THE ETHICAL AND LAW

AUTHORITY IN THE ERA OF

ASEAN ECONOMIC COMMUNITY

KEWENANGAN ETIK DAN HUKUM

DI ERA MEA

Soetedjo*
Vice Chairman of The Central of MKEK
(2nd periode , 2012-2018)
Presented in Annual Meeting & 8th Mukernas PDUI
Jakarta, April 9th, 2017
 THE ETHICAL AND LAW AUTHORITY IN
THE ERA OF ASEAN ECONOMIC COMMUNITY
(AEC)
SEKAPUR SIRIH
Ass Wr Wb, Properous regards to all of us, good
morning and Merdeka. Ladies and Gentlemen
First of all, I would like to thank to God, who has
given us hints and guidance also wealthy, healthy
and safety, so we can attend this meeting to day.
The second, thanks to coordinating committee
who has given me a good chance to be speaker, in
the topic of : The Ethical and Law Authority in the
Era of Asean Economic Community (AEC).
This Topic is very important to be discussed, to
find a good consensus,especially from Seniors and
all of us.
LET US REALIZE

NODOCTOR CAN BE
SPECIALIST IN ALL
AREAS OF MEDICINE

OF COURSE DOCTORS ALWAYS

IN UNION AND UNITY
 8TH ANNUAL
THE
SCIENTIFIC MEETING OF PDUI
JAKARTA, APRIL 7-9TH, 2017
IN THE THEME :

Menjawab Tantangan
Profesionalisme Dokter Umum
di Era Masyarakat Ekonomi Asean
(MEA)
To anwer the professionalism challanges of
GP in the Era of The ASEAN ECONOMIC
COMMUNITY (MEA),
(May be also in BPJS Era and Commission of Eradication
Corruption (KPK)
 THE CHALLENGES OF
PROFESIONALISM OF THE GP
IN THIS ERA

I. Three Eras in this time are :

1. BPJS ERA
2. ERADICATION CORRUPTION COMMISSION ERA
3. ASIAN ECONOMIC COMMUNITY.(MEA)

II.They all come (almost) in the same time,

AS OVERLAPPING CONDITION.
 LET US TO BEGIN
THIS PRESENTATION TO
REMEMBER
RENE DECRATES, Who is he?
1. HE WAS A FRENCH PHILOSOPHER
2. THE FIRST FAVOR : WHOS SEPARATED
MEDICINE FROM RELIGION
3. THE SECOND, HE SAID: BECAUSE
YOU THINK OF COURSE YOU
THERE ARE
So we remember with Cak Lonthong as Indonesian comidian
 SUB TOPICS WILL BE
4 DISCUSSED ARE :
1. MEA and the challanges of the quality medical
services and medical conduct.
2. Mastering all regulation relationship with task,
autority, right and duties.
3. Mastering of medicoethicolegal problems shall
be faced by GP in Primary health services.
4. Mastering what to do in facing many kinds of
cases relationship with ethical and
professionalism of the doctors.
 THE ASIAN ECONOMIC
COMMUNITY (AEC)
1. THE ASIAN ECONOMIC COMMUNITY has
come into force began at the end of 2015.
Effectuation of MEA, the States joined in
possible to sell goods and services to member
states, and so competition be gets tight.
2. MEA not only to open trading of goods and
services but also professional employment like
a doctor, lawyer, accountant and other.
3. Indonesia in the same time has
National Health Insurance (JKN-
BPJS- without FRAUD according KPK)
 ARE WE READY
TO FACED WITH MEA ?
1. INDONESIA in general has low education,
under JUNIOR SECONDARY SCHOOL (SMP): In
year 2014 = 76,4 M OR 64 % TOTAL
EMPLOYMENT 118 M.
2. (LOW) INFRASTRUCTURE QUALITY.
3. INDUSTRIAL FRAGILITY, Limitation of
energy supply, THE ATTACK BY IMPORT
OF GOODS FROM OUTER, AND SO ON.
4. BUT, NAWACITRA JOKOWI-JK, ARE STILL
REPAIRING THESE CONDITIONS.
5. THE FOR EVER QUESTION IS :
ARE WE READY ?
 IN THE MEDICAL FIELD
PENDING THE NEGOTIATION
IMA (IDI) HAVE THOUGH THAT :
1. Only to medical 1. ...the meaning is
science has not Only, specific of
been there in specialits/ sub
Indonesia. specialist will be
2. Shall perform to affected.
transfer of medical
2.... According
science and
technology, so just economic
only in the education principle, just only
hospital. in the big city.
 PENDING THE NEGOTIATION
IMA (IDI) HAVE THOUGH THAT :
3. Indonesian 3. ...Like exchange
doctors may also program, there is
be work in that some balance.
outer country.
4. Shall have 4. ....The same with
Regristration Letter Indonesian doctor.
(STR) and Practical
License ( SIP).
5. Fluence of 5. ....Fluence of
Indonesian ASEAN language?
speaking.
II. MEA and The challanges of the
Quality medical services and
Medical conduct
(MEA dan tantangan kualitas
yankes dan etika kedokteran)
 THE QUALITY CHALLANGE
OF MEDICAL SERVICES
IN MEA ERA AND ALSO BPJS ERA
1. THE FIRST CHALLANGEs OF GENERAL
DOCTOR ARE ; 144 POINT
COMPETENCY.
2. ESPECIALLY TOGETHER WITH BPJS
SERVICES.
3. THERE ARE QUANTITY LIMITATIONS
TO HAVE REFERRAL SYSTEM.
4. GET PATIENTS BELIEVE, OF COURSE
DOCTORS NEED GOOD ETHICAL ,
GOOD ATTITUDE, AND AS A SMART
DOCTORS.
 AS WE KNOW

THE ONE OF THE IMPORTANT TASK

OF THE DOCTOR IS CLINICAL CASE
MANAGEMENT, THAT CONSIST OF
TRILOGY COMPULSIONS WITH
EXTENTION IN MORAL, ETHICS, AND
LAWS. (IN MEA OR NOT).
 TRILOGY COMPULSIONS OF
CLINICAL CASE MANAGEMENT
IN MEA

1. Diagnosis:
How to recognize the cause of symptom, sign,
and syndrome to determine, what kind of
diseases.
2. Treatment:
To reduce and eliminate the symptom, to
make recover and better again, and also to
restore sense of well-being.
3. Prognosis:
Estimating the extent of patients suffering
from remain treated or not.
 MISDIAGNOSIS

The number of misdiagnosis in advanced country

still high , around 17%.
Even in Emergency unit (UGD) reach 20 - 40 %.

Misdiagnosis is caused by :
1. Mistake / error by doctor.
2. Mistake by specialist / Consultant
3. Mistake by laboratory finding/medical equipment
4. Patient constribution; through many ways. ****
(Curran, W, J, 1980)
 HIGH TECHNOLOGY
1.There are many High-tech equipment to help
doctors to make diagnosis.

2. The main purpose high-tech equipment just

only to :
o To increase accuracy.
o To decrease the uncomfordable and the risk .
o To widen the view of making diagnosis. .
(Gibbons, T, B, 1980, Dahlan S )

3. So, The High-tech equipment just only to

decrease and not to remove the number of
misdiagnosis.
 MEDICAL CONDUCT AND LAW OF
INDONESIAN DOCTOR

1. According 12 grains of Medical oath

( 12 butir sumpah dokter) and 21
articles ( 21 pasal) of Medical code
( KODEKI), Indonesian doctor well
enough.
2. Indonesian doctor also more
carefully, with any 28 violation
forms of Medical discipline by
MKDKI. And....
3. The existing of legal medicine, we
have.
III. Mastering all regulation
relationship with task,
autority, right and duty,
 THE AIM OF TREATMENT
1. To cure the disease. Menyembuhkan penyakit.
2. To health promotion or preventive medicine. Promosi
kesehatan atau pencegahan penyakit.
3. To maintain or to increase QOL. Mempertahankan atau
meningkatkan QOL.

4. To Prevent of death that has not been in time. Mencegah

kematian yang belum waktunya.
. (Johnson, et al, Dahlan S.)
 THE AIM OF TREATMENT

.
5 To maintain functional state or
compromise condition. Mempertahankan
status fungsional atau menjaga kondisi kompromistis
6. Education and consulting according
condition and prognosis. Edukasi serta
konseling, kaitannya dengan kondisi dan prognosis.
7. To protect severity or dangerous
during caring. Mencegah memberat /bahaya
selama dlm perawatan.
8. Hopice care. Membimbing kematian dgn tenang .
8. (Johnson, et al, Dahlan S.)
 TREATMENT IN BRIEF

1. According indication, and

avoid contra indication.
2. Good informed consent.
3. Conducted in carefully .
IV. Mastering of medico-
ethico-legal problems shall
be faced by GP in Primary
Health Services.
 INDONESIA HAS
MANY REGULATIONS
1. UUD 1945: Psl. 28 ayat(3),Penyelenggaraan
Jaminaan sosial Psl. 34 ayat(2); Hak thd jaminan sosial.
2. UU NO. 29 TH. 2004 : PRAKTIK
KEDOKTERAN.

3. UU NO. 40 TH. 2004 : SJSN*

4. UU NO. 36 TH 2009 : KESEHATAN
5. UU NO. 44 TH 2009 : RUMAH SAKIT
6. UU NO. 24 TH 2011 : BPJS**
7. PP NO. 101 TH 2012 : PENERIMA PBI
8. PP NO. 12 R5H 2013 : JAMINAN
KESEHATAN
9. PERMENKES NO. 71 TH 2013 YANKES PD
JAMKESNAS.
 CONSULTATION PROBLEM
BECAUSE :
NO DOCTOR CAN BE SPECIALIST
IN ALL AREAS OF MEDICINE.
CONSULTATION NEED IN THE FRAME :
o ERECTING OF DIAGNOSIS ;
o SPECIFICATION OF PROGNOSIS;
o DECISION OF TREATMENT AND
ANOTHER CLINICAL WISDOM.
 REFERRAL PROBLEM

HOW ABOUT PATIENT NEED

REFERRAL?
1. LIMITATION OF THE DOCTORS, IN:
a. COMPETENCY; OR
b. CLINICAL PRIVILEGE THEIR
HAVE.
2. LIMITATION OF THE MEDICAL FACILITY,
ESPECIALY IN:

a. MEDICAL STAFF;
b. FACILITY EQUIPMENT IN THE
PRIMARY SERVICES.
V. Mastering what to do to
facing many kinds of cases
relationship with ethical and
professionalism doctor
 The Wisdom Words in
Clinical practice
A physician who fails enter the
body ( and the mind) of a
patient with the lamp of
knowledge and understanding
can never treat disease............
dikutip dari Dahlan s , 2012
 DOCTORS POSITION
IN THE BASIC PRINCIPLES

1. RESPECT OF AUTONOMY
2. BENEFICENCE
3. NONMALFICENCE
4. JUSTICE
AS PRIMA FACIE THAT ARE MAY BE IN
CONTRADICTIONS OR CONFLICT.
 CLINICAL ETHICS
Is Practical disciplin that served structural approach,
useful to introduction, analysis, and to be done ethical
isues in medical clinic.

The referrence are :

1. Medical Indication.
2. Patient Preferences ( for ex : DNR).
3. Quality of Life.
4. Contextual Features.
(Jonsen, Siegler dan Winslade, 2006)
 REMEMBER
DOCTORS FRAUD
IN GENERAL

1. Decied ( penipuan)
2. Misrepresentation ( penyesatan)
3. Hidden fact ( penyembunyian fakta)
4. Manipulation ( manipulasi)
5. Breach of trust ( pelangg. kepercayaan)
6. Subterfuge ( akal-akalan)
7. White crime ( kejahatan tanpa kekerasan)
 HUMAN ARE THE PLACE OF
MISTAKES, GOD IS THE TRUTH.
MANY DIFFERENCE OF THE MISTAKES
OF THE DOCTORS (?)

1. MALPRACTICE , Malparaktik.
2. NEGLIGENCE,Kelalaian ,hukum, mgd sifat/ watak pelaku.
3. ERROR JUDGEMENT. Kesalahan penilaian
4. ACCIDENT, MISCHAP, MISFORTUNE, Kecelakaan medik
5. CHULD IN CRIMINAL LAW, Kesalahannya hrs jelas benar.
6. NEGLIGENCE IN CIVIL LAW, Melanggar kew. hukum
7. NEGLIGENCE IN CRIMINAL LAW Kealpaan sehingga
pasien cacat/ meninggal.
 10 FRAUDS OF THE DOCTOR,
ACCORDING CEC / KPK, 2014

A. 5 Frauds by Health Service-Facility/

Fasyankes, with whom they made contract /Mou.
B. 5 Frauds by Doctors: Without contract/ Mou.
C . Shall thought, A may be more than B.

D. Fraud by Doctor is more ethical

dilemmas. unrealized fraud.

A.Fraud by Health Service Facility: 5.
a. UP CODING : Kode Dx/. lebih tinggi.
b. PHANTOM BILLING : Tagihan tanpa pelayanan
c. INFLATED BILLS : Tagihan lebih tinggi
d. CANCELLED SERVICE: Tagihan tindakan batal.
e. KEY STROKE MISTAKE: Meng- in put tagihan > tinggi
.
B. Fraud by Doctor: 5
(HEAVY ETHICAL DILEMMAS) :

f. SERVICE UNBUNDLING: Tak tuntas (3- 4 -- >2) stent

g. STANDARD OF CARE : Pelayanan disesuaikan
dengan tarif .
h. NO MEDICAL VALUE : Obat/ Dx. Tak manfaat
i. UNNECESSARY TREATMENT: Obat tak dibutuhkan
j. LENGTH OF STAY : Perpanjangan masa
rawat. (ICU/ Ru.)
 DOCTORS
SELF PROTECTION
1. MENGABDIKAN PROFESI dengan jujur sesuai perannya;
2. USAHAKAN bekerja sesuai kompetensi, kewenangan, dan clinical
privileges;
3. KETAATAN PADA Sumpah dokter, ETIKA , KODEKI, Disiplin dalam
menjalankan profesi; termasuk standar layanan dan SPO;
4. INFORMED CONSENT, termasuk menghormati HAM dan Rahasia
kedokteran.
6. DEFENSIVE MEDICINE. Kalau perlu (?).
7. HINDARI Medical error (diagnostic errors, treatment errors,
preventive errors, dan others).
 MALPRACTICE PROPHYLAXIS

1. Refuse to take the case

2. Never guarantee a cure.
3. Watch the time factor.
4. Watch the reverse time factor.
5. Keep up with the advance of medicine.
6. Do not be too advance.
7. Do not experiment.
8. Get the patients informed consent for all procedures.
9. Good housekeeping.
10. Employ at least ordinary skill and care at all times.
11. When in doubt, seek consultations.
12. Cooperate with your profession.
13. Watch your patient relations.
14. Watch your public relationss
(Morris, Moritz, Dahlan S)
 MOU
INDONESIAN POLICE INDONESIAN
MEDICAL ASSOCIATION ( 2017)
THE PARTY OF MOU
MOU INDONESIAN POLICE IMA
IN CENTRAL JAVA PROVINCE
MARKED SIGNATURE AND THE
BEST COMMAND OF JOINT
GREETING
MOU OF ALL MUNICIPAL AND
COUNTY IN CENTRAL JAVA
PROVINCE
SINERGI IDI DENGAN POLDA
JATENG
SINERGI IDI DENGAN POLDA
JATENG
MOU OF ALL MUNICIPALS AND
COUNTIES IN CENTRAL JAVA
PROVINCE
MOU OF ALL MUNICIPALS AND
COUNTIES IN CENTRAL JAVA
PROVINCE
 FOR CONTEMPLATION

Just the right true

doctors who
comfortable so the
doctor

Hanya dokter yang benar-benar dokter yang

nyaman jadi dokter
 THE RESUMES ARE:
1. DOCTOR IS NOT A PROFESSION WITHOUT RISK.
2. MANY PROBLEMS FACED BY ALL DOCTOR, IN
THEIR PRACTICE, IN ERA BPJS, ERA OF
CORRUPTION ERADICATION COMMISSION, AND
MEA ERA.
3. DOCTORS SHOUD BE MASTERING, MEDICAL
ETHIC , MEDICAL DISCIPLINE, MEDICAL LAW.
4. DO IN COMPETENCE WE HAVE, GOOD
INFORMED CONSENT, GOOD COMMUNICATION
WITH OUR PATIENT AND FAMILY.
5. TAKE LEGAL OF MEDICAL PRACTICE.
8. PROCEED MOU FROM THE CHIEF INDONESIAN
POLICE - PB. IDI , TO PROVINCE ; KAPOLDA- IDI
WIL AND MUNICIPAL OR COUNTY;
KAPOLTABES/ KAPORESTA- IDI CABANG.
THE VIOLATION OF LIGHT
ETHICAL CONDUCT
THE CRIMINAL MALPRACTICE
(?)
 THE TRUE OF
CRIMINAL MALPRACTICE
 THE TRUE OF
CRIMINAL MALPRACTICE
 SET UP
THE ARGUMENTS
DOCTOR MAASTERING MEDICAL
CODE ISNT ENOUGH