bioetik dlam prak kedok

7/28/2019 Bioetik Dlam Prak Kedok.

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BIOETHICSINMEDICAL PRACTICE

SULIATI


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Essentially, bioethics is the process of

making moral decisions regarding health

care. The process of decision-making as well

as the transmission of those ethical decisionsis an important matter of study for the health

professional (Kreps & Thornton, 1984)


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In this paper we will discuss the topics in

which ethical issue are part of the practice

of medicine, as following :

1. Concept of informed consent

2. The doctor-patient relationship from

practitioners perspective

3. The patients autonomy vs paternalism

4. Managing ethical dilemmas in healthservice


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SULIATI P. AMIR


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DOCTOR PATIENT RELATIONSHIPFROM PRACTITIONERS PERSPECTIVE


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The relationship between doctor and

patient is based on the concept of

partnership and collaborate effort, in whichthe doctor clinical expertise and the

Patients individual needs and preferences

are shared (BMA, 1993)


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Doctor are generally regarded as having a

positive duty to do good (beneficence). TheTraditional duty to do good has been

accompanied by the obligation to do no harm

primum non nocere (first do no harm)nonmaleficence (Stauch et al, 2006).

The members of the medical profession

undertake to place the interests of their patientsbefore their own in many circumstances.

(Stauch et al, 2006).


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The most common form of relationship is the

therapeutic relationship.

Doctors are expected to use their skills to thebest of their ability not only to treat the

condition

which is the subject of the consultation but also

to advise how best patient should conduct

themselves in order to maintain their heath.

(BMA, 1993).

As a prerequisite to choosing treatmentpatients

have the right to receive information from

doctors and to discuss the benefits and risks of

appropriate treatment.


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PATIENT AUTONOMY VS

PATERNALISTIC

1. The conflict between respect for autonomyand the desire to help the patient brings usthe problem of paternalistic ( Jonsen et al,

2010).2. In the context of heath care ethics

paternalistic involves acting without consentor even overriding a persons wishes oractions in order to benefit harm to patient(Garrett et al 1993, Stauch et al, 2005 )


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DEFINITION

1. Autonomy is the right of person to choose

and follow his or her own of life and action

(Bodenheimer & Grumbach, 2009)

2. Autonomy is the ability to make your own

decisions about what to do, rather than

being influence by someone else

(Collins EL Dict.1994)


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The health care formulation the principle of

autonomy can be expressed as follows :

You shall not treat a patient without informed

consent of the patient or his or her lawful

surrogate, except in narrowly defined

emergencies (Garret et al, 1993)


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PATERNALISTIC ( Stauch et al, 2006)

Term paternalistic many to act like father Thepaternalistic doctor knows best and regards himself asbeing the best judge as to what is for the patients owngood. It is interesting to consider the duty ofbeneficence in relation to the parent-child relationship.

Paternalistic ( Garrettet al,1993 )

1. In its dictionary meaning, its refers to ruling orcontrolling of others in a way what suggest a fathersrelationship with his children

2. In, the context of health care ethics, paternalism

involves acting without consent or over reading apersons wishes (consent) or actions in order tobenefit the patient or of least to preference harm tothe patient


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In clinical ethics, respect for patient

preferences take place within a therapeutic

relationship, that is, when some health

problem prompts a patient to seek help froma physician and a physician responds with

diagnosis, advice, and a proposed treatment.

In this relationship, physicians possess a defacto power : they have knowledge and skills

that the patient needs (Jonsen et al, 2010).


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The therapeutic relationship can be distortedby what has been called physicianspaternalism: a physicians assumes that his

or her medical judgment alone shoulddetermine the course of care. Modernmedical ethics refuse this sort ofpaternalism. Instead, both the physicians

and the patient must form an alliance inwhich medical recommendations and patientpreference together guide the course of care.(Jonsen et al, 2010)


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MANAGING ETHICAL DILEMMAS

IN HEALTH PRACTICE


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Bioethics identifies four ethical principles that

are particularly relevant to clinical medicine :

the principles of beneficence,

nonmaleficence, respect for autonomy, andjustice. (Bodenheimer and Grumbach, 2009;

Jonsen et al, 2010).


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THE FOUR PRINCIPLES OF MEDICAL ETHICS

(BODEN HUMER & GRUMBACH, 2009)

Nonmaleficenc

e

The duty care providers to do no

harm

Beneficence The obligation of health care

providers to help people in need

Autonomy The right of a person to choose and

follow his or her own plan life and

action

Justice The concept of treating everyone in

a fair manner


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