Relevansi Dan Dinamika Pengembangan Etik Kedokteran

LEARNING OBJECTIVESAimed competency:Conducting ethical justification in every clinical decisions and

activities in rendering honorable quality care. Topic :Relevancy and dynamics of biomedical ethics development

Lecture objectives:1. Understanding the relevancy of the existency of medical

profession ethics. C3, A1, P1 2. Understanding the meaning of biomedical ethics concept. C3,

A1, P1 3. Understanding the determinant of bioethics development:

empirical experiences, philosophic and sosciologic studies, and religions norms. C3, A1, P1

4. Understanding the role and the position of professional organization in medical profession ethics codification. C3, A1, P1

RELEVANCYMedical Profession Ethics

Competency dedicated his/her life public trust

appreciation specific privilege

authority autonomy

recognized profession Medical Profession

Social contract

RELEVANCYMedical Profession Medical Ethics

Social contract reciprocal commitment by the profession quality care

updated competency honorable care

medical profession ethics ethical codes and guidelines medical ethics

RELEVANCYMedical Ethics

Medical Ethics: A moral commitment by the medical profession, that they will honor the specific privilege trusted by the community by rendering honorable quality medical care.

Medical ethics code: the moral references in rendering honorable medical care.

Ethics Ethics

scientific

scientific estheti

cs

estheti

cs

Mankind Activities

Arts Nice-bad

Knowledge right-wrong

Moral good-bad

Mankind Activities

Moral implicationsImpact to human being/ humanities

Moral issues

Moral judgment

Moral decision

Modification of activities

Moral facts

Competency

References=Moral ity

Proactive

MEANING

Moral dimension of activities value system: good or bad morality

Morality for a specic ectivitiies/ community ethics

Medical ethics = morality for medical profession

MEANINGA Study

Philosophical studyMoral philosophy Ethics philosophy

What should be adopted

Theoretical Ethics - Normative EthicsPrescriptive Ethics

MEANINGSA study

Empirical practices Community morality

Applied Ethics – Descriptive ethics

Sociologic study

Biomedical SciencesMedical Technologies

Rapid development ample choice more sophisticated team approach complicated system Widening the scope of ethical problems

DEVELOPMENT

Widen Scope different ethics references

Different health professionals: Nursing ethics Pharmacist ethics etcHealth care dilivery system: Hospital ethics Decision maker ethics etc Biomedical study: Health research ethics ethicsetc

DEVELOPMENT

Biomedical SciencesMedical Technologies

Rapid development Object – subject: human - mankind The study – outcome of the study influence human dignity More expensive Team approach - System development of the dimensions/ intensity of ethical problems

DEVELOPMENT

before: focus mainly on patient safety and interest

More complicated moral issue on: Social justice Human dignity Respect of life

DEVELOPMENTDimensions and intensity

BIOMEDICAL ETHICS CONCEPT Integration all dimensions

BIOMEDICAL ETHICS – BIOETHICS

Compilation all aspects of medical ethics development But still in the context of health

“study on ethical, social, laws on other issues related to medical cares and biomedical sciences“

Medical ethics is part of bioethics A scientific discipline

DEVELOPMENT OF BIOMEDICAL ETHICS

Four media:

1.Empirical experiences

2. Sociologic studies

3. Philosophy studies

4. Religion norms

EMPIRICAL EXPERIENCES

Medical practice:

Rapidly develop

Moral conduct of doctors

Accepted morality

Compilation

New ethical guideline

SOCIOLOGIC STUDIES

Medical practice:

Varied practiced morality

Practiced

Sociologic studies

Generalization

Suggested ethical norms

PHILOSOPHIC STUDIES

Moral philosophy

Moral theory

Bioethics principle

Recommended norms

Theoritical ethics

Science philosophy

MoralPhilosophy

Sciences

Moral norms

rightwrongnature

goodbad

endeavor

THEORYUtilitarian

Good - bad ~ Consequences

Multiple consequences studies

Rule Utilitarian Act Utilitarian

THEORYDeontology - Kantianism

Good - Bad ~ Ratio - thinking Maxim = moral responsibility

Positive dutiesNegative duties multiple dimension

THEORYIndividualism

Good - Bad ~ Individual right freedom to decide - liberalism Positive/ negative right

Individual person vs Community Individual responsibility

THEORYCommunitarian

Good - Bad ~ Communal morality community responsibility X liberalism

THEORYEthics of care - Feminism

Good - Bad ~ Emotional binding Moral commitment Caring – Loving – Inner binding Inter relationshipReciprocal needs

RELIGION

Religion norms

Practicalaspects

Interpretation

Ethical codes

Varied medium

Dynamics of thinking and practices

Varied norms

Universalisme vs Relativisme

Basic principle: universal

Praxis: relative

CODIFICATIONMedical ethics - World

World Medical Association

International Code of Medical Ethics(London – 1948 revision)

+ Declaration

CODIFICATIONMedical ethics - Indonesia

Peer GroupProfessional Organization

MKEK IDI

Compilation Codification KODEKI

Fatwa - Pendapat

CODIFICATIONBiomedical study - World

•Nurenberg Code – 1947 Autonomy – Risk – Scientific foundation•Helsinki Declaration – 1967 – cccc Written protocol – risk manageable•WHO-CIOMS – 1982-1983-1991 Ethical Review Committee•USPH – Belmont Report – 1978-cccc Animal study

CODIFICATIONBiomedical study - Indonesia

FKUI - Indonesian Dean - 1987Pedoman Etik Penelitian Kedokteran Indonesia

Badan POM - 2000 Cara Uji Klinik yang Baik

Komnas Etik Penelitian Keseh. 2010Pedoman Etik Penelitian Kesehatan Indonesia

CODIFICATIONHospital ethics

Based on medical ethicsPioneered by the doctorAdopted by the government

PERATURAN MENTERI KESEHATANNo.24/Menkes/SK/XII/1988.

Developed by peer group - PERSI

KODERSI-2001

DEVELOPMENTRegulation and enforcement

Community morality

Profession Ethics

System bylaws

State laws

CLOSING REMARKBioethics - dynamics

Focal point: professional conducts

AltruismHolly tradition of medical profession

i. Believe in God.ii. Pure goaliii. Holly characteriv. Humblev. Seriousnessvi. Scientific and social integrityvii. Peer spirit