Teori Etika & Pemecahan

Masalah/Dilema Etik
Menggunakan Prima Facie Kaidah
Dasar Bioetika

Agus Purwadianto.
Jakarta, 2006
Medis atau
etis?
Kasus Konkrit 1
Keputusan Pilar Keputusan Klinis sehari2
Medis

-
Keputusan
etis
 Indikasi
Biomedik medik
Keputusan Pilar Keputusan Klinis sehari2
Medis

Info-
etis
-
Keputusan
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
The Scope of ethics in Medicine

bioethics
Deduction
Macro level = logic

rights Politics of Health

justification Meso level

consci
ence Health services delivery
self
Macho level
reflection Health care teams
ethics
Micro level Induction
= casuistry
Clinical medicine
Concrete
Daily living
 Principles-based ethics
 Prima Facie
T.Beauchamp & Childress (1994) & Veatch (1989)

Patient’s preference

Beneficence
Autonomy

Non Maleficence Justice

Contextual features Clinical Decision

Making EBM
Quality of life

Value-based medicine
 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
Group No. Tutor’s name
 Medical
Indication
Deductive logic
Beneficen Autonomy Justice
Non Maleficence
ce

Method =
Logic Thinking  critical analysis

Combination of
It’s characteristics = Patient’s Context
 Medical
Indication TROEF = berubah
menjadi ……
Beneficen Autonomy Justice
Non Maleficence
ce

pihak II capable pihak III

pihak II person Non pasien
kesakitan/
Umum bebas wakil/wali
menderita,
BAIK Elektif kluster pop
gadar,pra-cacat
“kranjang rentang >> Komunitas
Distress
Sampah” hak pilih a Penyandang
Rentan
uzur, // DRnya dana
terjepit Berpotensi
tanpa pilihan Dirugikan/
Miskin Paling krg
bodoh. diuntungkan
 Medical ENRICHMENT OF
Indication JUSTIFICATION

Beneficen
ce Non Maleficence Autonomy Justice

(NEW) ILLAH = actual duty = contextuality

PRIMA
FACIE
CETERIS PARIBUS

DEDUCTIVE >< : DETECT

LOGIC DEVIATION
“OPPOSITION”
CREATIVE THINKING

Not stipulated in the text =

VALUE
Patient’s Context
CONFORM
 Keketatan Pemikiran Logis = Jln kepastian
R.Veatch, 1981

KAIDAH DASAR
BIOETIK

“Domino”

Rule of thumb,
Prima Facie Absolut
Hanya disebut
Kartu Bridge/“Troef”
Actual duty = contextuality
> prima facie duty Lurus,
mengikat
(Ross, 1939)
TERGANTUNG …….  BERUBAH MENJADI
 Implementation of the 1st year students

EBP3KH Module

KODEKI
PENDALAMAN
PASAL2 HDP Group
67 WHO SEARO Our own Presentation
(Dr. Tenar’s) cases
cases Plennary
Session

Individual/Group : Take home exam

 Kaitan Etik - Moralitas

Yg dipercaya & diperbuat

Manusia = praktek
Moralitas Pembenaran
Menghargai
“Seharusnya”
menjunjung

refleksi
NILAI Teori
Benar “seyogyanya”
Meta
cocok
Baik Etik Etika
Standar rasional
& metode peroleh E

Praksis = Normatif
Tuntunan Perilaku Tuntutan Berpikir
Logis  Kritis
 Kaitan Etik - Moralitas
Teori Etika
Moralitas
Virtue tujuan
Aktor Deontologi teleologi/
Eudamonia Perbuatan Utilitarian refleksi
Bukan nabi
= kewajiban akibat
Meta
Etik Etika

Praksis = Normatif
Tuntunan (cara/alat Tuntutan Berpikir
mencapai)Perilaku Logis  Kritis,
Pembenaran moral
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
Category Domain 1ST year 4th year 6th year
students students students

1st 4th 6th

Morality Moral 3rd basic
justification
team basic
Practical Critical work continuing
Reasoning basic leading
Ethics Profes-
critical to sional
reasoning group’s Develop-
analysis value
ment
Normative
Conduct clarifi-
Ethics cation
Code of Ethics
3rd 1st module Total modules
AP-2004
as tools As implementation
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)
 Indikasi Deontologi
Biomedik medik
Keputusan Pilar Keputusan Klinis sehari2
Medis

Info-
Virtue
etis
-
Keputusan
medik

pilihan pasien
kualitas hidup
fitur kontekstual
teleologi

Utilitarian
1 komunitas
Insight Core Problem
Keywords

Basic Beneficence
Nonmaleficence
Moral Autonomy
Justice
Principle
Metode AP
Metode AP

Prima Facie Context vs Text

Choose 1-2 out
of 4 most
Principle relevan
(problem
solving)

Ethics Virtue - eudamonia

Theory Duty - deontologist

Utilitarian –
teleologist eg
happiness
Metode AP

Ethical Culture
Custom
Relativism

Ethical Science &

technology
determinant
Dilemma Societal &
capital
determinant
Ceteris Choose 1 most
influential
Paribus principle

Ethical
Consistency

Problem Coherent
Corespondency

Solving Pragmatic

Metode AP
Metode AP

Legal Administrative
Penal

Option Civil