Kd Bn Prima Facie 2013

KAIDAH DASAR BIOETIKA & PRIMA FACIE

Yuli Budiningsih & Agus Purwadianto, 2013.

Definition:THE DISCIPLINE DEALING WITH WHAT IS GOOD AND BAD AND WITH MORAL DUTY AND OBLIGATION (Websters).ETHICS OFFERS CONCEPTUAL TOOLS TO EVALUATE AND GUIDE MORAL DECISION MAKINGMEDICAL ETHICS IS A DISCIPLINE / METHODOLOGY FOR CONSIDERING THE IMPLICATIONS OF MEDICAL TECHNOLOGY / TREATMENT AND WHAT OUGHT TO BE (Univ of Washington School of Medicine)

Ethics can be described as a sub-branch of applied philosophy that seeks what are the right and the wrong, the good and the bad set of behaviours in a given circumstance

Bioethics is a quasi-social science that offers solutions to the moral conflicts that arise in medical and biological science practice.

The Four Principles of Bioethics in 13th Century Muslim Scholar Maulanas Teachings,Sahin Aksoy,Faculty of Medicine,Dept Med Ethics & History of Medicine,Turki.

Ethics is : the study of morality careful and systematic reflection on and analysis of moral decisions and behaviour, whether past, present or future. Morality is : the value dimension of human decision-making and behaviour.

Since ethics deals with all aspects of human behaviour and decision-making, it is a very large and complex field of study with many branches or subdivisions. Medical ethics is the branch of ethics that deals with moral issues in medical practice.

Medical ethics is closely related, but not identical to, bioethics (biomedical ethics).

Medical ethics focuses primarily on issues arising out of the practice of medicine.

Bioethics is a very broad subject that is concerned with the moral issues raised by developments in the biological sciences more generally.

The study of ethics prepares medical students to recognize difficult situations and to deal with them in a rational and principled manner.

Ethics is also important in physicians interactions with society and their colleagues and for the conduct of medical research.

From Hippocrates came the concept of medicine as a profession, whereby physicians make a public promise that they will place the interests of their patients above their own interests.

In recent times medical ethics has been greatly influenced by developments in human rights. In a pluralistic and multicultural world, with many different moral traditions, the major international human rights agreements can provide a foundation for medical ethics that is acceptable across national and cultural boundaries.

Moreover, physicians frequently have to deal with medical problem resulting from violations of human rights, such as forced migration and torture.

Medical ethics is also closely related to law. In most countries there are laws that specify how physicians are required to deal with ethical issues in patient care and research. In addition, the medical licensing and regulatory officials in each country can and do punish physicians for ethical violations.

Different ways of approaching ethical issues:

Non rational :1.obedience2.imitation3.feeling4.intuition5.habit Rational:1.Deontology2.consequentialism3.principlism4.virtue ethics

Principles of Bioethics = Kaidah Dasar Bioetik:Consist of 4 principles: 1. Beneficence 2. Non Maleficence 3. Autonomy 4. Justice Derivative principles : confidentiality, truth telling, informed consent, privacy, promise keeping, honesty.

ContextBeneficence : do good, altruism, the best practice for the patientNon maleficence: do no harmAutonomy: right to self determinationJustice: fairness, equality

The World Medical Assembly in 1999: Physicians gathered there, representing medical associations from around the world, decided, to strongly recommend to MedicalSchools worldwide that the teaching of Medical Ethics and Human Rights be included as an obligatory course in their curricula.

Modern healthcare has given rise to extremely complex and multifaceted ethical dilemmas. All too often physicians are unprepared to manage these competently. This subject is specifically structured to reinforce and strengthen the ethical mindset and practice of physicians and provide tools to find ethical solutions to these dilemmas. It is not a list of rights and wrongs but an attempt to sensitise the conscience of the physician, which is the basis for all sound and ethical decision-making.

As physicians, we know what a privilege it is to be involved in the patient-physician relationship, a unique relationship which facilitates an exchange of scientific knowledge and care within a framework of ethics and trust.In recent times, this relationship has come under pressure due to resource constraints and other factors, and it shows the necessity of strengthening this bond through ethical practice.

The module of ethics helps prepare medical students and physicians to better navigate through the many ethical challenges we face in our daily practice and find effective waysTO PUT THE PATIENT FIRST.

According to these definitions, ethics is primarily a matter of knowing whereas morality is a matter of doing.

Their close relationship consists in the concern of ethics to provide rational criteria for people to decide or behave in some ways rather than others.

WHY STUDY MEDICAL ETHICS?Ethics is and always has been an essential component of medical practice. Ethical principles such as respect for persons, informed consent and confidentiality are basic to the physician-patient relationship.

However, the application of these principles inspecific situations is often problematic, since physicians, patients, their family members and other healthcare personnel may disagree about what is the right way to act in a situation.

Medicine is both a science and an art.Science deals with what can be observed and measured, and a competent physician recognizes the signs of illness and disease and knows how to restore good health.

But scientific medicine has its limits, particularly in regard to human individuality, culture, religion, freedom, rights and responsibilities.

The art of medicine involves the application of medical science and technology to individual patients, families and communities, no two of which are identical.

By far the major part of the differences among individuals, families and communities is non-physiological, and it is in recognizing and dealing with these differences that the arts, humanities and social sciences, along with ethics, play a major role. Indeed, ethics itself is enriched by the insights and data of these other disciplines.

The ethical directives of medical associations are general in nature;they cannot deal with every situation that physicians might face in their medical practice. In most situations, physicians have to decide for themselves what is the right way to act, but in making decisions, it is helpful to know what other physicians would do in similar situations.

Medical codes of ethics and policy statements reflect a general consensus about the way physicians should act and they should be followed unless there are good reasons for acting otherwise.

Fact:

Physicians in clinical decision-making tend to only take the medical decisions while ignoring the ethical aspect.

Medical or ethical case?

Tergopoh-gopoh spt ini, benar atau tidak ?

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

Value - NormValueNot concrete (no empirical-observational facts) subjective (basic/motivation of will, idea, hope and internal judgment/mind of human behavior/action explicitly or tacitly NormsConcreteValue objectivation

Values Pre-moralNot refered to specific concrete norm of human actionMoralImperative of human to conduct or to refer specific action of concrete norm;

Moral philosophy :Normative ethics : the answer of how we value the most legitimate norm in the cluster of norms? Whats behind (the foundation of) legitimate norm (de jure) as well as existing norm (de facto)Praxis E. : the answer of what is the means/instrumental to human action, whatever his condition is?

Morality = basic moral attitude The paradigm of the good/truth in the community/societyThe most fundamental of basic and strongest lawThe doing rights as maxim (principle)No deliberation

Example of morality :

a. Beliefs/religion normsConsist of teaching for human to be a wise n understandable man (virtue ethics) b. Prophetic Religion norms (theonomic ethics).

NORMS (:modernity)Ethics (narrow interpretation) Goals of the goodness of personal life or clearness/purity of conscience (intra-personal principles). Law Goals of peaceful social life (inter-personal principles) after socializing & enforcing determined-normsEtiquette Goals of harmony of social life, esp. physical aspect (inter-personal principles)Religion/beliefsGoals of akhlak/good behavior purification & celestial (world + heaven) (intra-personal principles)

Etika (ethics) normative (reflective/prescriptive E., deontological, das sollen, E as science, moral philosophy) what should I do? = oughtconsicencePraxis (teleological E, das sein, ethics as action/behaviour)my action good or bad? = isrights

Bioethics (F. Abel)

Interdisciplinary study of (ethical) problems which arised from biological and medical science & technological development.

Specific characteristic of morality

Very fundamental norm/principles : value > any other consideration/judgment.Universal law (valid to whoever, whatever, wherever etc) .Rational & objective normsRelated with the happiness of others eg : Golden Rule principle.All human have morality.

Check list (Observation Sheets) Tutors nameGroup No.

Beneficence CriterionYesNoPromoting altruismGuaranteeing human dignityViewing patient/family not as profit objectsMaximize agregat net benefitCompassionate paternalismGuaranteeing minimal life of patientRestricting goal based approachMaximize patient satisfaction


Beneficence Criterion (2)YesNoMaximize overall highest happinessContinuing professional developmentGiving effective-low priced medicineApplying Golden rule principlePromoting patients best interestetc


Non Maleficence CriterionYesNoHelping emergency patientTreating vulnerable patientsNot killing patient (no euthanasia)Not humiliating/abusing patientNot respect patient as objectTreating unproportionally Not preventing patient from dangerAvoiding misrepresentation to P


Confidentiality CriterionYesNoNot disclosing to friends/relatives Careful waivers : duty/permission to warnCareful relation about public figuresPrudent ommiting sensitive information from medical recordPrudent action to 3rd parties & public officialsPrudent action of partner notification


Justice CriterionYesNoApply everything universally Taking last portion when dividing something Giving P-with same position, similar opportunity Respect Ps rights : affordability, equality, accessibility, availability, quality) Respect Ps legal rightsetc


Justice CriterionYesNoRespecting others rights Caring the vulnerables (the least advantage people) Not abusing/discriminating Wise in macro-allocation etcetc


Autonomy CriterionYesNoRespecting self-determination rights, supporting of Ps dignity Not intervening decision making process of the P (elective condition) Truthfullness Respect privacy Confidentiality etcSupporting Ps rationality Compassionate informed consent

The patients contexts for prima facies choice(Agus Purwadianto, 2004)

Time

General benefit result, most of people,

Elective, educated, bread-winner, mature person

Vulnerables, emergency, life saving, minor

> 1 person, others similarity, community / socials rights

BeneficenceAutonomy

Non maleficenceJustice

-KeputusanMedisKeputusan etisPilar Keputusan Klinis sehari2

-KeputusanMedisKeputusan etisPilar Keputusan Klinis sehari2BiomedikInfo-medikIndikasimedikpilihan pasienkualitas hidupfitur kontekstualMindset non medisStruktur Psiko-Sosio-budaya

Micro levelClinical medicineThe Scope of ethics in MedicineMacro levelPolitics of Health Meso levelHealth services deliveryMacho levelHealth care teamsconsciencerightsethicsselfreflectionjustificationDeduction= logicInduction= casuistrybioethicsConcreteDaily living

Principles-based ethics Prima FacieT.Beauchamp & Childress (1994) & Veatch (1989)BeneficenceNon MaleficenceAutonomyJusticeContextual featuresQuality of lifeClinical DecisionMaking Patients preferenceMedical indicationValue-based medicineEBM

= Deductive logicBeneficenceNon MaleficenceAutonomyJusticeCombination ofIts characteristics = Patients Context Method = ballancing of specification= Logic + creative thinking = critical analysis + wisdom MedicalIndicationrulesParticular/Concrete caseprinciplesmoralityNorms(ballanced-specific rules)Method of justificationbioethicsVALUE-based = INTRINSIC MORALITYtheory of ethics

PRIMA FACIE = TRUMP = change into .......BeneficenceNon MaleficenceAutonomyJusticeMedicalIndicationpihak II UmumBAIKkranjangSampahpihak IIkesakitan/menderita,gadar,pra-cacatDistressRentanuzur, terjepit tanpa pilihanMiskinbodoh.capable person bebasElektifrentang >>hak pilih a// DRnya pihak IIINon pasienwakil/walikluster popKomunitasPenyandangdanaBerpotensiDirugikan/Paling krg diuntungkan

ENRICHMENT OF JUSTIFICATION BeneficenceNon MaleficenceAutonomyJustice Not stipulated in the text = Patients Context MedicalIndicationDEDUCTIVELOGICPRIMAFACIECETERIS PARIBUSCREATIVE THINKING(NEW) ILLAH = actual duty = contextuality OPPOSITIONVALUECONFORM>< : DETECTDEVIATION

TERGANTUNG . BERUBAH MENJADI

The patients contexts for prima facies choice(Agus Purwadianto, 2004)

Time

General benefit result, most of people,

Elective, educated, bread-winner, mature person

Vulnerables, emergency, life saving, minor

> 1 person, others similarity, community / socials rights

BeneficenceAutonomy

Non maleficenceJustice

Etika Dokter RI

n Kemurnian niat = sikap moral tanpa pamrih ?n Kesungguhan kerja = tindakan baik & adil ?n Kerendahan hati = sopann Integritas ilmiah & sosial = martabat profesi luhur (hormat diri sendiri & adil)

InsightCore ProblemKeywordsBasicMoral PrincipleBeneficenceNonmaleficenceAutonomyJusticeMetode AP

Prima FaciePrincipleContext vs TextChoose 1-2 out of 4 most relevan(problem solving)EthicsTheory Virtue - eudamoniaDuty - deontologistUtilitarian teleologist eg happinessMetode AP

EthicalRelativismCultureCustomEthicalDilemmaScience & technology determinant Societal & capital determinantMetode AP

Ceteris ParibusChoose 1 most influential principleEthical Problem SolvingConsistencyCoherentCorespondencyPragmaticMetode AP

Metode AP

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Kd Bn Prima Facie 2013