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 Penderita
Setiap dokter harus senantiasa mengingat 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 doctors
Rules or codes of medical ethics
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
relationships
a practitioner in whatsoever form of practice, 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!!!!!