Bioethics and Humanities Division

Medical Education Unit

FK USU
Etik berasal dari Yunani
ETHOS yang baik, yang
layak.

Etik Kedokteran Prinsip2

moral atau asas2 akhlak yg harus
diterapkan oleh para dokter dalam
hubungannya dengan pasien, teman
sejawatnya & masyarakat umumnya.
LANDASAN ETIK
KEDOKTERAN
Sumpah Hippokrates (460 377 S.M)
Deklarasi Jenewa (1948)
Lafal Sumpah Dokter Indonesia (1960)
International Code of Medical Ethics
Kode Etik Kedokteran Indonesia
Pernyataan-pernyataan (Deklarasi) Ikatan
Dokter Sedunia.
KODE ETIK KEDOKTERAN INDONESIA
(KODEKI)

4 KELOMPOK KEWAJIBAN DOKTER :

I Kewajiban umum dokter
II Kewajiban terhadap penderita
III Kewajiban terhadap teman sejawat
IV Kewajiban terhadap diri sendiri
 I Kewajiban Umum Dokter
1. Setiap dokter harus menjunjung tinggi,
menghayati & mengamalkan Sumpah Dokter.
2. Seorang dokter harus senantiasa melakukan
profesinya menurut ukuran yang tertinggi.
3. Dalam melakukan pekerjaan kedokterannya
tidak untuk kepentingan pribadi.
4. Hal2 yg tidak layak dilakukan dokter
memuji diri sendiri, menerapkan
pengetahuannya dlm segala bentuk tanpa
kebebasan profesi, menerima imbalan selain
daripada yg layak sesuai jasanya kecuali dengan
keikhlasan penderita.
5. Mengutamakan kepentingan penderita.
6. Hati2 dengan penemuan teknik atau
pengobatan baru yg belum diuji
kebenarannya.
7. Seorang dokter hanya memberi keterangan
atau pendapat yg dapat dibuktikan
kebenarannya.
8. Pelayanan kesehatan paripurna.
II Kewajiban Terhadap
Setiap dokter harus senantiasa mengingat
Penderita
akan kewajibannya melindungi hidup mahluk
insani.
Sesuai standar pelayanan medik, bila tidak
mampu menangani pasien wajib merujuk
kepada dokter lain yg ahli dlm penyakit tsb.
Memberikan kesempatan kepada penderita
berhubungan dgn keluarga dll.
Merahasiakan segala sesuatu yg
diketahuinya tentang seorang penderita
bahkan penderita sampai meninggal dunia.
Kewajiban memberikan pertolongan darurat.
III KEWAJIBAN DOKTER TERHADAP TEMAN
SEJAWATNYA
1. Setiap dokter memperlakukan teman
sejawatnya sebagaimana ia sendiri
ingin diperlakukan.
2. Setiap dokter tidak boleh mengambil
alih penderita dari teman sejawatnya
tanpa persetujuannya.
ETIK PROFESI DAN DISIPLIN
DALAM KODEKI
Pasal 10
Setiap dokter wajib bersikap tulus ikhlas dan
mempergunakan segala ilmu dan
ketrampilannya untuk kepentingan pasien.
Dalam hal ini ia tidak mampu melakukan
suatu pemeriksaan atau pengobatan, maka
atas persetujuan pasien, ia wajib merujuk
pasien kepada dokter yang mempunyai
keahlian dalam penyakit tersebut.
IV KEWAJIBAN DOKTER TERHADAP
DIRI SENDIRI
1 Setiap dokter harus memelihara
kesehatannya, supaya dapat bekerja
dengan baik.
2 Setiap dokter hendaknya senantiasa
mengikuti perkembangan ilmu pengetahuan
dan tetap setia kepada cita-citanya yg luhur.
Colleagues/ kolega
A fellow member of a profession, staff, or
academic faculty; an associate
from French collgue, from Latin collga one
selected at the same time as another, from
com- together + lgre to choose
Synonim: partner/mitra
Principles governing the
relationship between
Rules or codes of medical ethics
doctors
Mutual respect and understanding
Camaraderie / friendship
Professional relationship
between two doctors
1. between student and
teacher;
2. between doctors in the same
discipline (either specialists
or GP) ;
3. between general practitioner
(GP) and consultant;
4. between two doctors in
different specialities;
5. between the doctor and
his doctor-patient.
Between student and
teacher
to teach his students all he knows, freely and
without thought for remuneration. (Hipocratic
oath)
The professionally sound and ethically upright
teacher is in the best position to appear as a role
model for his impressionable pupils.
There is no age bar to the process of learning and
it does not matter whom one learns from. It
should not be surprising that one day the student
may indeed be teaching his own professor in the
course of conferences, seminars and workshops.
Professional services of
physicians to each other
cheerfully render professional services to his
physician-colleagues and their immediate family
members without seeking monetary
compensation. However, there is no rule that a
physician should not charge another colleague
for his services
The immediate family consists of parents, spouse
and children.
Dependants include non-earning members of the
family dependent upon the doctor for their
survival.
Duties of the physician
profession at large
Doctors may criticise one another, but only face-
to-face and in complete confidence. To criticise a
colleague in front of a patient is both damming
and dangerous and can never be justified.
the utmost care and tact be maintained when
listening to patients complaining about how they
have been treated or handled by other doctors.
a doctor is urged to expose incompetent or
corrupt, dishonest or unethical conduct on the
part of members of the profession without fear
or favour as these are against the best interests
of patients.
Etiquette of inter -
professional
a practitioner in whatsoever form of practice,
relationships
should take positive steps to satisfy himself
that a patient who applies for treatment or
advice is not already under the active care of
another practitioner before he accepts him.
a practitioner should not accept as a patient
any patient whom he has attended as a
consulting practitioner, or as a deputy for a
colleague.
Ethics in consultations
Physician belong to a profession that has traditionally functioned in an
extremely hierarchical fashion.
Consultations are encouraged in cases of serious illnesses, especially in
doubtful or difficult conditions.
The rights of the patient to ask for a second opinion should be respected.
With the rapid growth in scientific knowledge and its clinical applications,
medicine has become increasingly complex. Individual physicians cannot
possibly be experts in all their patients diseases and potential treatments
and they need the assistance of other specialist physicians and skilled
health professionals such as nurses, pharmacists, physiotherapists,
laboratory technicians, social workers and many others. Physicians need to
know how to access the relevant skills that their patients require and that
they themselves lack.
The attending doctor may certainly suggest the names of the consultants of
his choice but even then, in the event of a difference of opinion between
him and patient or his relatives of the patient, the choice of the latter should
prevail.
In the event of irreconcilable difference of opinion between the two doctors,
the circumstances should be impartially and frankly explained to the patient
concerned. It is now up to the patient to decide which of these he will follow
or, indeed, whether he will seek further advice from a new consultant.
a cooperative model of decision-making has
replaced the authoritarian model that was
characteristic of traditional medical
paternalism.
As members of the medical profession,
physicians have traditionally been expected to
treat each other more as family members
than as strangers or even as friends.
The WMA Declaration of Geneva includes
the pledge, My colleagues will be my sisters
and brothers.
For example, where fee-for-service was the
principal or only form of remuneration for
physicians, there was a strong tradition of
professional courtesy whereby physicians did
not charge their colleagues for medical
treatment.
This practice has declined in countries where
third-party reimbursement is available. Besides
the positive requirements to treat ones
colleagues respectfully and to work
cooperatively to maximize patient care, the
WMA International Code of Medical Ethics
contains two restrictions on physicians
relationships with one another: (1) paying or
receiving any fee or any other consideration
solely to procure the referral of a patient; and
(2) stealing patients from colleagues.
 Proper etiquette of consultation laid
down in the International Code of
Ethics
The attendance of the practitioner should cease when the
consultation is concluded, unless the patient has dispensed with
the services of his first doctor and engaged those of another.
In no case should the consultant treat the patient alone or hand
him over to his assistant or admit him to a nursing home or
hospital without the knowledge of the the referring physician or
injure the latters position in any respect. (Emergencies form an
exception to this rule. In such an event, the consultant should
inform the referring physician at the first opportunity after the
crisis has been tided over.)
When a consultant sees a patient in his rooms at the request of
a medical practitioner, it is his duty to write to the latter, stating
his opinion on the case and the line of treatment he thinks
should be adopted. He should not see this patient again without
a fresh note from the first doctor.
A doctor called upon in an emergency must treat the patient,
but after the crisis, the consultant must retire in favour of the
original attendant of the patient.
 Proper etiquette of consultation laid
down in the International Code of
Ethics
Obtain the opinion of an appropriate colleague acceptable
to your patient if diagnosis or treatment is difficult or
obscure, or in response to a reasonable request by your
patient.
When referring a patient, make available to your colleague,
with the patient's knowledge and consent, all relevant
information and indicate whether or not they are to assume
the continuing care of your patient during their illness.
When an opinion has been requested by a colleague, report
in detail your findings and recommendations to that doctor.
Should a consultant or specialist find a condition which
requires referral of the patient to a consultant in another
field, only make the referral following discussion with the
patient's general practitioner - except in an emergency
situation.
Respect to Teachers
In the Hippocratic tradition of medical ethics,
physicians owe special respect to their teachers.
The Declaration of Geneva puts it this way: I will give to my
teachers the respect and gratitude which is their due.
Although present-day medical education involves multiple
student-teacher interactions rather than the one-on-one
relationship of former times, it is still dependent on the good
will and dedication of practising physicians, who often receive
no remuneration for their teaching activities.
Teachers have an obligation to treat their students respectfully
and to serve as good role models in dealing with patients.
Students concerned about ethical aspects of their education
should have access to such mechanisms where they can raise
concerns.
The obligation to report incompetence,
impairment or misconduct of ones colleagues
is emphasised in codes of medical ethics. For
example, the WMA International Code of
Medical Ethics states that A physician
shall... strive to expose those physicians
deficient in character or competence, or who
engage in fraud or deception.
On the one hand, a physician may be tempted
to attack the reputation of a colleague for
unworthy personal motives, such as jealousy,
or inretaliation for a perceived insult by the
colleague.
A physician may also be reluctant to report a
colleagues misbehaviour because of friendship
or sympathy
Despite these drawbacks to reporting wrong
doing, it is a professional duty of physicians. Not
only are they responsible for maintaining the
good reputation of the profession, but they are
often the only ones who recognise incompetence,
impairment or misconduct.
Reporting colleagues to the disciplinary authority should
normally be a last resort after other alternatives have
been tried and found wanting.
The first step might be to approach the colleague and say
that you consider his or her behaviour unsafe or
unethical. If the matter can be resolved at that level,
there may be no need to go farther.
If not, the next step might be to discuss the matter with
your and/or the offenders supervisor and leave the
decision about further action to that person. If this tactic
is not practical or does not succeed, then it may be
necessary to take the final step of informing the
disciplinary authority
Medicine is at the same time a highly
individualistic and a highly cooperative
profession.
On the one hand, physicians are quite
possessive of their patients.
The weakening of medical paternalism has
been accompanied by the disappearance of
the belief that physicians own their patients.
Physicians will have to be able to justify their
recommendations to others and persuade
them to accept these recommendations. In
addition to these communication skills,
physicians will need to be able to resolve
conflicts that arise among the different
participants in the care of the patient.
..Ideally, healthcare decisions will reflect
agreement among the patient, physicians
and all others involved in the patients care.
However, uncertainty and diverse
viewpoints can give rise to disagreement
about the goals of care or the means of
achieving those goals.
Limited healthcare resources and
organisational policies may also make it
difficult to achieve consensus
Case Study
Dr. C, a newly appointed anaesthetist in a
city hospital, is alarmed by the behaviour of
the senior surgeon in the operating room.
The surgeon uses out-of-date techniques
that prolong operations and result in greater
post-operative pain and longer recovery
times. Moreover, he makes frequent crude
jokes about the patients that obviously
bother the assisting nurses. As a more junior
staff member, Dr.C is reluctant to criticize
the surgeon personally or to report him to
higher authorities. However, he feels that he
must do something to improve the situation.
Case Study contd
Dr. C is right to be alarmed by the behaviour of the
senior surgeon in the operating room. Not only is
he endangering the health of the patient but he is
being disrespectful to both the patient and his
collegeous. Dr.C has an ethical duty not to ignore
this behaviour but to do something about it.
As a first step, he should not indicate any support for
the offensive behaviour, for example, by laughing at
the jokes. If he thinks that discussing the matter with
the surgeon might be effective, he should go ahead and
do this. Otherwise, he may have to go directly to higher
authorities in the hospital. If they are unwilling to deal
with the situation, then he can approach the appropiate
physician licencing body and ask it to investigate.
 Sejak terwujudnya praktek kedokteran

Masyarakat mengetahui beberapa sifat

mendasar & melekat pada diri seorang
dokter yg baik & bijak yaitu :
1. Kemurnian niat
2. Kesungguhan kerja
3. Kerendahan hati
4. Integritas ilmiah & moral yg tidak diragukan
THANK
YOU
YA!!!!!