Teori Etika & Pemecahan

Masalah/Dilema Etik
Menggunakan Prima Facie Kaidah
Dasar Bioetika



Agus Purwadianto.
Jakarta, 2006



Medis atau
etis?

Kasus Konkrit 1

-
Keputusan
Medis
Keputusan
etis
Pilar Keputusan Klinis sehari2

-
Keputusan
Medis
Keputusan
etis
Pilar Keputusan Klinis sehari2
Biomedik
Info-
medik
Indikasi
medik
pilihan pasien
kualitas hidup
fitur kontekstual
Mindset non medis
Struktur Psiko-
Sosio-budaya
Tergopoh-gopoh spt ini, benar atau tidak ?
Kalau yang ini 1 dari ratusan
korban tsunami/lumpur panas ? (di luar RS >> korban)
Atau pasien = istri Kaisar Jepang yg ingin th/ ke AS
Micro level
Clinical medicine
The Scope of ethics in Medicine
Macro level
Politics of Health
Meso level
Health services delivery
Macho level
Health care teams
consci
ence
rights
ethics
self
reflection
justification
Deduction
= logic
Induction
= casuistry
bioethics
Concrete
Daily living
Principles-based ethics
Prima Facie
T.Beauchamp & Childress (1994) & Veatch (1989)
Beneficence
Non Maleficence
Autonomy
Justice
Contextual features
Quality of life
Clinical Decision
Making
Patients preference
Medical indication
Value-based medicine
EBM
Check list (Observation Sheets)

Beneficence Criterion Yes No
Promoting altruism
Guaranteeing human dignity
Viewing patient/family not as profit
objects
Maximize agregat net benefit
Compassionate paternalism
Guaranteeing minimal life of patient
Restricting goal based approach
Maximize patient satisfaction
Tutors name
Group No.
Deductive logic
Beneficen
ce
Non Maleficence
Autonomy Justice
Combination of
Its characteristics = Patients Context
Method =
Logic Thinking critical analysis
Medical
Indication
TROEF = berubah
menjadi
Beneficen
ce
Non Maleficence
Autonomy Justice
Medical
Indication
pihak II
Umum
BAIK
kranjang
Sampah
pihak II
kesakitan/
menderita,
gadar,pra-cacat
Distress
Rentan
uzur,
terjepit
tanpa pilihan
Miskin
bodoh.
capable
person
bebas
Elektif
rentang >>
hak pilih a
// DRnya
pihak III
Non pasien
wakil/wali
kluster pop
Komunitas
Penyandang
dana
Berpotensi
Dirugikan/
Paling krg
diuntungkan
ENRICHMENT OF
JUSTIFICATION
Beneficen
ce
Non Maleficence
Autonomy Justice
Not stipulated in the text =
Patients Context
Medical
Indication
DEDUCTIVE
LOGIC
PRIMA
FACIE
CETERIS PARIBUS
CREATIVE THINKING
(NEW) ILLAH = actual duty = contextuality
OPPOSITION
VALUE
CONFORM
>< : DETECT
DEVIATION
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)

TERGANTUNG . BERUBAH MENJADI
Our own
(Dr. Tenars) cases
Implementation of the 1
st
year students
67 WHO SEARO
cases


Group
Presentation
Plennary
Session

Individual/Group : Take home exam
EBP3KH Module

KODEKI
PASAL2 HDP
PENDALAMAN
Kaitan Etik - Moralitas

Moralitas

Etik
Praksis =
Tuntunan Perilaku
Normatif
Tuntutan Berpikir
Logis Kritis
refleksi
Meta
Etika
Standar rasional
& metode peroleh E
Yg dipercaya & diperbuat
Manusia = praktek
Teori
seyogyanya
Pembenaran
Seharusnya
NILAI
Menghargai
menjunjung
Benar
Baik
cocok
Kaitan Etik - Moralitas

Moralitas

Etik
Praksis =
Tuntunan (cara/alat
mencapai)Perilaku
Normatif
Tuntutan Berpikir
Logis Kritis,
Pembenaran moral
refleksi
Meta
Etika
Teori Etika
Virtue
Deontologi teleologi/
Utilitarian
Aktor
Eudamonia
Bukan nabi
Perbuatan
= kewajiban
akibat
tujuan
Relevancy of PBE
Actual to & match with clinical ethics
setting (Jonsen & Siegler Method)
DR need a solution as well as
guidance use critical reasoning
analysis tools close to the work of
Ethical Reviewing Board (R. Veatch
method)
In line with student rationality
completing power to analysis
preserving the logics (deductive
method of Henry Richardson)
Relevancy of PBE (2)

Match with the MET method to achieve its
objectives = cognitive developmental
approach : + affective dev. app : >
cultural transmission
In line with ethico-legal approach very
useful to achieve defend argumentation
against the wrong & abuses legal
arguments (Agus P method 2002)
More practicable ethics to analyze tightly
coupled ethics-discipline-legal case of
every professional misconduct now
relevant with Medical Practice Act 2004
Relevancy of PBE
(3)
A previous step to value clarification
method (Howard Brody)
Fertilizer to prima-facie-ism
relevant to multiculturalism and
critical to globalization as
homogenization power to universal
bioethics norm (AP 2004)
Connecting with Asian values : ethics
of love (Darryl Macer UNESCO
Bangkok)
ETHICAL PRINCIPLISM (PRINCIPLE-
BASED APPROACH) POSITION
Phase-out curriculum
Conduct

Code of Ethics
basic
critical
reasoning
analysis
basic
continuing
Profes-
sional
Develop-
ment
Practical

Ethics
basic
team
work
leading
to
groups
value
clarifi-
cation
Moral
justification

Critical
Reasoning
Normative

Ethics
Morality
Domain 1
ST
year
students
4
th
year
students
6
th
year
students
Category
AP-2004
1
st

3
rd

4
th
6
th

1
st
module
as tools
Total modules
As implementation
3
rd

Teori Hidup baik
(bermakna)
1.Cinta menyatu ke Illahi (Plato, sufisme
Islam, Kejawen)
2. Kebahagiaan (eudamonia)
3. Kebajikan/keutamaan (virtue)
Aristoteles
4. Hindari perasaan sakit (Epikurus).
5. Rela menyatukan diri dengan (hukum)
alam sebagai sunatullah (Stoa)

Teori Hidup baik
(bermakna)
6. Cinta kepada Tuhan (Agustinus)
7. Mengikuti hukum kodrat (cinta kepada
Tuhan plus keutamaan)
8 Not having, but being (Erich Fromm).
9. Kebebasan/otonomi subyek sebagai
sumber moralitas (Kant)
10.Pandangan dunia/lebenswelt
(Habermas)


Etika Dokter RI

Kemurnian niat = sikap moral tanpa
pamrih ?
Kesungguhan kerja = tindakan baik &
adil ?
Kerendahan hati = sopan
Integritas ilmiah & sosial
= martabat profesi luhur (hormat diri
sendiri & adil)


-
Keputusan
Medis
Keputusan
etis
Pilar Keputusan Klinis sehari2
Biomedik
Info-
medik
Indikasi
medik
pilihan pasien
kualitas hidup
fitur kontekstual
Utilitarian
1 komunitas
= moral acquintance
Virtue
Deontologi
teleologi
Insight
Core Problem
Keywords
Basic
Moral
Principle
Beneficence
Nonmaleficence
Autonomy
Justice
Metode AP
Prima Facie
Principle
Context vs Text
Choose 1-2 out
of 4 most
relevan
(problem
solving)
Ethics
Theory
Virtue - eudamonia
Duty - deontologist
Utilitarian
teleologist eg
happiness
Metode AP
Ethical
Relativism
Culture
Custom
Ethical
Dilemma
Science &
technology
determinant
Societal &
capital
determinant
Metode AP
Ceteris
Paribus
Choose 1 most
influential
principle
Ethical
Problem
Solving
Consistency
Coherent
Corespondency
Pragmatic
Metode AP
Legal
Option
Administrative
Penal
Civil
Metode AP