You are on page 1of 29

Konsekuensi Etik terhadap Korporatisasi Praktik Kedokteran

Mubasysyir Hasanbasri

Perkembangan Status Dokter
Apakah Dokter telah Berubah?

Dokter Petugas Kemanusiaan Patients Physicians Activist .

Dokter Profesional Patients Physician Professional .

Dokter Pemain Politik Third Party Patients Physician Political .

Dokter Pekerja Government Third Party Hospitals Physician Workers Business Patients .

Apakah perkembangan ini normal? Jika tidak. apa alasa saudara? .

pidana .Perbandingan Status Dokter Aktivis alasan Kontrol Hukum Penderitaan Hati nurani Tidak berlaku Profesi Tugas negara Pasien Etika Kedokteran Hukum profesi Politisi Kontrak Pihak Ketiga Hukum Perdata Pekerja Job Pemilik Perusahaan Hukum Perdata.

Etika versus Hukum Komisi Etik Pengadilan Pidana Pengadilan Perdata Pengadilan Tata Usaha Malpraktik Kerugian Publik Kerugian Pasien Kesalahan PNS Dokter .

Perbedaan Mekanisme Kontrol Eksternal dalam Bidang Kedokteran Hukum Profesi Pidana Perdata Tata Usaha Bentuk Kerugian Malpraktik Kerugian keamanan publik Kerugian material Hubungan kerja atasan dan bawahan Penggugatan ketetapan atau keputusan pejabat negara Pihak ketiga tidak ada. Penjelasan Dokter dan RS bisa digugat .

Applicatioin of Rational Choice Theory in Medical Practice .

Questions • What are the concerns of those promoting rational choice theory? • 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 individual physicians. . professional associations. patients and society? • What we could aggree on about what we can and what we can not do as a member of medical profession.

• Medical ethics – Medical ethics committee .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.

Physician’s Conflict of Interests and Rational Choice Theory .

• Rational Choice Theory and Physician’s Conflict of Interests • Individual vs social rationalit= Problems of ethics .

• Rationality = Means -----------------> End .means and end. • What is important to rationality is that someone does something to achieve his goal.

• Not rational – if someone smoke while he does not have the goal to enjoy it.Rational is • the achievement of a goal through a means. – The goal is essential in understanding whether or not someone’s behavior is rational. .

personal or social. Benefits in this sense are various and can be financial or nonfinancial. • Rational choice theory states that someones do something because of the benefit they think they will get. or short term or long term. For that reason. At least we will discuss two approaches to see someone’s interest. .Rational Choice Theory of Individual Behavior • When I discuss about physicians’ perspective. I mean we will look at the issues from the interest of physicians. we should know what are the interest of physicians in health care setting.

• People may do social things for gaining popularity. . • People smoke for the short-term enjoyment. although they know smoking is bad in the longterm framework.Various sorts of benefits from rational choice perspective • People are generous to other people not in exchange for others doing good for him. • People keep away from smoking because of the risk to lung cancer. but for the promise of reward given by god in future days.

steady income • .additional goals: humanitarian • .get more money • .self satisfaction .professional – enjoy the job .Goal of becoming a physician: • .

Patients have their rights if they do not want to comply to what physicians ask them to do. To view the benefit or the consequence of medical intervention to patients. Every individuals regardless of their social and economic status have the same rights to health services. Libertarianism Utilitarianism .three perspectives that we can use to evaluate if our medical practices or health care policies are ethical Approach Egalitarianism Primary concern To view access to health is the same to individuals from different social status. To view infidividual rights is the first consideration.

To set up community health centers in remote area The use of tax money for paying health care service for the poor. A physician who uses the money from a pharmaceutical campany to purchase a medical equipment. Unethical Ethical Ethical . Private practitioners reject to treat poor patients but refer them to public hospitals. Physicians send less dangerous victims to hospitals rather than the very serious ill victims.Medical or health care policy practices Egalitaria nism Libertaria nism Utilitaria nism Example: Corporatization of health care Physician compulsory service in remote areas after graduation from medical school. A hospital manager who fires a physician who treat the patient with HIV. Physician tell spouse of a patient with HIV. A physician prefer to escape from helping casualties of a traffict accidents. A physician who quits from a medical team in armed conflict area.

. tetapi yang dimaksudkan adalah alasan sosial.Catatan penting dari kuliah kemarin • Kuliah dimulai dengan bertanya alasan mahasiswa ingin menjadi dokter. dan telah mendapat • Mendiskusikan arti dari jawaban yang bodoh – Di sini seharusnya saya menjelaskan mengapa orang berpikir alasan sosial dan alasan individual – Benarkan alasan individual merupakan alasan yang lebih masuk akal daripada alasan sosial/publik. – Yang bodoh lebih banyak daripada yang masuk akal – Melayan masyarakat tanpa alasan. • Klasifikasi jawaban bodoh dan yang reasonable. kemanusiaan.

– Praktik kedokteran tidak berbeda dari praktik profesional lain. dan mana yang menjadi bagian aktivis kemanusiaan.Memastikan apa yang mau saya jelaskan – Bagaimana mungkin praktik kedokteran yang memiliki kode etik yang bekerja atas kepentingan pasien. . • Bekerja atas dasar kontrak. – Mana praktik yang kedokteran itu.

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. . apakah mereka akan mau bekerja di desa? – Jika menjadi dokter.• Bertanya kepada mahasiswa: – Jika lulus fakultas kedokteran.

Yang penting adalah kebutuhan keduanya.Berkaitan dengan rasionalitas • Setiap kegiatan selalu ada alasan. • Apakah karena persoalan itu. • Karena alasan itu bisa berbeda-beda. Negosiable. Itu berarti pekerjaan kita harus berbasis pada kenyataan atau kebutuhan pasien. • Terus apakah kita harus bekerja dalam ketidak rasionalan. maka mempertimbangkan rasionalitas itu tidak ada gunanya. kemudian muncul etik atau upaya etik itu sesuatu yang tidak masuk akal? .

– Kita sudah ada informed consent • Dokter sudah digaji cukup sehingga ia tidak lagi memiliki kesempatan membuat pilihan yang berarti ketika berhadapan dengan pasien – Pihak asuransi bernegosiasi dengan dokter – Dokter kontrak dengan pemerintah dalam memberikan pelayanan. – Membuat kontrak. .Kondisi apa yang membuat praktik kedokteran bisa ideal? • Ada negosiasi antara provider dan pasien.

Take that action. is there a chance to develop another solution option while it does not add harm to patients? Yes. or are there similar situation that can be applied to a situation that you face Yes. follow the rule No. No. Perform impartialitas test. .Quick Method in Dealing with Ethical Problems Are there rules so far dealing with the ethical dilemma situation. Perform interpersonal justifiability test. Perform universability test.

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? Univerzability Justifiability Interpersonal . Tiga Jenis Uji Etik dalam Memecahkan Masalah Etik Jenis Uji Etik Imparsialitas Isu Uji Etik yang Ditanyakan pada Petugas Kesehatan Apakah saudara ingin memperolah tindakan ini jika saudara sendiri berada pada posisi pasien? Apakah Saudara ingn mendapat perlakuan seperti itu dalam semua situasi relevan yang sama? Could you give good reasons in justifying your choice to others? Do you think your friends. teachers.Tabel 6. bDo y Apakah saudara bsa memberikan alasan yang bagus untuk menjustifikasi tindakan saudara kepada pihak lain? Akankah kolega saudara.