Etik berasal dari Yunani “ETHOS” yang baik, yang layak.

Etik Kedokteran Prinsip2 moral atau asas2 akhlak yg harus diterapkan oleh para dokter dalam hubungannya dengan pasien, teman sejawatnya & masyarakat umumnya.

Sumpah Hippokrates (460 – 377 S.M) Deklarasi Jenewa (1948) Lafal Sumpah Dokter Indonesia (1960) International Code of Medical Ethics Kode Etik Kedokteran Indonesia Pernyataan-pernyataan (Deklarasi)

Ikatan Dokter Sedunia.

4 KELOMPOK KEWAJIBAN DOKTER : I Kewajiban umum dokterII Kewajiban terhadap penderita III Kewajiban terhadap teman sejawatIV Kewajiban terhadap diri sendiri

1. Setiap dokter harus menjunjung tinggi, menghayati & mengamalkan Sumpah Dokter.

2. Seorang dokter harus senantiasa melakukan profesinya menurut ukuran yang tertinggi.

3. Dalam melakukan pekerjaan kedokterannya tidak untuk kepentingan pribadi.

4. Hal2 yg tidak layak dilakukan dokter memuji diri sendiri,

menerapkan pengetahuannya dlm segala bentuk tanpa kebebasan profesi, menerima imbalan selain daripada yg layak sesuai jasanya kecuali dengan keikhlasan penderita.

5. Mengutamakan kepentingan penderita.

6. Hati2 dengan penemuan teknik atau pengobatan baru yg belum diuji kebenarannya.

7. Seorang dokter hanya memberi keterangan atau pendapat yg dapat dibuktikan kebenarannya.

8. Pelayanan kesehatan paripurna.

Setiap dokter harus senantiasa mengingat akan kewajibannya melindungi hidup mahluk insani.

Sesuai standar pelayanan medik, bila tidak mampu menangani pasien wajib merujuk kepada dokter lain yg ahli dlm penyakit tsb.

Memberikan kesempatan kepada penderita berhubungan dgn keluarga dll.

Merahasiakan segala sesuatu yg diketahuinya tentang seorang penderita bahkan penderita sampai meninggal dunia.

Kewajiban memberikan pertolongan darurat.

1. Setiap dokter memperlakukan teman sejawatnya sebagaimana ia sendiri ingin diperlakukan.

2. Setiap dokter tidak boleh mengambil alih penderita dari teman sejawatnya tanpa persetujuannya.

Pasal 10 Setiap dokter wajib bersikap tulus

ikhlas dan mempergunakan segala ilmu dan ketrampilannya untuk kepentingan pasien. Dalam hal ini ia tidak mampu melakukan suatu pemeriksaan atau pengobatan, maka atas persetujuan pasien, ia wajib merujuk pasien kepada dokter yang mempunyai keahlian dalam penyakit tersebut.

1 Setiap dokter harus memelihara kesehatannya, supaya dapat bekerja dengan baik.

2 Setiap dokter hendaknya senantiasa mengikuti perkembangan ilmu pengetahuan dan tetap setia kepada cita-citanya yg luhur.

A fellow member of a profession, staff, or academic faculty; an associate

from French collègue, from Latin collēga one selected at the same time as another, from com- together + lēgāre to choose

Synonim: partner/mitra

Rules or codes of medical ethics Mutual respect and understanding Friendship

1. between student and teacher;

2. between doctors in the same discipline (either specialists or GP) ;

3. between general practitioner (GP) and consultant;

4. between two doctors in different specialities;

5. between the doctor and his doctor-patient.

to teach his students all he knows, freely and without thought for remuneration. (Hipocratic oath)

The professionally sound and ethically upright teacher is in the best position to appear as a role model for his impressionable pupils.

There is no age bar to the process of learning and it does not matter whom one learns from. It should not be surprising that one day the student may indeed be teaching his own professor in the course of conferences, seminars and workshops.

‘cheerfully render professional services to his physician-colleagues and their immediate family members without seeking monetary compensation.’ However, there is no rule that a physician should not charge another colleague for his services

The immediate family consists of parents, spouse and children.

Dependants include non-earning members of the family dependent upon the doctor for their survival.

Doctors may criticise one another, but only face-to-face and in complete confidence. To criticise a colleague in front of a patient is both damming and dangerous and can never be justified.

the utmost care and tact be maintained when listening to patients complaining about how they have been treated or handled by other doctors.

a doctor is urged to expose incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession without fear or favour as these are against the best interests of patients.

‘a practitioner in whatsoever form of practice, should take positive steps to satisfy himself that a patient who applies for treatment or advice is not already under the active care of another practitioner before he accepts him.’

‘a practitioner should not accept as a patient any patient whom he has attended as a consulting practitioner, or as a deputy for a colleague.

Physician belong to a profession that has traditionally functioned in an extremely hierarchical fashion.

Consultations are encouraged in cases of serious illnesses, especially in doubtful or difficult conditions.

The rights of the patient to ask for a second opinion should be respected. With the rapid growth in scientific knowledge and its clinical applications,

medicine has become increasingly complex. Individual physicians cannot possibly be experts in all their patients’ diseases and potential treatments and they need the assistance of other specialist physicians and skilled health professionals such as nurses, pharmacists, physiotherapists, laboratory technicians, social workers and many others. Physicians need to know how to access the relevant skills that their patients require and that they themselves lack.

The attending doctor may certainly suggest the names of the consultants of his choice but even then, in the event of a difference of opinion between him and patient or his relatives of the patient, the choice of the latter should prevail.

In the event of irreconcilable difference of opinion between the two doctors, the circumstances should be impartially and frankly explained to the patient concerned. It is now up to the patient to decide which of these he will follow or, indeed, whether he will seek further advice from a new consultant.

a cooperative model of decision-making has replaced the authoritarian model that was characteristic of traditional medical paternalism.

As members of the medical profession, physicians have traditionally been expected to treat each other more as family members than as strangers or even as friends.

The WMA Declaration of Geneva includes the pledge, “My colleagues will be my sisters and brothers.”

For example, where fee-for-service was the principal or only form of remuneration for physicians, there was a strong tradition of ‘professional courtesy’ whereby physicians did not charge their colleagues for medical treatment.

This practice has declined in countries where third-party reimbursement is available. Besides the positive requirements to treat one’s colleagues respectfully and to work cooperatively to maximize patient care, the WMA International Code of Medical Ethics contains two restrictions on physicians’ relationships with one another: (1) paying or receiving any fee or any other consideration solely to procure the referral of a patient; and (2) stealing patients from colleagues.

The attendance of the practitioner should cease when the consultation is concluded, unless the patient has dispensed with the services of his first doctor and engaged those of another.

In no case should the consultant treat the patient alone or hand him over to his assistant or admit him to a nursing home or hospital without the knowledge of the the referring physician or injure the latter’s position in any respect. (Emergencies form an exception to this rule. In such an event, the consultant should inform the referring physician at the first opportunity after the crisis has been tided over.)

When a consultant sees a patient in his rooms at the request of a medical practitioner, it is his duty to write to the latter, stating his opinion on the case and the line of treatment he thinks should be adopted. He should not see this patient again without a fresh note from the first doctor.

A doctor called upon in an emergency must treat the patient, but after the crisis, the consultant must retire in favour of the original attendant of the patient.

Obtain the opinion of an appropriate colleague acceptable to your patient if diagnosis or treatment is difficult or obscure, or in response to a reasonable request by your patient.

When referring a patient, make available to your colleague, with the patient's knowledge and consent, all relevant information and indicate whether or not they are to assume the continuing care of your patient during their illness.

When an opinion has been requested by a colleague, report in detail your findings and recommendations to that doctor.

Should a consultant or specialist find a condition which requires referral of the patient to a consultant in another field, only make the referral following discussion with the patient's general practitioner - except in an emergency situation.

In the Hippocratic tradition of medical ethics, physicians owe special respect to their teachers. › The Declaration of Geneva puts it this way: “I will give to

my teachers the respect and gratitude which is their due.” › Although present-day medical education involves multiple

student-teacher interactions rather than the one-on-one relationship of former times, it is still dependent on the good will and dedication of practising physicians, who often receive no remuneration for their teaching activities.

› Teachers have an obligation to treat their students respectfully and to serve as good role models in dealing with patients.

› Students concerned about ethical aspects of their education should have access to such mechanisms where they can raise concerns.

The obligation to report incompetence, impairment or misconduct of one’s colleagues is emphasised in codes of medical ethics. For example, the WMA International Code of Medical Ethics states that “A physician shall... strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.”

On the one hand, a physician may be tempted to attack the reputation of a colleague for unworthy personal motives, such as jealousy, or inretaliation for a perceived insult by the colleague.

A physician may also be reluctant to report a colleague’s misbehaviour because of friendship or sympathy

Despite these drawbacks to reporting wrong doing, it is a professional duty of physicians. Not only are they responsible for maintaining the good reputation of the profession, but they are often the only ones who recognise incompetence, impairment or misconduct.

Reporting colleagues to the disciplinary authority should normally be a last resort after other alternatives have been tried and found wanting.

The first step might be to approach the colleague and say that you consider his or her behaviour unsafe or unethical. If the matter can be resolved at that level, there may be no need to go farther.

If not, the next step might be to discuss the matter with your and/or the offender’s supervisor and leave the decision about further action to that person. If this tactic is not practical or does not succeed, then it may be necessary to take the final step of informing the disciplinary authority

Medicine is at the same time a highly individualistic and a highly cooperative profession.

On the one hand, physicians are quite possessive of ‘their’ patients.

The weakening of medical paternalism has been accompanied by the disappearance of the belief that physicians ‘own’ their patients.

Physicians will have to be able to justify their recommendations to others and persuade them to accept these recommendations. In addition to these communication skills, physicians will need to be able to resolve conflicts that arise among the different participants in the care of the patient.

Ideally, healthcare decisions will reflect agreement among the patient, physicians and all others involved in the patient’s care.

However, uncertainty and diverse viewpoints can give rise to disagreement about the goals of care or the means of achieving those goals.

Limited healthcare resources and organisational policies may also make it difficult to achieve consensus

Dr. C, a newly appointed anaesthetist in a city hospital, is alarmed by the behaviour of the senior surgeon in the operating room. The surgeon uses out-of-date techniques that prolong operations and result in greater post-operative pain and longer recovery times. Moreover, he makes frequent crude jokes about the patients that obviously bother the assisting nurses. As a more junior staff member, Dr.C is reluctant to criticize the surgeon personally or to report him to higher authorities. However, he feels that he must do something to improve the situation.

Dr. C is right to be alarmed by the behaviour of the senior surgeon in the operating room. Not only is he endangering the health of the patient but he is being disrespectful to both the patient and his collegeous. Dr.C has an ethical duty not to ignore this behaviour but to do something about it.

As a first step, he should not indicate any support for the offensive behaviour, for example, by laughing at the jokes. If he thinks that discussing the matter with the surgeon might be effective, he should go ahead and do this. Otherwise, he may have to go directly to higher authorities in the hospital. If they are unwilling to deal with the situation, then he can approach the appropiate physician licencing body and ask it to investigate.

Sejak terwujudnya praktek kedokteran

Masyarakat mengetahui beberapa sifat mendasar & melekat pada diri seorang dokter yg baik & bijak yaitu :

1. Kemurnian niat2. Kesungguhan kerja3. Kerendahan hati 4. Integritas ilmiah & moral yg tidak

diragukan

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