ethics rational choice
TRANSCRIPT
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Konsekuensi Etik terhadap
Korporatisasi Praktik Kedokteran
Mubasysyir Hasanbasri
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Perkembangan Status Dokter
Apakah Dokter telah Berubah?
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Dokter Petugas Kemanusiaan
Physicians
ActivistPatients
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Dokter Profesional
Physician
ProfessionalPatients
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Dokter Pemain Politik
PhysicianPolitical
Third Party
Patients
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Dokter Pekerja
BusinessGovernment
PhysicianWorkers
Third Party
Patients
Hospitals
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Apakah perkembangan ini
normal?
Jika tidak, apa alasa saudara?
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Perbandingan Status Dokter
Aktivis Profesi Politisi Pekerja
alasan Penderitaan Tugas
negara
Kontrak Job
Kontrol Hati nurani Pasien PihakKetiga
PemilikPerusahaan
Hukum Tidak
berlaku
Etika
Kedokteran
Hukumprofesi
Hukum
Perdata
Hukum
Perdata,pidana
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Etika versus Hukum
PengadilanPerdata
PengadilanTata Usaha
Malpraktik
KomisiEtik
Dokter
KesalahanPNS
PengadilanPidana
KerugianPasien
KerugianPublik
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Perbedaan Mekanisme Kontrol Eksternal
dalam Bidang KedokteranHukum Profesi Pidana Perdata Tata Usaha
Bentuk
Kerugian
Malpraktik Kerugian
keamananpublik
Kerugian
material
Hubungan
kerja atasandan bawahan
Penjelasan Dokter dan RSbisa digugat
Penggugatanketetapan
atau
keputusanpejabatnegara
Pihak ketigatidak ada.
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Applicatioin of Rational Choice
Theory in Medical Practice
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Questions
What are the concerns of those promoting rational choicetheory?
What are ethical problems?
What is ethics?
What are the sources of ethics?
Why should a physician join a profession? Do they really join it?
How should we relate ethics to the interests of individualphysicians, professional associations, patients and society?
What we could aggree on about what we can and what wecan not do as a member of medical profession.
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Ethical Problems
Ethical problems
Those regarded by the ethics committee as
deviated from code of ethics
Activitities or intervention regarded as not
appropriate to humanity interest.
Medical ethics
Medical ethics committee
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Physicians Conflict of Interests and
Rational Choice Theory
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Rational Choice Theory and Physicians
Conflict of Interests
Individual vs social rationalit= Problems of
ethics
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means and end.
What is important to rationality is that
someone does something to achieve his goal.
Rationality = Means -----------------> End
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Rational is
the achievement of a goal through a means.
Not rational if someone smoke while he does not have the goal
to enjoy it.
The goal is essential in understanding whether or
not someones behavior is rational.
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Rational Choice Theory of Individual
Behavior
When I discuss aboutphysicians perspective, Imean we will look at theissues from the interest ofphysicians. For thatreason, we should knowwhat are the interest ofphysicians in health caresetting. At least we will
discuss two approaches tosee someones interest.
Rational choice theorystates that someonesdo something because
of the benefit theythink they will get.Benefits in this senseare various and can befinancial or non-financial, personal orsocial, or short termor long term.
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Various sorts of benefits from rational
choice perspective
People are generous to
other people not in
exchange for others doing
good for him, but for the
promise of reward given
by god in future days.
People may do social
things for gainingpopularity.
People smoke for theshort-term enjoyment,although they knowsmoking is bad in thelongterm framework.
People keep awayfrom smoking becauseof the risk to lungcancer.
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Goal of becoming a physician:
- steady income
- professional enjoy the job - get more
money
- additional goals: humanitarian
- self satisfaction
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three perspectives that we can use to evaluate if our medical
practices or health care policies are ethical
Approach Primary concern
Egalitarianism
To view access to health is the same to individualsfrom different social status. Every individualsregardless of their social and economic statushave the same rights to health services.
LibertarianismTo view infidividual rights is the first consideration.
Patients have their rights if they do not want tocomply to what physicians ask them to do.
UtilitarianismTo view the benefit or the consequence of
medical intervention to patients.
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Medical or health care policy practices Egalitarianism
Libertarianism
Utilitarianism
Example:Corporatization of health care
Unethical Ethical Ethical
Physician compulsory service in remote areas aftergraduation from medical school.
Private practitioners reject to treat poor patients butrefer them to public hospitals.
To set up community health centers in remote area
The use of tax money for paying health care servicefor the poor.
Physician tell spouse of a patient with HIV.
Physicians send less dangerous victims to hospitals ratherthan the very serious ill victims.
A physician who quits from a medical team in armed
conflict area.
A physician who uses the money from a pharmaceuticalcampany to purchase a medical equipment.
A hospital manager who fires a physician who treat thepatient with HIV.
A physician prefer to escape from helping casualties of atraffict accidents.
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Catatan penting dari kuliah kemarin
Kuliah dimulai dengan bertanya alasan mahasiswa inginmenjadi dokter.
Klasifikasi jawaban bodoh dan yang reasonable.
Yang bodoh lebih banyak daripada yang masuk akal
Melayan masyarakat tanpa alasan, tetapi yang dimaksudkan adalahalasan sosial, kemanusiaan, dan telah mendapat
Mendiskusikan arti dari jawaban yang bodoh
Di sini seharusnya saya menjelaskan mengapa orang berpikir alasansosial dan alasan individual
Benarkan alasan individual merupakan alasan yang lebih masuk akaldaripada alasan sosial/publik.
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Memastikan apa yang mau saya
jelaskan
Bagaimana mungkin praktik kedokteran yang
memiliki kode etik yang bekerja atas kepentingan
pasien.
Praktik kedokteran tidak berbeda dari praktikprofesional lain.
Bekerja atas dasar kontrak.
Mana praktik yang kedokteran itu, dan mana yang
menjadi bagian aktivis kemanusiaan.
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Bertanya kepada mahasiswa:
Jika lulus fakultas kedokteran, apakah mereka
akan mau bekerja di desa?
Jika menjadi dokter, apakah ia akan menolak
pasien yang menelpon ketika ia sudah sampai di
rumah? Atau dibangun malam hari karena
masalah yang sepele?
Dari sini dokter harus berpikir penting mengenai public
health program.
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Berkaitan dengan rasionalitas
Setiap kegiatan selalu ada alasan.
Karena alasan itu bisa berbeda-beda, makamempertimbangkan rasionalitas itu tidak adagunanya.
Terus apakah kita harus bekerja dalam ketidakrasionalan. Itu berarti pekerjaan kita harus berbasispada kenyataan atau kebutuhan pasien. Yang pentingadalah kebutuhan keduanya. Negosiable.
Apakah karena persoalan itu, kemudian muncul etikatau upaya etik itu sesuatu yang tidak masuk akal?
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Kondisi apa yang membuat praktik
kedokteran bisa ideal?
Ada negosiasi antara provider dan pasien.
Membuat kontrak.
Kita sudah ada informed consent
Dokter sudah digaji cukup sehingga ia tidak lagimemiliki kesempatan membuat pilihan yang berarti
ketika berhadapan dengan pasien
Pihak asuransi bernegosiasi dengan dokter
Dokter kontrak dengan pemerintah dalam memberikan
pelayanan.
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Are there rules so far dealing with the ethical dilemma situation, or are there similarsituation that can be applied to a situation that you face
Yes, follow the rule No, is there a chance to develop another solution
option while it does not add harm to patients?
No.
Perform impartialitas test.
Perform universability test.
Perform interpersonal justifiability test.
Yes.
Take that action.
Quick Method in Dealing with Ethical Problems
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Jenis Uji Etik Isu Uji Etik yang Ditanyakan pada Petugas Kesehatan
Imparsialitas Apakah saudara ingin memperolah tindakan ini jika saudara sendiriberada pada posisi pasien?
Univerzability Apakah Saudara ingn mendapat perlakuan seperti itu dalam semua
situasi relevan yang sama?
Justifiability
InterpersonalCould you give good reasons in justifying your choice to others? Do you
think your friends, teachers, bDo y
Apakah saudara bsa memberikan alasan yang bagus untuk
menjustifikasi tindakan saudara kepada pihak lain? Akankah kolega
saudara, atasan, atau masyarakat luas akan puas dengan jawaban
saudara? Dapatkah saudara mempertahankan alasan yang masuk akal
jika ada orang bertanya tentang tindakan saudara? Dapatkah anda
memberikan alasan yang akan saudara jelaskan di muka umum?
Tabel 6. Tiga Jenis Uji Etik dalam Memecahkan Masalah Etik