MEDICAL ETHICS

AND LAW
Firman Lubis MD MPH
(FKUI)
Irawan Yusuf (FK UnHas)
R. Samsu Hidayat (FKUI )
Setyawati B (FKUI)
Septe,ber 2015
DOCTOR’S PROFESSION
• Care provider to patient (majority)
• Researcher (a few)
• Lecturer (a few, limited)
• Administrator/manager (a few)
• Advocator/activist (a few, not
attractive)
 Five Star Doctor
• Care provider
• Decision maker
• Communicator/educator
• Community leader
• Manager
 Preventive Medicine
• Five levels of prevention
Health promotion
Specific protection
Early diagnosis and prompt treatment
Disability limitation
Rehabilitation
Primary, secondary and tertiary
prevention
 DOCTOR-PATIENT
RELATIONSHIP
• A unique and special relationship
• Guided and regulated by medical
ethics and law
• Basically, three type of relationship
• “Mechanic” type relationship
• Paternalistic type relationship
• Therapeutic contract relationship
THERAPEUTIC CONTRACT
RELATIONSHIP
• Equal position
• Two ways communication
• Openness
• Trust
• Rights and duties of each part
 THE RIGHTS OF THE
PATIENT
• The right to medical information
• The right to informed consent
• The right to choose his/her doctor
• The right to medical confidential
• The right to accept/refuse treatment
• The right to second opinion
• The right to his/her medical records
• The right to die in dignity
• The right to receive/decline spiritual and
moral comfort
 THE DUTY OF PATIENT
• The duty to provide informations
• The duty to obey doctor’s instructions
• The duty to fulfill health facilities’
regulations
• The duty to pay the service fee
• The duty to be frank
• The duty to keep personal
confidential of the doctor
 THE RIGHTS OF
DOCTOR
• The right to refuse to work beyond MPS
• The right to refuse unethical intervention
• The right to terminate professional
relationship with patient
• The right to privacy
• The right to fairplay
• The right to obtain fee
• The right to protect patient
confidentiality
 THE DUTY OF DOCTOR
• The duty to work in accordance with
MPS ( Medical Professionalim
Standard)

• The duty to ask informed consent

• The duty to help emergency patient

Human Rights Approach
• Health is a human right issue
• Right based approach: health law
• Health is the right of every human beings
• The right to health: the right to the
highest attainable standard of physical
and mental health
• The right imposes a duty and
responsibility upon state to promote and
protect the health of individual and
community and ensure quality health care
 Humanism -
Professionalism
• Humanism manifest by such personal attributes
as altruism, duty, integrity, respect for others, and
compassion

• Professionalism is a set of observable behaviors,

which in context of medicine have been codified
by which individual physician fulfill the medical
profession’s social contract with society(The p[hysycian’s
Charter, Lancet 2002; Ann Int med 2002 )

• The link between humanism and

professionalism : Humanism provides the
passion that animates professionalism
 Medical Professionalism
• The term “professionalism is derived from
Latin “professus meaning to have declared
publicly(Oxford Dictionary)

• Professionalism is a set of observable behaviors,

which in context of medicine have been codified by
which individual physician fulfill the medical
profession’s social contract with society(The p[hysycian’s
)
Charter, Lancet 2002; Ann Int med 2002

• Three pillars of medical professionalism

:
Competence; Autonomy; Ethics
 MEDICAL ETHICS
• Universal medical ethics
• Indonesian medical ethics (Kodeki)
• Content of the Kodeki
Preamble
General duty
The duty of doctor to patient
The duty of doctor to colleagues
The duty of doctor to him/herself
Closure
 GENERAL DUTY
• Article 1 : Every doctor has to respect,
understand and follows doctor’s oath
• Article 2 : Every doctor has to perform
his/her professional task in accordance
to high standard
• Article 3 : A doctor should not
influenced by his/her personal interest
in doing his/her task
• Etc.
 MEDICAL LAW
• Doctor-patient relationship

• Doctor-medical facilities’ relationship

• Medical service-third party relationship

• Agreement/contract in medical service

 The role of
Professionalism in
Indonesian Medical Council
Medical cited 7 areas
Education
of competence
– Ethics, Moral, Professionalism, Patient safety
– Effective Communication
– Clinical competence
– Based on Academic Medical Science
– Problem Solving
– Information management
– Mawas diri dan Pengembangan diri
 Medical Ethics
• Why we need ethics?
• What’s the difference between ethics
and law?
• What’s the situation of medical ethics
in our country?
• Who should look after medical ethics?
• How could we strengthen medical
ethics in medical profession?
Medical Ethics Violation
• What are the most medical ethics
violation in our country?
• Why these violations happened?
What are the causes?
• What are the common ethics issues
in the Aviation Medicine field?
• Some real ethics violation examples
in your experiences?
 15 Domain bukti
Profesionalisme
Personal attribute (1)
• Menunjukkan sikap sesuai Kode Etik Dokter
Indonesia

• Mennjaga kerahasiaan dan kepercayaan pasien

• Menunjukkan saling kepercayaan dan saling

menghormati dalam hubungan dokter-pasien

• Menunjukkan rasa empati dengan pendekatan

menyeluruh (holistik)
 15 Domain bukti
Profesionalisme
Personal attribute (2)
• Mempertimbangkan masalah pembiayaan dan hambatan
lain dalam memberikan pel. kesehatan serta dampaknya

• Mempertimbangkan aspek etis dalam penanganan

pasien sesuai standar profesi

• Mengenal alternatif dalam menghadapi pilihan yang sulit

• Menganalisis secara sistimatik dan mempertahankan

pilihan etik dalam pengobatan setiap individu pasien
 15 Domain bukti
Profesionalisme
Collaborative attribute (3)
• Menghormati setiap orang tanpa melihat status sosial
Menghormati setiap orang tanpa melihat status sosial
• Mengakui setiap individu mempunyai kontribusi dan peran
yang berharga tanpa memandang status sosial.
• Berperan serta dalam kegiatan yang memerlukan
kerjasama dengan petugas kesehatan lainnya
• Mengenali dan menjadi penengah ketika terjadi konflik
• Memberi tanggapan konstruktif pada masukan orang lain
• Mempertimbangkan aspek etis dan moral dalam hubungan
dengan petugas kesehatan lain secara profesional
• Mengenal dan bertindak sewajarnya saat TS melakukan
tindakan yang tidak profesional