Isu Dan Etika Pada Perawatan Paliatif PDF

ISU DAN ETIK PADA
PERAWATAN PALIATIF
Ns. Leni Merdawati, S.Kep. M.Kep
LOGO Bagian Keperawatan Medikal Bedah F.Kep Unand
www.themegallery.com
Ethical issues in palliative care:
• Quality of life
• Value of life
• Meaning of life
Palliative Care:
A Clarification Contents
Penanganan nyeri dan distress pasien
Menegaskan
Menegaskan bahwa
bahwa kehidupan
kehidupan dan
dan kematian
kematian
adalah
adalah proses
proses yang
yang normal
normal
Company
Tidak bermaksud menunda atau mempercepat kematian
L/O/G/O
Integrasi aspek psikologis dan spritual
Support
Support system
system pada
pada klg
klg selama
selama masa
masa perawatan
perawatan
dan
danberduka
berduka
Pendekatan
Pendekatan Tim
Tim dalam
dalam memberikan
memberikan dukungan
dukungan dan
dan
Konseling saat berduka
Konseling saat berduka
Emerging Ethical Issues
1. Inadequate or Insufficient Communication:
• Staff and patient/family

• Physician and patient/family
• Physician and nurse or other staff
• Physician to physician
• Language barriers
• Inadequate discussion re: treatment goals and expectations, degree of suffering,
measure of success
2. Ressource Allocation :
• Staff allocation
• Lack of bedside time
• Lack of time for quality communication
• Level of care, WH/WD treatments
Emerging Ethical Issues
3. Competencies in Palliative Care Skills :
• Communication skills
• Understanding of euthanasia, terminal sedation
• Cultural and religious issues related to dying persons
• Power issues
• Pain and symptom management
• Balance of patient choices and family needs and choices
Ethical Priciples Decision-Making
ability of the person to choose and

act for one’s self free of controlling
influences
1. Autonomy • coercion from physician, nurse,
consultant
• coercion from family members
• coercion/pressure from religious
group,dogmas
ability to make decisions based

upon our personal values and
pertinent information, which will
enhance our personal growth and
goals
Ethical Principles Decision-Making, Cont,,
Respect for autonomy

requires
• Honoring each person’s values and viewpoints

• Listening to the other person as they share their values and
choices and questions
• That we assess each patient, to assure that they are capable
of autonomous decisions
Autonomy (Rod MacLeod)
 Recognises the individual’s right and ability to
decide for him - or - herself according to their
beliefs, values and life plan
 Decisions are unique and may be different from the
course that is deemed “right” or “wise”
 Gentle truth-telling and exchange of accurate
information about their health status, options,
planned care and future expectations is essential
 Informedconsent
BENEFICENCE
Semua Tindakan Untuk Kepentingan Terbaik
pasien
Skenario Terbaik :
Berinteraksi dengan pasien dengan cara yang
memaksimalkan nilai-nilai pasien dan pemahaman
mereka tentang kualitas hidup yang baik.
Skenario Terburuk :
Kita bersikap paternalistik dalam interaksi kita
dengan pasien; Tidak menghormati nilai-nilai
mereka.
Beneficence
“Doing good”
Standard health care activities including:
 effective pain and symptom management
 sensitive interpersonal support
 acknowledgement of the person as a unique
human being to be respected and valued
Nonmaleficence
• Do no harm
• Make no knowing act or decision, or lack of
sharing information which will cause direct
harm to the patient.
“more subtle -- not sharing treatment options
which you disagree with, but which are beneficial
• Truth-telling: share all truly beneficial information which

will assist the person in making a good decision.
• Confidentiality: duty to respect the privacy of shared
information.
• overridden when
we need to enlist others to confront a patient
who has made a decision which is inconsistent
with prior decisions
duty to protect others (homicidal/suicidal)
Non- maleficence
“Doing no harm”
 unnecessary physical pain
 unnecessary psychological distress
 insensitive truth-telling
 denigration of the individual
 continued aggressive life-prolonging or cure-
orientated treatment not suited to the patient’s need
or wishes
 unnecessary or unwanted over sedation
 premature, unrequested or uninformed withdrawal
of treatment
JUSTICE :
Pertimbangkan keputusan terhadap Pasien

dalam konteks kebutuhan pasien dalam skala
yang lebih luas
Pasien merupakan bagian dari masyarakat yang

tidak bisa terpisahkan
Semua Intervensi yang dilakukan oleh tenaga

Kesehatan memberikan dampak terhadap diri
dan masyarakat
Pelayanan Kesehatan bertanggung jawab

terhadap Kesehatan masyarakat
JUSTICE
 Concept of fairness or what is deserved
 Describes what individuals are legitimately
entitled to and what they can claim
 Sometimes justice may serve to limit
autonomy; what the individual wishes,
chooses, or feels entitled to may not be
possible or allowable in the context of the
society
SIX VALUES IN MEDICAL ETHICS
(Mohanti. K.B 2009) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902121/
Autonomy - patient has the right to

choose or refuse the treatment
Beneficence - a doctor should act

in the best interest of the patient
ETHICS
VALUES Non-maleficence - first, do no harm
Justice - it concerns the distribution

of health resources equitably.
Dignity - the patient and the persons

treating the patient have the right to dignity
Truthfulness and honesty - the concept

of informed consent and truth telling
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References :
Alligood, M. R. (2014). Nursing theory & their work (8 th ed). The CV Mosby. Company St. Louis.
Toronto. Missouri: Mosby Elsevier. Inc. Anema, M. G. 2010 .

Barb Supanich Barb, (2008) Ethical Issues in Palliative Care Nursing. Medical Director, Palliative Care
Mohanti, K.B (2009)’ Ethics in Palliative Care. Indian J Palliat Care. 2009 Jul-Dec; 15(2): 89–92. doi:
10.4103/0973-1075.58450. PMCID: PMC2902121. PMID: 20668583
Macleod Rod. Ethical Issues in Palliative Care : Introduction . Palliative Care University of Sydney HammondCare

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ISU DAN ETIK PADA

Penanganan nyeri dan distress pasien

• Staff and patient/family

ability of the person to choose and

ability to make decisions based

Respect for autonomy

• Honoring each person’s values and viewpoints

• Truth-telling: share all truly beneficial information which

Pertimbangkan keputusan terhadap Pasien

Pasien merupakan bagian dari masyarakat yang

Semua Intervensi yang dilakukan oleh tenaga

Pelayanan Kesehatan bertanggung jawab

Autonomy - patient has the right to

Beneficence - a doctor should act

Justice - it concerns the distribution

Dignity - the patient and the persons

Truthfulness and honesty - the concept

Toronto. Missouri: Mosby Elsevier. Inc. Anema, M. G. 2010 .

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