Dasar etikolegal Pembentukan

Asosiasi DSJ
Agus Purwadianto
Ethico-legal System
Agus Purwadianto, 2005

MEDICAL INDICATION CONTEXTUALITY BALLANCING

CONFLICT OF INTERE
Health
Health Personnel
Personnel Law
Law as
as
Health
Health Facilities
Facilities social
social engineering
engineering Value of
Health
Health system
system
Health (Micro

Medical
PROFESSIONALISM
Goals

Responsibility Accountability
Patients’
Ethics Discipline Liability Safety

Professional
Dignity
SOCIAL CONTRACT

Patient/Client
PUBLIC
Community
Family TRUST
BEST INTEREST, QUALITY OF LIFE
PREFERENCES,
 Continuum of Professionalism
Agus Purwadianto - 2008

• Dr
Bermasalah

Kompe- Kewe- Etika

tensi nangan Profesi

Ketrampilan kekuasaan Kualitas personal bonafide

Medik &
High Learning
Kelihatan Formal
Di”bawah
permukaan”
Dirasakan Pasien EKSTERNAL
INTERNAL : Nurani, sikap, Empati, “kekitaan”
Kepribadian, kes. mental Pahlawan kemanusiaan
 Profession (Goode)
• A prolonged specialized training in a body of
abstract thought
• A collectivity of service orientation

• Robinson David : Patients, Practitioners & Medical care, Aspects of medical

sociology . William Heinemann Medical Books, London, 1978.
 Additional characteristic of
Profession
• Set their own standard of education
• adult socialization experience > general occupation
• Professional practice legally ruled by licensure
• License Evaluating Body has their own member
• Almost all it’s regulation arranged by their own
 Additional characteristic of
•
Profession (2)
The scope of work, otherwise of money, prestige
and authority, need the high integrity
• The actor cannot controlled or evaluated by
layman
• The existing valid norm generally stricter than
legal rule.
• It’s member have strong identity and association
• It’s a lifetime binding work.
 Requirements
• Main factors :
– Result of extensive training,
– Have a significant intelectual components
in obligation
– Give important services to public/society
• General
– certification, professional organization, &
autonomy in services
 Infra-structure of profession
• Long education & training  collegium 
medical council
• Intellectuality  professional organization
• Important services  highly status among
citizen  rapid social tract mobility
• Certification  validation  continuing
education
• Autonomy  code of ethics & ethical
board/peer review  self-regulating &
disciplining >< monopoly/abuse of professional
power  >< white collar crime/professional
crime
• Risk  medical defense union, professional
indemnity insurance
 Type of Profession
• Consulting
– Fee for service : basic values, > monopolistic, self-
regulating
– Solo (rural areas)  corporate (urban areas)
• Scholarly
– Salary based
 Bonafide
• Focus : motivation to help actual client
• Do for the actual Patient’s best interest
• Service continuation of potential clients
• competent
• His aura  resulting client responsibility &
discipline
• Professional autonomy = freedom of discipline
• Self governing & regulating (the essence of
profesionalism)  medicine is a moral
enterprise grounded in a covenant of trust
 Goal of
Medicine

• Lege Artis
Doctrine Professionalism

Bonafide

Maintain technical
expertise

competency
Self-regulation

Liability College
CME/CPD
Prof organization
Discipline = Code ethics/peer review
Social Ethics = Respectable status
accountability Personal responsibility Pr.insurance/MDU/MPS
 Professionalism
• The conduct, aims or qualities that
characterize or mark a profession or a
professional person
– Webster’s collegiate dictionary
• Constituting those attitudes and behaviors
that serve to maintain patient interest above
physician self-interest
» A Physician Charter - American Board of Internal
Medicine (2002)
 PROFESSIONALISM
• PROFESSIONALISM IS THE AGENCY THROUGH
WHICH INDIVIDUALS FULFILL THE
PROFESSION’S CONTRACT WITH SOCIETY
• PROFESSIONALISM IS BASED ON A SET OF
PRINCIPLES AND REQUIRES THAT INDIVIDUALS
MEET CERTAIN PRINCIPLED REPONSIBILITIES

AAMC
 Professionalism (sociological
criteria 1)
• Social contract between profession –
public
• Moral understanding among profesionals
 concrete reality of high standard of
competence & moral responsibility 
grant authority to control key aspect of
their market n working conditions via
licensing & credentialing
• Based on mutual trust
• Canadian medical association, 2001
 Professionalism (sociological
criteria 2)
• A long & disciplined educational process
• Discretionary authority & judgment
• An active & cohesive professional
organizations
• Acknowledged social worth
• A strong level of commitment
• A unique body of knowledge & skill
• Bishop, 1996
How important systematic way of choosing
type of profesion
• “it is striking how few professional schools offer
students an opportunity to examine the nature of
their profession-- ......its historical roots, its function
in society, its sociological characteristics, and its
assumptions about the political and social order.
• Such questions will of course arise during a
professional education, but few professional schools
seem to think it valuable to confront them in any
systematic fashion”
• (Callahan and Bok,1980)
 ABIM's elements of professionalism
• altruism,
• accountability,
• excellence,
• duty,
• honor and integrity, and
• respect for others
 Challenges to Professionalism
• abuse of power,
• arrogance,
• greed,
• misrepresentation,
• impairment,
• lack of conscientiousness, and
• conflict of interest.
 Pasal 36 ART IDI - Majelis
Pengembangan Pelayanan Keprofesian
• 1. Unsur struktur IDI di tingkat Pusat dan
Wilayah yang bertugas untuk pengelolaan
sistem yandok bermutu dan terjangkau,
melalui berbagai upaya pengembangan
keprofesian, standarisasi dan akreditasi .
• 2. Dalam melaksanakan tugasnya MPPK
bertanggungjawab dan melaporkan secara
periodik kepada Ketua IDI sesuai
tingkatannya.
 Pasal 36 ART
• MPPK terdiri dari : Divisi Perhimpunan Dokter
Pelayanan Primer (PDPP), Divisi Perhimpunan
Dokter Pelayanan Spesialis (PDSp), dan Divisi
Perhimpunan Dokter Seminat (PDSm).
• 4. Kepengurusan : perwakilan unsur-unsurnya
yang tergabung dalam divisi masing-masing.
• 5. Unsur-unsur : PDPP, PDSp, PDSm.
• 6. Ketua MPPK dipilih dari salah satu Ketua
Perhimpunan.
 Pasal 37 ART Tugas & wewenang
• 1. usulkan sisbangrof kedokteran terkait penjaminan mutu
yandok kpd Ketum PB .
• 2. laksanakan & evaluasi kegiatan pengelolaan
sisbangprofdok.
• 3. koordinasikan kegiatan keprofesian unsur-unsurnya
(PDPP, PDSp., PDSm.,dll).
• 4. usulkan & rekomendasikan perubahan nama
perhimpunan, perhimpunan baru, dan
• pembubaran perhimpunan kepada Ketua Umum Pengurus
Besar
• 5. usulkan pedoman akreditasi penyelenggaraan PKB
kepada Ketua Umum Pengurus Besar.
 Pasal 38 - Unsur MPPK
• PDPP, PDSp dan PDSm)
• Perhimpunan tsb pada tingkat pusat
dan cabang
• Pengurus Perhimpunan tingkat pusat
ditetapkan oleh Ketua Umum PB IDI
• Pengurus Perhimpunan tingkat cabang
ditetapkan oleh Ketua Umum PB IDI
atas usul Ketua Perhimpunan Pusat
yang bersangkutan
 Pasal 41 – Tugas Wewenang MKKI
• 1. usulkan sisdikprof kpd Ketua Umum PB
• 2. binawasev Kolegium dlm kegiatan pendidikan
profesi kedokteran.
• 3. koordinasikan kegiatan kolkedok
• 4. usulkan jakdal ujian nasional pendidikan profesi
kedokteran kepada Ketum PB.
• 5. usulkan dan merekomendasikan pengakuan
keahlian dalam bidang kedokteran kepada Ketum PB.
• 6.gusulkan & rekomendasikan cabang keilmuan baru
dalam bidang kedokteran kepada Ketua Umum
Pengurus Besar.
 Asosiasi DSJ
• Beda dgn PDHMI : ada unsur kewenangan
penelitiannya dlm rangka SJ
• Secara personal dpt masuk ke PDHMI, tetapi
secara legal lbh kuat utk unsur kewajiban
standar kompetensinya dlm SJ
• Perlindungan o/ Pem & IDI krn dukungan
politis dan legal bila dugaan malpraktek
• Leverage utk daya tawar profesi
 Keterkaitan asosiasi DSJ
• IDI – PDSm “baru” (pasca FORKAJIAN TRADKOM)
 sbg “spesies baru” keseminatan yg
memproduksi bukti ilmiah sembari praktek
profesi  TUGAS LBH MULIA
• NAKES KHUSUS  berkemampuan hybrid
allopathic + JAMUOLOGI cq ALKOM INDONESIA
 kompetitif di masa depan  offer ke ASEAN
via AFAS
• APKESI  yg pencipta formula  bisa menjadi
principle investigator  calon PROFESOR RISET;
yg penerap formula/substansi tunggal sbg
PELAKSANA PENELITI
 Kolegium
• DSJ bersama PDSp atau PDSm atau PDPP
lainnya akan memudahkan membuat
kolegium jamuologi sbg kolegium CAM
• Kolegium CAM (bersama atau tanpa Kolegium
“ketrampilanologi”) akan melahirkan kolegium
Battra
• PDHMI dpt spt koin dua sisi dgn asosiasi DSJ
dgn catatan bbrp PDSm yg tergab dlm Forkom
CAM IDI menyetujuinya.
 Critical mass vs strategic power
• Secara sosiologis jumlah DSJ yang kian banyak
akan menambah keyakinan masy
• Secara profesi : diperlukan Dewan Etika khusus 
spt penegasan pelarangan MLM sbg self
regulating
• DSJ adalah produsen bukti  ada yg benar2
menjadi peneliti praktisi – praktisi peneliti
• Internasionalisasi : dgn pengakuan dari AFAS
(asean framework on services)  kekuatan
hybrid sejalan dgn papan praktek ganda
 kesimpulan
• DSJ perlu dibentuk asosiasi sesuai dgn teori
profesionalisme dan sosiologi profesi serta
sistem etikolegal
• Utk sementara dpt merangkap s bg anggota
PDSm yg ada sbg pendukung Forkom CAM ID
• Kekhususan penelitian adalah berkah secara
perlindngan etikolegal dan profesionalisme
serta kesempatan globalisasiI