Bioethics: Prof - Dr.Dr. H Soewadi, MPH, SPKJ (K)

International Programme Faculty of Medicine Gadjah Mada University
BIOETHICS
Prof.DR.Dr. H Soewadi, MPH, SpKJ (K)
Definition
int-prog medicine
Bioethics in the systematic study of the moral dimensions including moral vision, decisions, conduct and policy-of life sciences and health care, employing a variety of ethical methodologies in an inter-disciplinary setting. (Kuganse and Sheldon, 2000)
2
Basic Moral / Ethical Principle

int-prog medicine
1. Respect for Others
(autonomy, dignity, privacy, confidentiality, self-determination) 2. Beneficence, Non Maleficence, do no harm 3. Justice (threat each people morally right and proper)
3
int-prog medicine
Bioethics Health Ethics Medical Ethics Clinical Ethics Ethics in
Services Research Education

4
Disciplines, Departments, Field of Studies

int-prog medicine
Medicine, Health, Nursing, Midwifery, etc Sociology, Anthropology, Psychology, Philosophy, etc.
American College of Physician, 2000

int-prog medicine
Principles : - Beneficence - Non-maleficence - Autonomy truth telling

- disclosure - inform consent
Manual of Ethics
I. II. III.
Patient and Physician The Physician and Society The Physicians Relationship to other clinician
6
I. Patient and Physician

int-prog medicine
1. Initiating and discounting Patient 2. 3. 4. 5. 6. 7.
Physician Relationship Confidentiality The Patient and the Medical Record Disclosure Informed Consent Decisions about Reproduction Genetic Testing
7
int-prog medicine
8.
9. 10.
11.
12.
13.
14. 15.
16.
Medical Risk to Physician and Patient Alternative Treatment Disability Certification Care of the Physicians Family, Friends and Employees Sexual Contact between Physician and Patient Care of Patients Near the End of Life Patients Need the End of Life Making Decisions Near the end of life Advanced Care of Planning 8
int-prog medicine
17. Problems of life-sustaining Treatment With drawing or with holding Treatment Do Not Resuscitate Orders (DNR) Determination of death Organ donation Irreversible loss of Consciousness Intra venous fluids and Artificial feedings Physician assisted suicide and euthanasia
18. The ethics of practice The changing practice environment Financial arrangement Financial conflict of interest Advertising
int-prog medicine
II. The Physician and Society

Obligation of the Physician to society Resources allocation Relations of the Physician to government Ethics Committees and Consultation Medicine and Law Expert witnesses Strike by physician
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1. 2. 3. 4.
5.
6. 7.
The physicians Relationship to the other Clinicians

int-prog medicine
1. Attending Physicians and Physician in Training 2. Consultations 3. The impared physician 4. Peer Review 5. Conflicts among members of Health care team 6. Research 7. Clinical investigation 8. Innovative Medical Therapy 9. Scientific publication 10. Public announcement of research Discoveries
11
Clinical Ethics (Forrow, et. Al, 1999)

int-prog medicine
I.
Basic Ethical Principles 1. Fundamental Principle: A clinical intervention is justified if and only if the expected benefits outweigh the expected burdens from the perspective of the patient 2. Shared Decision Making a. Paternalism Complete patient autonomy b. Shared Decision Making 3. Two Rules: a. A competent patient 12 b. Patient is not competent
II. Medico-Legal Perspective

int-prog medicine
1. 2.
3.
4. 5.
Competent adult, have a legal right-to accept or refuseIncompetent adult, have the same rightSurrogate decision maker (proxy or healthcare agent)Each state, country has their own judicial guidance Brain death-specific criteria-patients legally dead
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III. An Approach for Specific Cases

int-prog medicine
1. Good decisions require good data 2. Seek out win-win solution and be
creative 3. Think about who should decide as well as what decision is best
14
IV. The Ethics Work-Up

int-prog medicine
1. 2. 3. 4. 5. 6.
FACTS = What are the important facts in the case? VALUES = What are the most important value at stake? CONFLICTS = What values, if any, are in conflict? POSSIBLE COURSES of ACTION DECISION AND JUSTIFICATION FURTHER REFLECTION Preventive ethics
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V. Resolving ClinicalEthical Disagreements

int-prog medicine
Disagreement about : - Fact - Values - How to weigh different values - Where decision-making authority lies?
16
VI. Preventive Ethics

int-prog medicine
a. Establish a trust worthy partnership
with patient and family b. Communicate early, often and realistically about goals and end points.
17

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International Programme Faculty of Medicine Gadjah Mada University

Basic Moral / Ethical Principle

1. Respect for Others

Bioethics Health Ethics Medical Ethics Clinical Ethics Ethics in

Services Research Education

Disciplines, Departments, Field of Studies

American College of Physician, 2000

Principles : - Beneficence - Non-maleficence - Autonomy truth telling

I. Patient and Physician

1. Initiating and discounting Patient 2. 3. 4. 5. 6. 7.

II. The Physician and Society

The physicians Relationship to the other Clinicians

Clinical Ethics (Forrow, et. Al, 1999)

II. Medico-Legal Perspective

III. An Approach for Specific Cases

IV. The Ethics Work-Up

V. Resolving ClinicalEthical Disagreements

VI. Preventive Ethics

a. Establish a trust worthy partnership

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