Kaidah Dasar Bioetik

Asep sukohar, dr

• Kemajuan teknologi global transparency dampaknya pada kehidupan dan ekonomi manusia, terjadinya benturan atau konflik pada profesi medis

Etika Disilpin

Hukum

Konflik Etiko-Legal

Etik Dan Humaniora (conts)

Goals :• To incorporate ethical concerns and issues into

all phases of the education medical students.• To help prepare students to understand their

own values and be ethically aware medical practitioners.

• To provide students with the knowledge, skills, and attitudes required to be clinically competent in medical ethics and to be able to make ethically-informed medical decisions.

• Goal:

• Behave in a professional, moral, and ethical way, and recognize the ethical issue as well as themedico-legal aspects of medical practice

• KIPDI III (terbaru)

Teach other

Practice by doing

Group discussion

Demonstration

Audiovisual

Reading

Lecture

80 %

75 %

50 %

30 %

20 %

10 %

5 %

LEARNING PYRAMID IN MEDICINE

The patient’s contexts for prima facie’s choice(Agus Purwadianto, 2004)

J usticeNon maleficence

AutonomyBeneficence

Time

General benefi t result, mos t o f people,

Elect iv e, educ at ed, bread-winner, ma ture person

Vu lnerab les, emergency, lif e sav ing, minor

> 1 p erson, others similari ty, community / social ’s r ights

TERGANTUNG ……. BERUBAH MENJADI

Medis atau etis?

Kasus Konkrit 1

-

KeputusanMedis

Keputusan etis

Pilar Keputusan Klinis sehari2

-

KeputusanMedis

Keputusan etis

Pilar Keputusan Klinis sehari2Biomedik

Info-medik

Indikasimedik

pilihan pasienkualitas hidup

fitur kontekstual

Mindset non medisStruktur Psiko-Sosio-budaya

Tergopoh-gopoh spt ini, benar atau tidak ?

Kalau yang ini 1 dari ratusan korban tsunami, lumpur panas ?? (di luar RS >>)

Principles-based ethics Prima Facie

T.Beauchamp & Childress (1994) & Veatch (1989)

Beneficence

Non Maleficence

Autonomy

Justice

Contextual featuresQuality of life

Clinical DecisionMaking

Patient’s preference

Medical indicationValue-based medicine

EBM

• MALPRAKTEK?→HASIL AKHIR/’’PROSES?– DUTY– DELIRICTION OF DUTY– DIRECT CAUSE– DEMAGE

TROEF = berubah menjadi ……

Beneficence

Non Maleficence Autonomy Justice

MedicalIndication

pihak II UmumBAIK“kranjangSampah”

pihak IIkesakitan/menderita,gadar,pra-cacatDistressRentanuzur, terjepit tanpa pilihanMiskin

bodoh.

capable person bebasElektifrentang >>hak pilih a

// DRnya

pihak IIINon pasienwakil/walikluster popKomunitasPenyandangdanaBerpotensiDirugikan/Paling krg

diuntungkan

ENRICHMENT OF JUSTIFICATION

Beneficence Non Maleficence Autonomy Justice

Not stipulated in the text = Patient’s Context

MedicalIndication

DEDUCTIVELOGIC

PRIMAFACIE

CETERIS PARIBUS

CREATIVE THINKING

(NEW) ILLAH = actual duty = contextuality

“OPPOSITION”

VALUECONFORM

>< : DETECTDEVIATION

Prima Facie

Keketatan Pemikiran Logis

Rule of thumb,Hanya disebut

KAIDAH DASARBIOETIK

Absolut

Lurus, mengikat

Kartu Bridge/“Troef”

“Domino”

R.Veatch, 1981

Actual duty = contextuality> prima facie duty

(Ross, 1939)

Kaitan Etik - Moralitas

Moralitas

Etik

Praksis =Tuntunan Perilaku

NormatifTuntutan Berpikir Logis Kritis

refleksi

MetaEtika

Standar rasional& metode peroleh E

Yg dipercaya & diperbuat Manusia = praktek

Teori“seyogyanya”

Pembenaran“Seharusnya”

NILAI

Menghargaimenjunjung

BenarBaik

cocok

Teori Hidup baik (bermakna)

1.Cinta menyatu ke Illahi (Plato, sufisme Islam, Kejawen)

2.  Kebahagiaan (eudamonia) 3.  Kebajikan/keutamaan (virtue) Aristoteles4.  Hindari perasaan sakit (Epikurus).5. Rela menyatukan diri dengan (hukum) alam

sebagai sunatullah (Stoa)

Teori Hidup baik (bermakna)

• 6. Cinta kepada Tuhan (Agustinus)7. Mengikuti hukum kodrat (cinta kepada Tuhan plus keutamaan)8  Not having, but being (Erich Fromm).9. Kebebasan/otonomi subyek sebagai sumber

moralitas (Kant) 10.Pandangan dunia/lebenswelt (Habermas) 

Insight Core Problem

Keywords

BasicMoral

Principle

Beneficence

Nonmaleficence

Autonomy

Justice

Metode AP

Chosen Principle

Choose 1-2 out of 4 most relevant

(problem solving)

EthicsTheory

Virtue - eudamonia

Duty - deontologist

Utilitarian – teleologist eg happiness

Metode AP

EthicalRelativism

Culture

Custom

EthicalDilemma

Science & technology determinant

Societal & capital determinant

Quality of life

Metode AP

Prima Facie’s Principle

Deductive Logic/Ceteris

Paribus

Calculated Assumption

(other principle stable)

Solving the ProblemConsistency

Coherent

Correspondent

Pragmatic

Context vs Text

Choose 1-2 out of 4

(most stringent)

Metode AP

Legal Option

Administrative

Penal

Civil

Metode AP

• Deduktive: dibentuk dari pengalaman, teori, dogma yg bersifat umum, di bentuk dugaan.

Tugas Pelaporan

ETHICAL PROBLEM SOLVINGNama Mahasisw a :

Case Ethical Problem Alternative Based Alternative Decision Self Assesment Verification ReasonsNo. on Values System

INSIGHT KDB + CHOSEN PRINCIPLE PRIMA FACIE VALUETHEORY ETHICS E. RELATIVISM CETERIS P CLARIFIC.

E. DILEMMA DEDUCTIVE LSOLVING PROB

No.

Kasus

Langkah

Modif H.B.

Pilihan Prinsip

relevan /Pendapat Singkat

Nama

Mahasiswa

1.

2.

3.

4.

5.

6.

Langkah (Langkah Modifikasi Howard Brody method)Kasus No. :______Prinsip Yang dipilih Kelompok :______________________________Nama Mahasiswa :______________________ CONFORMED / NOT CONFORMEDAlasan :______________________________________

KESIMPULAN KDB = metode pengajaran etik sbg penjernih

logika & peningkat daya kritis mhsw dlm menyeimbangkan keputusan etis thd keputusan medis di klinik

Analisis etikolegal = pelengkap utama KDB yg berguna utk membina sikap tanggungjawab, kesadaran hukum & profesionalisme DR kelak

Modul (sbg perangkat) = alat praktis permudah pemahaman etika, hukum & HAM dlm aplikasinya di Kurikulum Berbasis Kompetensi