ETHICS VS LAW

PRIJO SIDIPRATOMO
KETUA MKEK IDI 2012-2018
DEKAN FK UPNVJ
DISAMPAIKAN DALAM KULIAH PAKAR DI FK UPN
10 Mei 2019
Introduction
• It is now a firmly established belief that legal and ethical considerations are
integral to medical practice in the planning for the care of the patient.
• The advances in medical sciences and growing sophistication of the legal
framework in modern society as well as increasing awareness of human
rights and changing moral principles of the community at large, doctors
and other healthcare workers alike are now frequently caught in difficult
dilemmas in many aspects arising from daily practice.
• There is also growing anxiety both within the medical profession and in the
community regarding increasing trends of complaints and lawsuits against
doctors.
• Medical ethics has developed into a well based discipline which acts
as a "bridge" between theoretical bioethics and the bedside.
• 1 The goal is "to improve the quality of patient care by identifying,
analysing, and attempting to resolve the ethical problems that arise in
practice".
• 2 In addition to our moral obligations, doctors are also bound by laws
and official regulations which form the legal framework regulating
medical practice
• It is now a universal consensus that legal and ethical considerations
are inherent and inseparable parts of good medical practice across
the whole spectrum.
• The disciplines of law and ethics in medical practice overlap in many
areas and yet each has its unique parameters and distinct focus
Ethics is a philosophical
discipline about moral
problems, deals with art of
living
Medical Ethics

• a field of applied ethics, the study of moral values and

judgments as they apply to medicine. As a scholarly
discipline, medical ethics encompasses its practical
application in clinical settings as well as work on its
history, philosophy, theology, sociology, and
anthropology.

Based on definition of “Medical Ethics” http://en.wikipedia.org/wiki/Medical_ethics

 Medical Ethics
• Long history

• Third Dynasty (Egypt) 2700 BCE

• Code of Hammurabi (Babylon) 1750 BCE
• Oath of the Hindu Physician (Vaidya’s Oath) 15th cy. BCE
• Hippocratic oath (Hippocrates, ca 460-370 BCE)
• The Oath of Asaph and Yohanan (ca 6th cy. CE)
• Advice to a Physician (Persia) 10th cy. CE
• Oath of Maimonides 12th cy. CE
• Ming Dynasty (China) 14th cy. CE
• Seventeen Rules of Enjun (Japanese Buddhist Physicians) 16th cy. CE)

Drawn from Codes of Medical and Human Experimentation Ethics by Victoria Berdon and
Jennifer Flavin viewable at http://wisdomtools.com/poynter/codes.html
History cont.
• Percival's Code (England), 1803: basis for first AMA
Code of Medical Ethics.
• Beaumont's Code (United States), 1833: experimental treatments,
voluntary, informed consent.
• American Medical Association (AMA) - Code of Medical Ethics, 1847.
• Claude Bernard (France), 1865.
• Walter Reed (United States), 1898: introduces written consent “contracts”.
Allows healthy human subjects in medical experiments.
• Berlin Code or Prussian Code (Germany), 1900: no medical experiments when
subject not competent to give informed consent, in the absence of
unambiguous consent, or when information not properly explained to subject.
• Reich Circular (Germany), 1932: concerned with consent and well-being of the
subjects.

Drawn from “Codes of Medical and Human Experimentation Ethics” by Victoria Berdon and Jennifer
Flavin viewable at http://wisdomtools.com/poynter/codes.html
Modern issues and statements
• Nuremberg Code (1947)
• Medical research
• Declaration of Geneva, W.M.A. (1948, 1968, 1984, 1994, 2005, 2006)
• World Medical Association International Code of Medical Ethics
• AMA revision (1957)
• Declaration of Helsinki, application to medical research (1964, rev. 1975,
1983, 1989, 1996, 2000)

• Belmont Report (1979)

• AMA revision (2001)

Drawn from “Codes of Medical and Human Experimentation Ethics” by Victoria Berdon and Jennifer Flavin
viewable at http://wisdomtools.com/poynter/codes.html
Why study medical ethics?
• ethics is and always has been an essential component of
medical practice
• some ethical principles are basic to the physician-patient
relationship, but application in specific situations is often
problematic due to disagreement about what is the right
way to act)
• study of ethics prepares medical students to recognize
difficult situations and to deal with them in a rational and
principled manner
Why study medical ethics?
• integral part of medicine at least since the time of Hippocrates
concept of medicine as a profession

• in recent times - influence by developments in human rights (e.g.,

violations of human rights, such as forced migration and torture;
whether healthcare is a human right)

• closely related to law (e.g., medical licensing and regulatory officials),

but
ethics prescribes higher standards; occasionally requires that
physicians disobey laws that demand unethical behaviour; laws differ
significantly from one country to another while ethics is applicable
across national boundaries
Bioethics

• Medical ethics closely related to bioethics (biomedical

ethics), but
not identical
- medical ethics focuses primarily on issues arising out of
the practice of medicine
- bioethics: very broad subject, concerned with the moral
issues raised by developments in the biological sciences
- bioethics does not require the acceptance of certain
traditional values that are fundamental to medical ethics
Bioethics

• branch of applied ethics that studies the philosophical,

social, and legal issues arising in medicine and the life
sciences
• it is chiefly concerned with human life and well-being,
though it sometimes also treats ethical questions
relating to the nonhuman biological environment
Bioethics

• era of replacing human organs and their functions began

with chronic dialysis and renal transplantation in the
1960s. unprecedented problems (selection of
patients; "God Committee“)
• origin: Potter’s “Bioethics, the Science of Survival”
(1970), which suggests viewing bioethics as a global
movement; Callahan’s “Bioethics as a Discipline” (1973),
in which he argues for the establishment of a new
academic discipline; creation of institute in which
researchers should examine and analyze medical
dilemmas
Bioethics

• repeated story about the origin of the term bioethics is

incorrect
• German theologian Fritz Jahr published articles (1927,
1928, 1934) using the German term “Bio-Ethik” (which
translates as “Bio-Ethics”) and forcefully argued more
civilized, ethical approach to issues concerning human
beings and the environment
• his bioethical imperative: “Respect every living being, in
principle, as an end in itself and treat it accordingly
wherever it is possible.”
As Practical Ethics, Medical Ethics
focuses on:
The process of deciding what is the most appropriate
(right) course of action in a particular situation:
• given these facts
• given my skills and abilities
• operating with finite knowledge
• in real time
• and then effecting that course of action.
Ethical Problems

• Problems caused by fact of having to choose

between goods or things to which we owe an
obligation
• Bad rankings of goods
• Failure to grasp facts
• Ignorance
• Incompetence
• Willful blindness
• Bad factual analysis
• Often caused by personal or institutional distortion
Historically
• medical ethics may be traced to guidelines on the
duty of physicians such as the Hippocratic oath
a physician must recognize responsibility to patients
first and foremost, as well as to society, to other
health professionals, and to self. These are not laws,
but standards of conduct which define the essentials
of honorable behavior for the physician
 Autonomy
Beneficence

PHYSICIAN

Do no harm
Justice

Four basic Principles of Medical Ethics

Autonomy
• Patient has freedom of thought, intention
and action when making decisions
regarding health care procedures
• For a patient to make a fully informed
decision, she/he must understand all risks
and benefits of the procedure and the
likelihood of success.
Beneficence

• The practitioner should act in “the best

interest” of the patient - the procedure be
provided with the intent of doing good to
the patient
• This needs health care provider to,
- develop and maintain skills and knowledge by
continually updating training
- consider individual circumstances of all
patients
Non maleficence
• “Above all, do no harm,“ – Make sure that the
procedure does not harm the patient or others in
society
• When interventions undertaken by
physicians create a positive outcome
while also potentially doing harm it is
known as the "double effect."

Eg,. the use of morphine in the dying patient. eases

pain and suffering while hastening the demise
through suppression of the respiratory drive
Justice
• The distribution of scarce health
resources, and the decision of who gets
what treatment “fairness and equality”
• The burdens and benefits of new or
experimental treatments must be
distributed equally among all groups in
society
Medical malpractice
• An act or omission by a health care provider that
deviates from accepted standards of practice in the
medical community which causes injury to the
patient.
Medical/Healthcare law and ethics

• Law
• represents minimum standards
• applies broad societal standards and expectations
• Codes and guidelines
• set minimum professional standards
• reinforced with sanctions by self-regulating professions
• Ethics
• strives for maximum standards
• provides framework for resolving health care dilemmas
 Why Law is Necessary
 Law is the system of rules of conduct established by the
government of a society to maintain stability and justice.
 Law defines the legal rights and duties of the people and
provides the means of enforcing these rights and duties.
 Legal Intervention in Medicine
• Law moves more slowly than medicine or social mores
• Rules of doctoring are developed within a moral framework
– Constantly restructured by society
– Operating in an atmosphere of legal uncertainty
• Promotes confrontation within the triangular relationship of Medicine,
Law and Society
• Major function of Medical Jurisprudence is to break down barriers of
latent hostility.
 Examples for Requirement of a Degree of
Medico-legal Knowledge
– Completing a driver’s license application
– Respecting a patient’s decision to refuse treatment
– What to do (and not to do) with a dead body where there is
suspicion of an unnatural death
– Certification of the dead
– Role of the coroner and knowing which cases need referral
 Sources of Law
• Statute Law –government (Dáil)
• Courts (Common Law)
• European Community

• Also
– European Convention on Human Rights
• Government
– is a source of modern law (statute)
– Gives power of law making to other bodies (e.g council,
local government)

• A statute is a document which contains laws made by

parliament following defined procedures.
UU DALAM LINGKUP KESEHATAN R I
• 1. UU PRAKTEK KEDOKTERAN 29/2004
• 2. UU KESEHATAN 36/2009
• 3. UU TENAGA KESEHATAN 36/2014
• 3. UU RUMAH SAKIT 44/2009
RANGKUMAN
 Tujuan dari Etik dan Hukum adalah untuk mengatur
tertib dan tenteramnya pergaulan hidup dalam
masyarakat
 Etik merupakan norma , nilai, atau pola tingkah laku
kelompok profesi (dokter, drg, apt, sarjana kesmas,
keperawatan, wartawan, hakim, pengacara, akuntan)
dalam memberikan pelayanan jasa kepada masyarakat.
 Pekerjaan profesi mempunyai ciri: pendidikan formal,
berlandaskan etik profesi, mengutamakan pelayanan
kemanusiaan, ada izin, CDE, dan mempunyai organisasi
profesi).
 Profesi mencantumkan kewajiban “memenuhi Standar
Profesi”
 Etika mempunyai sanksi moral; dan profesi memiliki
sanksi disiplin profesi atau disiplin administratif
 Etika
 Etika adalah pengetahuan tentang moralitas,
menilai baik buruknya sesuatu ditinjau dari sisi
moral
 Etika dapat mengandung norma kesusilaan (yaitu
sikap dan perilaku), maupun norma kesopanan
(yaitu perilaku antar manusia), dan dapat
dipengaruhi oleh norma agama dan norma
hukum
 Etika Kedokteran adalah penerapan penalaran
moral pada masalah yang dihadapi dokter dalam
berprofesi sbg dokter
 Hukum adh peraturan perundang-
undangan yg dibuat oleh suatu
kekuasaan, dalam mengatur pergaulan
hidup masyarakat
 Hukum Perdata mengatur subyek dan
antar subyek dalam hubungan dan
kedudukannya yang sederajat.
 Hukum pidana adh peraturan mengenai
hukuman (penguasa dan pemerintah
mempunyai kedudukan yang tertinggi)
Hukum Kesehatan
 Peraturan dan ketentuan hukum untuk profesi kesehatan,
farmasi  obat-obatan, keshn jiwa, kesehatan masyarakat,
kesehatan kerja, kesehatan lingkungan, hygiene
 Tujuan Pembangunan kesehatan ( UU Kesehatan Pasal 3)
(untuk dapat meningkatkan kesadaran, kemauan, dan
kemampuan hidup sehat bagi setiap orang agar terwujud
derajat kesehatan yang optimal - lama)
 Untuk meningkatkan kesadaran, kemauan, dan
kemampuan hidup sehat bagi setiap orang agar terwujud
derajat kesehatan masyarakat yang setinggi-tingginya,
sebagai investasi bagi pembangunan sumber daya manusia
yang produktif secara sosial dan ekonomis
 Hukum kesehatan adalah peraturan perundang-
undangan yang menyangkut pelayanan kesehatan
(merupakan ketentuan hukum yg berhubungan
langsung dengan pemeliharaan dan pelayanan
kesehatan)

 Yang terlibat didalam hukum kesehatan adalah :

perorangan, lapisan masyarakat, penyelenggara
kesehatan, organisasi, sarana, pedoman standar
pelayanan kesehatan, ilmu pengetahuan
kesehatan, dan hukum
 Materi Pelengkap Wajib BP2KB
Dalam pelaksanaan kegiatan Ilmiah, penyelenggara wajib
menyertakan 2 pokok bahasan sebanyak 1/7 waktu kegiatan.

1. Materi menyangkut Etika kedokteran

2. Materi tentang patient safety.

 BUKU BUKU TERKAIT ETIK

IDI ON LINE
PERAN ETIK PADA PENDIDIKAN PROFESI DI
INDONESIA
 Professionalism

Excellence

Humanism

Accountability

Altruism
Ethical and Legal Understanding

Communication Skills

Clinical Competence (Knowledge of Medicine)

Arnold and Stern, 2006

ETIKA MENJADI LANDASAN DARI KOMPETENSI
 Beda
Etik & Hukum
==========================
 Berlaku untuk profesi  Berlaku untuk umum
 Disusun berdasarkan  Disusun oleh badan
kesepakatan anggota pemerintah yang
profesi berkuasa
 Etik bisa tertulis dan  Hukum tersusun rinci
tidak tertulis dalam UU dan
 Sanksi etik berupa lembaran negara
tuntunan  Sanksi hukum berupa
tuntutan
 Pelanggaran etik  Pelanggaran hukum
diselesaikan oleh diselesaikan oleh
Profesi aparat hukum /
pengadilan
 Penyelesaikan  Penyelesaian
pelanggaran etik tidak pelanggaran hukum
selalu disertai bukti harus dengan bukti
fisik fisik
Agus Purwadianto
 Kesulitan saat ini
• Etika mempunyai sanksi moral, profesi mempunyai sanksi disiplin profesi.
• Dan sekarang para ahli hukum menganggap bahwa standar prosedur dan
pelayanan kesehatan dianggap sebagai ranah hukum.
• Dan ini menurut profesi kesehatan dianggap bahwa memenuhi standar
profesi adalah bagian dari sikap etis dan profesional
• Sehingga penafsiran ahli hukum: pelanggaran standar profesi dapat
diartikan juga melanggar hukum
• Ini perlu diinformasikan kepada profesi kesehatan dan profesi hukum, hal
ini harus berbeda
LITERATURES
• 1. http://www.fmshk.org/article/746.pdf
• 2. Neuron.mefst.hr/.../med.../Introduction%20to%20medical%
• 3. www.kau.edu.sa/Files/.../ch-1health%20ethics%202.pp
• 4. Static.aston.ac.uk/applet/protected/...ethics/medical_law.ppt
• 5. waltontechs.pbworks.com/f/Chapter+1+Ethics+and+the+Law.pp
• 6. www.tcd.ie/medicine/histopathology/.../Introduction-and-ethics-
28th-August-2009.pp
• 7. https://fkunja2010.files.wordpress.com/.../etika-hukum-kesehatan.