bioetik KV

8/12/2019 bioetik KV

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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


7/33Tergopoh-gopoh spt ini, benar atau tidak ?


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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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