Professionalism and the Medical Practice Act

03/05/2011

1

THE WAY TO PROFESSIONALISM:Ethics and Medicolegal

HERKUTANTOHERKUTANTO

Department of Forensic Medicine &Department of Forensic Medicine & MedicolegalMedicolegal StudiesStudiesUniversity of IndonesiaUniversity of Indonesia

HerkutantoHerkutantoProfessor of Forensic Medicine and Medicolegal StudiesProfessor of Forensic Medicine and Medicolegal Studies

Fellow of Australian College of Legal Medicine

PhD in Medicine, MD,Forensic Specialist –University of Indonesia –Faculty of MedicineGrad. Dip. Forens.Med. -Monash University, Australia– Medical FacultyDip. Forens.Med -Netherland School of PublicHealth, The Netherland

• Sarjana Hukum (LL.B) –University of Indonesia,Faculty of Law

• Master of Laws (LL.M)La Trobe University,Australia, School of Law

MEDICAL EDUCATION

Others

• Chair of Legal Comp. IndonesianHospital Ass.

•• Expert Witness: Prita vs Omni HospExpert Witness: Prita vs Omni Hosp

LEGAL EDUCATION

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03/05/2011

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RATIONALE

• Requirement to meet the ProfessionalStandard – Medical Council

• Requirement to understand theProfessionalism in Medicine

OBJECTIVE

• To understand professionalism in medicine• To understand the general regulatory

framework for medical practitioners• To understand the medical practice act no

29/2004 (Indonesia)

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REGULATION OF MEDICALREGULATION OF MEDICALPRACTITIONERSPRACTITIONERS

• PROFESSIONAL REGULATIONS• CIVIL LAW

– Tort– Breach of Duty

• CRIMINAL LAW– Abortion law

Criminal liability

Error

Civil Liability

Disciplinaryliability

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PROFESSIONALISMPROFESSIONALISM

• Being part of a profession entails asocietal contract.

• The profession is granted a monopoly overthe use of a body of knowledge and theprivilege of self-regulation, and,

• in return, The profession guaranteessociety professional competence, integrityand the provision of altruistic service.

Sylvia R Cruess, Sharon Johnston and Richard L Cruess. Professionalism for medicine: opportunities and obligations.Sylvia R Cruess, Sharon Johnston and Richard L Cruess. Professionalism for medicine: opportunities and obligations.MJA 2002 177 (4): 208MJA 2002 177 (4): 208--211211

PROFESSIONALISMPROFESSIONALISM• An occupation whose core element is work, based on

the mastery of a complex body of knowledge and skills.It is a vocation in which knowledge of some departmentof science or learning, or the practice of an art foundedon it, is used in the service of others.

• Its members profess a commitment to competence,integrity, morality, altruism, and the promotion of thepublic good within their domain.

• These commitments form the basis of a social contractbetween a profession and society, which in return grantsthe profession autonomy in practice and the privilege ofself-regulation.

• Professions and their members are accountable to thoseserved and to society.

Oxford English DictionaryOxford English Dictionary

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Medical ProfessionalismBasic Concepts

• COMPETENCE

• SERVICE

• ETHICS

• ACCOUNTABILITY

Medical professionalism

• Commitment to the BestInterest of Patients

• Commitment to the Goals ofMedicine

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CHARACATERISTICS OFPROFESSION

• The privilege of self-regulation entails anabsolute obligation to guarantee thecompetence of members.

• recertification and revalidation are, withoutquestion, now regarded as professionalobligations

• The disciplining of unethical orincompetent practitioners must berigorous, open


PROFESIONAL AUTONOMY• Individually, physicians are granted sufficient

autonomy to act in the “best interests of theirpatients”.– Until late in the 20th century, autonomy was expressed in a

paternalistic fashion, but ….– modern society, recognising patient autonomy, now views the

physician–patient relationship as a partnership.

• The profession is also granted collective autonomythrough self-regulation.– It has the privilege and obligation to set and maintain standards

for education and training, entry into practice, and the standardsof practice.

– It must guarantee the competence of its practitioners, and– has an absolute obligation to discipline unprofessional,

incompetent, or unethical conduct.

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PROFESSIONALISM AUTONOMYProfessionalism autonomy rests on three claims:• that there is such an unusual degree of

knowledge and skill involved in medical workthat non-professionals are not equipped toevaluate or regulate it;

• that doctors are responsible-they may be trustedto work conscientiously, without supervision;

• that the profession itself may be trusted toundertake the proper regulatory action whenindividuals do not perform competently or ethically.


SOCIAL CONTRACTSOCIAL CONTRACTPROFESSIONALSPROFESSIONALS -- COMMUNITYCOMMUNITY

Self CredentialingSelf CredentialingSelf licensingSelf licensing

Moral responsibilityMoral responsibilityHigh standard of competenceHigh standard of competence

Market controlMarket controlWorking conditionWorking condition PROFESSIONALISMPROFESSIONALISM

William M Sullivan,William M Sullivan, Medicine under threat: Professionalism and professional identityMedicine under threat: Professionalism and professional identity, CMAJ 2000:162(5): 673, CMAJ 2000:162(5): 673

Clinical privilege

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CHARACATERISTICS OF PROFESSION

SELF GOVERNINGSELF REGULATINGSELF DISCIPLINING

Dahrendorf R, J. Royal Soc. Med., vol.77, march 1984, p.178.

Altruism

• There is agreement that the trust placed in theprofessions and..

• their privileged status are only justified by theexpectation that they will be altruistic

• For physicians this means consistently placingthe interests of individual patients and societyabove their own.

• Professions must be devoted to the public good.

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DEFINITION OFPROFESSIONALISM

• Professionalism may be defined as theobligation of the physician to uphold theprimacy of patients’ interests, to achieveand maintain medical competency, andto abide by high ethical standards.

NEUROLOGY 2008;71:1283-1288

THREAT TOPROFESSIONALISM

• Recent commentary has suggested that medical professionalism

is being threatened by commercialism and the legal system.

• Consideration of judicial rulings centered on primacy ofpatients’ interests (informed consent, end-of-life care, andconflicts of interest), medical competence (standard of care inmedical malpractice cases, medical futility cases, andconfidentiality of peer review), and enforcement of ethicalstandards (peer review by professional organizations)demonstrates that the law generally defers to standards setby the medical profession,

• but competing views over what health care model is operativemay generate non-deferential outcomes.NEUROLOGY 2008;71:1283-1288

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03/05/2011

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TWO MAJOR COMPONENTS OFTWO MAJOR COMPONENTS OFPROFESSIONALISMPROFESSIONALISM

CONDUCT– Empathy– Duty of Care

COMPETENCE– Cognitive & Psychomotor– Physically & Mentally

[1] Browne, Freeling, The Doctor-Patient relationship, E&S Livingstone Ltd., Edinburgh, 1967. p.22[2] Tahka V., The Patient Doctor Relationship, ADIS Health Science Press, Sydney, 1984. pp.3-4.

PROFESSIONALISM - HOW?• The Professional status is not an inherent right

by qualifications only but is granted in trust bythe society.

• The public must believe and see theprofessional to be trustworthy.

• To remain trustworthy, the professional mustmeet the obligations expected by the society.

• Failure to meet the trust and the professionalconduct and standards may mean the loss ofthat professional status.

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PRINCIPLES INPRINCIPLES INPROFESSIONALISMPROFESSIONALISM

•• TRUSTTRUST– The patient believe that the practitioners have a

duty of care, without being asked•• JUSTICEJUSTICE

– To provide every patients’ rights•• RECIPROCITYRECIPROCITY

– The trust of the patients depend on the credibilityof practitioners (Credat emptor)

COUNCIL (BOARD)COUNCIL (BOARD)• Instrumen utk menjaga profesionalisme• Dibentuk oleh masyarakat (dg UU – Medical Act)• Bertujuan melindungi masyarakat• Terdiri dari wakil profesi, wakil masyarakat, dan

stake holder lain• Menentukan siapa yang boleh menjadi anggota

komunitas profesi (mekanisme registrasi)• Menjaga kualitas pelayanan• Memberi sanksi atas anggota profesi yang

melanggar norma profesi (mekanisme pendisiplinan)

Medical Practitioners Board of Victoria, Annual Report 2001, Melbourne, 2001

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03/05/2011

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Registered Practitioners

Medical Council

Masyarakat / Pasien

Clinical privilege

ETIKA PROFESI vs DISIPLIN PROFESI vs. HUKUM

ETIKAETIKA• Masalah Moral

– Baik - Buruk• Dilemma Norma

Internal (etikaprofesi)

• Kehormatan Profesi– Kualitas Moral

• MKEK – Org.Profesi– Anggota Profesi

• Lingkup - sasaran:– Diri sendiri

DISIPLIN• Standar Profesi /

Perilaku-Pelayanan• Pelanggaran Standar

profesi (Benar –Salah)

• Kualitas Profesi(Pelayanan-Perilaku)

• KONSIL – JointCommission– Anggota Profesi– Masyarakat– Pemerintah

• Lingkup - sasaran:– Pasien / Klien

• Underskilled• Communication

Problems• Sexual

harrashment

HUKUM• Norma Hukum• Pelanggaran Norma

Hukum ( Benar –Salah)

• Kedamaian(mencegah –mengatasi konflik)– Perdata - Pidana

• PENGADILAN– Hakim– Penggugat/Jaksa– Tergugat /

terdakwa

• Lingkup - sasaran:– Dokter– Rumah Sakit

• Kelalaian

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03/05/2011

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Barriers to MedicalProfessionalism

• ARROGANCE• GREED• ABUSE OF POWER• MISREPRESENTATION• IMPAIRMENT• CONFLICT OF INTEREST• NON-CONCIENTIOUSNESS

The evolution of theconcept of the professions

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Early 1900s until the 1950s

• Supports the concepts of professionalism– described the professions,– the rationale for their being,– stressed the service commitment of individual

professionals.

• It recognised the conflict between altruismand self-interest, butbut believed thatcommitment to service would result inaltruistic behaviour.

Parsons T. The professions and social structure.Parsons T. The professions and social structure. Social ForcesSocial Forces 1939; 17: 4571939; 17: 457--467.467.

the questioning society of the 1960s

• physicians exploited their monopoly tocreate a demand for services which they thensatisfied

• serious failures in self-regulation, and abuseof collegiality to protect incompetent orunethical physicians

• criticised physicians for pursuing their ownfinancial interests at the expense of bothindividual patients and society.

• it questioned the benefits of professionalismto society

Freidson E. Profession of medicine: a study of the sociology of applied knowledge. New York: Dodd and Mead, 1970Freidson E. Profession of medicine: a study of the sociology of applied knowledge. New York: Dodd and Mead, 1970

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1980 - 2000• growing importance of governments and the

corporate sector in healthcare• medicine has lost control over the medical

marketplace– no longer dictating its structure, methods of payment,

or levels of remuneration• control shifted from the profession to the State

and/or the corporate sector• They have returned to support the "professional

model" - devoted to the public good — oneobserver calls it "civic professionalism".

The principal threats to medicine'sprofessional status

public mistrustpublic mistrust• medicine failed to self-regulate in a way that can

guarantee competence, and that it put its owninterest above that of patients and the public– Bristol: medicine has protected incompetent or

unethical colleagues in the name of collegiality• the dual role of medical associations

– acting as expert advisors on matters of health as wellas representing their members

– has created a difficult conflict of roles

Sullivan W. Work and integrity: the crisis and promise of professionalism in North America. New York: Harper Collins, 1995: 1Sullivan W. Work and integrity: the crisis and promise of professionalism in North America. New York: Harper Collins, 1995: 16.6.

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The opportunity to rebuild trustThe opportunity to rebuild trust• control of healthcare has passed from

medicine to the State and the corporatesector, so has the blame for defects in thehealthcare system

• Patients remain attached to their physiciansand do not wish either the State orcorporate sector to make decisions abouttheir care.

• The public and physicians share a view ofthe changes needed in healthcare systems

Krause E. Death of the guilds: professions, states and the advance of capitalism, 1930 to the present. New Haven: Yale UniverKrause E. Death of the guilds: professions, states and the advance of capitalism, 1930 to the present. New Haven: Yale Universitsity Press, 1996.y Press, 1996.

MEDICAL PRACTICE ACTNo 29/2004

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PURPOSE

1.Protecting the People

2.Guiding the Doctors

INDONESIAN MEDICAL COUNCIL

MEDICALCOUNCIL

REGISTRATIONREGISTRATION

EDUCATIONEDUCATIONSTANDARDSTANDARD

NURTURING &NURTURING &EMPOWERMENTEMPOWERMENT

REGISTRATIONREGISTRATION

EDUCATIONEDUCATIONSTANDARDSTANDARD

NURTURING &NURTURING &EMPOWERMENTEMPOWERMENT

DENTALCOUNCIL

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Fit

RegisteredPractitioners

Clinical Privilege

Credentialing

Re-CredentialingMedical Practice

DisciplinaryTribunal

Unfit

Working PermitWorking PermitAUTHORITY

IMMIGRATIONWorkingWorkingPermitPermit

STATESTATESTATESTATE

MEDICAL COUNCIL

MEDICAL PRACTICE

Medical College

World MedicalAssembly

Medical malpractice involves thephysician’s failure to conform to thestandard of care for treatment of thepatient’s condition, or lack of skill, ornegligence in providing care to thepatient, which is the direct cause ofan injury to the patient.

STATEMENT ON MEDICAL MALPRACTICESTATEMENT ON MEDICAL MALPRACTICE4444thth World Medical Assembly, Marbella, Spain, September 1992World Medical Assembly, Marbella, Spain, September 1992

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STATEMENT ON MEDICAL MALPRACTICESTATEMENT ON MEDICAL MALPRACTICE4444thth World Medical Assembly, Marbella, Spain, September 1992World Medical Assembly, Marbella, Spain, September 1992

• A distinction must be made between medicalmalpractice and an untoward result occurring inthe medical treatment that is not the fault of thephysician

• An injury occurring in the course of medicaltreatment which could not be foreseen ….. is anuntoward result

• In an untoward result, physician should not bearany liability

What is foreseeableWhat is foreseeable –– is what the defendant will pay foris what the defendant will pay forI.Kennedy, A.Grubb, Principles of Medical Law, Oxford Univ.Press, London, 1998, p.415

REGISTRATION

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PRINCIPLES

• EVERY MEDICAL & DENTAL PRACTITIONERSMUST BE REGISTERED BY THE IMC

• REQUIREMENT– DIPLOMA– OATH– PHYSICALLY & MENTALLY SOUND– CERTIFICATE OF COMPETENCE (LEARNED

COLEGE)– STATEMENT TO COMPLY WITH THE MEDICAL

ETHICS• RE-REGISTRATION: 5 YEARS,

LULUSAN LUAR NEGERI

• HARUS DI EVALUASI– KESAHAN IJASAH– ADAPTASI DAN SERTIFIKAT KOMPETENSI– SURAT ANGKAT SUMPAH/JANJI– KETERANGAN SEHAT FISIK & MENTAL– PERNYATAAN AKAN MEMATUHI ETIKA

PROFESI• MILIKI IJIN KERJA,• MAMPU BAHASA INDONESIA

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HAL KHUSUS

• S.T.R SEMENTARA– WNA DLM RANGKA DIK-LAT-LIT-YAN– SETAHUN

• S.T.R BERSYARAT– PESERTA PPDS, WNA YG IKUT DIKLAT– WNA YG MEMBERIKAN DIKLAT TIDAK

PERLU S.T.R. BERSYARAT, TAPI ATASPERSETUJUAN K.K.I.

S.T.R TAK BERLAKU

• DICABUT BERDASAR PERATURAN• HABIS MASA BERLAKU, TIDAK DAFTAR

ULANG• ATAS PERMINTAAN YBS• MENINGGAL DUNIA• DICABUT OLEH K.K.I

TATA CARA REG, REG ULANG, REG BERSYARAT, REGTATA CARA REG, REG ULANG, REG BERSYARAT, REGSEMENTARA DIATUR OLEH PERATURAN K.K.ISEMENTARA DIATUR OLEH PERATURAN K.K.I

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WEWENANG PEMEGANG S..T.R.

• MEWAWANCARAI PASIEN• MEMERIKSA FISIK DAN MENTAL• MENENTUKAN PEMERIKSAAN PENUNJANG• MENEGAKKAN DIAGNOSIS• MENENTUKAN PENATALAKSANAAN• MELAKUKAN TINDAKAN MEDIS• MENULIS RESEP• MENERBITKAN SURAT KETERANGAN• MENYIMPAN OBAT• MERACIK OBAT, KHUSUS DI TERPENCIL

PENYELENGGARAAN PRAKTIK

1. SURAT IJIN PRAKTEK2. PELAKSANAAN PRAKTIK3. PEMBERIAN PELAYANAN:

– STANDAR PELAYANAN– PERSETUJUAN TINDAKAN– REKAM MEDIS– RAHASIA KEDOKTERAN– KENDALI MUTU DAN KENDALI BIAYA– HAK DAN KEWAJIBAN DOKTER– HAK DAN KEWAJIBAN PASIEN– PEMBINAAN

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SURAT IJIN PRAKTEK

• PRAKTEK WAJIB MEMILIKI S.I.P.• SIP DITERBITKAN DINAS KESEHATAN

KABUPATEN/KOTA• MAKSIMUM 3 TEMPAT, SATU SIP SATU

TEMPAT• SYARAT:

– MEMILIKI S.T.R.– MEMILIKI TEMPAT PRAKTIK– REKOMENDASI ORG PROFESI

PELAKSANAAN PRAKTIK

• DASAR: KESEPAKATAN DOKTER-PASIEN

• BILA BERHALANGAN:PEMBERITAHUAN ATAU TUNJUKPENGGANTI, YG JUGA PUNYA SIP

• WAJIB PASANG PAPAN PRAKTIK,ATAU BILA DI RS: DAFTAR DOKTER

• SARKES DILARANG MEMPEKERJAKANDOKTER TANPA SIP

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STANDAR PELAYANAN

• WAJIB MENGIKUTI STANDAR YAN• STANDAR YANDOK: DIBEDAKAN

MENURUT JENIS & STRATA SARKES• STANDAR YANDOK: DITETAPKAN

PERATURAN MENTERI KESEHATAN

Kendali Mutu dan Kendali BiayaPasal 49

• Setiap dokter atau dokter gigi dalammelaksanakan praktik kedokteran ataukedokteran gigi wajib menyelenggarakankendali mutu dan kendali biaya.

• Dalam rangka pelaksanaan kegiatansebagaimana dimaksud pada ayat (1) dapatdiselenggarakan audit medis.

• Pembinaan dan pengawasan ketentuansebagaimana dimaksud pada ayat (1) danayat (2) dilaksanakan oleh organisasi profesi.

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Pasal 50Dokter atau dokter gigi dalam melaksanakan

praktik kedokteran mempunyai hak

1. memperoleh perlindungan hukum sepanjangmelaksanakan tugas sesuai dengan standarprofesi dan standar prosedur operasional;

2. memberikan pelayanan medis menurut standarprofesi dan standar prosedur operasional;

3. memperoleh informasi yang lengkap dan jujurdari pasien atau keluarganya; dan

4. menerima imbalan jasa.

Pasal 51Dokter atau dokter gigi dalam melaksanakanpraktik kedokteran mempunyai kewajiban :

1. memberikan pelayanan medis sesuai dengan standarprofesi dan standar prosedur operasional sertakebutuhan medis pasien;

2. merujuk pasien ke dokter atau dokter gigi lain yangmempunyai keahlian atau kemampuan yang lebihbaik, apabila tidak mampu melakukan suatupemeriksaan atau pengobatan;

3. merahasiakan segala sesuatu yang diketahuinyatentang pasien, bahkan juga setelah pasien itumeninggal dunia;

4. melakukan pertolongan darurat atas dasarperikemanusiaan, kecuali bila ia yakin ada orang lainyang bertugas dan mampu melakukannya; dan

5. menambah ilmu pengetahuan dan mengikutiperkembangan ilmu kedokteran atau kedokteran gigi.

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Pasal 52Pasien, dalam menerima pelayanan pada

praktik kedokteran, mempunyai hak:

1. mendapatkan penjelasan secara lengkaptentang tindakan medis sebagaimanadimaksud dalam Pasal 45 ayat (3);

2. meminta pendapat dokter atau dokter gigilain;

3. mendapatkan pelayanan sesuai dengankebutuhan medis;

4. menolak tindakan medis; dan5. mendapatkan isi rekam medis.

Pasal 53Pasien, dalam menerima pelayanan padapraktik kedokteran, mempunyai kewajiban

:

1. memberikan informasi yang lengkapdan jujur tentang masalahkesehatannya;

2. mematuhi nasihat dan petunjuk dokteratau dokter gigi;

3. mematuhi ketentuan yang berlaku disarana pelayanan kesehatan; dan

4. memberikan imbalan jasa ataspelayanan yang diterima.

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PERSETUJUAN TINDAKANMEDIK (Informed Consent)

• TINDIK HARUS DISETUJUI “PASIEN”,SETELAH DIBERI PENJELASAN:– DIAGNOSIS DAN TATA CARA TINDIK– TUJUAN TINDIK– ALTERNATIF DAN RISIKO– RISIKO DAN KOMPLIKASI YG MUNGKIN– PROGNOSIS TINDIK

• PERSETUJUAN : LISAN/ TERTULIS• TINDIK RISIKO TINGGI: TERTULIS• SELANJUTNYA: PERATURAN MENTERI

03/05/2011 Herkutanto, 200154

?

RISK ARISE FROMMEDICAL PROCEDURES

RISK ARISE FROMTHE DISSEASE

let the patientCHOOSE THE RISK

INFORMATIONFROM PHYSICIAN

INFORMED OPINION

I N F O R M E D D E C I S I O N

CONSENT TOTHE MEDICAL PROCEDURES

(accept risk arise from medical procedure )

REFUSETHE MEDICAL PROCEDURES

(accept risk arise from thedissease)

?

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REKAM MEDIS

• WAJIB MEMBUAT REKAM MEDIS• HARUS SEGERA DIBUAT, DIBUBUHI

NAMA, WAKTU, TTD PETUGAS• REKAM MEDIS MILIK SARKES, ISINYA

MILIK PASIEN• HARUS DISIMPAN SBG RAHASIA• SELANJUTNYA PERATURAN MENTERI

RAHASIA KEDOKTERAN• WAJIB SIMPAN RAHASIA

KEDOKTERAN• DAPAT DIBUKA:

– KEPENTINGAN KESEHATAN PASIEN– PERMINTAAN PENEGAK HUKUM– PERMINTAAN PASIEN– PERUNDANG-UNDANGAN

• LEBIH LANJUT: PERATURAN MENTERI

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KENDALI MUTU / BIAYA

• WAJIB MENYELENGGARAKANKENDALI MUTU DAN BIAYA

• DAPAT DISELENGGARAKAN AUDITMEDIS

• PEMBINAAN DAN PENGAWASAN OLEHORG PROFESI

HAK DOKTER

• PERLINDUNGAN HUKUM SEPANJANGSESUAI STANDAR PROFESI & S.O.P

• MELAKSANAKAN SESUAI S.P & S.O.P• MEMPEROLEH INFO YG JUJUR &

LENGKAP DARI PASIEN/KELUARGA• MENERIMA IMBALAN JASA

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KEWAJIBAN DOKTER

• BERI YANMED SESUAI S.P. & SOP,SERTA KEBUTUHAN MEDIS PASIEN

• MERUJUK BILA TAK MAMPU• MERAHASIAKAN• PERTOLONGAN DARURAT, KECUALI

BILA YAKIN ADA ORANG LAIN YGBERTUGAS DAN MAMPU

• MENAMBAH IPTEKDOK

HAK PASIEN

• MEMPEROLEH PENJELASAN• MEMINTA PENDAPAT KEDUA• MENDAPAT PELAYANAN SESUAI

KEBUTUHAN MEDIS• MENOLAK TINDAKAN MEDIS• MENDAPATKAN ISI REKAM MEDIS

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KEWAJIBAN PASIEN

• BERI INFO YG LENGKAP DAN JUJUR• MEMATUHI NASIHAT DAN PETUNJUK• MEMATUHI KETENTUAN SARKES• MEMBERI IMBALAN JASA

PEMBINAAN• DILAKUKAN OLEH KONSIL BERSAMA-

SAMA DENGAN PEMERINTAH DANORG PROFESI

• BERTUJUAN:– MENINGKATKAN MUTU YANKES– MELINDUNGI MASYARAKAT– MEMBERI KEPASTIAN HUKUM

• DILARANG:– SEOLAH-OLAH DOKTER

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DISIPLINARY MEASURES

MAJELIS KEHORMATAN DISIPLINKEDOKTERAN INDONESIA

PENGADUANPEMERIKSAANKEPUTUSAN

M.K.D.K.I• LEMBAGA OTONOM K.K.I, INDEPENDEN• MKDKI BERTANGGUNGJAWAB KPD KKI• MKDKI PROP DIBENTUK KKI ATAS USUL

MKDKI• PIMPINAN: KETUA, WAKIL, SEKR• KEANGGOTAAN:

– ORG PROF : 3 DR, 3 DRG– ASOSIASI R.S. : 1 DR, 1 DRG– 3 SARJANA HUKUM

• DITETAPKAN MENTERI ATAS USUL ORGPROFESI, MASA BAKTI 5 TAHUN, SUMPAH

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SYARAT ANGGOTA MKDKI• WNI• SEHAT JASMANI DAN ROHANI• BERTAKWA• BERKELAKUAN BAIK• USIA 40 – 65 TH• PERNAH PRAKTIK MIN 10 TH, MEMILIKI

S.T.R.• SH: PERNAH PRAKTIK DI BID HUKUM 10 TH• CAKAP, JUJUR, MORAL, ETIKA, INTEGRITAS,

REPUTASI BAIK

TUGAS MKDKI

• MENERIMA PENGADUAN, MEMERIKSA,MEMUTUSKAN KASUS PELANGGARANDISIPLIN

• MENYUSUN PEDOMAN DAN TATACARA PENANGANAN KASUSPELANGGARAN DISIPLIN

• ANGGARAN: K.K.I

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PENGADUAN

• DIAJUKAN TERTULIS OLEH SETIAPORANG YG MENGETAHUI ATAUDIRUGIKAN

• TIDAK MENGHILANGKAN HAK SETIAPORANG UNTUK MELAPORKANDUGAAN PIDANA KE PIHAK YGBERWENANG DAN/ATAU MENGGUGATKERUGIAN PERDATA KE PENGADILAN

PEMERIKSAAN DANKEPUTUSAN

• BILA DITEMUKAN PELANGGARAN ETIKADITERUSKAN KE ORG PROFESI

• KEPUTUSAN MKDKI MENGIKAT DOKTERDAN KKI

• KEPUTUSAN:– TIDAK BERSALAH– SANKSI DISIPLIN

• SANKSI:– PERINGATAN TERTULIS– REKOM PENCABUTAN STR ATAU SIP– IKUTI DIKLAT TERTENTU

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CRIMINAL PENALTYCRIMINAL PENALTY

• PIDANA 3 TH / DENDA 100 JUTA– WNI, PRAKTIK TANPA STR– WNA, PRAKTIK TANPA STR SEMENTARA/

BERSYARAT– PRAKTIK TANPA SIP

• PIDANA 5 TH / DENDA 150 JUTA– PRAKTEK SEOLAH-OLAH ADALAH DOKTER

• PIDANA 1 TH / DENDA 50 JUTA– TIDAK PASANG PAPAN PRAKTIK– TIDAK BUAT REKAM MEDIS– TIDAK PENUHI KEWAJIBAN DOKTER ~ Pasal 51

• PIDANA 10 TH / DENDA 300 JUTA– MEMPEKERJAKAN DOKTER TANPA SIP– BILA KORPORASI: TAMBAH 1/3 + CABUT IJIN

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PHYSICIANPHYSICIAN –– PATIENTPATIENTRELATIONSHIPRELATIONSHIP

PRINCIPLES IN CONSUMERISMPRINCIPLES IN CONSUMERISM•• COMMERCIALISMCOMMERCIALISM

– Financial competition between the business and theconsumers

– The business places its financial interests above all isacceptable

• SOCIAL CLASS CONFLICTS– Marxism: the oppression of the bourgeois against the

proletar *)– The professionals is identified as the bourgeois; the

patients diidentikkan is identified as the proletar

*) Marx, K and Engels,F Basic writings on politics and philosophy; edited with an introduction by Lewis S. Feuer, London : Collins, 1972.

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PROFESSIONALISMPROFESSIONALISM vsvs CONSUMERISMCONSUMERISMIN HEALTH SERVICESIN HEALTH SERVICES

PROFESSIONALISMPROFESSIONALISM• Credat Emptor• Fiduciary (trust)• Compassion• Empathy• Health Law• Peer Standard• Fault Base Liability• Disciplinary Tribunal

CONSUMERISMCONSUMERISM• Caveat Emptor• Non-fiduciary• Not Available• Not Available• Consumer Law• Industrial Standard• Strict Liability• Not Available

KOMERSIALISMEKOMERSIALISME vs.vs. PROFESSIONALISMEPROFESSIONALISME

KOMERSIALISMEKOMERSIALISME• Boleh melakukan

tindakan berdasarkanpertimbanganfinansial

• Caveat Emptor (letthe buyer beware)

PROFESSIONALISMEPROFESSIONALISME• Dilarang melakukan

tindakan medisberdasarkan pertim-bangan finansial

• Credat Emptor (let thepatient trust)

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PENERAPAN KOMERSIALISMEPENERAPAN KOMERSIALISMEPADA PELAYANAN KESEHATANPADA PELAYANAN KESEHATAN• Semua asas professionalisme diganti

secara konsisten oleh asas komersialisme• Dokter / RS boleh meletakkan kepentingan

(finansial) nya diatas kepentingan pasien– Menghindari layanan yg tidak menguntungkan– No pay – no service

• Dokter / RS senantiasa pada posisi konflik(kepentingan) dengan pasien

PRINCIPLES INPRINCIPLES INMEDICAL ETHICSMEDICAL ETHICS

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PROFESSIONALPROFESSIONAL –– PATIENTPATIENTRELATIONSHIPSRELATIONSHIPS

• There are special principles of specialrelationship between– Healthcare professionals – patients– Researchers - subjects

• Four treating principles– Veracity– Privacy– Confidentiality– Fidelity

VERACITYVERACITY• Obligation to tell the truth• Derived from respect of:

– Autonomy: disclosure and consent– Fidelity: promise keeping– Trust: professional – client relationship

• Scope:– Limited disclosure and deception

• D/ & P/ of cancer– Disclosure of unwanted information

• Focus on the best interest of patientsBeauchamp, TL, Childress, JF, Principles of Biomedical Ethics, 4th ed., Oxford Univ.Press, Oxford, 1995

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PRIVACYPRIVACY• Definition: hard to define

– A state or condition of physical or informationaccessibility with the right to its control

• Justification– A necessary condition for maintaining intimate

relationship of respect, love, friendship, trust bygranting other access to someone

• The right to privacy has also been recognized in majorhuman rights documents such as the UniversalDeclaration of Human Rights.

Routledge Encyclopedia of Philosophy, Version 1.0, London: RoutledgeRoutledge Encyclopedia of Philosophy, Version 1.0, London: Routledge

Beauchamp, TL, Childress, JF, Principles of Biomedical Ethics, 4th ed., Oxford Univ.Press, Oxford, 1995

CONFIDENTIALITYCONFIDENTIALITY• Confidentiality present when a person discloses

information to another, who pledge not to divulgethat information to a third party

• Confidential information is both private anvoluntary imparted in confidence and trust

• Respect for autonomy• Medical confidentiality

– Legal Obligation to maintain confidentiality– Specific rules for disclosure of medical information to

third parties


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FIDELITYFIDELITY

• Loyalty, trustworthiness, credibility• Keeping promise• Respect for autonomy, justice, and utility


Resources1. William M Sullivan, Medicine under threat: Professionalism and

professional identity, CMAJ 2000:162(5): 673

2. Sylvia R Cruess, Sharon Johnston and Richard L Cruess. Professionalismfor medicine: opportunities and obligations. MJA 2002 177 (4): 208-211

3. Dahrendorf R, J. Royal Soc. Med., vol.77, march 1984

4. Browne, Freeling, The Doctor-Patient relationship, E&S Livingstone Ltd.,Edinburgh, 1967. p.22

5. Tahka V., The Patient Doctor Relationship, ADIS Health Science Press,Sydney, 1984.

6. Hastings centre report, Special Supplement, November December 1996

7. Routledge Encyclopedia of Philosophy, Version 1.0, London: Routledge

8. Beauchamp, TL, Childress, JF, Principles of Biomedical Ethics, 4thed., OxfordUniv.Press, Oxford, 1995

9. Singapore Medical Association http://www.sma.org.sg/cmep

10. Eliot Freidson http://itsa.ucsf.edu/~eliotf/

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http://www.sma.org.sg/cmep

http://itsa.ucsf.edu/~eliotf/



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Documents

Professionalism and the Medical Practice Act