Komunikasi Interpersonal,

Etika dan
Profesionalisme Dokter
Dr. dr.Syahrul, SpS(K)
D epa rtment of Neurology, Fa culty of M edi ci ne, S yi ah K uala Uni versity
K ul iah Bl ok 1 , 1 4 S eptember 2 0 18
 Komunikasi Interpersonal
Relationships based on openness, trust and good
communication will enable you to work in
partnership with your patients to address their
individual needs

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1.Komunikasi Dokter dengan Pasien dan Keluarga

How Good medical humanity applies to you ?

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14/09/18 4
 Good Doctors
Patients need good doctors.
Good doctors make the care of their patients
their first concern: they are competent, keep their
knowledge and skills up to date, establish and
Maintain good relationships with patients and
colleagues, are honest and trustworthy, and act
with integrity.
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Humanisme

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 Patients are entitled to good doctors

Good doctors make the care of patients their first concern;

they are competent,
keep their knowledge and skills up to date,
establish and maintain good relationships with patients
and colleagues, are honest and trust worthy
and act with integrity.

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 To fulfil your role in the doctor-patient
partnership must be :
a. be polite, considerate and honest
b. treat patients with dignity
c. treat each patient as an individual
d. respect patients' privacy and right to confidentiality
e. support patients in caring for themselves to improve and maintain their
health
f. encourage patients who have knowledge about their condition to use this
when they are making decisions about their care.

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Competence : Patients doctor communication

Medical Care
Collaboration
Scholarship
Professionalism
àHumanities Medicine

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Establishing a relationship of trust with patients

Make the care of patients your first concern.

Protect and promote the health of patients and the public.
Provide a good standard of care and practice by:
◦ keeping your professional knowledge and skills up to date
◦ recognising, and working within, the limits of competence
◦ working with colleagues in ways that best serve patients’
interests.

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 Cultural Competence
Must be aware of cultural diversity and function effectively and respectfully
when working with and treating people of all cultural backgrounds.
Should acknowledge :
◦ that Indonesia has a culturally diverse population
◦ that a doctor’s culture and belief systems influence his or her
interactions with patients and accept this may impact on the
doctor-patient relationship
◦ that a positive patient outcome is achieved when a doctor and
patient have mutual respect and understanding.
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 2. Komunikasi Dokter dengan Tenaga Kesehatan
The doctor–colleaguesrelationship

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 Teamwork working

Most doctors work in teams with a wide variety of health

professionals and non-medical health and disability
workers.
Working in teams is likely to become even more common
in the future.
Working in teams does not change your personal
accountability for your professional conduct and the care
you provide.
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 The doctor–colleagues relationship

Referring the patient to another practitioner

when this is in the patient’s best interests

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 The doctor–colleagues relationship

Consult and take advice from colleagues

when appropriate

Keep colleagues well informed when sharing

the care of patients

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 3. Komunikasi Dokter dengan Masyarakat Umum
Humanitydoctors

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 Etika
Ethics

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 Etika dan Moral .
MORAL ETIKA
Latin Yunani

§ Morales, mos, moris, adat, § Ethicos, ethos-adat

istiadat,kebiasaan, cara, kebiasaan, praktek
tingkah laku
§ Tabiat, watak, akhlak, cara
hidup

Hati nurani & penilaian (judgment)

Kegiatan praktis seseorang
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Etika dibagi = 1. Etika Umum
(klasifikasi)

2. Etika Khusus
- Individual
- Institusional
- Sosial
Filsafat : - kajian, ilmu filsafat
- moral & moralitas
Praktek : - pedoman & aturan
(profesional) baik & benar
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 Moral - Etika – Asas – Aturan- Kode Etik Profesi
1 Ajaran
Ajaran Moral Ajaran tentang bagaimana manusia
Moral harus hidup dan bertindak menjadi
manusia yang baik
Sistem nilai tentang perbuatan manusia yang
2 Moral dianggap baik/ buruk, benar / salah, pantas /
tidak pantas
3 Falsafah Mencari penjelasan , mengapa perbuatan
Moral tertentu dinilai baik/ buruk, benar/salah, pantas
/tidak pantas

4 Kerangka berpikir yang disusun oleh filsuf

Teori2 tertentu-untuk memberi pembenaran, mengapa
etika suatu perbuatan dinilai baik dari pendekatan
moral
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 Moral - Etika – Asas – Aturan - Kode Etik Profesi

5 Asas2
Ajaran Moral Asas-asas yang diturunkan dari teori-teori
etika sebagai kaidah-kaidah dasar moral
etika bagi manusia

6 Seperangkat norma atau pedoman untuk

Aturan2 mengukur perbuatan, berupa aturan dan
etika larangan yang didasarkan pada asas –asas
etika
7 Seperangkat aturan etika yang khusus berlaku
Kode Etik untuk semua anggota asosiasi profesi tertentu,
Profesi sebagai konsensus bersama, yang memuat aturan
dan larangan yang wajib di taati oleh semua
anggota dalam menjalankan profesi
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 Teori-teori Etika
KLASIK KONTEMPORER

1. Utilitarianisme 1. Budi Pekerti Luhur

◦ Teologi Virtue/character/Value-based
◦ Compassion
◦ Konsenkuensialisme
◦ Discernment
◦ Consequence-based ◦ Dapat di dipercaya
2. Deontologi ◦ Integritas moral tinggi
◦ Kewajiban 2. Etik mengasuh
◦ Obligation-based ◦ Caring/relation -based
3. Hukum Kodrat 3. Penalaran praktis
◦ Lex Naturalis ◦ Kasuistik, care - based
◦ Natural Law 4. Pancasila, filsafat moral dan teori etika
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Asas – Asas Etika medis Traditional Asas-Asas Etika Medis
KONTEMPORER

1. Beneficence
2. Non maleficence (Primum non 1. - Menghormati
pasien
otonomi
nocere) - Universal Human right UN,
3. Menghormati hidup manusia - HAM

4. Konfidensialitas 2. Keadilan /justice

5. Kejujuran (veracity) 3. Berkata benar / truth telling /
veracity
6. Tidak mementingkan diri
7. Budi Pekerti Tingkah laku luhur

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 Kegiatan- kegiatan
Bidang-bidang Life Sciences

1) Biologi
2) Kedokteran
3) Keperawatan
4) Kependudukan
5) Epidemiologi
6) Kesehatan Linkungan
7) Sosiologi – antropologi kesehatan
8) Etika institusional Rumah Sakit
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Kesehatan :

WHO 1948
: Keadaaan sejahtera yang sempurna dari badan, mental,
dan sosial, dan bukan hanya tidak ada penyakit atas
kelemahan
UU RI. No. 23 Th 1992 :
Keadaan sejahtera dari badan, jiwa, dan sosial yang
memungkinkan setiap orang hidup produktif secara social dan
ekonomis

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 sinergi
Kedokt sosial
BIOKULTURAL
INFOMEDIK kesmas

WELLNESS
Sisi sakit
Orang sakit
Kedokt Klinis

SISI SEHAT ORANG SEHAT

SISI SEHAT ORANG SAKIT
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 Bidang Kesehatan
1. Kode Etik Kedokteran
2. Kode Etik Keparawatan
3. Kode Etik Rumah Sakit
4. Majelis Kehormatan Etik Kedokteran (MKEK)
5. Majelis Kehormatan Etik Rumah Sakit (MAKERSI)
6. Majelis Kehormatan DISIPLIN Kedokteran Indonesia (MKDKI)

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 Kaidah –Kaidah Dasar Moral

§ Beneficence & non maleficence

§ Respect for person
§ Keadilan /justice
§ Budi pekerti

Kegiatan-kegiatan :
• Pendidikan
• Penelitian & pengembangan
• Pelayanan
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 Etika – Disiplin – Hukum

Etika
Hati nurani, pikiran pelaku
Benar/salah, baik/buruk, pantas /tidak pantas
Moral philosophy
Das sein und das sollan
(The “oughts” and “Shoulds” of Socienty)

Klasik dan Kontemporer

Kode etik profesi
Etika diperkuat Hukum
Homo homini lupus

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Hukum Etika – Disiplin - Hukum
Hukum & etika – menyatu hubungan antar manusia
Baik/buruk, pantas /tidak pantas, salah /benar.
Moral – Indonesia – Falsafah Pancasila
Pelanggaran norma & nilai-nilai etika dan hukum
Ringan, membahayakan masyarakat/ ketertiban umum à
fungsi hukum
Hal-hal kecil – merebut pasien, menjelekan nama baik
sejawat, mengiklan diri.à De minimus non curat lex
Aturan /regulasi internal profesi
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Disiplin Etika – Disiplin - Hukum
◦Discipline – jurusan ilmu Pengetahuan
◦Tata-tertib, keteraturan sikap-tindak, behavior

Dua disiplin – dapat saling berbenturan

Belanda : Medische Tuchtrech
mengadili dan memeberikan sangsi disiplin (tucht)
Ganti rugi – Perdata, Pidana

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 Disiplin
Etika – Disiplin - Hukum
GMC (General Medical Council)
Keputusan : 1) tidak melanggar disiplin
2) Kurang terampilà training
3) melanggar disiplin à tidak boleh praktek sementara
4) Pelanggaran berat à dicoret dari registrasi à tidak
boleh praktek di negara tersebut.
Gugatan ganti rugi dll - Pengadilan

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 Pelanggaran Disiplin

1. Medical Negligence
◦ Melakukan sesuatu yang seharusnya tidak dilakukan
◦ Tidak melakukan apa yang di lakukan sejawat lain

2. Serious Profesional Misconduct

◦ Hubungan sex dengan pasien
◦ Angkat bagian tubuh yang keliru
◦ Melantarkan pasien à cacat atau meninggal

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Hukum :
Keseluruhan asas dan aturan tentang perbuatan manusia yang ditetapkan atau diakui oleh
otoritas tertinggi
Hukum Perdata :
hukum yang mengatur hubungan atar orang dengan orang lain.
Hukum Pidana :
hukum yang mengatur perbuatan apa yang dilarang dan memberikan pidana (=hukuman)
kepada siapa yang melanggarnga
Hukum Administrasi Negara : (Tata Usaha Negara)
hukum yang mengatur cara menjalankan tugas (hak dan kewajiban) dan kekuasaan alat-
alat perlengkapan negara.
Hukum kebiasaan :
hukum tidak tertulis yang hidup dalam keyakinan masyarakat dan ditaati seperti suatu
peraturan perundangan
Hukum Yurisprudensi :
Hukum yang terbentuk karena keputusan hukum oleh hakim dalam prekara sejenis
sebelumnya.
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 Contoh-contoh kasus
Operasi – operasi mata
Operasi – operasi ginjal
Operasi anggota tubuh
Kebetulan ada bagian KANAN-KIRI

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 4. Dasar-Dasar Etika Kedokteran

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 4 Principles of Medical Ethics
Beauchamp & Childress 2008

1. Principle of respect for autonomy

2. Principle of non-maleficience
3. Principle of beneficence
4. Principle of justice

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 4 Principles of Medical Ethics
Autonomy respect for the patient’s right to self
determination
Non-maleficience the duty to ‘not do bad’
Beneficence the duty to ‘do good’
Justice to treat all people equally and equitably

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 5 Main Principles of Ethics
1. Truthfulness and confidentiality
2. Autonomy and informed consent
3. Beneficence
4. Non-maleficence
5. Justice

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 7 Principles of Healthcare Ethics
1. Non-maleficence
2. Beneficence
3. Health maximisation
4. Efficiency
5. Respect for autonomy
6. Justice
7. Proportionality
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 Dasar-Dasar Etika Kedokteran

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 Profesionalisme Dokter
Medical Professionalism

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 Profesionalisme Dokter
Medical Professionalism

A belief system about how best to organize and deliver health care
declare profess
competency standard
ethical values
implement trustworthy

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 Medical Professionalism
Physician-patient relationship, includes :
◦ A commitment to serve others;
◦ Dedication (knowledge, ethical, fair);
◦ Continued enhancement knowledge and skills;
◦ Fairness, courtesy, honesty, respect for patients, colleagues, and the public;
◦ Contributing to the public good;
◦ Education learners, application of standards to the profession, limitation of
the profession;
◦ Accepting responsibility for one’s own professional

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Terimakasih

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