Ethics Rational Choice

7/30/2019 Ethics Rational Choice

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Konsekuensi Etik terhadap

Korporatisasi Praktik Kedokteran

Mubasysyir Hasanbasri


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Perkembangan Status Dokter

Apakah Dokter telah Berubah?


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Dokter Petugas Kemanusiaan

Physicians

ActivistPatients


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Dokter Profesional

Physician

ProfessionalPatients


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Dokter Pemain Politik

PhysicianPolitical

Third Party

Patients


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Dokter Pekerja

BusinessGovernment

PhysicianWorkers

Third Party

Patients

Hospitals


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Apakah perkembangan ini

normal?

Jika tidak, apa alasa saudara?


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Perbandingan Status Dokter

Aktivis Profesi Politisi Pekerja

alasan Penderitaan Tugas

negara

Kontrak Job

Kontrol Hati nurani Pasien PihakKetiga

PemilikPerusahaan

Hukum Tidak

berlaku

Etika

Kedokteran

Hukumprofesi

Hukum

Perdata

Hukum

Perdata,pidana


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Etika versus Hukum

PengadilanPerdata

PengadilanTata Usaha

Malpraktik

KomisiEtik

Dokter

KesalahanPNS

PengadilanPidana

KerugianPasien

KerugianPublik


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Perbedaan Mekanisme Kontrol Eksternal

dalam Bidang KedokteranHukum Profesi Pidana Perdata Tata Usaha

Bentuk

Kerugian

Malpraktik Kerugian

keamananpublik

Kerugian

material

Hubungan

kerja atasandan bawahan

Penjelasan Dokter dan RSbisa digugat

Penggugatanketetapan

atau

keputusanpejabatnegara

Pihak ketigatidak ada.


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Applicatioin of Rational Choice

Theory in Medical Practice


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Questions

What are the concerns of those promoting rational choicetheory?

What are ethical problems?

What is ethics?

What are the sources of ethics?

Why should a physician join a profession? Do they really join it?

How should we relate ethics to the interests of individualphysicians, professional associations, patients and society?

What we could aggree on about what we can and what wecan not do as a member of medical profession.


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Ethical Problems

Ethical problems

Those regarded by the ethics committee as

deviated from code of ethics

Activitities or intervention regarded as not

appropriate to humanity interest.

Medical ethics

Medical ethics committee


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Physicians Conflict of Interests and

Rational Choice Theory


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Rational Choice Theory and Physicians

Conflict of Interests

Individual vs social rationalit= Problems of

ethics


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means and end.

What is important to rationality is that

someone does something to achieve his goal.

Rationality = Means -----------------> End


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Rational is

the achievement of a goal through a means.

Not rational if someone smoke while he does not have the goal

to enjoy it.

The goal is essential in understanding whether or

not someones behavior is rational.


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Rational Choice Theory of Individual

Behavior

When I discuss aboutphysicians perspective, Imean we will look at theissues from the interest ofphysicians. For thatreason, we should knowwhat are the interest ofphysicians in health caresetting. At least we will

discuss two approaches tosee someones interest.

Rational choice theorystates that someonesdo something because

of the benefit theythink they will get.Benefits in this senseare various and can befinancial or non-financial, personal orsocial, or short termor long term.


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Various sorts of benefits from rational

choice perspective

People are generous to

other people not in

exchange for others doing

good for him, but for the

promise of reward given

by god in future days.

People may do social

things for gainingpopularity.

People smoke for theshort-term enjoyment,although they knowsmoking is bad in thelongterm framework.

People keep awayfrom smoking becauseof the risk to lungcancer.


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Goal of becoming a physician:

- steady income

- professional enjoy the job - get more

money

- additional goals: humanitarian

- self satisfaction


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three perspectives that we can use to evaluate if our medical

practices or health care policies are ethical

Approach Primary concern

Egalitarianism

To view access to health is the same to individualsfrom different social status. Every individualsregardless of their social and economic statushave the same rights to health services.

LibertarianismTo view infidividual rights is the first consideration.

Patients have their rights if they do not want tocomply to what physicians ask them to do.

UtilitarianismTo view the benefit or the consequence of

medical intervention to patients.


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Medical or health care policy practices Egalitarianism

Libertarianism

Utilitarianism

Example:Corporatization of health care

Unethical Ethical Ethical

Physician compulsory service in remote areas aftergraduation from medical school.

Private practitioners reject to treat poor patients butrefer them to public hospitals.

To set up community health centers in remote area

The use of tax money for paying health care servicefor the poor.

Physician tell spouse of a patient with HIV.

Physicians send less dangerous victims to hospitals ratherthan the very serious ill victims.

A physician who quits from a medical team in armed

conflict area.

A physician who uses the money from a pharmaceuticalcampany to purchase a medical equipment.

A hospital manager who fires a physician who treat thepatient with HIV.

A physician prefer to escape from helping casualties of atraffict accidents.


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Catatan penting dari kuliah kemarin

Kuliah dimulai dengan bertanya alasan mahasiswa inginmenjadi dokter.

Klasifikasi jawaban bodoh dan yang reasonable.

Yang bodoh lebih banyak daripada yang masuk akal

Melayan masyarakat tanpa alasan, tetapi yang dimaksudkan adalahalasan sosial, kemanusiaan, dan telah mendapat

Mendiskusikan arti dari jawaban yang bodoh

Di sini seharusnya saya menjelaskan mengapa orang berpikir alasansosial dan alasan individual

Benarkan alasan individual merupakan alasan yang lebih masuk akaldaripada alasan sosial/publik.


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Memastikan apa yang mau saya

jelaskan

Bagaimana mungkin praktik kedokteran yang

memiliki kode etik yang bekerja atas kepentingan

pasien.

Praktik kedokteran tidak berbeda dari praktikprofesional lain.

Bekerja atas dasar kontrak.

Mana praktik yang kedokteran itu, dan mana yang

menjadi bagian aktivis kemanusiaan.


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Bertanya kepada mahasiswa:

Jika lulus fakultas kedokteran, apakah mereka

akan mau bekerja di desa?

Jika menjadi dokter, apakah ia akan menolak

pasien yang menelpon ketika ia sudah sampai di

rumah? Atau dibangun malam hari karena

masalah yang sepele?

Dari sini dokter harus berpikir penting mengenai public

health program.


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Berkaitan dengan rasionalitas

Setiap kegiatan selalu ada alasan.

Karena alasan itu bisa berbeda-beda, makamempertimbangkan rasionalitas itu tidak adagunanya.

Terus apakah kita harus bekerja dalam ketidakrasionalan. Itu berarti pekerjaan kita harus berbasispada kenyataan atau kebutuhan pasien. Yang pentingadalah kebutuhan keduanya. Negosiable.

Apakah karena persoalan itu, kemudian muncul etikatau upaya etik itu sesuatu yang tidak masuk akal?


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Kondisi apa yang membuat praktik

kedokteran bisa ideal?

Ada negosiasi antara provider dan pasien.

Membuat kontrak.

Kita sudah ada informed consent

Dokter sudah digaji cukup sehingga ia tidak lagimemiliki kesempatan membuat pilihan yang berarti

ketika berhadapan dengan pasien

Pihak asuransi bernegosiasi dengan dokter

Dokter kontrak dengan pemerintah dalam memberikan

pelayanan.


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Are there rules so far dealing with the ethical dilemma situation, or are there similarsituation that can be applied to a situation that you face

Yes, follow the rule No, is there a chance to develop another solution

option while it does not add harm to patients?

No.

Perform impartialitas test.

Perform universability test.

Perform interpersonal justifiability test.

Yes.

Take that action.

Quick Method in Dealing with Ethical Problems


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Jenis Uji Etik Isu Uji Etik yang Ditanyakan pada Petugas Kesehatan

Imparsialitas Apakah saudara ingin memperolah tindakan ini jika saudara sendiriberada pada posisi pasien?

Univerzability Apakah Saudara ingn mendapat perlakuan seperti itu dalam semua

situasi relevan yang sama?

Justifiability

InterpersonalCould you give good reasons in justifying your choice to others? Do you

think your friends, teachers, bDo y

Apakah saudara bsa memberikan alasan yang bagus untuk

menjustifikasi tindakan saudara kepada pihak lain? Akankah kolega

saudara, atasan, atau masyarakat luas akan puas dengan jawaban

saudara? Dapatkah saudara mempertahankan alasan yang masuk akal

jika ada orang bertanya tentang tindakan saudara? Dapatkah anda

memberikan alasan yang akan saudara jelaskan di muka umum?

Tabel 6. Tiga Jenis Uji Etik dalam Memecahkan Masalah Etik

Ethics Rational Choice

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