Post on 03-Jun-2018
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Teori Etika & Pemecahan
Masalah/Dilema Etik
Menggunakan Prima Facie KaidahDasar Bioetika
Agus Purwadianto.
Jakarta, 2006
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Medis atauetis?
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Kasus Konkrit 1
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KeputusanMedis
Keputusanetis
Pilar Keputusan Klinis sehari2
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KeputusanMedis
Keputusanetis
Pilar Keputusan Klinis sehari2Biomedik
Info-medik
Indikasimedik
pilihan pasien
kualitas hidupfitur kontekstual
Mindset non medisStruktur Psiko-Sosio-budaya
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Kalau yang ini 1 dari ratusankorban tsunami/lumpur panas ? (di luar RS >> korban)
Atau pasien = istri Kaisar Jepang yg ingin th/ ke AS
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Micro level
Cl inical medicine
The Scope of ethics in Medicine
Macro level
Politics of Health
Meso levelHealth services delivery
Macho level
Health care teams
conscience
rights
ethics
self
reflection
justification
Deduction= logic
Induction= casuistry
bioethics
ConcreteDaily living
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Principles-based ethicsPrima Facie
T.Beauchamp & Childress (1994) & Veatch (1989)
Beneficence
Non Maleficence
Autonomy
Justice
Contextual features
Quality of life
Clinical Decision
Making
Patients preference
Medical indicationValue-based medicine
EBM
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Check list (Observation Sheets)
Beneficence Criterion Yes No
Promoting altruism
Guaranteeing human dignity
Viewing patient/family not as profitobjects
Maximize agregat net benefit
Compassionate paternalism
Guaranteeing minimal life of patient
Restricting goal based approach
Maximize patient satisfaction
Tutors nameGroup No.
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Deductive logic
Beneficen
ceNon Maleficence Autonomy Justice
Combination of
Its characteristics = Patients Context
Method =
Logic Thinkingcritical analysis
Medical
Indication
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TROEF = berubahmenjadi
Beneficen
ceNon Maleficence Autonomy Justice
Medical
Indication
pihak IIUmumBAIKkranjang
Sampah
pihak IIkesakitan/menderita,gadar,pra-cacat
DistressRentanuzur,terjepittanpa pilihanMiskin
bodoh.
capablepersonbebasElektifrentang >>hak pilih a
// DRnya
pihak IIINon pasienwakil/walikluster popKomunitasPenyandangdanaBerpotensiDirugikan/Paling krg
diuntungkan
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ENRICHMENT OF
JUSTIFICATION
Beneficen
ce Non MaleficenceAutonomy Justice
Not stipulated in the text =
Patients Context
Medical
Indication
DEDUCTIVELOGIC
PRIMAFACIE
CETERIS PARIBUS
CREATIVE THINKING
(NEW) ILLAH = actual duty = contextuality
OPPOSITION
VALUE
CONFORM
>< : DETECTDEVIATION
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Prima Facie
Keketatan Pemikiran Logis = Jln kepastian
Rule of thumb,
Hanya disebut
KAIDAH DASAR
BIOETIK
Absolut
Lurus,
mengikat
Kartu Bridge/Troef
Domino
R.Veatch, 1981
Actual duty = contextuality> prima facie duty
(Ross, 1939)
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TERGANTUNG . BERUBAH MENJADI
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Our own
(Dr. Tenars) cases
Implementation of the 1styear students
67 WHO SEARO
cases
GroupPresentationPlennary
Session
Individual/Group : Take home exam
EBP3KH Module
KODEKI
PASAL2 HDP PENDALAMAN
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Kaitan Etik - Moralitas
Moralitas
Etik
Praksis =
Tuntunan Perilaku
NormatifTuntutan Berpikir
Logis Kritis
refleksi
MetaEtika
Standar rasional& metode peroleh E
Yg dipercaya & diperbuatManusia = praktek
Teoriseyogyanya
PembenaranSeharusnya
NILAI
Menghargaimenjunjung
BenarBaik
cocok
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Kaitan Etik - Moralitas
Moralitas
Etik
Praksis =
Tuntunan (cara/alat
mencapai)Perilaku
NormatifTuntutan BerpikirLogis Kritis,
Pembenaran moral
refleksi
MetaEtika
Teori Etika
Virtue
Deontologi teleologi/Utilitarian
AktorEudamoniaBukan nabi Perbuatan= kewajiban akibat
tujuan
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Relevancy of PBE
Actual to & match with clinical ethicssetting (Jonsen & Siegler Method)
DR need a solution as well as
guidance use critical reasoninganalysis tools close to the work ofEthical Reviewing Board (R. Veatchmethod)
In line with student rationalitycompleting power to analysispreserving the logics (deductivemethod of Henry Richardson)
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Relevancy of PBE (2)
Match with the MET method to achieve itsobjectives = cognitive developmental
approach: + affective dev. app : >cultural transmission In line with ethico-legal approach very
useful to achieve defend argumentationagainst the wrong & abuses legalarguments (Agus P method 2002)
More practicable ethics to analyze tightlycoupled ethics-discipline-legal case ofevery professional misconduct now
relevant with Medical Practice Act 2004
R l f PBE
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Relevancy of PBE(3) A previous step to value clarification
method (Howard Brody) Fertilizer to prima-facie-ism
relevant to multiculturalism andcritical to globalization ashomogenization power to universalbioethics norm (AP 2004)
Connecting with Asian values : ethicsof love (Darryl Macer UNESCOBangkok)
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ETHICAL PRINCIPLISM (PRINCIPLE-BASED APPROACH) POSITION
Phase-out curriculum
Conduct
Code of Ethics
basic
critical
reasoninganalysis
basic
continuing
Profes-
sional
Develop-
ment
Practical
Ethics
basic
teamwork
leading
to
groupsvalue
clarifi-
cation
Moral
justification
CriticalReasoning
Normative
Ethics
Morality
Domain 1STyearstudents
4thyearstudents
6thyearstudents
Category
AP-2004
1st
3rd
4th 6th
1
st
moduleas tools
Total modulesAs implementation
3rd
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Teori Hidup baik(bermakna)
1.Cinta menyatu ke Illahi (Plato, sufismeIslam, Kejawen)
2. Kebahagiaan (eudamonia)
3. Kebajikan/keutamaan (virtue)Aristoteles
4. Hindari perasaan sakit (Epikurus).
5. Rela menyatukan diri dengan (hukum)alam sebagai sunatullah (Stoa)
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Teori Hidup baik(bermakna)
6. Cinta kepada Tuhan (Agustinus)7. Mengikuti hukum kodrat (cinta kepadaTuhan plus keutamaan)
8 Not having, but being (Erich Fromm).9. Kebebasan/otonomi subyek sebagai
sumber moralitas (Kant)10.Pandangan dunia/lebenswelt
(Habermas)
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Etika Dokter RI
Kemurnian niat = sikap moral tanpapamrih ? Kesungguhan kerja = tindakan baik &
adil ? Kerendahan hati = sopan Integritas ilmiah & sosial
= martabat profesi luhur (hormat dirisendiri & adil)
Indikasi D t l i
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KeputusanMedis
Keputusanetis
Pilar Keputusan Klinis sehari2Biomedik
Info-medik
Indikasimedik
pilihan pasien
kualitas hidupfitur kontekstual
Utilitarian
1 komunitas=
Virtue
Deontologi
teleologi
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Insight Core ProblemKeywords
Basic
Moral
Principle
Beneficence
Nonmaleficence
Autonomy
Justice
Metode AP
Metode AP
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Prima Facie
Principle
Context vs Text
Choose 1-2 out
of 4 mostrelevan
(problem
solving)
Ethics
TheoryVirtue - eudamonia
Duty - deontologist
Utilitarian
teleologist eg
happiness
Metode AP
Metode AP
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Ethical
Relativism
Culture
Custom
Ethical
Dilemma
Science &
technology
determinant
Societal &
capital
determinant
Metode AP
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Ceteris
Paribus
Choose 1 most
influential
principle
EthicalProblem
Solving
Consistency
Coherent
Corespondency
Pragmatic
Metode AP
Metode AP
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Legal
Option
Administrative
Penal
Civil
Metode AP
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