appiness

?ontinuing pro/essionadeeop&ent

=iing e//etie-ow pried &ediine

Apping =oden rue prinipe

Pro&oting patients *est interest

et



28/78


!on Mae/iene ?riterion es !o

Beping e&ergen patient

4reating unera*e patients

!ot kiing patient (no eut+anasia%

!ot +u&iiating"a*using patient

!ot respet patient as o*7et

4reating unproportiona

!ot preenting patient /ro& danger

Aoiding &isrepresentation to P



29/78


?on/identiait ?riterion es !o

!ot disosing to /riends"reaties

?are/u waiers ' dut"per&ission to warn

?are/u reation a*out pu*i /igures

Prudent o&&itting sensitiein/or&ation /ro& &edia reord

Prudent ation to 3rd parties @ pu*i

o//iiasPrudent ation o/ partnernoti/iation



30/78


Justie ?riterion es !o

Apping eert+ing uniersa

4aking ast portion o/ diidingso&et+ing

=iing P-sa&e positions si&iaropportunit

Respet Ps rig+ts ' a//orda*iit,

eOuait, aessi*iikt, aaia*iit,Ouait%

Respet Ps ega rig+ts

et 4utors na&e=roup !o.


31/78


Justice Criterion - GENERL !es No

Patient " co#$liance to t%e SP ' (N )RG*clinical$at%+ay

Patient " not de#anding un$roved * futile

treat#ent)r " using la,s*%os$italiation SP on #ostscientific rigorous ./golden0 standard1

)r " treat as ,est E2M n not e3cessively

,urdenso#e4ealt% P " Pro$er use of scarce resource of d+%ole society or $reventive action of it


32/78


Justie ?riterion es !o

Respeting ot+ers rig+ts

?aring t+e unera*es (t+e eastadantage peope%

!ot a*using"disri&inating

Kise in &aro-aoation

et

et



33/78

2eneficen

ceNon Maleficence utono#y Justice

5 6)2 R(G()

Logika PENGG7GT

4rs dii#,angi

Cara 8

Logic T%inking critical analysis

Medical

(ndication

Pro/esionais&e $B

Pro/esionais&e DR


34/78

Our own

(Dr. Tenar’s) cases

Implementation of the 1st year students

Select of 67 cases

WHO SEARO

$o%&P$e'e*ioPle*$+

I,i-i,%*l/$o%& : T*e o0e e*0

E#P3B Modue#at+ 2005

Prinipes *ased et+is Prima Facie


35/78

Prinipes-*ased et+is Prima FacieT.Beauchamp & Childress (1994) & Veatch (1989)

Jonsen & ie!ler ("##")

Beneficence

Non Maleficence

Autonomy

Justice

Contextual features

Quality of life

Clinical Decision

Making

Patients pre/erene

Media indiationaue-*ased &ediine

E#M

#A


36/78

Dedutie ogi

2eneficen


Combination of

It’s characteristics = atient’s Context

Met%od 8 ,allancing of s$ecification

8 Logic 9 creative t%inking 8

critical analysis 9 +isdo#

Medical

(ndication

rues

Partiuar"?onrete ase

prinipes

#A


37/78

E#E>A!


38/78

4R8E9 : *eru*a+&en7adi

2eneficen


Medical

(ndication

&i* IIU0%0BAIK$**4

S*0&*5

&i* IIe'*i*/0e,e$i*64*,*$6&$*7c*c*Di'$e''Re*%8%$6e$e&i*&* &ili*Mi'i

9o,o.

c*&*9le&e$'o9e9*'Elei $e*4 ;;

* &ili *

// DR+*

&i* IIINo &*'ie


39/78

?8!4EQ4>A


40/78

E!R?BME!4 89

J>$49?A48!

2eneficen

ce Non Maleficence utono#y Justice

Not sti,ulate- in the text =

atient’s Context

Medical

(ndication

DED>?4E$

?REA4E 4B!!=

(!EK%


41/78

Dari ogniti/ &en7adi $ikap

Awa penge&*angan daa kritis &+sw


42/78

4+e D88R Mode

Deter&ine

Options

Outo&es R ee

http://www.mfrc.ameslab.gov/


43/78


44/78

8ptions

=* o&io' ,o I*-e>

K+at are so&eeCtre&e +oies A& onsidering

seera +oies K+at resoures or

+ep do +aeaaia*e

K+at resoures

K+ose +ep



45/78

8uto&es

K+at oud +appen*ased on t+e 8ption

?+oose K+at oud +appen i/

do not+ing K+o wi *e a//eted

* w+at do

s it t+e R=B4 t+ingto do



46/78

Ree

A/ter an option is+osen, Return to

see i/ t+e originaOuestion is sti aid.



47/78


48/78

1a

1* 2

3

Priorit o/ spei/iation in 4enars ase ' 1a"1* 2 3

#8E4B?$ prinipes @ PB Agus Purwadianto,200


49/78

#8E4B?$ prinipes @ PBnterention

2eneficence utono#y

NonMaleficence

Justice

E!E"#$ %&'(#!G &uman rights

GeneralsoationSuarantineo/ s&pto&ati$oia-distane

Measures4rae restrition#order ontro

ES>49AR PR8?E$$RE?PR8?4

)istributive/

Global *ustice

)o !o &arm

>4


50/78

#8E4B?$ prinipes @P+ar&aeutia Praties

2eneficence utono#y

NonMaleficence

Justice

+atient’s E!E"#$ &uman rights

GeneralE99?A?Drug in/or&ationn/or&ed +oieDrug ontro

Reasona*e PrieES>49AR PR8?E$$RE?PR8?4Do+a Prinipes

)istributive/

Global *ustice

)o !o &arm

>4


51/78

Peran #ioetika (1%

Penera+ ko&unikasi g etis, tak +anae/ekti/.

Menuntun +idup *ersa&a se7a+tera MA$ARAA4 = DEKA$A"MA4A!="#ERADA#

Me&perta7a& daa pikir kritis t+d sesuatu niaig ada di )*eakang kenataan atau ideoogitertentu #E


52/78

PERA! #8E4A (2% PE!EM#A!= AP-A! @

E4ER$EDAA! P4ED8 ME!JAM! !RA! PR89E$ Praktekkedokteran"ke/ar&asian"A$>BA!

keperawatan (aue *ased &ediine"#M% Mengkritisi pradok"ankes g ko&ersia,

ekspoitati/, &eanggar &ora"nir&anusiawi


53/78

Pro/ession

4o pro/ess : to proai& so&et+ingpu*i

4+e at : trustwort+iness :o&&it&ent to an idea to w+i+ t+es+oud on/or& : t+e essene o/pro/ession

4o *e o&petent to +ep patients 4o +ae t+e patients *est interests in

&ind

E ik D k REtik D kt R


54/78

Etika Dokter REtika Dokter R,i KODEKI I?SAN5

Kemurnian niat = sikap moral tanpa pamrih Kemurnian niat = sik ap moral tanpa pamrih /non/nonmaleficence = deontologis maleficence = deontolo gis

Kesungguhan kerja = tindakanKesu ngguhan kerja = tindakan tgjwb tuntas ,tgjwb tuntas ,

perhatikan keselamatan pasien perhatikan keselamatan pasien (semua KDB)(semua KDB)teleologi & utilitarian teleolo gi & utilitarian

Kerendahan hati = sopan Kerendahan hati = so pan irtue irtue

!ntegritas ilmiah & sosial !nte gritas ilmiah & sosial

= martabat profesi luhur (hormat diri sendiri &adil) profesionalisme & etika sosial & petuhisistem etikolegal

Metode AP


55/78

Insiht Core Problem – ofcontextKeywords - text

! MA$A MA$A ?AMP>RA!

4M#A!= $E MA?B8 AA!AB JAD MA$A>M

Metode AP


56/78

PA$A< 8DE

?A>PA! PA$A<

PE!JEPA! PA$A

PE!JE!= =>!AA! )4E$4 PE!


57/78

Core Problem

Keywords

BasicMoral

Principle

Beneficence

Nonmaleficence

Autonomy

ustice

Metode AP

A #!=>!= =>!AA! 4E$4 PE! (B8RT8!4A<


58/78

r ma

!aciePrinciple

Context !s "ext

Choose 1-# out

of $ mostrele!an

%problem

sol!in&'

$APAAB = A4A> #APA $APAAB = BAR>$ D8R#A!A! !8! MAME!4A$!A

D84ER ' BR$ #E!E9?E!?E A4A> BR$ AD<

Metode AP


59/78

"thics

#heory(irtue - eudamonia

)uty - deontolo&ist

*tilitarian –

teleolo&ist e&

happiness +

conse uentialist

DE8!48


60/78

"thical

$elativism

Culture

Custom

B*)AA . BANAK ANAK BANAK /00KI 222

ANAK 3AKI-3AKI 4 B0/5A/6A 222 %60N)0/'

7/I0N"A8I K0K*A8AAN 90N60:P37I"I/

7/AN6 A;A9 2

97"I(A8I /8 )AN )7K"0/ 2222

Metode AP


61/78

"thical

%ilemma

8cience <

technolo&y

determinant

8ocietal <

capital

determinant

E#M ' PR8=!8$$

M>!8-8MPR8MA$ $ 8$ME4$#A


62/78

&eteris

Paribus

Choose 1 most

influential

principle

BI'( PI'I)(* + #"#(P P(%(

%,K,*(* K" IB, B(.I /#/*/MI IB,

B"*"!I&"*&"0 */*M('"!I&"*&"0 1,#I&" =

%I(*(P #(KB"$P"*($,)

Metode AP


63/78

"thicalProblemolvin

Consistency

Coherent

Corespondency

Pra&matic

Metode AP

$EM>A EP>4>$A! MED DARABA!EPADA PE!=B8RMA4A! EP>4>$A!

#> A!D>!= $#= 848!8M

Metode APibiliPR89E$8!A


64/78

"thico-

'eal

/ption

Administrati!e

Penal

Ci!il

/esponsibility

Accountability

3iability

PR89E$8!A


65/78

%p senior3konsultan y

dosen!K3pemuasa $

%p

PP% 4basah53%P,3%, senior

Puskes 26 1am P## Preklinik Pasca P##PP% minor Karya7an biasa

Koasisten

Etika Sosial &

Latent “UKP” Error

1 kesuksesan

2N!6 $enderitaan

PARAD8$ '

?+arter on


66/78

?+arter onMedia Pro/essionais&

9unda&enta Prinipes'Prinipe o/ pri&ar o/ patient we/are :

$ene%icence non male%icencePrinipe o/ patient autonom' Prinipe o/ soia ustice

Annals of Internal 9edicine= (ol 1>? Issue >= @ eb ##

http.++wwwannalsor&+c&i+content+full+1>?+>+#$>

reeansi


67/78

Pro/essiona Responsi*iities

?o&&it&ent to i&proing aess to are ?o&&it&ent to a 7ust distri*ution o/

/inite resoures ?o&&it&ent to sienti/i knowedge ?o&&it&ent to &aintaining trust *

&anaging on/it o/ interest ?o&&it&ent to pro/essionaresponsi*iities

Pease isit ' www.pro/essionais&.org


68/78

Pro/essiona Responsi*iities

?o&&it&ent to pro/essiona o&petene

?o&&it&ent to +onest wit+ patient

?o&&it&ent to patient on/identiait

?o&&it&ent to &aintaining appropriatereations wit+ patients

?o&&it&ent to i&proing Ouait o/ are

Dina&ika Pengertian


69/78

Dina&ika PengertianBuku&

Medikoega"ega =unakan peraturan g sd+ ada (di*uat oe+penguasa"pe7a*at sa+ &asa au% s*g )paung+uku& : >RD$ EPA$4A! B>>M ttp *isaterus U>!8 666

Etikoega #uat peraturan *aru *er*asis etika (penguasa"e7a*at

sa+ kini utk kepentingan &asa depan%, krn g a&asd+ tak &e&adai"kasus konkrit *& ada aturanna,aki*at perke&*angan iptek, &asarakat dunia"oka,kapita, d : $8$8>M utk apai EADP A!4AR PR#AD

#ia tea+ disa+kan ' &en7adi &edikoega &asa depan

PELANARAN DISIPLINPELANARAN DISIPLIN


70/78

PELANARAN DISIPLIN @PELANARAN DISIPLIN @

i$ *44%4*


71/78

9ediDole&al-0tiDo3e&al

Masa

au

Masa

kini

Masa

depan

ProdukBuku&

Buku& Medis

Eauasi

Masi+


72/78

AB


73/78

KODE ETIK KEDOKTERANII @ KE=A#IBANMORAL

Aturan Pro/esi ' !iai, $tandar, Prinsip (aida+ Dasar#ioetika% @ Aturan (pasa-pasa%


74/78

F%4'i Ko,e Ei Ke>M MA4ERAM 4A4A>M 98RMA


75/78

au kepeduian uta&a-kuAku sopan @ teiti kpd-&u

Marta*at @ priasi-ku a,a ku-+argai

usi&ak @ ke+or&ati pendapat-&u

u*eri in/o sesuai #B$-&u

Bak2-&u 8,

Ao, ikut urun re&*ug 666

Jaga penget @ ketra&pian-kusetiap saat

4a+u *atas ko&petensi pri*adi-ku 6

Bor&ati @ Jaga n/o RB$-&u

Jangan saa+ gunakan kekuasaan-ku

nti Periaku-#aik Pro/esi

Agus Purwadianto, 200

Aga&a-ku tak &e&*uat


76/78

gprasangka ter+adap-&u

RWk ao rWk 66er7asa&a 4i&De&i kepentingan

ter*aik-ku

Ju7ur @ 4erperaa 66666

aau takaik-praktek

?epat tanggap *ertindak


77/78

Accountability

Discipline

Agus ur/a-ianto0 1223

Patients’ Safet

La! as

social en"ineerin"

Lia#ilit

*l%e o ?e*l

Patient"?ient9a&i

?e*l Pe$'oel?e*l F*ciliie'?e*l '+'e0

Media =oas

Res$onsi#ilit

Et%icsP$oe''io*l

Di4i+

PR;ESS(NL(SM

SC(L CNTRCT

P72L(C TR7ST

2EST (NTEREST<

PRE;ERENCES<

ME)(CL (N)(CT(NCNTE=T7L(T!

2LLNC(NG

CN;L(CT ; (NTEREST

?o&&unit$oiet

>7L(T! ; L(;E

2LLNC(NG

:( 2(ET(6


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kdb rumpun ilmu kes ui 2015

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